Matrix Model and Cognitive - Behavior Therapy for Methamphetamine Dependence: The Problems to Implementation in Four Cities of Iran

Background: Methamphetamine dependence is a health concern in Iran. The matrix model and cognitive - behavior therapy are the two treatment programs for this problem. Objectives: The current study aimed at exploring the problems associated with delivering these two treatments for methamphetamine dependence among patients dependent on methadone in four cities of Iran (Tehran, Shiraz, Isfahan, and Karaj). Methods: A total of 3000 subjects (2200 males and 800 females) participated in the study from December 2012 to December 2016. Fifteen psychologists participated in the study. Participants were recruited from 179 outpatient psychiatric and psychological centers as well as methadone treatment clinics. Results: Females, compared with males, were more likely to state long duration of treatment (70.8% vs. 48.5%, P = 0.01), high costs (57.1% vs. 44.8%, P = 0.01), and boredom associated with the treatments (54.3% vs. 42.4%, P = 0.01). Males, compared with females, were more likely to state the necessity of professional training of psychologists for treatment delivery (46.4% vs. 29.3%, P = 0.01), interference of the treatments with job and life (46.3% vs. 15.7%, P = 0.01) and the intensiveness of the treatments (45.4% vs. 15.7%, P = 0.01). Interviewing psychologists also stated that long duration of the two treatments led to a high attrition rate (52%) among the patients. All of them (100%) stated that intensive and long - term professional training of psychologists was needed. Almost 60% of the psychologists stated that both treatments were intensive, which led to poor patient engagement. Conclusions: The problems associated with delivering these two treatments should be managed in methadone withdrawal centers in Iran. Lower costs and brief interventions should be provided for such patients.