Provigil (Modafinil) Plus Cognitive Behavioral Therapy for Methamphetamine Use in HIV+ Gay Men: A Pilot Study

Therapeutics, New York State Psychiatric Institute, New York, New York, USA.
The American Journal of Drug and Alcohol Abuse (Impact Factor: 1.78). 01/2009; 35(1):34-7. DOI: 10.1080/00952990802342907
Source: PubMed


To evaluate the efficacy of modafinil combined with cognitive behavioral therapy (CBT) for treatment of methamphetamine (MA) dependence among HIV+ gay men.
In a single blind trial, modafinil was administered for 12 weeks, followed by a 4-week placebo phase. CBT was conducted for 18 sessions over the 16-week study. Primary outcome measures were self-reported use of days per week plus urine toxicology assays. Additional measures included the Beck Depression Inventory, Cravings Scale, and O/C Crystal Use Scale. Response was defined as > 50% decline in days used per week. Thirteen patients were enrolled over an 18-month period.
Ten patients (77%) completed the trial, although two discontinued modafinil due to side effects. Six of the ten study completers reduced their MA use by > 50%.
These preliminary results suggest good retention using combined medication and psychotherapy, and support further examination of modafinil and CBT in double-blind placebo controlled trials.

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    • "More recent studies support the finding that the provision of provigil (modafinil) as a conjunct therapy to cognitive-behavioural treatment for specific subgroups of MA users to be more than 50% effective in reducing MA use. These authors found that bupropion and baclofen are effective in managing abstinence and drug use outcomes while modafinil may be useful in situations when participants start to decrease their use (McElhiney et al., 2009). They conclude that MA users do not respond so well to pharmacotherapy but with some success in reduced craving seen in studies utilising buproprion in outpatient setting. "
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    ABSTRACT: Methamphetamine (MA) is a public health problem both in Australia and internationally and very little is known about the most cost-effective treatment options. This study is a review of recent studies and an assessment of current treatment options for MA dependence. Treatment options for MA dependence can be divided into outpatient and inpatient modality settings according to the level of drug use. Moderate improvements through higher rates of retention in treatment (especially residential rehabilitation) have been found in individuals who completed either cognitive-behavioural therapy or counselling as a form of outpatient treatment and in those users who completed a residential rehabilitation treatment programme at an inpatient treatment modality. There remains a need for further research to investigate the efficacy of existing treatment options in individuals with MA use problems and to address the economic impact of those interventions in terms of cost-effectiveness/cost utility.
    Journal of Substance Use 08/2012; 17(4):363-383. DOI:10.3109/14659891.2011.592900 · 0.48 Impact Factor
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    • "diet and exercise control Assessed changes in self - reported safer - sex behaviors over 12 months 4 . McElhiney , 2009 59 10 HIV - infected , meth - dependent MSM Six of the 10 participants who completed the study reported reduced meth use of over 50% Single - blinded pilot study of modafanil + CBT over 16 weeks Biweekly urine drug screens and self - reported meth use . Assessed depression using the Beck Depression Inventory 5 . "
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    ABSTRACT: Men who have sex with men (MSM) have the highest incidence of HIV infection in the United States. One of the contributing factors to HIV spread among this group is the use of crystal methamphetamine ("meth"). The objective was to review the behavioral impact of crystal meth use in HIV-infected MSM and potential treatment options. A systematic review of MEDLINE identified studies that evaluated the clinical effects of crystal meth on the HIV-infected MSM population. Search terms included HIV, methamphetamine, MSM, antiretroviral therapy, adherence, resistance, and treatment. U.S. citations in the English language in peer-reviewed journals until December 2010 were included. The primary author reviewed eligible articles, and relevant data including study design, sample, and outcomes were entered into an electronic data table. The 61 included studies highlight that HIV-infected MSM who use crystal meth are more likely to report high-risk sexual behaviors, incident sexually transmitted infections, and serodiscordant unprotected anal intercourse, compared to HIV-infected MSM who do not use crystal meth. Medication adherence in this population is notably low, which may contribute to transmission of resistant virus. No medications have proven effective in the treatment of crystal meth addiction, and the role of behavioral therapies, such as contingency management are still in question. HIV-infected MSM who abuse crystal meth have worse HIV-related health outcomes. Behavioral interventions have shown variable results in treating crystal meth addiction, and more investigation into rehabilitation options are needed. The results presented support efforts to develop and implement novel interventions to reduce crystal meth use in HIV-infected MSM.
    AIDS patient care and STDs 11/2011; 26(1):36-52. DOI:10.1089/apc.2011.0153 · 3.50 Impact Factor
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    • "Recent randomized trials of modafinil to treat MA-dependent users (De La Garza et al., 2010; Heinzerling et al., 2010; McElhiney et al., 2009; McGaugh et al., 2009; McGregor et al., 2008; Shearer et al., 2009) have shown the drug to be well tolerated with limited side effects and minimal adverse events (particularly at 200 mg), but none have examined the benefits to cognition. "
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    ABSTRACT: The cognitive benefits of modafinil to patients undergoing 7-day inpatient withdrawal from methamphetamine (MA) dependence were examined as part of a double-blind, randomized, placebo-controlled pilot trial. Recent evidence has identified modafinil-related improvements in treatment outcomes for MA-dependent patients; however, the benefits to cognition function, which is critical to treatment success but known to be impaired, has yet to be examined. The first 20 participants recruited to the study were administered either 200 mg of modafinil (once daily) or placebo, and a neuropsychological test battery (including an MA version of the emotional Stroop task) at admission (n = 17) and discharge (n = 14). Follow-up interviews were conducted at 1-month postdischarge (n = 13). After participant withdrawals (3 in each group), treatment was associated with a significant improvement in immediate verbal memory recall and nonsignificant trend toward improvement on executive function and delayed memory tasks. No benefit was seen for measures of verbal learning, visual memory, processing speed, or verbal fluency. All participants showed a significant attentional bias for MA-related stimuli on the emotional Stroop task. The magnitude of bias predicted both retention in treatment and relapse potential at follow-up but was not significantly ameliorated by modafinil treatment. While nonsignificant, the effect sizes of modafinil-related improvements in executive function and memory were consistent with those found in more robustly powered studies of cognitive benefits in attention-deficit/hyperactivity disorder and schizophrenia, supporting the need for further research.
    Experimental and Clinical Psychopharmacology 12/2010; 18(6):489-97. DOI:10.1037/a0021791 · 2.71 Impact Factor
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