kumenisches Hainich Klinikum g Gmb H Akademisches Lehrkrankenhaus
Ökumenisches Hainich Klinikum g. Gmb. H Akademisches Lehrkrankenhaus des Universitätsklinikums Jena Fachkrankenhaus für Neurologie, Kinder- und Jugendpsychiatrie, Psychiatrie und Psychotherapie Treatment of methamphetamine addicts in the clinical practice in Germany SUPRAT Suchtfragen in Praxis und Theorie e. V. Dr. med. Katharina Schoett k. schoett@suprat. de
Clinical work as a senior physician at the department for addiction medicine at the ÖHK Mühlhausen/Thüringen Engaged in several national committees in the addiction sector (member of the board of the German society for addiction medicine, Chairman of the medical board for addictions of the State Chamber of Medicine in Thuringia) Involved in the efford to fill the gaps between theory and practice – founding member of Su. Pra. T 6/15/2021 Dr. K. Schoett: Treatment of meth addicts My working background …
Structure of the lectures 01 Introduction about the situation of stimulant dependency in Germany 02 Experiences from the clinical work 03 Focus of therapeutic work 04 Specific challenges 6/15/2021 Dr. K. Schoett: Treatment of meth addicts
Changes on the German drug market • Nationwide cannabis is the most frequently used narcotic, followed by amphetamine. Novel psychoactive substances have become a significant phenomenon in the field of illegal drugs in Germany. • Specific and resilient epidemiological data regarding methamphetamine are missing. Prevalence: In the epidemiological addction survey 2015 it was estimated, that 0, 6 % of the adults have used methamphetamine at some point in their life. • Regarding the amount of the overall drug seizures crystal roughly remains constant since 2012 (2016: 62 kg) and takes the third place after cannabis and amphetamine. So far NPS are not beeing reported. • In the last 4 years, the number of drug-related deaths subsequently increased (1 333 in 2016, an increase of 9% over the same period in the prior year). Number of meth-related death rose from 24 to 26. The number of NPSrelated deaths has increased significantly (from 39 to 98 cases). Drogen- und Suchtbericht der Bundesregierung 2017 6/15/2021 Dr. K. Schoett: Treatment of meth addicts
Epidemiology – regional differences There are significant regional differences regarding the prevalence and the consumer culture. These are particular attributable to: • the availability • the accessibility for different ages and groups of people • the consumption traditions It can be assumed, that there is a nondependent use for several years, before an affected person attracts attention and for example claims help for him/herself in medical settings, that are specialized on addiction treatment. 6/15/2021 Dr. K. Schoett: Treatment of meth addicts
Epidemiology – Different case groups of users Compared to “typical drug users”, there are quite different groups of users in connection with novel substances. A qualitative study with methamphetamine using individuals in Germany has identified the following groups of people with an abusive consumption pattern: • • Consuming individuals in the leisure area Consumption in school/educational contexts Consumption at work Consumption in the context of parenthood Consuming individuals with psychological co-morbidities/traumata Scenes, that focus on sexual settings Consuming individuals with excessive consumption patterns/random poly-drug use http: //www. bmg. bund. de/fileadmin/dateien/Publikationen/Drogen_Sucht/Forschungsberichte/ATS-Bericht_final. pdf 6/15/2021 Dr. K. Schoett: Treatment of meth addicts
Structure of the lectures 01 Introduction about the situation of stimulant dependency in Germany 02 Experiences from the clinical work 03 Focus of therapeutic work 04 Specific challenges 6/15/2021 Dr. K. Schoett: Treatment of meth addicts
Structure of the German addiction treatment system (simplified) 6/15/2021 outpatient • counselling • Medical practice • Specialist outpatient clinics inpatient • Emergency department • Qualified withdrawl (approx. 3 weeks) • Rehab (drugs: 6 month; alcohol: 3 month) Dr. K. Schoett: Treatment of meth addicts Self-help groups
Utilisation of addiction care systems So far, there is no diagnosis category for NPS in addiction medicine. All diagnosis are made according to the ICD -10. As a result it cannot be estimated, how many people seek medical treatment because of NPS. Due to the subsumtion of methamphetamine, a clear statement about larger substance categories is difficult. Main diagnoses in outpatient and inpatient treatment Opioids Cannabis Sedativa Cocaine Stimulants others multiple outpatient 33, 4 % 41, 2 % 2, 0 % 5, 8 % 15, 8 % 0, 3 % 1, 7 % inpatient 32 % 14 % 9% 2% 8% 1% 34 % rehab 22 % 24 % 2% 5% 14 % 0% 32 % Source: Reitox-Workbook Treatment 2015/2016 6/15/2021 Dr. K. Schoett: Treatment of meth addicts
Approach to the subject … from my personal perspective Admissions to the qualified drug withdrawal to the Ökumenischen Hainich Klinikum g. Gmb. H Mühlhausen/Thüringen (N=500 to 700/year) 6/15/2021 Dr. K. Schoett: Treatment of meth addicts year Opioids Meth 2005 59% 0% 2007 51% 0, 1% 2010 49% 4% 2012 39% 45% 2014 29% 66%
Typical consequences of a constant use • Withdrawal seldomly is of a physical nature, but it still exists and is characterized by restlessness, insomnia, irritability and cravings. Often they don`t get taken seriously. • Depressive and psychotic symptoms accompany the acute withdrawal, but they decline within 1 -2 weeks. The cravings are considerable and last for at least five weeks. Anhedonia can last up to several months. The depression, when coming down, can lead to suicidal tendencies and deserve special attention and exploration. • Frequently there is an emotional instability and irritability. Often the patients themselves are annoyed by their aggressive and irritable behavior, because it normally isn`t a part of them. • The cognitive resources are remarkably low and need to recover. The endurance and memory are significantly reduced, which is the reason, that the “normal” duration of therapeutic units cannot be followed through. They need to be evaluated time and again. Every therapy requires, that the client can pay attention to the given materials and to understand remember them. 6/15/2021 Dr. K. Schoett: Treatment of meth addicts
Pilotstudy with Meth addicted parents • N = 37 (18 inpatient + 11 outpatient + 8 Rehab) with 64 children 54. 1 % female In most cases, the consumption of methamphetamine began before the age of 21 (51. 4%). • Only 37. 8% lived with their children. (21. 6 % solely with kids, 16. 2% with partner and kids). But: The prime desire for the own treatment: better relationship to the children (81%). • The children of the consumers are remarkably young (average of 6. 3 years). 65% have contact to the youth welfare department. • A constant social inclusion is difficult: 86. 5% of parents are separated; frequent moves (2. 3 times) • Own treatment preparedness: 76% are affiliated with addiction counseling services. 43% have been to an inpatient treatment before. Source: Preiß J: Addiction to methamphetamine and parenthood. Analysis of high-risk-groups. Bachelor's thesis at the TU Chemnitz, 2016. 6/15/2021 Dr. K. Schoett: Treatment of meth addicts
The Matrix-Model Intensive Outpatient Treatment for people with stimulant use disorders The Matrix model offers a comprehensive structured an evaluated treatment package for adults with abuse or addiction from stimulants. It includes the following components: • • • Counselor‘s treatment manual Client‘s handbook Client‘s treatment companion Counselor‘s family education manual Using Matrix with women clients Anger Management for Substance Abuse and Mental Health Clients It can by optain from the Su. Pra. T assocciation (www. suprat. de) With general support of the Thuringia ministry for work, social affairs, health women and family 6/15/2021 Dr. K. Schoett: Treatment of meth addicts
Structure of the lectures 01 Introduction about the situation of stimulant dependency in Germany 02 Experiences from the clinical work 03 Focus of therapeutic work 04 Specific challenges 6/15/2021 Dr. K. Schoett: Treatment of meth addicts
New: S 3 -guidance for treating methamphetamine related disorders Publisher: Federal drugs commissioner The Federal Ministry of Health and the German Medical Association Internet: www. crystal-meth. aezq. de www. awmf-leitlinie. de Work and care: ÄZQ-editing Contains 135 coordinated recommendations 6/15/2021 Dr. K. Schoett: Treatment of meth addicts
Guidance: diagnostic procedures at the initial contact Level of recommendation Recommendation 2 -1 Each medica. I/therapeutical setting shall do a risk assessment with the necessary information wich allowed decision about further measures if patients/clients report a stimulant use. 2 -2 A subject spezific diagnosis (differential diagnosis) shall be effected or is to be concluded, if there are suspicios cases of psychological comorbidities. 2 -3 If a diagnosis backup is not possible in the initial contact setting it shall be tried to motivate the user to go into an appropriate addiction specific setting. 6/15/2021 Dr. K. Schoett: Treatment of meth addicts
Guidance: treatment plan Level of recommendation Recommendation 2 -7 For persons who actively seek help with the help systems, a consultation appointment should be made possible within 24 hours. 2 -10 The therapy goals of the consuming individual shall be considered in the treatment planning. These recommendations also base on clinical experiences, since there are no verified, scientific findings yet about which methamphetamine users with what kind of consumption patterns and frequency get optimal help in which kind of therapeutic setting. 6/15/2021 Dr. K. Schoett: Treatment of meth addicts
Guidance: acute therapy – qualified withdrawal Level of recommendation Recommendation 4 -7 A stationary, qualified withdrawal treatment shall be offered, in cases of withdrawals from methamphetamine. 4 -8 Depending on the individual needs, the duration of the stationary withdrawal treatment shall at least last for 3 weeks. 4 -10 As a seamless and pursuing treatment, patients shall be offered post-acute forms of interventions right after the withdrawal phase. 6/15/2021 Dr. K. Schoett: Treatment of meth addicts
Guidance: post-acute-treatment Level of recommendation Recommendation 5 -4 To reach a sustainable stabilization of abstinence and as relapse prevention, right after the post-acute-treatment (including the detoxification), there should be a coordination and continuity of care for at least one year. 5 -9 Each methamphetamine-consuming individual shall get a psychotherapeutic councelling or therapy offer, that is equitable to the need and motivation, regardless of an addiction diagnosis. 5 -19 To alleviate the withdrawal symptoms and to stabilize the abstinence, methods of sports therapy (training therapy, physical conditioning) shall be offered and mediated. 6/15/2021 Dr. K. Schoett: Treatment of meth addicts
Giudance: comorbid psychological and somatic illnesses Level of recommendation Recommendation 6 -4 The methamphetamine-related disorder and comorbid disorders should preferably be treated in an integrated manner. If this is not possible, treatment elements for both disorders should appropriately be coordinated. Common comorbid psychological illnesses: • • further addiction schizophrenia ( especially with negative symptoms) depression ( no sufficient effectiveness of antidepressants!) bipolar disorder attention-deficit/hyperactivity syndrome insomnia ( al least 4 weeks after the withdrawal ends) neurocognitive disorders 6/15/2021 Dr. K. Schoett: Treatment of meth addicts
Structure of the lectures 01 Introduction about the situation of stimulant dependency in Germany 02 Experiences from the clinical work 03 Focus of therapeutic work 04 Specific challenges 6/15/2021 Dr. K. Schoett: Treatment of meth addicts
Which areas of focus exist in general? • differentiated consideration of the different consumer groups • research (so far, there is little scientific data from Germany, for example regarding the dissemination) • universal access to knowledge, equally for affected individuals and for assistants (e. g. Meth. Care) • dissemination of guidance (e. g. guidance for the treatment of methamphetaminerelated disorders) • dissemination of support systems and implementation of specialized offers (e. g. Breaking Meth), strengthening of prevention meassures, e. g. in the work context 6/15/2021 Dr. K. Schoett: Treatment of meth addicts
Challenges in the future: Not to forget NPS The number of newly discovered novel substances is just one of several measures, the EMCDDA uses. For example, 423 (almost 70%) of the 620 currently controlled NPS where discovered on the drug market in 2015, in contrast to 365 in 2014 and 299 in 2013. This shows, how complex the market has gotten in the meantime. 68% 6/15/2021 Dr. K. Schoett: Treatment of meth addicts 2015 59% 2014 48% 2013
NEPTUNE – Novel Psychoactive Treatment UK Network Has been published in 2015 by the Club Drug Clinic in London. It is based on the available evidence and the clinical consensus of a selected expert group. It primarily aims at clinicians in several settings. Since 2016, the compendium is available in German language and free of charge. Publisher: Su. Pra. T e. V. SUPRAT Suchtfragen in Praxis und Theorie e. V. 6/15/2021 Dr. K. Schoett: Treatment of meth addicts Internet: www. suprat. de
Thank you for your kind attention 6/15/2021 Dr. K. Schoett: Treatment of meth addicts
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