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UW studies an intervention for crystal meth use
UW studies an intervention for crystal meth use
by Tim Menza and Damon Jameson - Special to the SGN

Here in Seattle, many of us struggle with crystal meth, whether through personal experience, or through the experiences of friends, partners, lovers, and family. Although the topic of crystal meth use has been extensively covered in public forums and articles in the Gay press, crystal meth addiction remains an unresolved issue.

Guys use crystal meth for many reasons: it feels good; it helps guys connect, have free, liberated sex, and shed feelings of guilt, shame, and isolation. The use of crystal meth and other substances (alcohol being #1 among Gay and Bi men) is one of many intersecting forces, including depression, poverty, homophobia, and racism, that impact both our wellness as a community and our sexual decision-making.

In a recent population-based survey of Seattle men who have sex with men (meaning Queer, Gay, Bisexual, transgender, questioning, or no label), approximately 10% reported using crystal in the previous 12 months. While this means that most men in Seattle did not use crystal meth in the previous 12 months, the consequences for those who did are not trivial.

In many cities, including Seattle, university researchers, public health officials, and community-based organizations have found strong, consistent links between crystal meth use and acquiring HIV. Guys who use crystal are 2-3 times more likely to get HIV than guys who do not use crystal.

For positive guys, crystal use takes a toll on the immune system, makes it hard to stick to meds, and accelerates HIV-associated dementia.

While crystal meth is no more addictive and no harder to quit than other drugs, substantial barriers do exist to the access of programs for crystal meth use. In Seattle and San Francisco STD clinics, 70% of men who use meth indicate that they have tried to cut back or stop using; however, only 12% have ever attended a support group or accessed drug treatment. When presented with a hypothetical program that provided incentives for not using crystal, 68% of these men expressed considerable or extreme interest in attending such a program.

Therefore, researchers at the University of Washington decided to undertake a study of a contingency management intervention for crystal meth use. Contingency management is the practice of rewarding individuals for meeting a specific behavioral goal (i.e., not using meth as documented by urinalysis) and withholding that reward when that goal is not met. The rewards are generally in the form of vouchers that can be exchanged for goods and services, never for cash.

Researchers and substance use treatment programs have successfully employed contingency management for a number of different populations, in a number of different settings, for a number of substance use disorders. Because crystal impairs cognition, individuals who use meth often find intensive treatment programs and support groups overwhelming. Contingency management programs may help meth users reduce or stop their use so that their brains can begin to recover and they can engage in programs that explore the nexus of issues surrounding their use with greater success. If successful, a contingency management program could be used alone or as a lead-in to counseling and treatment programs. Currently, the New York City Health and Hospital Addiction Treatment Service uses contingency management as a complement to its chemical dependency treatment programs (regardless of sexual orientation and substance of choice). And although contingency management programs have not been rigorously studied for meth use among men who have sex with men outside of the drug treatment setting, San Francisco offers the intervention as a stand-alone program.

Will monetary incentives outweigh the benefits (both perceived and real) of crystal meth use? Stay tuned for the answer. Meanwhile, here are the details of the study, dubbed Project Rewards. The study is funded by the National Institute on Drug Abuse and it will enroll 80 participants. Potential participants will be HIV-negative guys who have sex with men who use crystal meth and are at least 18 years of age. Participants will attend 5 study visits over 6 months. The benefits of the study include free HIV and STD testing and free treatment for bacterial STD (gonorrhea, syphilis, chlamydia). Participants will be compensated for their time and travel.

While the study is open to HIV-negative men now, if successful, the program will be made available to all Gay and Bi men who use crystal.

For more information about the study and links to resources for crystal meth in the Seattle area and beyond, visit uwreward.org or call (206) 661-2943.

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