National Amphetamine-Type Stimulant Strategy Background Paper: Monograph Series No. 69
5.1 Amphetamine-type stimulant treatment presentations
- Acknowledgements
- Abbreviations
- List of Tables
- List of Figures
Chapter 1: Introduction- Chapter 2 Setting the Context
- Chapter 3: Effects of Amphetamine-Type Stimulants
- Chapter 4: Prevention and Harm Reduction
Chapter 5: Treatment and Service Provision- 5.1 Amphetamine-type stimulant treatment presentations
- 5.2 Initial engagement
- 5.3 Treatment access and retention
- 5.4 Withdrawal management
- 5.5 Psychosocial interventions
- 5.6 Pharmacotherapy
- 5.7 Other interventions
- 5.8 Managing co-occurring mental health and amphetamine-type stimulant problems
- 5.9 Workforce development
- 5.10 Summary
- Chapter 6: Law Enforcement
- Appendix 1
- Appendix 2
As indicated in Chapter 3, there are a number of adverse consequences arising from use of amphetamine-type stimulants (ATS). However, as noted in a review by Baker and colleagues (2004), many amphetamine users do not seek treatment and often have a weak relationship with treatment services in that retention rates are low. Earlier reviews observed that this was to some extent because the services were not perceived as being oriented to ATS users’ needs and offered little in the way of specific treatment for ATS related problems. Rather, they were largely designed to provide treatment to alcohol and opioid problems (e.g., Kamieniecki et al., 1998; Vincent et al., 1999).
While the last decade has seen improvements in the knowledge base to guide interventions, and many services have mobilised to respond to the challenges set by increased ATS use, the clinical evidence base continues to lag behind that which exists for treating other drug problems, such as tobacco, alcohol and opioid dependence, and treatment links with people affected by ATS use remain tenuous. With this in mind, it is also pertinent to point out that many of the approaches used to engage and treat other drug dependent clients are relevant to working with ATS dependent individuals (e.g., building a therapeutic alliance; good assessment; identification of underlying and co-existing conditions; integrated as opposed to disaggregated care for co-existing problems).
Discussions focused on treatment were dominant throughout the consultation process. Some general observations included the need:
- To seek the input of drug users to determine what works;
- For specific ATS treatments versus blindly applying what works for other drugs;
- For more research to define a typology of different presentations matched to best practice in treatment;
- To adopt a holistic approach that addresses the broader socioeconomic issues rather than just the immediate presentation;
- To build the evidence-base to inform treatment; and
- To provide better support, resources and improved access in relation to treatment in rural and remote areas.
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Of the total closed treatment episodes, 52% (70,068) involved at least one other drug of concern (Australian Institute of Health and Welfare, 2006a). Where the principal drug of concern was amphetamine, 66% included at least one other drug of concern – in other words, polydrug use was relatively common among treatment seekers. When all drugs of concern are considered, 22% of treatment episodes included amphetamine as one of the drugs of concern. No differences in rates were found according to gender or Indigenous status. With regards to jurisdictional differences, amphetamine was the second most common drug of concern in Western Australia (26%) and South Australia (18%). For closed treatment episodes where the client reported amphetamine as their principal drug of concern, 82% reported being current or past injectors. This was second to heroin, reported by 91%.
With regards to the type of service accessed, The AODTS-NMDS 2004-05 indicated that counselling accounted for the highest proportion of closed treatment episodes (42%) where amphetamine was the principal drug of concern (Australian Institute of Health and Welfare, 2006a). This was followed by assessment only (16%), rehabilitation (15%) and withdrawal management/detoxification (13%). The median number of treatment days within a treatment episode was 20 days for amphetamine.
The Ecstasy and Related Drugs Reporting System (EDRS) includes data on regular ecstasy users’ (REU) utilisation of health and medical services specifically in relation to their use of ecstasy and other drugs. In the 2006 EDRS, 22% of the national sample reported accessing medical or health services in relation to their drug use in the last six months (Dunn et al., 2007). Of these, the majority reported seeing a general practitioner (50%), followed by a counsellor (29%), and a drug and alcohol worker (24%). Smaller proportions reported attending an emergency department (16%) and a hospital (10%). Ecstasy was the drug most commonly reported as the main drug for which help was sought (EDRS samples regular ecstasy users), followed by crystal methamphetamine. For those who saw a GP, 31% reported accessing the service for ecstasy and 12% for crystal methamphetamine.
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