Correlation between Psychological Distress with Level of

Methamphetamine Dependence in Male Chronic Methamphetamine

Users in the Rehabilitation Center of North Sumatra Province

Vita Camellia

, M. Surya Husada

, Fasihah Irfani

and Dudy Aldiansyah

Department of Psychiatry, Faculty of Medicine, Universitas Sumatera Utara, Medan, Indonesia

Department of Neurology, Faculty of Medicine, Universitas Sumatera Utara, Medan, Indonesia

Department of Obstetric and Gynecology, Faculty of Medicine, Universitas Sumatera Utara, Medan, Indonesia

Keywords: Psychological Distress, Dependence Level, Chronic Amphetamine Users.

Abstract: The aim of this study was to find the correlation between psychological distress and level of

methamphetamine dependence in male chronic methamphetamine users. Drug users have fulfilled the

inclusion criteria, has been done detoxification, male, methamphetamine use disorder, not psychotic. The

exclusion criteria are those who have general medical illnesses based on the history of the disease, have a

history of previous head trauma and organic mental illnesses. Structured interviews with MINI ICD-10 to

determine subject is indeed a substance use disorder. To know the psychological distress, we determine it

with the Hospital Anxiety and Depression Scale (HADS), and to see the score level of dependence, we used

WHO ASSIST (The Alcohol, Smoking and Substance Involvement). The study found that out of 88 males

subjects with methamphetamine use disorder. The median of dependency level score is 30.5 (6-41), and mean

of HADS score is 15.67 (4.76). This study obtained Pearson correlation of psychological distress level scores

and dependency level scores with r = 0.242, p = 0.023. There is a significant weak correlation between

psychological distress level scores and dependency level scores.

1 INTRODUCTION

Methamphetamine dependence is a serious public

health problem in the world with medical, psychiatric,

cognitive, socioeconomic and legal consequences.

The use of amphetamine is ranked second after

cannabis as the most commonly used prohibited

substance worldwide. Globally it is estimated that

33.8 million people aged 15-64 years are

methamphetamine-dependent (Glasner-Edwards et

al., 2009; Karila et al., 2010; Marshall et al., 2011;

Opsal et al., 2013). In Indonesia, drug abuse among

students in 2018 from 13 provinces reached 2.29

million people and one of the community groups

prone to drug abuse are those who are in the 15-35

year range or millennial generation (PUSLITDATIN,

2019).

Glasner-Edwards et al., (2009) found that

symptoms of depressive pre-treatment had clinical

significance in the attachment to treatment and

became a chronic condition of depression, symptoms

and depressive syndrome at the end of treatment and

follow-up (in the next 30 days) showed the

association of Initial use of methamphetamine and

abstinence from methamphetamine with decreased

symptomatology of depression and major depressive

disorders associated with greater overall severity in

methamphetamine users.

Depression and anxiety often occur in

methamphetamine users, short-term abstinence can

improve depression and quality of life but do not

improve anxiety in methamphetamine abusers.

In chronic methamphetamine users, repeated and

sustained release of monoamine in central nervous

system (CNS) has a major role in the chronic

neurological influence of methamphetamine abusers.

Frequent use causes dopamine depletion in CNS and

damages the dopamine and serotonin terminals.

Damage to monoamine neurotransmission has

important effects on brain circuits and mood

regulation and also functions of self-control,

motivation, cognitive performance, and

psychological stress. These changes bring the user

unable to be happy without substances (anhedonia)

which makes it easier to cause severe depression.

322

Camellia, V., Husada, M., Irfani, F. and Aldiansyah, D.

Correlation between Psychological Distress with Level of Methamphetamine Dependence in Male Chronic Methamphetamine Users in the Rehabilitation Center of North Sumatra Province.

DOI: 10.5220/0010181100002775

In Proceedings of the 1st International MIPAnet Conference on Science and Mathematics (IMC-SciMath 2019), pages 322-325

ISBN: 978-989-758-556-2

During abstinence and release of substances, the

patient will experience different symptoms. These

symptoms are related to recurrence of substance use.

This study wants to find the correlation between

psychologic distress and the level of

methamphetamine dependence on chronic users, after

detoxification at a rehabilitation center in Northern

Sumatra, Indonesia.

2 METHODS

Subjects were chronic methamphetamine users who

underwent treatment in the rehabilitation of the

province of North Sumatra (research period May to

November 2019) who had fulfilled the inclusion and

exclusion criteria as research subjects.

Inclusion criteria:

 Detoxification has finished;

 Has used methamphetamine for more than a year;

 Criteria for mental behavioral disorders due to

methamphetamine use are met;

 The sample has a dependency level score based on

WHO ASSIST (The Alcohol, Smoking and

Substance Involvement

) > 4;

 Willing to participate in research;

 Minimum education in junior high.

Exclusion criteria:

 Has a history of previous medical ailments;

 Have been treated by a psychiatrist before;

 Has an organic mental disorder;

 Have psychotic symptoms.

2.1 Procedure

A total of 88 males subjects will have a urine drug test

to ensure that the subject has abstained and completed

detoxification then a structured interview with MINI

(The Mini International Neuropsychiatric Interview)

according to ICD-10 to establish a diagnosis of

mental behavioral disorders due to substance use.

Hospital Anxiety and Depression Scale (HADS) to

see the problems of depression symptoms and their

anxiety or psychological distress with the sum score

on each depression or anxiety scale having a range of

0-21 and Ozalp said that the total score ≥ 17 is optimal

for identifying affective psychopathology cases

(Ozalp et al., 2008; Zigmond & Snaith, 1983). To see

the level of dependency, the WHO ASSIST

questionnaire was used. it is made for use by all

cultures and can be used in different cultures. To

screen tobacco, alcohol, cannabis/cocaine,

amphetamine and sedative/hypnotic/ benzodiazepine

stimulants, hallucinogens, inhalants, opioids, and

other substances (WHO, 2010).

WHO ASSIST determine the risk score of each

substance used to discuss appropriate interventions

with substance users. WHO ASSIST consists of eight

questionnaire items which were carried out within 5

minutes. WHO ASSIST gets information about

substance users throughout the life and related to

problems throughout the last three months and values:

 0 (never); not using the last three months;

 1 (one or two times); up to twice in the last three

months;

 2 (every month); an average of 1-3 times per

month for three months;

 3 (every week); 1-4 times every week;

 4 (every day); 5-7 times per week or almost every

day.

History of substances used, types of substances,

and the degree of dependence measure with WHO

ASISST can determine the type of intervention used.

If the WHO ASSIST score 0-3, it does not require

intervention, a score of 4-26 requires a brief

intervention and a score of more than 27 require more

intensive treatment, and to see the demographic

characteristics and background of the environment

and family factors, a questionnaire will be used which

will be filled out by the subjects.

2.2 Statistical Analysis

The data is analyzed whether the distribution is

normal or not with the normality test, if it is not

normally distributed then a non-parametric test is

performed to see the correlation between the level of

psychological distress and the level of dependence

that is the Pearson correlation test. It is meaningful if

p < 0.05, using SPSS.

3 RESULTS

This study found that (see table 1) out of a total of 88

males chronic methamphetamine users had an age

range (years) with a median value of (min-max) being

24 (15-40) years, the median age for first use is 18

(12-33) years, and the median of use duration is 5 (1-

21). According to the marital status, the dominant

ones are 53 subjects (60.2%) who have not been

married, in education level (senior high school) is 78

subjects (88.6%), and 58 subjects (65.9%) are

employed. The score of level of dependency was

found median (min-max) namely 30.5 (6-41). HADS

score with a mean (standard deviation) is 15.67

(4.76). This study obtained Pearson correlation of

Correlation between Psychological Distress with Level of Methamphetamine Dependence in Male Chronic Methamphetamine Users in the

Rehabilitation Center of North Sumatra Province

323

psychological distress level scores and dependency

level scores with r = 0.242 and p = 0.023 (see table

2).

Table 1: Characteristics of chronic methamphetamine users

with Substance use disorders.

Variable n (%)

Median

(

min-

)

e 24

(

15-40

)

e of first time use

(

12-33

)

Duration of use 5 (1-21)

Marital Status

Single

Married

Divorce

53 (60.2)

27 (30.7)

(

9.1

)

Education level

Junior high

Senior high

Academic de

ree

8 (9,1)

78 (88.6)

(

2,3

)

Occupation

Employed

Unem

58 (65.9)

(

34.1

)

Table 2: Correlation of HADS scores and

Methamphetamine dependency scores.

HADS score

WHO ASSIST r = 0.242

score p = 0.023

n = 88

Pearson correlation test

4 DISCUSSION

This study found that the higher the level of

dependence of chronic methamphetamine users show

a higher level of psychological distress, although this

correlation shows a significant relationship with a

positive correlation, but the relationship shown is a

weak relationship. This study found the average

HADS (Hospital Anxiety and Depression Scale)

score showed a high level of psychological distress

that is above the cut-off. And the level of the

dependence of chronic methamphetamine users more

than half is above a score of 30.5. Which shows a high

level of dependency. All respondents who were

predominantly educated were high school and

unmarried and according to Gywali, et al, that risk

factors for depression and anxiety among patients

with substance use disorders in western countries that

have been reported were female, younger age, low

family income and single. Gyawali et al., (2016)

found in their study that 51.1% who were treated at

the Kathmandu Hill medical center experienced high

psychological distress symptoms by using the Kessler

psychological distress instrument with multivariate

analysis showing various factors related to

psychologic distress symptoms including age,

education, the severity of substance abuse using the-

10 DAST and family function.

Glassner-Edwards et al., (2010) who assessed

psychiatric problems, substance use and functional

outcomes of methamphetamine users with

concomitant anxiety disorders three years after

treatment. That anxiety disorders are associated with

poor drug and alcohol use, high health service use and

high psychiatric symptoms including suicide.

Emphasis on symptoms and anxiety syndromes in

methamphetamine users can help to optimize

meaningful treatment outcomes. Studies have shown

that high symptoms of anxiety and depression affect

help-seeking behaviors such as getting diagnosed and

treated for substance abuse disorders, which also

affect treatment adherence, decreased quality of life,

increased risk of breathing, increased social isolation

and the risk of premature death.

This study found that half of the respondents who

underwent rehabilitation were using

methamphetamine for less than five years and half

had rehabilitation after using methamphetamine more

than five years. This shows the religiosity in seeking

treatment which is in line with the research of Lee et

al., (2012) found that previous mental health

problems were high and at present from respondents

using methamphetamine, they found as many as 22%

(18 people) reported mental health problems

preceding methamphetamine use and as many as 72%

reported having mental health problems after regular

methamphetamine use the first time and around the

same time as problematic methamphetamine users

(Lee et al., 2012). Respondents identified a time delay

of five years between the time of the first problematic

use of methamphetamine and the search for a

treatment for problems related to methamphetamine.

This study also found that half of the respondents

started using methamphetamine under the age of 18,

the earliest is 12 years old and the latest is 33 years

old. While the duration of using of respondents is

stretched from five years to 21 years. The

interconnection of substance use and psychological

distress from adolescents (aged 16 years) to half-life

(age 47 years) and continual use over time in African

Americans (in cohorts), they found substance use,

alcohol and ongoing psychological distress from

adolescence to middle age in men and women. Also

found that substance use in adolescents predicts

greater psychological distress in young adulthood in

groups of men.

IMC-SciMath 2019 - The International MIPAnet Conference on Science and Mathematics (IMC-SciMath)

324

The explanation for psychological distress and

substance use problems is self-medication. People

who use psychoactive substances to alleviate

psychological symptoms, another explanation that the

use of substances causes psychological distress. The

use of substances including intoxication and

substance release can induce symptoms of anxiety

and depression, which will then change

spontaneously with the cessation of use and reduction

of withdrawal symptoms. Furthermore, the use of

substances can cause prolonged psychological

distress due to the consequences of the use of putting

the individual on a long journey of loss.

This study suggests that it is necessary to detect

the presence of psychological distress in chronic

methamphetamine users before detoxification, post-

detoxification to determine the appropriate treatment

according to the individual's needs. Stuart et al.,

(2017) stated that various studies supporting

psychologic treatments that combine elements of

psychotherapy, psychoeducation and relapse

prevention are the main treatments for

methamphetamine users who focus on abstinence and

reduce mental health symptoms, including cognitive

behavioral therapy and motivational interviewing

approaches that have been shown to be effective in

reducing the use of methamphetamine focusing on

abstinence and reducing mental health symptoms,

including cognitive-behavioral therapy and

motivational interviewing approaches that have been

shown to be effective in reducing the use of

methamphetamine and depressive symptoms in

people who use methamphetamine.

ACKNOWLEDGEMENTS

This study funded by DRPM of Ministry of Research

Technology and High Education of the Republic of

Indonesia.

REFERENCES

Glasner-Edwards, S., Marinelli-Casey, P., Hillhouse, M.,

Ang, A., & Mooney, L. (2009). Depression among

methamphetamine users: association with outcomes

from the methamphetamine treatment project at 3-year

follow-up. J Nerv Ment Dis, 197(4), 225–231.

Glassner-Edwards, S., Mooney, L., Marinelli-Casey, P.,

Hillhouse, M., & Ang, A. (2010). Anxiety disorders

among methamphetamin dependent adults: association

with posttreatment functioning. Am J Addict, 19(5),

385–390.

Gyawali, B., Choulagai, B., Paneru, D., & Ahmad, M.

(2016). Prevalence and correlates of psychological

distress symptoms among patients with substance use

disorders in drug rehabilitation centers in urban Nepal:

a cross-sectional study. BMC Psychiatry, 16, 314.

Karila, L., Weinstein, A., Aubin, H., Benyamina, A., &

Reynaud, M. (2010). Pharmacological approaches to

metamphetamin dependence: a focused review. Br J

Clin Pharmacol, 69(6), 578–592.

Lee, N., Harney, A., & Pennay, A. (2012). Examining the

temporal relationship between methamphetamine use

and mental health comorbidity. Advances in Dual

Diagnosis, 5(1), 23–31.

Marshall, B., Wood, E., Shoeveller, J., Buxton, J.,

Montaner, J., & Kerr, T. (2011). Individual, social and

environtmental factors associated with initiating

methamphetamine injection: implications for drug use

and HIV prevention strategies. Prev Sci, 12(2), 173–

180.

Opsal, A., Kristensen, O., Larsen, T., Syversen, G., &

Rudshaug, E. (2013). Factors associated with

involuntary admissions among patients with substance

use disorders and comorbidity: a cross-sectional study.

BMC Health Services Research, 13, 57.

Ozalp, E., Soygur, H., Cankurtaran, E., Turhan, L.,

Akbiyik, D., & Geyik, P. (2008). Psychiatric morbidity

and its screening in Turkish women with breast cancer:

a comparison between the HADS and SCID test.

Psychooncology, 17, 668–675.

PUSLITDATIN. (2019). Penggunaan narkotika di

kalangan remaja meningkat.

Stuart, A., Baker, A., Bowman, J., McCarter, K., & Denhan,

A. (2017). Protocol for systematic review of

psychological treatment for methamphetamine use: an

analysis of methamphetamine use and mental health

symptom outcomes. BMJ, 7, e015383.

WHO. (2010). ASSIST the alcohol, smoking and substance

involvement screening test. WHO Library Cataloguing

in Publication Data.

Zigmond, A., & Snaith, M. R. (1983). The hospital anxiety

and depression scale. Acta Psychiatr Scand, 67, 361–

370.

Correlation between Psychological Distress with Level of Methamphetamine Dependence in Male Chronic Methamphetamine Users in the

Rehabilitation Center of North Sumatra Province

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