• Revista Internacional de Investigación en Adicciones 2024 Vol. 10 (2)
• ISSN print: 2448-573X
• ISSN on-line: 2448-6396
• DOI: 10.28931/riiad.2024.2.02
• Received on: August 8th, 2024
  Accepted on: September 24th, 2024

Original article

Comparison of Use, Barriers, Treatment Seeking, and Mental Health Problems in Residential Methamphetamine Users

Resumen

Introducción: el consumo de metanfetamina ha aumentado en Aguascalientes desde el 2013 al 2020, por lo que el gobierno implementó el programa Reintegra con el objetivo de iniciar la rehabilitación voluntaria en lugar de tomar el camino legal usual para las personas implicadas en el sistema de justicia por delitos menores.

Objetivo: comparar la historia de consumo, problemas asociados a consumo, el uso de servicios de salud y las barreras para el acceso al tratamiento, así como depresión y conducta suicida entre los consumidores de metanfetamina que ingresaron a tratamiento residencial a través del Grupo Reintegra, con los que iniciaron tratamiento por otras circunstancias.

Método: el estudio fue descriptivo, comparativo y transversal con 865 personas en centros residenciales. Los participantes fueron categorizados en el Grupo Reintegra (n = 453) y el Grupo No Reintegra (n = 412). Los datos se recolectaron mediante un cuestionario. Se realizaron estadísticas descriptivas e inferenciales, incluidos análisis de regresión logística.

Resultados: los participantes de Grupo Reintegra mostraron una mayor prevalencia de hábitos de consumo, consideraron su consumo menos peligroso, reportaron menos problemas asociados con el consumo de metanfetamina, expresaron menos intención de dejar el consumo y buscaron ayuda en menos lugares en comparación con el Grupo No Reintegra. La regresión logística identificó diferencias entre los grupos, relacionadas con el número total de sustancias consumidas, el número de lugares donde se buscó ayuda y la gravedad de los problemas relacionados con el consumo.

Discusión y conclusiones: los hallazgos resaltan diferencias entre los participantes según su ingreso al tratamiento, muestran desafíos y subrayan la importancia de intervenciones personalizadas para mejorar su eficacia.

Palabras clave: metanfetamina, perfiles de usuarios, trastornos relacionados con sustancias, centros de rehabilitación, barreras de acceso a los servicios de salud.

Abstract

Introduction: methamphetamine use has increased in Aguascalientes between the years 2013 to 2020, thus the government has implemented the Reintegra Program with the purpose to begin voluntary rehabilitation instead of taking the usual legal path for the individuals involved with the justice system for minor offenses.

Objective: to compare the consumption history, associated problems, use of health services, barriers to access treatment, as well as depression and suicidal behavior in methamphetamine users who entered residential treatment by the Reintegra Program with those who began undergoing treatment due to other circumstances.

Method: the study was descriptive, comparative and cross-sectional with 865 individuals in residential centers. Participants were categorized into the Reintegra Group (n = 453) and Not-Reintegra Group (n = 412). Data were collected using a questionnaire. Descriptive and inferential statistics were performed, including logistic regression analyses.

Results: Reintegra Group participants showed higher prevalence of using habits, considered their use less dangerous, reported fewer associated problems with meth use, expressed less intention to quit using meth and sought help in fewer places when compared to the Not-Reintegra Group. Logistic regression identified differences between the groups, related to the total number of substances used, number of places where they sought help, and severity of problems related to meth use.

Discussion and conclusions: findings highlight differences between participants based on their enrollment in the program, displaying unique challenges and underscoring the importance of personalized interventions to enhance their effectiveness.

Key words: methamphetamine, user profiles, substance-related disorders, rehabilitation centers, barriers to access of health services.

INTRODUCTION

The United Nations Office on Drugs and Crime (UNODC) reports a global expansion in the methamphetamine market, with amphetamine-type stimulants being highly used among people in treatment (UNODC, 2023). In Aguascalientes, Mexico, methamphetamine consumption has risen significantly among the population, increasing from 9.6% in 2013 to 38.8% in 2018, surpassing the national average (Centros de Integración Juvenil [CIJ], 2018).

Methamphetamine, particularly in its crystalline form, known as meth, crystal or crystal meth, is a stimulant drug with a highly addictive potential, low cost, and wide availability (National Institute on Drug Abuse [NIDA], 2023; Winslow et al., 2007). Its high potency and ability to induce addiction quickly can lead to severe consequences for users. Meth use has been associated with negative effects, including cognitive impairments, cardiovascular problems, and a high risk of addiction and relapse. Prolonged use can result in consequences such as anorexia, insomnia, aggression, weight loss, and dermatological and dental problems begin to emerge (Meredith et al., 2005; Winslow et al., 2007). Chronic use can even lead to irreversible neurological changes and psychiatric disorders, like anxiety, depression, paranoia, psychosis, and suicidal behavior (Winslow et al., 2007). Despite these consequences, it takes an average of 10 years before people with substance use disorders seek treatment, and only 17.7% do so (Borges et al., 2007). Some difficulties when seeking treatment include a negative perception of health services by users, stigma, and structural barriers such as the cost of consultation, transportation, and the distance to service locations (Martínez et al., 2023a; 2023b; 2024).

In Mexico, the government provides treatment opportunities through Specialized Medical Units - Primary Care Centers for Addictions (UNEME-CAPA, for its acronym in Spanish) and the Centers for Youth Integration (CIJ, for its acronym in Spanish). Meanwhile, non-government providers offer care through residential centers or “Annexes”. In 2020, 2,694 people, most of them adults with an average age of 28.9 years, sought substance use treatment in Aguascalientes (Comisión Nacional Contra las Adicciones [CONADIC], 2020). Of these, 1,690 individuals sought care in non-governmental centers with meth (66.9%), alcohol (21%), and cannabis (6.2%) as their primary substances used (Sistema de Vigilancia Epidemiológica de las Adicciones [SISVEA], 2020).

The governmental Reintegra Program, which aims to reduce crime and help substance users reintegrate into society, has offered rehabilitation program, which lasts five years, to those involved with the justice system for minor offenses related to meth use. Post-detox, detainees are referred to UNEME-CAPA for assessment and potential enrollment in certified residential centers (Secretaría General de Gobierno [SEGGOB], 2019). Government reports showed a decrease in residential robberies and vehicle theft in 2019, and a 22% drop in health-related arrests compared to the previous year since 2019 and lowered recidivism rates among participants (Secretariado Ejecutivo del Sistema Nacional de Seguridad Pública [SESNSP], 2019; Gobierno del Estado de Aguascalientes, 2018; 2019).

It is important to mention that the information regarding the people that seek help for meth use is limited, therefore this study aims to describe and compare consumption history and associated problems, the use of health services and barriers to access treatment, as well as depression and suicidal behavior in methamphetamine users of the Reintegra Group against the group of those who started treatment due to other circumstances.

METHOD

Study design

A descriptive, comparative and cross-sectional study was designed for individuals in residential centers. To carry out the comparison between the variables of interest, two groups were organized: the Reintegra Group (RG), and the Not-Reintegra Group (NRG).

Participants

The sample was selected by convenience, considering the residential centers that utilize the Reintegra Program. The study included 13 residential centers certified by CONADIC and 10 undergoing certifications. The sample consisted of 865 participants, divided into RG (n = 453) and NRG (n = 412). The inclusion criteria were that participants utilized meth as their drug of impact and the voluntary acceptance to participate in the study.

Instrument

We designed a brief survey (BS) with a total of 69 questions, divided into sociodemographic data (6 questions), variables like consumption history (9), problems associated with consumption (1), seeking help and use of services to deal with meth use (12), barriers to seeking services (1), depression (35) and suicide attempts (5). Depression was measured with the revised version of the Center for Epidemiologic Studies’ Depression Scale CES-D-R), chosen for its global and local use (Fried et al., 2022; González-Forteza et al., 2008; 2011). Data reporting focused on participant description, as mentioned in previous studies by Martínez et al. (2023a; 2023b).

The CES-D-R section of the BS was applied using the Google Forms software on a tablet. No personal identification data was collected.

Procedure

The application of the BS was carried out in each residential center by a team of researchers. The objectives of the research were verbally explained to the participants, and their signed informed consent was requested in order to answer the BS.

Ethical considerations

The participants signed an informed consent document where they were informed about the objectives of the study and the use of their data exclusively for research purposes and managed only by the research team. It was clarified that their participation would be neither punished nor rewarded by the residential center at any time. For information protection, we followed the Universidad Autónoma de Aguascalientes’s ethical standards. Additionally, the ethics and scientific aspects of the protocol used in this study were approved by the Institutional Committee of Bioethics of the University.

Data analysis

The data analysis included the variables specified in Table 1. The CES-D-R was analyzed according to González-Forteza et al. (2011). First, we used descriptive statistics for each variable, and then we used Pearson’s correlation statistical test to explore the relationship between suicidal behavior and meth use. Then we used the Mann-Whitney U tests (for ordinal variables and those that did not meet the assumptions of normality and equality of variances) and Student’s t-test (for those variables that met the assumptions of normality) to discover if there were differences in the variables measured between groups, based on results of the Shapiro-Wilk test, skewness (establishing a range between -2 to 2) and Kurtosis measures. Additionally, we calculated the effect size given by utilizing Cohen’s d for the Student’s t-test, and the rank-biserial correlation (RBC) for the Mann-Whitney U test.

Finally, we carried out a logistic regression in order to identify the variables that would best detect the participants that belonged to RG. All analyses were made with Jeffrey’s Amazing Statistics Program (JASP), with a significant level of α = .05.

RESULTS

Of the 865 total participants, 453 (52.37%) were part of the RG, while the remaining 412 (47.63%) belonged to the NRG. 84.9% were men (n = 734), 14.3% were women (n = 124), and 0.8% (n = 7) preferred not to indicate their gender.

The participants’ ages ranged from 12 to 66 years, with an average of 26.9 years. The mean age of participants in the RG was 27.8, and 26 in the NRG. There was a statistical difference in the age between groups (U863 = 102723.5, p < 0.01, RBC = .101). Table 2 shows the sample’s demographic characteristics.

Figure 1 shows the distribution of participants by their residence: 91.9% resided in Aguascalientes state and the other 8.1% in another state. Of the 91.9% who resided in Aguascalientes, 58.2% of them lived in the capital city, while the rest in other municipalities.

Drug use

Participants in the total sample reported the following cases of concurrent substance use: 87.5% used tobacco; 84.7% alcohol, and 82.3% cannabis (Table 3), and the results were similar between groups. Participants in the total of the sample used 4.8 substances on average (SD = 1.7), meanwhile the RG used 4.8 (SD = 1.7) and the NRG used 4.9 (SD = 1.6). No significant differences were found in the substances used (U₈₆₃ = 89220, p = .256, RBC = -.04).

Participants in the total sample reported the start of meth use at age 15, and the average age of first use for the whole sample was 19.8 years. The RG had an average age of initiation of consumption of 19.2 years, with a range of 8 to 54 years, and the NRG had an average age of initiation of 20.45, with a range of 9 to 62 years. This difference was found to be statistically significant (U₈₆₃ = 100864.5, p = .039, RBC = .08).

We found that the median consumption for the RG (Mdn = 6, Range = 6) was higher than the NRG (Mdn = 5, Range = 6) in the variable total of consumption habits. The RG represented more consumption in the last year and last month. This difference was statistically significant (U863 = 75617.5, p < .001, RBC = -.19).

The results regarding how participants view their meth use show that 30.4% of the RG and 39.3% of the NRG consider their meth consumption as very dangerous; 44.8% of the RG and 38.8% of the NRG as dangerous, and 22.5% of the RG and 21.6% of the NRG as not dangerous. We found a statistical difference (U852 = 97687, p < .001, RBC = .073) between groups, where the NRG (M = 2.2) considered their consumption more dangerous than the RG (M = 2.0).

Associated Problems and Use of Health Services

The most common problems related to meth use were weight loss (94.9%), sleep problems (80.4%), anxiety (75.3%), and violent behavior (64.7%; see Martínez et al., 2023a, for an in-depth description). The RG reported less associated problems (M = 5.6, SD = 2.6) than the NRG (M = 6.3, SD = 2.5), and this difference was statistically significant (t₈₆₃ = 3.559, p < .001, d = .242). Despite the problems mentioned, the highest percentage of people who use meth do not use governmental services like CIJ, UNEME-CAPA or hospitals (Figure 2).

The RG and the NRG reported that 89.1% and 91.7% of participants, respectively, had tried to quit using meth once in their life; 96.9% and 97.3% wanted to stop consuming at the time of the interview, and 68.8% and 78.1% sought help in order to achieve their goal of quitting. There was a significant higher intention to quit meth use in the NRG (M = 2.7) than the RG (M = 2.55; U₈₆₃ = 102296, p = .005, RBC = .096).

On average, participants look at 1.8 (SD = 1.17) sources for help to quit using meth. In the RG, this average was 1.8 (SD = 1.19) and in the NRG was 2.2 (SD = 1.16). We found a statistically significant difference in this variable (U₈₆₃ = 112567.5, p < .001, RBC = .207). Table 4 shows the principal sources of help mentioned by the participants.

Barriers to Healthcare Services to Address Substance Use Disorders

Table 5 shows the main barriers for seeking help that the surveyed people faced. On average, participants reported 2.12 (SD = 1.9) barriers, and the most frequent were that they considered that services were aimed at other groups (41.6%), followed by minimizing the importance of receiving clinical attention (35%), and not finding time to schedule receiving healthcare (29.8%). We did not find statistical difference (U₈₆₃ = 93578, p = .945, RBC = .003) in the number of barriers in average between the RG (M = 2.1, SD = 1.97) and the NRG (M = 2.14, SD = 2.02). A detailed analysis of barriers was made in Martínez et al. (2023a).

Depression and Suicidal Behavior

Table 6 shows the depression-related results obtained with the CES-D-R scale. We discarded 77 participants (46 from the RG, and 31 from the NRG) from this analysis because they did not complete the CES-D-R test. Of the 788 people who answered the CES-D-R test, 22% presented depressive symptoms and were classified as having clinically relevant major depressive episode (MDE) symptoms (4%; 16 from the RG and 19 from the NRG); highly probable MDE symptoms (7.1%; 30 from the RG, and 31 from the NRG), and probable MDE symptoms (11.1%; 54 from the RG, and 42 from the NRG). We did not find statistical differences between groups in depression (U₇₈₆ = 77205.5, p = .89, RBC = -.004).

According to the suicidal behavior test results, we found that 33.4% of participants attempted suicide at some time in life, of which 143 belonged to the RG and 146 to NRG (31.5% and 35.4% of each group, respectively).

We utilized the Pearson’s correlation test to explore the relationship between suicide and meth use by examining the possible link with age, age of onset of meth use, number of drugs used concurrently, number of consumption episodes in the last year and the previous month before entering the residential center, the number of health problems linked to meth use, and number of years consuming meth. We found a statistically significant association between the number of drugs used concurrently (r₈₆₄ = .15, p < .001) and the number of health problems associated with meth use (r₈₆₄ = .25, p < .001).

Predictive analysis

A logistic regression was carried out to detect which variables could best explain belonging to the RG. For this, the backward entry method was used with likelihood ratio. Seven variables were entered: total substances used, total problems, total consumption habits, intention to quit, number of places where they have sought help, total barriers, and how they classified their meth consumption.

The analysis was carried out in two steps. First, the variable intention to quit was eliminated (β = -0.27, p = .868) since it did not provide any significant contribution to belonging to the RG. Second, we established the model by six variables (R2 = .209): total substances used (β = -.117, p = .007, OR = .889), total problems (β = .173, p < .001, OR = 1.189), total consumption habits (β = -.250, p < .001, OR = .779), number of places where they sought help (β = .474, p < .001, OR = 1.606), total barriers (β = -.262, p < .001, OR = .769) and how they classified their consumption (p = .029); all of these make a significant contribution to belonging to the RG. When considering meth consumption specifically as “very dangerous”, a greater contribution to belonging to the RG is obtained, but this is not significant (β = 2.049, p = .061, OR = 7.759). The results of the analysis showed that there are some variables that, although they have statistical significance, do not present an association.

Therefore, it can be interpreted that reporting a greater number of problems due to meth consumption increases the risk of belonging to the RG by 1.189 times, and reporting a greater number of places where help has been sought increases the risk of belonging to the RG 1.606 times. We found that tobacco consumption (OR = 3.129; p < .001) increases the risk of belonging to the RG by 3.129 times and alcohol (OR = 2.08; p < .001) increases it by two times (Table 3).

The contingency table was used to analyze whether the fact of attempting suicide increased the risk of belonging to the RG, but no risk was found associated with this variable (OR = 0.840, 95% CI = 0.633 - 1.115, p = .228).

DISCUSSION AND CONCLUSIONS

The study aimed to compare the consumption history and associated problems, the use of health services and barriers to accessing treatment, as well as depression and suicidal behavior in methamphetamine users from the RG against the NRG. The results show that the age of initiation of consumption of the RG participants was older than that of the NRG participants. The earlier age of initiation in the RG suggests that individuals who start using meth at a younger age may be more likely to develop psychological problems (Brecht et al., 2007; Grant & Dawson, 1998; Poudel & Gautam, 2017; Trujillo et al., 2019) as well as legal problems (Doherty et al., 2008; Gordon et al., 2004; Karlén et al., 2020). On the other hand, the substance uses habits of the participants showed that the RG had a higher level of consumption of meth than the NRG, which is consistent with reports that point out a relationship between meth use and criminal behavior (Gizzi & Gerkin, 2010; Goldsmid & Willis, 2016; Prendergast et al., 2006). Lastly, we found that the NRG considered their meth consumption more dangerous than the RG. The age of the start of consumption and the perception of danger in the NRG could be related to the studies that show that the higher the risk perception, the less likely to start and maintain consumption (Villatoro-Velázquez et al., 2017; Mendez-Ruiz et al., 2018).

Even with the differences observed in habitual consumption of meth, all the participants tried to stop consuming in the past or had the desire to stop consuming during the interview regardless of the group, but the NRG have greater intentions to quit meth use. This information highlights the difficulties faced when trying to stop consuming meth that could be related with the substance’s strong addictive potential (Alexander et al., 2018; Clifford et al., 2023;NIDA, 2023; Winslow et al., 2007), and it also points to the need of studies regarding the elements that most influence people’s decision to avoid consumption, since there are difficulties when trying to quit said consumption despite having the intention to do it.

A variable that needs to be investigated is the perception of problems associated with meth use, since the results show that the RG reports less associated problems with meth consumption. The differences observed between the groups could also provide information regarding why the RG has sought help in less places than the NRG. It is important that meth users seek help, but it is also important for the mental health professionals and institutions to have the experience and knowledge to attend to this section of the population. The study done by Dunn et al. (2023) suggests that the places that tend to these groups could be barriers to access treatment due to their limited clinical experience, knowledge, and treatment options.

Even with the differences between where the RG and the NRG seek help, the results show that the participants face the same barriers to access treatment. Barriers like believing that services were aimed at other groups, minimization of the importance of receiving clinical attention, and not finding the time to schedule receiving healthcare. These results are similar to the ones observed in Martínez et al. (2023a), which identified that the main barriers for the patients in residential treatment in Aguascalientes were both that they did not believe that the service was for them, and they did not have time to attend appointments. The information about barriers highlights the importance of ensuring that methamphetamine users understand the benefits of receiving clinical attention. It also underscores the relevance of developing better interventions that make these users feel that services are tailored to their needs.

Another thing that needs to be considered in the meth interventions is the connection between meth use and depression and suicide attempts. This study found no differences between groups regarding depression symptoms, but 22.2% of participants experienced said symptoms and 33.4% reported suicide attempts, which are similar to the results observed in other studies (Martínez et al., 2023b). These results highlight the importance of including prevention components for suicide and other mental health disorders in treatment programs for meth consumption as well as conducting analyses of the effectiveness of their implementation.

Finally, the results show that the risk of belonging to the RG increases both according to the number of problems related to meth consumption and the number of places where the participants sought help. In the same way, the consumption of tobacco and alcohol combined with meth increases the risk of belonging to the RG. It is important to mention that the consumption of meth, as well as the use or mixing of different psychoactive substances at the same time has been related to more suicide attempts and reports of health problems (Bayazit et al., 2024; Xing et al., 2023).

The results of this research provide insight into the characteristics of participants enrolled in the RG compared to the NRG, allowing for more targeted intervention strategies. Additionally, the findings highlight the importance of developing programs that prevent substance use and increase awareness of its consequences, thereby enhancing risk perception regarding drug use. This is particularly significant given that the age of onset for substance use and the perception of associated problems in the RG is lower than in the NRG. Furthermore, the RG sought help from fewer sources than the NRG.

The results also indicate that the Reintegra Program attracts participants with specific characteristics, which may explain their enrollment in this program. Future efforts should focus on both evaluating the Reintegra Program’s effectiveness, particularly due to its impact on reducing robberies and recidivism rates, and analyzing results based on participants’ characteristics to assess whether the intervention meets their needs for success.

In conclusion, these results demonstrate that comparing the characteristics of meth users who enroll in interventions through different pathways can provide valuable insights for developing more comprehensive programs. Additionally, they underscore the importance of preventing meth use and considering critical information in program design.

Limitations of the Study

Some limitations of the study include the fact that data collection occurred during the intervention, which prevents us from determining whether the intervention influenced the results, particularly regarding participants’ intentions to quit, the risk of consumption, and issues associated with meth use. Similarly, we could not evaluate the outcomes of the intervention, although we gathered additional information that may help improve the program to better align with the characteristics of meth users.

FUNDING

This research was found by the Consejo Nacional de Humanidades, Ciencias y Tecnologías (CONAHCYT) through project number 3225, entitled “Development and evaluation of indicated and selective intervention programs in methamphetamine, fentanyl and heroin users, and their comorbidity with mental health problems and suicidal behavior.”

CONFLICT OF INTEREST

The authors declare that they have no conflict of interest.

AUTHORS CONTRIBUTION

We especially want to thank José Luis Vazquez and Jimena Kalawski from the Comisión Interamericana para el Control del Abuso de Drogas (CICAD) for their valuable support in the translation and their suggestions for the manuscript.<KIMM and YLOA contributed substantially to the conception, design, acquisition, analysis, interpretation of data for the work and drafting the work. ÁC contributed with statistical analysis. MEP, MAPP, and FJPC contributed by revising the work critically for important intellectual content and with drafting the text.

REFERENCES

Alexander, A. C., Obong’o, C. O., Chavan, P. P., Dillon, P. J., & Kedia, S. K. (2018). Addicted to the ‘life of methamphetamine’: Perceived barriers to sustained methamphetamine recovery. Drugs: Education, Prevention and Policy, 25(3), 241-247. https://doi.org/10.1080/09687637.2017.1282423

Bayazit, H., Baronia, R., & Wakefield, S. M. (2024). Methamphetamine intoxication and suicidal ideation/behavior in the emergency department. Current Medical Research and Opinion, 40(5), 849-854. https://doi.org/10.1080/03007995.2024.2333429

Borges, G., Wang, P. S., Medina-Mora, M. E., Lara, C., & Chiu, W. T. (2007). Delay of First Treatment of Mental and Substance Use Disorders in Mexico. American Journal of Public Health, 97(9), 1638-1643. https://doi.org/10.2105/AJPH.2006.090985

Brecht, M.-L., Greenwell, L., & Anglin, M. D. (2007). Substance use pathways to methamphetamine use among treated users. Addictive Behaviors, 32(1), 24-38. https://doi.org/10.1016/j.addbeh.2006.03.017

Centros de Integración Juvenil [CIJ]. (2018). Diagnóstico del consumo de drogas en el área de influencia de CIJ Aguascalientes. México: CIJ. http://www.cij.gob.mx/ebco2018-2024/9870/9870CD.html

Clifford, B., Van Gordon, K., Magee, F., Malone, V., Siefried, K. J., Graham, D., & Ezard, N. (2023). “There’s a big tag on my head”: exploring barriers to treatment seeking with women who use methamphetamine in Sydney, Australia. BMC Health Services Research, 23(1), 162. https://doi.org/10.1186/s12913-023-09125-z

Comisión Nacional Contra las Adicciones [CONADIC]. (2020). Demanda de Tratamiento por droga de impacto en la Red Nacional de Atención a las Adicciones, 2020. México: CONADIC. Retrieved from https://app.powerbi.com/view?r=eyJrIjoiODNhYzY1MmUtOGRhZi00Nzc0LWI1MDAtZTI0ZjVkYWVlMzM5IiwidCI6IjlmODAzYzcyLTMyMzMtNDRlNi04ZTg0LTc2NGU0Y2JiMThmNCJ9&pageName=ReportSection5c35cefe07599f97da6e

Doherty, E. E., Green, K. M., & Ensminger, M. E. (2008). Investigating the long-term influence of adolescent delinquency on drug use initiation. Drug and Alcohol Dependence, 93(1-2), 72-84. https://doi.org/10.1016/j.drugalcdep.2007.08.018

Dunn, J., Yuan, M., Ramírez, F., Garneau, H., Brown-Johnson, C., Breland, H., Antonini, V., Larkins, S., Rawson, R., & McGovern, M. (2023). Addressing Methamphetamine Use in Primary Care: Provider Perspectives. Journal of Addiction Medicine, 17(1), 60-66. https://doi.org/10.1097/ADM.0000000000001035

Fried, E. I., Flake, J. K., & Robinaugh, D. J. (2022). Revisiting the theoretical and methodological foundations of depression measurement. Nature Reviews Psychology, 1(6), 358-368. https://doi.org/10.1038/s44159-022-00050-2

Gizzi, M. C., & Gerkin, P. (2010). Methamphetamine Use and Criminal Behavior. International Journal of Offender Therapy and Comparative Criminology, 54(6), 915-936. https://doi.org/10.1177/0306624X09351825

Gobierno del Estado de Aguascalientes. (2018). 2o Informe de Gobierno. Retrieved from https://www.aguascalientes.gob.mx/SEPLADE/Docs/InformesGobierno/SegundoInforme2018/2do_Informe_completo.pdf

Gobierno del Estado de Aguascalientes. (2019). 3er Informe de Gobierno. Retrieved from https://www.aguascalientes.gob.mx/SEPLADE/Docs/InformesGobierno/TercerInforme2019/3er_InformeMOS.pdf

Goldsmid, S., & Willis, M. (2016). Methamphetamine use and acquisitive crime: Evidence of a relationship. Trends and Issues in Crime and Criminal Justice, 516. https://doi.org/10.52922/ti149987

González-Forteza, C., Jiménez-Tapia, J. A., Ramos-Lira, L., & Wagner, F. A. (2008). Aplicación de la Escala de Depresión del Center of Epidemiological Studies en adolescentes de la Ciudad de México. Salud Pública de México, 50(4), 292-299.

González-Forteza, C., Solís, C., Jiménez, A., Hernández, I., González-González, A., Juárez, F., Medina-Mora, M., & Fernández-Várela, H. (2011). Confiabilidad y validez de la escala de depresión CES-D en un censo de estudiantes de nivel medio superior y superior, en la Ciudad de México. Salud Mental, 34(1), 53-59.

Gordon, M. S., Kinlock, T. W., & Battjes, R. J. (2004). Correlates of Early Substance Use and Crime Among Adolescents Entering Outpatient Substance Abuse Treatment. The American Journal of Drug and Alcohol Abuse, 30(1), 39-59. https://doi.org/10.1081/ADA-120029865

Grant, B. F., & Dawson, D. A. (1998). Age of onset of drug use and its association with DSM-IV drug abuse and dependence: Results from the national longitudinal alcohol epidemiologic survey. Journal of Substance Abuse, 10(2), 163-173. https://doi.org/10.1016/s0899-3289(99)80131-x

Karlén, M., Nilsson, T., Wallinius, M., Billstedt, E., & Hofvander, B. (2020). A Bad Start: The Combined Effects of Early Onset Substance Use and ADHD and CD on Criminality Patterns, Substance Abuse and Psychiatric Comorbidity among Young Violent Offenders. Journal for Person-Oriented Research, 6(1), 39-55. https://doi.org/10.17505/jpor.2020.22045

Martínez, K. I., Ojeda, Y. L., Hernández, J., & Contreras-Peréz, M. E. (2023b). Depression and Suicidal Behavior Comorbidity in Patients Admitted to Substance-Use Residential Treatment in Aguascalientes, Mexico. Journal of Evidence-Based Social Work, 20(4), 508-519. https://doi.org/10.1080/26408066.2023.2172368

Martínez, K. I., Ojeda, Y. L., Robles, L., & Paz, M. A. (2023a). Barriers to methamphetamine treatment seeking in residential centers in Aguascalientes, Mexico. Frontiers in Psychology, 14. Retrieved from https://www.frontiersin.org/articles/10.3389/fpsyg.2023.1193453

Martínez, K. I., Robles, L., Ojeda, Y. L., & Hernández, J. (2024). Rompiendo el cristal: Percepciones de los usuarios de metanfetamina sobre los desafíos para acceder y permanecer en un tratamiento. Health and Addictions/Salud y Drogas, 24(1), 9-24. https://doi.org/10.21134/haaj.v24i1.888

Mendez-Ruiz, M. D., Ortiz-Moreno, G. A., Eligio-Tejada, I. A., Yáñez-Castillo, B. G., & Villegas-Pantoja, M. A. (2018). Percepción de riesgo y consumo de alcohol en adolescentes mexicanos de preparatoria. Aquichan, 18(4), 438-448. https://doi.org/10.5294/aqui.2018.18.4.6

Meredith, C. W., Jaffe, C., Ang-Lee, K., & Saxon, A. J. (2005). Implications of Chronic Methamphetamine Use: A Literature Review. Harvard Review of Psychiatry, 13(3), 141-154. https://doi.org/10.1080/10673220591003605

National Institute on Drug Abuse [NIDA]. (2023). What is methamphetamine? NIDA. Retrieved from https://nida.nih.gov/publications/research-reports/methamphetamine/what-methamphetamine

Poudel, A., & Gautam, S. (2017). Age of onset of substance use and psychosocial problems among individuals with substance use disorders. BMC Psychiatry, 17(1), 10. https://doi.org/10.1186/s12888-016-1191-0

Prendergast, M. L., Farabee, D., Cartier, J., & Henkin, S. (2006). Involuntary Treatment Within a Prison Setting: Impact on Psychosocial Change During Treatment. In C. R. Bartol & A. M. Bartol (Eds.). Current perspectives in forensic psychology and criminal justice (pp. 231-238). Sage Publications, Inc.

Secretaría General de Gobierno [SEGGOB]. (2019). Convenio de Colaboración Interinstitucional que Celebran el Secretariado Ejecutivo del Sistema Estatal de Seguridad Pública, la Secretaría de Seguridad Pública del Estado de Aguascalientes, y el Instituto de Servicios de Salud del Estado de Aguascalientes para el Cumplimiento de la Estrategia de Prevención Terciaria “Reintegra”. SEGGOB. Retrieved from https://www.google.com/url?client=internal-element-cse&cx=1cc7b19f1c1e4cc33&q=https://eservicios2.aguascalientes.gob.mx/NormatecaAdministrador/archivos/EDO-8-86.pdf&sa=U&ved=2ahUKEwi30LOLu-P8AhXyk2oFHaywCeIQFnoECAAQAQ&usg=AOvVaw3DTlNrCdT0uz0LiyPWS1gg

Secretariado Ejecutivo del Sistema Nacional de Seguridad Pública [SESNSP]. (2019). Incidencia Delictiva del Fuero Común 2019. SESNSP. Retrieved from https://www.gob.mx/sesnsp/acciones-y-programas/incidencia-delictiva-del-fuero-comun-nueva-metodologia?state=published

Sistema de Vigilancia Epidemiológica de las Adicciones [SISVEA]. (2020). Informe SISVEA 2020. México: SISVEA. Retrieved from https://www.gob.mx/cms/uploads/attachment/file/746477/informe_sisvea_2020.PDF

Trujillo, C. A., Obando, D., & Trujillo, A. (2019). An examination of the association between early initiation of substance use and interrelated multilevel risk and protective factors among adolescents. PLoS One, 14(12), e0225384. https://doi.org/10.1371/journal.pone.0225384

United Nations Office on Drugs and Crime [UNODC]. (2023). World Drug Report 2023. UNODC. Retrieved from https://www.unodc.org/unodc/en/data-and-analysis/world-drug-report-2023.html

Villatoro-Velázquez, J. A., Resendiz-Escobar, E., Mujica-Salazar, A., Bretón-Cirett, M., Cañas-Martínez, V., Soto-Hernández, I., Fregoso-Ito, D., Fleiz-Bautista, C., Medina-Mora, M. E., Gutiérrez-Reyes, J., Franco-Núñez, A., Romero-Martínez, M., & Mendoza-Alvarado, L. (2017). Encuesta Nacional de Consumo de Drogas, Alcohol y Tabaco, ENCODAT 2016-2017: Reporte de Drogas. CONADIC. https://drive.google.com/file/d/1zIPBiYB3625GBGIW5BX0TT_YQN73eWhR/view?usp=sharing

Winslow, B. T., Voorhees, K. I., & Pehl, K. A. (2007). Methamphetamine Abuse. American Family Physician, 76(8), 1169-1174. https://pubmed.ncbi.nlm.nih.gov/17990840/

Xing, D. G., Horan, T., Bhuiyan, S., Faisal, A. S. M., Densmore, K., Murnane, K. S., Goeders, N. E., Bailey, S. R., Conrad, S. A., Vanchiere, J. A., Patterson, J. C., Kevil, C. G., & Bhuiyan, M. A. N. (2023). Social-geographic disparities in suicidal ideations among methamphetamine users in the USA. Psychiatry Research, 329, 115524. https://doi.org/10.1016/j.psychres.2023.115524