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EVALUATION OF INTERNET AS TREATMENT SUPPORT FOR METHAMPHETAMINE USERS IN RECOVERY

Gopika Chandra, MD, PhD, MPH, Edward Mensah, PhD, Thomas M. Lyons, PhD, Rebecca Roberts, MD, Elizabeth Calhoun, PhD, Wayne Wiebel, PhD and Jacek L. Ubaka, MD, MPH

University of Illinois at Chicago School of Public Health, Chicago, IL

Special thanks to Darrell Wehmeier, who made this study possible on www.kci.org

The Internet has begun to provide community for persons suffering from many conditions. Involvement with people facing a similar problem is a core component of health-related social support. It is said “Online self-help networks are like surrogate families. Members share common problems, help each other toward mutual goals, and support each other through good times and bad. The support they provide is available for free and, in most cases, around the clock, as needed. The study assessed whether the Internet has a role in treatment support for meth users in recovery and provides social support to family and friends of meth users. We report the results of this study conducted between November 2008 and March 2009.

A total of 245 meth users and 204 family/friends of meth users partially or entirely completed the survey. Overall, mean age of meth user was 37.4 years, 66.5% were females, and 85.1% were Caucasian. The male to female ratio is 1:2 indicating a higher predominance of female meth users compared with male meth users in this study population. Mean age of family/friends of meth users was 42 years, 61% were females, and 63% were Caucasian. One individual reported to be African American visited www.kci.org for informational purposes for writing a school report or research project, otherwise no African American or blacks participated in the study. Other racial groups identified were Asian, Hispanic, Hispanic White, Native Hawaiian or other Pacific Islander, American Indian or Alaskan Native, which included less than 5% of study population.

Previous research has shown that smokers who seek Internet assistance for quitting smoking are, like Internet users in general, i.e. more educated, more likely to be employed, and less likely to be a member of a minority group than smokers who seek assistance from the American Cancer Society telephone counseling service or elsewhere. We notice a similar trend of ethnicity, employment status, and educational level among meth users who completed the online questionnaire on www.kci.org. In our study population, 43.2% meth users reported to be high school graduate or GED and 32% had obtained a college graduate or associate’s degree. Almost 60% of meth users were full-time or part-time employed. No statistically significant association was found between level of education, employment status and meth use.

MA or amphetamine use is prevalent among whites in rural counties and African American or Hispanics in urban counties. Our findings show predominance of White meth users globally. A geo-mapping was conducted by Survey Gizmo and the survey participants were mapped on the world map using geo-tracking by Internet Protocol (IP) addresses. No IP addresses were tracked individually to protect individual information. In the figures 1 and 2, the blue dots depict the IP address location. For both Meth users and family/friend, the blue dots are spread centrally in North America, Europe, New Zealand, Australia, and Asia indicating widespread survey participation. This finding is similar to results reported by other authors that online interventions for smoking and alcohol cessation are able to reach large numbers of smokers and alcoholics interested in quitting addiction.

Figure 1: Geographical distribution of Meth users

Figure 3: Geographical distribution of family/friend of Meth user

In order to know the stage of recovery based on Transtheoretical Model (TTM) of Change, only meth users completed the Stages of Change Readiness and Treatment Eagerness Scale (SOCRATES). We explain drug use pattern, social support preferences, Internet use pattern in relation to individual stage of recovery (Precontemplation, Contemplation, Preparation/Action, and Maintenance).

Study participants existed in different stages of recovery. We found that 53% meth users had attended social support meetings for treatment of meth use. These meetings may be Alcohol Anonymous (AA), narcotic anonymous (NA), crystal meth anonymous (CMA) etc. A total of 21.5% meth users reported attending social support meeting at least once a week while 23% attended every several months.

Meth users attending social support meetings at least 1-2 times per month or once every week had higher TTM stage of recovery than meth users attending meetings every several months. This finding suggests that meth users’ regularly attending meetings have greater motivation to recover from meth use.

Meth Use Pattern: Meth users reported varied meth use ranging from 1 day to 1 year ago. Meth users were questioned about the route of Meth administration. Since the question allowed participants to check all possible routes of Meth administration among the choices provided, the results are not mutually exclusive. This means individuals may be using Meth via multiple routes. Smoking was reported to be the most common route of Meth administration (92%) followed by snorting (85%). Some individuals reported intravenous use, oral ingestion in form of pills, with drinks etc., rectal enema, and hot-railing.

Meth users who last used meth at ≥ 6 months had higher TTM stage compared with meth users with last meth use < 6 months ago. These meth users were also 46% more likely to have higher recognition of the problem compared with meth users who last used meth <6 months. Meth users with most recent meth use ≥6 months ago were also 40% more likely to have ambivalent (unsure) about their drug use.

Internet Use Pattern: Meth users frequently accessed medical information on the Internet, similar to findings reported by PEW survey for the general population. We found that they also used Internet for seeking information on drugs, sex partners, and other meth users; online purchase; playing games; news; and, communication purposes such as email, social networking etc. There was no statistically significant difference in type of information accessed by the meth users and family and friends of users (should be this way throughout), although greater number of meth users were looking for information on finding sex partners compared with family/friends of meth users.

Most meth users (~79%) reported visiting www.kci.org less than 5 times a week. Meth users that visit www.kci.org >5 times/week had higher TTM recovery stage compared with meth users visiting www.kci.org <5 times/week (contemplation/maintenance versus Precontemplation; P < 0.05). This observation suggests that meth users frequently visiting www.kci.org may have greater motivation to recover from meth use.

Most meth users (66%) and family/friends of meth users (64%) reported spending less than 1 hour per day on drug recovery websites. The optimal time spent on drug recovery websites for recovery seemed to be 1-2 hours per day: meth users spending 1-2 hours per day scored higher TTM stage of recovery than meth users spending more than 2 hours. In other words, meth users spending more than 2 hours did not show statistically significant improved recovery.

Thirty eight percent of meth users and 43% of family/friends of meth users reported visiting other drug recovery online websites. Although data shows that meth users visiting other drug recovery websites had higher TTM stage of recovery compared to meth users that did not, this difference is not statistically significant. The most popular website among meth users and family/friends of meth users was www.crystalmeth.org, excluding www.kci.org. Majority of the meth users (86%) and family/friends of meth users (89%) accessed Internet at home at most times. Meth users accessing Internet at home did not have higher TTM stage compared with meth users accessing at other places such as work, school, public library etc.

Social Support Preferences: Previous literature reports family and friends as primary social support preference for drug users. In our study as well, most meth users (46%) felt that family and friends assisted in their recovery followed by preference for support group meetings (18%), Internet (11%), and inpatient and outpatient treatment (7.4%), respectively. These findings again highlight the importance of developing a social support frame-work during drug use recovery.

A total of 85% meth users agreed that Internet provides help during recovery from meth use. Our findings suggest that meth users receive more social support from online KCI discussion board and chat-room compared with family/friends of meth users. Contrary to the above finding, significantly more meth users than family/friend of meth users (43% versus 23%) reported Internet facilitates drug abuse for them. It is possible that family/friends of meth users are unaware of the ways that the Internet facilitates drug use due to their use limited to informational and support purposes.

Message board was reported to be the most helpful online tool for social support during recovery (meth users, 55% versus family/friend of meth user, 63%, respectively). When meth users were asked how much help and social support they get from the online KCI discussion board and chat room, 29% reported a “great deal”, 24% reported “some”, and 20% said a “little” while 24% said “none”. Meth users who reported to receive “some or “great deal” of help and social support from discussion boards and chat-room had no significant improved TTM stage than meth users receiving “little” or no help.

Family/friends of meth users tend to receive more social support from www.kci.org than meth users. In the qualitative review, we reported that family/friends of meth users found their informational and emotional needs different than meth users.

Our study findings suggest that social support meetings are effective for sustained recovery and online support is an effective treatment support technology for meth users. It is plausible that online social support will fill the gap when professional help is inaccessible and a social support meeting is unavailable. Our recommendation is to provide KCI members with a strategy to utilize online resources on www.kci.org to achieve best results during recovery process. We recommend spending at least 1-2 hours/day on www.kci.org and visit at least ≥5 times a week. Future research must be focused on developing strategies to increase attendance at social support meetings, which will further help sustained abstinence from drug abuse and further investigate the role of Internet in treatment support compared with other interventions.