Amphetamine-type stimulants (ATS) include an array of psychoactive substances, the most commonly used illicit ATS being methamphetamine, amphetamine and ecstasy (3,4-Methylenedioxymethamphetamine) [1, 2]. There are now an estimated 35 million ATS users worldwide compared with combined total of 29 million opioid and cocaine consumers [3, 4]. The age of initiation of ATS is typically in the mid-late teens, with levels of use often peaking in early adulthood. In Australia, the lifetime prevalence of use is highest among those aged 20-29 years (ecstasy 25%, meth/amphetamine 15%), with the respective 12-month figures being 10% and 6% among the same age group .
While the bulk of ATS use is recreational in nature, this population includes a sizable proportion of people who become dependent and experience chronic debilitating health problems as a result of their use of ATS . Major health concerns include paranoia, aggression, increased risk of stroke and cardiovascular pathology . Dependence on ATS, like dependence on any drug, is typically associated with a reduction in quality of life, premature mortality and elevated levels of crime . This is particularly the case with the use of more potent ATS, such as crystalline methamphetamine, and with more efficient routes of administration (e.g., smoking or injecting) . Reducing the impact of ATS use requires the simultaneous development of effective management strategies and methods to improve the uptake and accessibility of treatments for this population. The spectrum of ATS use will also need to be considered, from irregular use through to stimulant use disorders (abuse, dependence) .
Despite the widespread use of ATS, a systematic review concluded that, to date, there are insufficient data to support the use of pharmacotherapies such as fluoxetine, amlodipine, imipramine and desipramine in the treatment of amphetamine abuse and dependence . However, research continues to assess other potential agents in the treatment of stimulant abuse [12, 13]. A review of psychosocial treatments for methamphetamine dependence reported that the intensive application of psychological interventions (e.g., contingency management, cognitive behavior therapy (CBT), motivational interviewing) can result in a moderate reduction in stimulant use . Brief cognitive behavioral interventions, of up to four sessions duration, have also been shown in previous research to be associated with significant reductions in amphetamine use and significantly greater likelihood of abstinence than controls . However, these types of structured psychological interventions are not widely implemented in community-based treatments for drug use, and ATS users seeking help from traditional drug and alcohol services frequently report their needs are not being met . For example, among a sample of methamphetamine users in Queensland, Australia, the majority felt that more information about methamphetamine use should be available and more accessible outside treatment services and business hours . In particular, respondents reported that needle and syringe programs, methadone maintenance programs and outpatient counseling should not be co-located, as doing so is viewed as a key barrier to treatment access. The need to develop appropriate, novel treatments that are well accepted by ATS communities is clear, including options for accessing treatments outside mainstream specialist treatment services .
Given that psychological treatments can reduce stimulant use [15, 18], there is the potential to develop internet-based treatments for ATS users, with many internet-based CBT treatment packages currently accessible via the world wide web . The critical advantage offered by web-based interventions for mental health and substance use problems is that they have the potential to greatly reduce key barriers to obtaining treatment, in particular, stigma (given the anonymous access), cost (with free treatment), reach (potentially worldwide coverage and 24 hour access), especially for those living outside of metropolitan areas [20, 21]. This is important in the context of ATS use, not only because of the number of people potentially requiring treatment but because surveys show that stimulant users are reluctant to seek treatment from existing drug treatment services as most are tailored toward clients with opiate or alcohol problems [1, 22]. Furthermore, for those with addictive disorders, access to treatment ‘24/7’ may be a particularly important benefit of internet services, allowing the potential to capitalize on times of high motivation to change behavior and access to resources when the risk of relapse is high.
Internet-based interventions have already been demonstrated as effective for the treatment of depression and a range of anxiety disorders . With respect to substance use, web-interventions have been effective in reducing problematic use of alcohol in young adults  and in reducing cannabis use via school-based interventions that involve on-line materials . Brief internet interventions have been shown to reduce drug use and ‘high-risk’ behavior in human immunodeficiency virus (HIV) positive drug users  and a computerized intervention using combined CBT and motivational interviewing (MI) has been reported to reduce cannabis and alcohol use among those with co-morbid major depression . However, the current authors are not aware of any evaluated internet based interventions for the use of ATS.
The objective of the study was to adapt existing face-to-face psychological approaches (i.e., CBT and MI) for delivery via the internet to reduce the use of ATS and associated problems plus improve motivation to reduce ATS use, with assessment of effectiveness at 3 and 6 months post-intervention.