Author Archives: EVQ

Meth Inside Out Video

Meth Inside Out

“This exceptional video series accomplishes a goal few manage to attain: teaching science-based content in an engaging way to assist with the delivery of effective substance abuse treatment. A real step forward for the field.”
– Deni Carise, Ph.D., Director, Treatment Systems Section, Treatment Research Institute, Philadelphia

This research-based educational video curriculum on methamphetamine was co-produced by UCLA ISAP and Eyes of the World Media Group. The series is designed to equip meth users, their families, and the professionals who assist them with a solid understanding of the biological basis of addiction, effective tools for recovery, and, most important, hope for the future.

Created for maximum flexibility, the curriculum is designed to meet the needs of treatment centers, correctional facilities, community centers, social service agencies, and universities. The series is composed of 3 episodes, which can be used individually or as a set. Handbooks allow counselors to maximize the educational potential of each episode.

Meth Inside Out uses innovative 3D animations of the brain to illustrate how methamphetamine impacts the brain in an engaging and accessible way. This animation shows how meth use causes a massive release of dopamine, the brain’s pleasure chemical.


International Talks:
Methamphetamine use in South Africa: Do increased rates of methamphetamine smoking represent an HIV transmission threat? Richard A. Rawson, Ph.D., UCLA ISAP
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Bridges have been built: Is anyone using them? (Netherlands, September 2006) Richard A. Rawson, Ph.D., UCLA ISAP
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Methamphetamine and the Brain: New Knowledge; New Treatments (UN Embassy, Vienna, March 2006). Richard A. Rawson, Ph.D., UCLA ISAP-UCLA Research Center
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Delivery Systems for Substance Abuse Treatment: Integration with Primary Care and Mental Health and Social Services (Istanbul, Turkey). Richard A. Rawson, Ph.D., UCLA ISAP
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Training in Cognitive Behavioral Therapy for Substance Abuse Treatment: A Comparison of 3 Training Methods. Donnie W. Watson, Ph.D., Solomon Rataemane, M.D., Richard A. Rawson, Ph.D., Lusanda Rataemane, M.S., and Jason McCuller, M.S.
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Research Efforts in South Africa (November 2005). Donnie W. Watson, Ph.D., Richard A. Rawson, Ph.D., Solomon Rataemane, M.D.
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Drug Abuse Research in the Middle East; An Exercise in Cooperation. Richard A. Rawson, Ph.D., UCLA ISAP
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Update on Research Efforts in South Africa. Donnie W. Watson, Ph.D., UCLA ISAP/Friends Research Institute, Inc.
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Drug Abuse Problems in the Middle East (Cairo, Egypt). Richard A. Rawson, Ph.D., UCLA ISAP
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Delivery Systems for Substance Abuse Treatment – An International Conference (Istanbul, Turkey, September 2005)
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Drug Abuse Research in the Middle East: An Exercise in Cooperation and Training. Richard A. Rawson, Ph.D., UCLA ISAP
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Drugs Misuse Among Universities’ Students in Gaza Strip (Orlando, Florida, June 2005). M. Afifi, M.D., S. Elsousi, Ph.D., Z. AbuRsas, M.Sc., Substance Abuse Research Center, Palestine
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Buprenorphine and the NIDA CTN: Research to Practice (XIII World Congress of Psychiatry, Cairo, Egypt, September 14, 2005). Walter Ling, Richard Rawson
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Creating a Cooperative Drug Abuse Research Network in the Middle East. Richard A. Rawson, Albert Hasson, UCLA ISAP
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Research Strategies to Test Behavioral/Psychotherapy Treatments for Substance Use Disorders: Several Examples (Cairo, Egypt, September 2004). Richard A. Rawson, Ph.D., UCLA ISAP
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Translational Research on Reinforcement as a Determinant of Substance Use Disorders (Netherlands). Stephen T. Higgins, Ph.D., University of Vermont
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UNDOC Project


Methamphetamine Tool Kit
April 2006 – June 2006
Richard A. Rawson, Principal Investigator
The California Department of Alcohol and Drug Programs contracted with ISAP to write 20 topical briefing sheets on methamphetamine (MA) for clinicians (with a secondary audience being counties and other states). Topics covered were MA use among women, men, adolescents, men who have sex with men, and ethnic minority groups; children exposed to parental MA use and production; MA and criminal justice, the environment, HIV and HCV, and co-occurring disorders; general health effects of MA; detoxification from MA; MA myths; MA prevalence in California, trends in MA treatment admissions in California, and knowledge needed to better address the MA problem in California; guidelines for effective assessment, treatment planning, and recovery for MA users; and best practices for treating MA-dependent individuals.

Drug Endangered Children

Children of MethMethamphetamine is a highly addictive psychoactive stimulant that produces an intensely euphoric high, with a “crash” that causes depression, irritability, insomnia, nervousness, and paranoid aggressive behaviors (ONDCP, 1999)—all of which present a risk of serious neglect and abuse to the children of meth-dependent parents. Many children who survive abuse or neglect are angry, antisocial, physically aggressive, and even violent (Dunn et al., 2002; Thompson, 1998). They may perform poorly in school and engage in delinquent behavior (Dembo et al., 1988; Hildyard & Wolfe, 2002). For some, the consequences include low self-esteem, depression, hopelessness, suicide attempts, and self-mutilation (Dube et al., 2001). They may behave compulsively, suffer panic attacks, be highly distrustful of others, and tend toward dangerous play and sexual promiscuity (Brohl, 1996; Kang, Deren, & Goldstein, 2002). These children are also at high risk to continue intergenerational patterns of drug abuse, criminal behaviors, and neglectful parenting (Dunn et al., 2002; Sheridan, 1995).

Children who live in home-based meth labs are not only exposed to their parents’ chaotic and drug-focused lifestyles, but also to the highly psychoactive stimulant and the toxic precursor chemicals associated with meth production. Exposure to these chemicals is known to cause severe health problems in adults, and can cause death from accidental ingestion. However, long-term affects of the chemical exposure on children remain unknown (Kolecki, 1998). Clearly, the combination of exposure to the toxic effects of the drug itself and to the aberrant behavior of the adult meth users puts children living in these settings in a uniquely dangerous and damaging environment. However, currently no data exist to measure the impact of this circumstance.


Training has long histories of conducting drug abuse research and training in Los Angeles County and other parts of Southern California and throughout the country. The County and adjacent areas constitute a rich environment in which to conduct drug abuse research training, providing an ecological setting in which all permutations of drug abuse abound. The region has a publicly financed, centrally monitored system of treatment agencies and a multifaceted network of educational/research institutions with a large number of prominent scientists working in drug abuse research. Additionally, UCLA ISAP has some of the top investigators in the field of substance abuse. This affords us the opportunity to offer training experience to groups across the country, through presentations at conference as well as individually tailored trainings.


Meth Treatment

Meth EffectsMeth dependence is a difficult disorder to treat. The following characterization of the clinical challenges of treating meth users is condensed from CSAT TIP #33. Withdrawal from meth dependence is characterized by a protracted anhedonia and dysphoria that is accompanied by severe craving for the drug. Craving frequently occurs in response to exposure to conditioned cues (stimuli present during past episodes of meth use and euphoria). Such cues evoke powerful craving for meth via classical conditioning principles. The likelihood of continued meth smoking or injecting appears to be, in part, related to the strength of the craving experienced from these craving-generating cues. The withdrawal dysphoria present in the context of ubiquitous meth availability and ubiquitous conditioned cues can produce a very pernicious dependence; indeed, inpatient hospitalization may be indicated to treat long-term meth dependence, at least in initial stages of detoxification. Medically managed inpatient care is expensive, however, and widespread meth abuse has appeared in impoverished populations with very limited access to such inpatient resources.

Psychosocial/Behavioral Treatments
Presently, there are two approaches that have evidence to support their efficacy for the treatment of meth dependence, but there is a much larger literature on treatments that work with the other major illicit stimulant problem in the U.S., cocaine dependence. Although there are a number of differences in the pharmacology and physiological effects produced by meth and cocaine, these drugs have many common properties and similar effects. Research examining the treatment responses of meth and cocaine users suggests that cocaine and meth users have very similar outcomes when exposed to the same treatments. In addition, large scale treatment system evaluations have reported comparable outcomes for cocaine and meth users.

Matrix Model
During the 1980s, the Matrix Institute on Addictions group in Southern California created a multi-element treatment manual with funding support from NIDA, designed for application with stimulant users on an outpatient basis. The Matrix approach evolved over time, incorporating treatment elements with support from scientific evidence, including cognitive behavioral therapies (i.e., relapse prevention techniques), a positively reinforcing treatment context, many components of motivational interviewing, family involvement, accurate psychoeducational information,12-step facilitation efforts, and regular urine testing. The approach is delivered using a combination of group and individual sessions delivered approximately three times per week over a 16 week period followed by a 36 week continuing care support group and 12 step program participation. Over 15,000 cocaine and meth users have been treated with this approach during the past 20 years. The manual and related materials have been published by Hazelden and SAMHSA. (for more details see,, and Matrix Institute)

Matrix Treatment
In 1999, CSAT funded a large scale evaluation of the Matrix Model for the treatment of meth users coordinated by UCLA. Roughly 1,000 meth dependent individuals were admitted into eight different treatment study sites. In each of the eight sites, 50% of the participants were randomly assigned to either Matrix treatment or to a “treatment as usual” (TAU) condition, which was comprised of a variety of counseling techniques idiosyncratic to each site. The study results showed that individuals assigned to treatment in the Matrix approach received substantially more treatment services, were retained in treatment longer, gave more meth-negative urine samples during treatment and completed treatment at a higher rate than those in the TAU condition. These in-treatment data suggested a superior response to the Matrix approach. When data at discharge and follow up were examined, it appeared that both treatment conditions produced comparable post-treatment outcomes. Participants in both conditions showed very significant reductions in meth use, significant improvements in psychosocial functioning, and substantial reductions in psychological symptoms, including depression. Follow up data indicated that over 60 percent of both treatment groups reported no meth use and gave urine samples that tested negative for meth (and cocaine) use. Use of other drugs, such as alcohol and marijuana were also significantly reduced.

A particularly interesting finding was that across the eight treatment sites, the ‘drug court site’, e.g., the one that enrolled individuals who were participating under a drug court program, produced superior results compared to the other seven sites, suggesting a substantial beneficial influence of drug court involvement. Overall, this evaluation is the largest controlled study of meth treatments that has ever been conducted.

Contingency Management (CM). Positive reinforcement is a powerful tool in increasing desired behaviors. School teachers who give ‘special prizes’ for superior performance, companies who give employee incentive bonuses for meeting production goals, AA meetings that give ‘chips’ and cakes to acknowledge successful progress in achieving sobriety are all examples of the effective use of positive reinforcement. Many existing treatment programs informally use positive reinforcement as part of their treatment milieu. Frequently, the reinforcement takes the form of verbal praise, or earning program privileges, or ‘graduating’ to a higher level of status in the program or some other practice to acknowledge and reward progress in treatment. CM is simply the systematic application of these same reinforcement principles. In many of the studies investigating CM approaches, treatment participants can earn ‘vouchers’ that are exchangeable for non-monetary desired items (e.g., free movie tickets, restaurant dinners, grocery vouchers, gasoline coupons, etc.). Typically the individual can earn larger valued rewards for longer periods of continuous abstinence from drugs and alcohol.

Over the past 30 years, a number of researchers and research groups at Johns Hopkins (Stitzer, Silverman), Vermont (Higgins and colleagues), Connecticut (Petry and colleagues), and UCLA (Roll and colleagues) have demonstrated the powerful effect of CM techniques to reduce heroin, benzodiazepine, cocaine and nicotine use. Recently CM techniques have been implemented with meth users in Southern California by the group at UCLA and by researchers in the NIDA Clinical Trials Network. The results of these investigations have provided powerful support to the efficacy of this behavioral strategy as treatment for meth abuse. Individuals who have been assigned to CM conditions have shown better retention in treatment, lower rates of meth use and longer periods of sustained abstinence over the course of their treatment experience. Without question, CM is a powerful technique that can play an extremely valuable role in improving the treatment response of meth-dependent individuals.

Research efforts to develop medications to aid in the treatment of meth-related disorders are at a relatively early stage of development. Currently there are no medications that can quickly and safely reverse life threatening meth overdoses. Similarly, there are no medications that can reliably reduce the paranoia and psychotic symptoms that frequently contribute to episodes of dangerous and violent behavior associated with meth use. As clinicians will attest, it would be tremendously helpful to have medications that could help meth users recover more quickly from the effects of chronic use. Medication(s) that could reduce symptoms in the early days and weeks of recovery could be extremely valuable in promoting engagement and retention in behavioral and psychosocial treatments.

The problem of relapse to meth use is a complex process. However, one important set of contributing factors is the unpleasant emotional and cognitive impairments that accompany the protracted abstinence syndrome for months after meth use is discontinued. Medications that could lessen the severity of these symptoms could be of tremendous value in providing more successful treatments. At present, there have been fewer than 10 placebo-controlled double-blind efficacy trials of potential meth pharmacotherapies. One of the limiting factors in rapidly evaluating medications for meth-related disorders is that there are relatively few experienced pharmacotherapy research groups in the midwestern and western geographical areas impacted by meth. The need to develop new research groups capable of conducting addiction pharmacotherpy groups west of the Mississippi is a critical need to increase the pace of medication development.

In response to this need, the National Institute on Drug Abuse (NIDA) has recently established the Methamphetamine Clinical Trials Group (MCTG), a network designed to provide new clinical research teams and sites in geographic areas where meth use is a major public health problem. This network funded by NIDA, consists of sites in San Diego and Costa Mesa, California, Honolulu, Hawaii, Des Moines, Iowa and Kansas City, Missouri and a coordinating center at UCLA. Studies of promising pharmacotherapies will be moved into these sites for assessment in double-blind, placebo-controlled trials.


Special Populations – Adolescents

Over two million youth experienced substance abuse problems in the United States in 2003. Marijuana by far is the most widely used drug among high school youth and young adult populations. According to the Monitoring the Future survey, marijuana use rates were highest amongst twelfth graders and college students (34.9% & 33.7%, respectively) in the year prior to the survey. While results from this survey show that lifetime rates of methamphetamine use was down for high school students, it was up for young adult college students. Meth has become a growing problem among youth 25 years and younger, particularly within the Western U.S. as witnessed by criminal justice, health care, and treatment data.

There is a paucity of published literature on treatment involved youth in the U.S. Nationally, there was an increase of 65% in the number of overall adolescent treatment admissions for drug abuse between 1992 and 2002. According to treatment statistics from the California Alcohol and Drug Programs, meth admissions for youth have been on the rise since 2000. The Phoenix House, a large drug treatment center, revealed to CBS news that meth use accounted for almost half of the center’s adolescent admissions in 2005.