Treatment of drug-induced stereotypy.

Abstract

One adult of a minority ethnicity, who met criteria for amphetamine-induced psychosis in remission, received treatment for an amphetamine-induced stereotypic behavior. His stereotypic behavior was treated with habit reversal training (HRT), and the treatment's effects were assessed using direct observation procedures. As a result of a two hour intervention, his stereotypic behavior was reduced to near zero levels, and maintained at four month follow-up. Key words: amphetamine, stereotypic behavior, treatment, habit reversal. ********** Amphetamines are quickly becoming one of the most commonly used and manufactured illicit drugs in the world. According to a United Nations report, over 35 million people regularly use amphetamine, compared to the 15 million who regularly use cocaine and the 10 million who use heroin (United Nations Office for Drug Control and Crime Prevention, 2000). Methamphetamine, a derivative of amphetamine, is also one of the fastest growing substance abuse problems in the United States (Yacoubian & Peters, 2004). Once considered largely a concern on the West Coast (e.g., Rawson, Anglin, & Ling, 2002), methamphetamine is becoming much more common in the midwest (Yacoubain & Peters, 2004). Methamphetamine is not only a problem in metropolitan areas; its usage is equally, if not more, common in rural areas (Leukefeld et al., 2002). The increase is due at least in part to the fact that methamphetamine is relatively easy to manufacture and can be created from ingredients that can be purchased legally. Additionally, the effects of methamphetamine last up to 10 to 12 hours, and typical use of methamphetamine costs only about 25% as much as typical cocaine use (Rawson et al., 2000). It is also easy to obtain; the U.S. Department of Justice statistics show that from 1990 to 1996, 64% of high school juniors and seniors reported that they could easily obtain methamphetamine. Like any narcotic, there are both direct effects of the substance and side effects. The direct effects of methamphetamine include increased alertness and energy, elevated self-confidence, and a sense of well-being. The adverse side-effects of prolonged methamphetamine use can include paranoia, slurred speech, motor instability, violent behaviors (Hall, McPherson Twemlow, & Yudko, 2003), psychosis (Lin, Ball, Hsiao, Chiang, Ree, & Chen, 2004), and stereotypic behaviors such as purposeless physical activity, tremors, muscle tics, bruxism (teeth grinding), and athetosis (strange motor movements). This relation between amphetamine use and stereotypic behaviors is well documented in the nonhuman literature (e.g., Canales & Graybiel, 2000, Balsara, Jadhav, Muley, & Chandorkar, 1979). The motor-activating effects of amphetamine in rats is often used for investigating the neurophysiological substrates in human stimulant abuse (Canales, Gilmour, & Iversen, 2000). Rats' behaviors will become increasingly focused and repetitive with increased dosages of amphetamine (Seiden, Sabol, & Ricaurte, 1993). This change in the rats' behavior has been directly liked to changes in the basal ganglia (Canales & Graybiel, 2000). Stereotypic behaviors in rats can be introduced by dopaminergic stimulation of the striatum and can be abolished by intrastriatal blockage of dopaminergic transmission (Arnt 1985; Fibiger, Fibiger & Zis, 1973; Creese & Iverson, 1972). This would seemingly suggest a medically-based intervention for substance-induced stereotypic behaviors; but research is beginning to show that environmentally-based interventions are effective at changing behavior that was the result of brain damage, while demonstrating reliable changes in brain physiology (Latsch, Thulborn, Krisky, Shobat, & Sweeney, 2004). Thus, stereotypic behaviors that are amphetamine-induced may be treatable through environmental manipulations. To date there are no published accounts of the treatment of drug-induced stereotypic behaviors, but there are environmentally based treatment options. …