Background: Impulsivity and craving are key features of methamphetamine use. Metacognition may play a part in these processes. Metacognition, or beliefs about thinking, is made up of strategies, knowledge and processes that appraise, monitor and control cognition. These metacognitions may impact on whether the craving experience is controlled or not, and if not may lead to apparently impulsive behavior. This study examined whether craving metacognitions changed as a result of treatment.

Method: 214 regular methamphetamine users were randomly assigned to 2 or 4 sessions of Cognitive Behaviour Therapy with Motivational Interviewing or a control group receiving a only self help booklet. The Craving Beliefs Questionnaire was used to measure craving cognitions; it is a 20 item self report measure developed as a clinical tool to measure an individual's perception of their craving experience rather than a measure of quantity, frequency or intensity of cravings.

Results: At baseline there was no significant mean differences between the three treatment arms on the cravings cognition scale (F(2,211)=0.96; p=0.385). Over the follow-up times (5-weeks and 6 months) only the 4-session treatment arm appeared to have a better rate of improvement. Simple random intercept models using maximum likelihood estimates highlighted no difference between the control group and the 2-session treatment arm (X2 = 2.11, p=0.146) nor the 4-session treatment arm (X2 = 3.01, p=0.083). When controlling for baseline craving cognition scores there was a significant improvement for those in the 4-session arm (X2 = 5.22, p=0.022) compared to the control group; but not for the 2-session arm (X2 = 0.07, p=0.792)

Discussion: Four sessions appears to be superior in changing craving cognitions likely because the 4 session treatment contained greater emphasis on cognitive therapy. Further analysis of covariates need to be undertaken as well as analyses predicting outcomes based on craving cognitions.