Psychosocial burden and therapy motivation in methamphetamine dependence

Background: Abuse and dependence of "Crystal Meth" (methamphetamine, MA) are particularly determined by psychiatric comorbidity and socially precarious life situations. MA use is attributed to typologies, which include: e.g., motives, such as increasing performance in work and leisure time, emotional coping or social adjustment attempts. However, knowledge about the subjective psychosocial stress sensation (so-called "suffering pressure") with MA dependence is still missing. A typologisation of the psychosocial burden on MA-dependence is intended to reveal normative therapeutic motivations to obtain predictors for therapeutic processes.

Method: Female and male patients (N=108) were enrolled in two therapies designed specifically for the main diagnosis of MA dependency, i.a. interviewed on their subjective perception of stress (SCID, Documentation Standard III). Other survey tools included questionnaires (e.g., BDI, SCL-90-R) and cognitive performance tests (e.g., Cognitrone, Stroop). The hierarchical cluster analysis was performed using SPSS.

Results: In total, the data of 85 patients (female n=19, 22.4%) could be evaluated and divided into six types with specific features: Family-related Burdened (FAMB) n=6, 7.1%; Occupatio-nally Burdened (OCB) n=15, 17.6%; Non-Burdened (NONB) n=25, 29.4%; Mentally Burdened (MENB) n=8, 9.4%; Legally Burdened (LEB) n=27, 31.8% and Multiple Burdened (MULB) n=4, 4.7%. Type MENB showed with 62.5% (n=5) the largest proportion of women and at the same time the highest rate of therapy discontinuation (n=5; 62.5%). By contrast, NONBs were almost exclusively men (n=23, 92%), with a similar dropout rate of 48% (n=12). Premature therapy discontinuations were characterized especially in OCBs (n=6, 40%) and NONBs (n=12, 48%); half of them sanctioned because of drug relapses. In contrast, patients admitted to the LEBs and MULBs at therapy admission completed the treatment in three quarters of the cases.

Conclusions: "Suffering pressure" in the form of extrinsic motivation (e.g., by legal require-ments) as well as multiple stress sensations shows a positive effect on admission, continuation and regular completion of inpatient therapy; by contrast, low levels of subjective stress seem to be detrimental for the motivation. Therefore, psychosocial stressing may be valuable as a predictor variable in counseling and therapy for MA dependence.