Randomized, placebo-controlled trial of sertraline and contingency management for the treatment of methamphetamine dependence.
BACKGROUND
Methamphetamine dependence and associated medical and psychiatric concerns are significant public health issues. This project evaluated the efficacy of sertraline (50mg bid) and contingency management (CM) for the treatment of methamphetamine dependence.


METHODS
In this randomized, placebo-controlled, double-blind trial, participants completed a 2-week non-medication baseline and were randomized to one of four conditions for 12 weeks: sertraline plus CM (n=61), sertraline-only (n=59), matching placebo plus CM (n=54), or matching placebo-only (n=55). All participants attended clinic thrice-weekly for data collection, medication dispensing, and relapse prevention groups. Outcomes included methamphetamine use (urine drug screening and self-reported days of use), retention (length of stay), drug craving (visual analogue scale), and mood symptoms (Beck Depression Inventory).


RESULTS
No statistically significant main or interaction effects for sertraline or CM in reducing methamphetamine use were observed using a generalized estimating equation (GEE), although post hoc analyses showed the sertraline-only condition had significantly poorer retention than other conditions (chi(2) (3)=8.40, p<0.05). Sertraline conditions produced significantly more adverse events than placebo conditions. A significantly higher proportion of participants in CM conditions achieved three consecutive weeks of methamphetamine abstinence than those in non-CM conditions.


CONCLUSIONS
These data do not demonstrate improved outcomes for sertraline versus placebo for treatment of methamphetamine dependence; indeed, they suggest sertraline is contraindicated for methamphetamine dependence. Findings provide support for the use of contingency management for treatment of methamphetamine dependence.
Shoptaw
Steven
S
Center for Health Promotion and Disease Prevention, Department of Family Medicine, David Geffen School of Medicine at UCLA, 10880 Wilshire Blvd, Suite 1800, Los Angeles, CA 90024, USA. sshoptaw@mednet.ucla.edu
Huber
Alice
A
Peck
James
J
Yang
Xiaowei
X
Liu
Juanmei
J
Jeff Dang
Roll
John
J
Shapiro
Benjamin
B
Rotheram-Fuller
Erin
E
Ling
Walter
W
D000328:Adult; D003266:Continuity of Patient Care / Q000706:statistics & numerical data*; D003710:Demography; D003863:Depression / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology; D039721:Diagnostic and Statistical Manual of Mental Disorders; D007174:Disruptive, Impulse Control, and Conduct Disorders / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology; D004311:Double-Blind Method; D004334:Drug Administration Schedule; D005260:Female; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008694:Methamphetamine / Q000009:adverse effects / Q000652:urine; D017367:Selective Serotonin Reuptake Inhibitors / Q000627:therapeutic use*; D020280:Sertraline / Q000627:therapeutic use*; D013375:Substance Withdrawal Syndrome / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology; D019966:Substance-Related Disorders / Q000534:rehabilitation*; D011795:Surveys and Questionnaires; D016896:Treatment Outcome
D008694:Methamphetamine; D017367:Selective Serotonin Reuptake Inhibitors; D020280:Sertraline