Treatment outcome, cognitive function, and psychopathology in methamphetamine users compared to other substance users

Table 1 Phases of the therapeutic treatment concept

Therapy phase	Content and therapy frequency	Duration
Admission	Checking the entry requirements, e.g., recent drug use	Admission day
Entry phase	Diagnostics, self-reflection, strengthen and increasing motivation, defining therapy goals, treatment planning	2 wk
Main phase	Change-, testing and stabilization phase: psychoeducation (2x/wk), mindfulness-based relapse prevention (1x/wk), trigger analysis (1x/wk), individual psychotherapy (50 min/wk), sports (1x/wk), further offers according to the results of diagnostics e.g., nutrition counseling (1x/wk), body therapy (1x/wk), ergotherapy (1x/wk), assertiveness training (1x/wk)	22 wk
Discharge, planning aftercare	Follow-up plan, relapse prevention, arrangement of further care management e.g., contact to job center and clarified housing situation	2 wk

Table 2 Substance use in both groups

Substance class	n		P
	MA-group	OS-group
Alcohol	16	21	0.31
Cannabis	32	42	0.04
Cocaine	5	19	0.001
Hallucinogens	0	1	0.3
Opioids	3	7	0.18
Sedativa	2	3	0.65
Tobacco	49	42	0.07
Volatile solvents	1	0	0.3
Stimulants	55 (methamphetamine)	31 (amphetamine)	-

MA: Methamphetamine; OS: Other substances.

Table 3 Study instruments

Instrument	Description	Assessment
Becks Depression Inventory-II (BDI-II) (Hautzinger et al[29], 2006)	21-question multiple-choice self-report inventory measuring the severity of depression. Raw scores were used for analyses	T0, T1
Cognitrone (Wagner and Karner[30], 2003)	Computer administered Test of cognitive working speed and working accuracy (comparisons of geometrical figures). Scores were standardized into T-values according to test norms	T0, T1
Documentation standards III for the evaluation of the treatment of dependent individuals (German Society for Addiction and Therapy[31], 2001)	Defined items to assess substance use and related factors (e.g., years of substance use, age at use onset, number of withdrawals)	T0
Hamilton Depressive Rating Scale (HAMD)(Hamilton[32], 1960)	Clinician-administered depression assessment scale, containing 17 items of symptoms of depression. Time period: past week. Assessed as a semi structured interview. Raw scores were used for analyses	T0, T1
Inventory of personal psychosocial resources(Küfner et al[33], 2006)	Self-report questionnaire measuring psychosocial resources in the past and at present based on different scales, e.g., relationship, friends, financial and work situation. A total raw score of all scales measuring the present situation was built and used for analyses	T0, T1
Mannheimer Craving Scale (Nakovics et al[34], 2009)	Self-report questionnaire with 12 multiple choice items and 4 additional items measuring Craving within the last 7 d. Raw scores from the main 12 items were used for analyses	T0, T1
NEO-Five-Factor-Inventory (NEO-FFI)(Borkenau and Ostendorf[35], 2008)	Self-report questionnaire with 60 items for the measurement of the so-called “big five” personality traits (neuroticism, extraversion, openness, agreeableness, consciousness). Scores were standardized into T-values according to test norms	T0
Raven's Standard Progressive Matrices(Raven et al[36], 2016)	Nonverbal intelligence test, Computer version. Scores were standardized into IQ values according to test norms	T0
Structured Clinical Interview for DSM-IV Axis I (Wittchen et al[37], 1997)	Diagnostic structured interview to determine the presence of DSM-IV Axis I disorders	T0
Symptom Checklist 90-R (SCL-90R) (Franke[38], 1995)	Self-report questionnaire assessing symptoms of psychopathology on different scales. For this study two scales were use: intensity of depressive symptoms scale and “Positive Symptom Distress Index” (PSDI), a measure of intensity of present symptoms. Scores of both scales were standardized into T-values according to test norms	T0, T1
Wender Utah Rating Scale -short Version (Wursk) (Retz-Junginger et al[39], 2002)	Short version (25 items including 4 control items) of a self-report questionnaire assessing retrogradely childhood symptoms of attention deficit hyperactivity disorder. Raw Scores were built from the 21 core items and used for analyses	T0

Table 4 Comparison between MA- and OS-group at baseline T0

	MA-group	OS-group	P
n	55	55
Male	42 (76.4%)	47 (85.5%)	0.23
Age	30.0 (± 5.3)	32.0 (± 7.7)	0.12
Number of withdrawals (n = 48)	3.0 (± 4.1)	3.0 (± 4.1)	0.98
Raven‘s IQ (MA n = 50, OS n = 54)	93.7 (± 13.5)	100.1 (± 13.6)	0.02
Cognitrone working speed (MA n = 53, OS n = 54)	49.1 (± 8.0)	54.3 (± 9.0)	0.002
Cognitrone accuracy (MA n = 53, OS n = 54)	43.0 (± 8.9)	47.1 (± 9.8)	0.03
Personality factors	n = 37	n = 42
Neuroticism	22.8 (± 6.7)	25.1 (± 9.7)	0.24
Extraversion	25.0 (± 6.0)	25.2 (± 7.5)	0.89
Openness	26.3 (± 5.6)	28.6 (± 6.7)	0.11
Agreeableness	26.6 (± 4.2)	27.9 (± 6.8)	0.33
Conscientiousness	29.0 (± 5.6)	31.9 (± 6.6)	0.04
BDI-II Score (MA n = 42, OS n = 54)	13.6 (± 10.8)	16.8 (± 11.3)	0.17
HAMD Score (MA n = 46, OS n = 42)	5.3 (± 4.8)	8.3 (± 7.9)	0.04
SCL-PSDI Score (MA n = 39, OS n = 40)	53.5 (± 11.1)	59.3 (± 10.1)	0.02
Wursk Score (MA n = 36, OS n = 40)	n = 3628.6 (± 16.7)	n = 4030.8 (± 15.1)	0.56
Craving (MA n = 39, OS n = 40)	13.9 (± 9.5)	14.2 (± 8.0)	0.87
Years of education	n = 52	n = 50	0.048
≤ 9 yr	35	24
≥ 10 yr	17	26
Employment	n = 51	n = 48	0.19
Unemployed	43	33
Employed	4	7
Other (e.g., retiree)	4	8
Ever injected	n = 49	n = 40	0.75
	7	4

Data displays means ± standard deviation or number of participants (education and employment). Different n result from missing values. BDI-II: Becks Depression Inventory-II; HAMD: Hamilton Depressive Rating Scale; MA: Methamphetamine; OS: Other substances; SCL: Symptom Checklist; Wursk: Wender Utah Rating Scale-short Version.

Table 5 Number of comorbid diagnoses

	MA group, n = 54	OS group, n = 55	P
Depression	11	15	0.40
Anxiety disorder	5	0	0.03
Eating disorder	0	2	0.49
Obsessive-compulsive disorder	0	0	-
Posttraumatic stress disorder	15	12	0.47
Personality disorder	11	11	0.96
ADHD	6	7	0.80
Psychotic disorder	3	10	0.042
Somatoform disorder	18	0	< 0.001

Data displays number of participants diagnosed with the respective comorbidity. ADHD: Attention deficit and hyperactivity disorder; MA: Methamphetamine; OS: Other substances.

Table 6 Comparison over time and between groups (ANOVA results)

		MA-group	n	OS-group	n	P
BDI	T0	15.31 (± 11.55)	26	16.36 (± 12.39)	33	Ptimeb; PgrouP NS; PtimexgrouP NS.
	T1	7.27 (± 7.20)		8.97 (± 8.98)
Cognitrone accuracy	T0	43.62 (± 7.84)	26	44.93 (± 9.85)	28	Ptimeb; PgrouP NS; PtimexgrouP NS
	T1	50.50 (± 8.63)		52.54 (± 10.16)
Cognitrone speed	T0	48.81 (± 7.68)	26	57.18 (± 9.05)	28	Ptimeb; PgrouPb;PtimexgrouP NS.
	T1	54.08 (± 10.04)		62.61 (± 10.88)
HAMD	T0	6.52 (± 5.36)	25	9.59 (± 9.14)	27	Ptimeb; PgrouP NS; PtimexgrouP NS.
	T1	3.60 (± 4.77)		5.81 (± 5.98)
IPR	T0	204.43 (± 36.47)	21	201.78 (± 33.84)	27	Ptimea; PgrouP NS; PtimexgrouP NS.
	T1	215.48 (± 38.71)		217.78 (± 54.15)
MaCS	T0	14.39 (± 9.81)	23	14.59 (± 6.69)	27	Ptimeb; PgrouP NS; PtimexgrouP NS.
	T1	8.57 (± 5.71)		8.96 (± 8.04)
SCL 90R Depression Score	T0	58.14 (± 9.09)	21	62.70 (± 10.52)	27	Ptimeb; PgrouP NS; PtimexgrouP NS.
	T1	50.71 (± 8.19)		55.19 (± 11.55)
SCL 90 R PSDI	T0	55.90 (± 10.51)	21	61.26 (± 11.40)	27	Ptimeb; PgrouP NS; PtimexgrouP NS
	T1	51.71 (± 8.33)		52.61 (± 10.66)

^aP < 0.05.

^bP ≤ 0.001.

Data displays means and standard deviations. BDI: Becks Depression Inventory; BDI-II: Becks Depression Inventory-II; HAMD: Hamilton Depression Rating Scale; IPR: Inventory of personal resources; MaCS: Mannheimer Craving Scale; NS: Not significant; Pgroup: Group effect; Ptime: Effect of time; Ptimexgroup: Interaction effect; SCL: Symptom Checklist.