Info on Methamphetamine

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Methamphetamine Addiction: " Speed " Still Kills

 

 

By Cardwell C. Nuckols, PhD, and Joseph T. Kane, MDiv

 

Charles Manson and his crew, high on methamphetamine, were responsible for

the Sharon Tate murder. The HellÕs Angels were guarding the stage at

Altamont Speedway at a Rolling Stones concert when the concertgoers rushed

the stage. The guards, high on " speed, " killed some and injured others. The

children of the 60s remember that methamphetamine destroyed the Summer of

Love in San Francisco in 1967.

 

There is an old adage in the addictions field that if you wait long enough

the same drug will cycle every 20 to 30 years. Although methamphetamine

never really went away, the last decade has witnessed a sharp rise in use as

the drug has spread from being a west coast phenomenon to a national

epidemic. According to the 1994 National Survey on Drug Abuse it was

estimated that 3.8 million people had tried methamphetamine during their

lifetime. According to the 2000 survey this figure has climbed dramatically

to 8.8 million identified lifetime users. Data from the 2000 Drug Abuse

Warning Network (DAWN), an organization that collects information on

drug-related episodes from hospital emergency rooms in 21 metropolitan

areas, reported that methamphetamine-related emergencies increased from

10,400 in 1999 to 13,500 in the year 2000 - a 30-percent increase. " Speed "

still kills - those seduced by its powerful, mind-altering effects die from

violent acts, suicide, and accidents.

 

The drug goes by many names but it is commonly known as " speed, " " meth, "

" chalk, " " ice, " " crank, " and " glass. " It is a white, odorless,

bitter-tasting crystalline powder. The substance was developed early in the

20th century from its parent drug - amphetamine. It was used originally as a

nasal decongestant and bronchial dilatator

(http://www.nida.nih.gov/ResearchReports/Methamph2.html). From these humble

beginnings it has turned into a monster.

 

The nature of the beast

Methamphetamine, as compared to cocaine, is " home grown. " For example, with

the right ingredients such as a commonly utilized over-the-counter

decongestant called pseudoephedrine (Sudafed), and with a few pieces of

laboratory equipment, the drug can be produced in a bathroom, kitchen, or

even in the back of a van moving from place to place as a roving laboratory.

A close relative in the stimulant family is cocaine. Cocaine has to be

smuggled into the country while methamphetamine requires no sophisticated

entry strategy. It can be made practically anywhere.

 

Demographically cocaine has emerged as a drug most often used by black males

between the ages of 25 and 44 (Office of Applied Studies, Substance Abuse

and Mental Health Services Administration). It emerged as an east coast

phenomenon and is still most prevalent in eastern locations although it is a

national problem. The methamphetamine user is generally a white male -

although there is only a small difference in use between the male (53

percent) and female (47 percent) - between the ages of 20 to 40 (Office of

Applied Studies, Substance Abuse and Mental Health Services Administration).

As opposed to cocaine, there is a growing population of young

methamphetamine users between the ages of 15 and 20.

 

Methamphetamine users utilize a number of routes of administration to

achieve their desired drug effect. Methamphetamine can enter the body

through any conventional route. It can be ingested orally and will exhibit

its effects in approximately 30 minutes. As a white powder, it can be

insufflated or " snorted " up the nose creating an effect in three to five

minutes. Larger amounts of the drug can reach the brain when administered by

intravenous injection or by the pulmonary route. Injection of the drug is a

very common practice and allows the substance to hit the brain in 10 to 14

seconds (Nuckols & Curran, 1997). Smoking the drug cuts this time in half,

creating a powerful effect in just six to seven seconds. Preferred routes of

administration vary according to geographic location. For example

insufflation is the preferred route in Minneapolis, while smoking

methamphetamine is more popular in San Diego. In Texas, by far the most

common route of administration is intravenous injection

(http://www.nida.nih.gov/

ResearchReports/Methamph2.html).

 

Methamphetamine toxicity

What happens when this drug seduces the brain? First of all, the

neurotransmitter norepinephrine is elevated creating a " fight or flight "

like syndrome. Heart rate, blood pressure and body temperature increase.

There may be mild tremors of intent with diaphoresis and dilation of the

pupils. Increases in dopamine levels stimulate the reward center of the

brain producing an autoerotic-like sense of extreme pleasure. On the down

side, as dopamine increases significantly it also produces various levels of

paranoia. Initially the paranoia is context appropriate. In other words, the

user might believe that every noise is a police officer outside of the door

and repeatedly look through the " peep " hole for disconfirmation. This is

context appropriate since a substance abuser possessing an illegal substance

should be concerned about being arrested. As the dopamine levels continue to

rise the paranoia becomes delusional in nature. The substance abuser starts

to believe that people are out to get him or her (paranoid delusion)

sometimes leading to violence toward others. They also may believe that a

loved one may have violated their trust (jealous delusion) or they may even

project their desires into another (erotomanic delusion). For more

information, refer to DSM-IV under the section entitled " Delusional

(Paranoid) Delusions " for a further explanation of this phenomenon

(Diagnostic and Statistical Manual of Mental Disorders, 1994). These

delusions also partially explain the violent nature of the drug. Lastly,

serotonin levels rise causing the characteristic lack of appetite and

inability to sleep.

 

Methamphetamine users may suffer serious and life-threatening consequences.

High dose methamphetamine usage can cause convulsions, potentially fatal

hyperthermia (exaggerated body temperature), precipitate stroke in those

susceptible, and create optimal conditions for cardiac consequences

including myocardial infarction (heart attack). Use increases risk for HIV

and hepatitis B and C transmission. Recent brain imaging studies in former

methamphetamine users provide support for the findings that brain cell death

can be a result of methamphetamine abuse (http:

//www.nida.nih.gov/ResearchReports/Methamph2.html). This nerve cell loss or

damage appears similar to that found in individuals suffering from strokes

or Alzheimer's disease.

 

The treatment plan for the methamphetamine-addicted individual should

encompass three general areas: the Acute Abstinence Syndrome,

Psychotherapeutic Interventions, and Environmental Reward. An integrated

plan should be utilized to treat any co-occurring psychiatric disorders. The

following outlines the various aspects of the treatment plan.

 

The acute abstinence syndrome

Methamphetamine has a very long half-life ranging from 8 to 24 hours.

Because of this long half-life it takes the user an extended period of time

to come down from the effects of the drug. Compounding the situation is the

fact that drug " binges " can go on for several days. These stages of abuse

sometimes last as long as three to five days - or more. Clinically, the

methamphetamine addict can present for treatment in a delusional state that

can last up to a week. It has been reported that a methamphetamine psychosis

can continue for three to five days after discontinuation of the drug.

Haldol (Haloperidol) or a similar antipsychotic medication will need to be

employed during this period of time.

 

Unfortunately, detoxification treatment units have length of stay periods

that are often inadequate. This can compromise the treatment team's ability

to physically, behaviorally, socially, and psychiatrically stabilize the

client. Often little time exists for habilitation or rehabilitation

treatment and appropriate discharge planning. Detoxification timetables best

fit the alcoholic and heroin addict, due to the fact they were designed for

these populations. The stimulant addict generally will not exhibit signs of

an acute abstinence syndrome until four, five, or more days after

discontinuation of the drug. The abstinence syndrome can last up to the 10th

or 12th day post use.

 

During the first days after abrupt cessation of use, the methamphetamine

addict may be prone to cravings for drugs other than methamphetamine. This

is consistent with the binge patterns of use found in most of these addicts.

An extended binge is often followed by a period of days where there is low

desire for the drug. The addict will generally have a strong desire for

highly refined carbohydrates for these first few days post use. The

treatment team may consider using fruit and sports drinks such as Gatorade

during this period of time.

 

The Acute Abstinence Syndrome is more subtle than those from alcohol,

heroin, or Valium. The symptoms may look more like a " free floating "

anxiety, sometimes accompanied by stimulus-seeking types of acting out.

Clients often report euphoric recall deep sleep dreams that can be very

disturbing. Irritability, difficulty concentrating, and insomnia have been

reported. During this period of time cravings for the drug can become very

pronounced. Although there are no medications that specifically treat the

abstinence syndrome, many drugs are used to treat symptoms. For example, the

now lowered and depleted levels of norepinephrine, dopamine, and serotonin

can create dysphoria, anergia, depressive symptoms, mood swings, and

anhedonia. Medications such as the antidepressants (tricyclics and selective

serotonin reuptake inhibitors) can alleviate some of the problems of lack of

energy, mood swings, and depression. Certain dopamine-friendly medications

such as bromocriptine can be helpful in treating the anhedonia.

 

In the formulation of a treatment plan the use of medications can be

critical if the symptoms of depression, for example, preclude the client

from working a program of recovery. When necessary, medications can be

administered for a period of time and discontinued when the client is stable

- possibly three to six months into their recovery. If a depressive episode

later manifests itself, use of medication should be considered on a much

longer-term basis. Whenever possible a client should not be given a

" subscription " to the medication where, after a year of use, they may not

believe that they can ever function effectively without the drug. Where

there is no clearly established unipolar depression, bipolar depression, or

other psychiatric disorder, the medication should be presented as a

palliative solution that will help the client better manage his or her own

early recovery. The client should also be told that the symptoms that they

are experiencing are common at this stage of their abstinence. If the client

complains about the medication or discontinues use, the counselor may have

the client call the psychiatrist or the clinic for an appointment while the

client is still in the office.

 

Psychotherapeutic intervention

A second aspect of the treatment plan should involve the psychotherapeutic

interventions prescribed by the clinician. Generally, this involves the

various didactic learning experiences, individual, and group sessions that

the client will participate in. Historically, many of those with substance

abuse issues have been placed in process oriented group experiences and

60-minute didactic sessions (Nuckols & Curran, 1997). Many clinicians have

found this fruitless due to the fact that the methamphetamine addict

struggles to maintain focus and may be developmentally too immature to

participate.

 

Behaviorally oriented groups that stress problem solving and group building

work best with many of those with methamphetamine addiction. For example,

clinicians may find that in the process group modality that they are doing

all of the work trying to keep the client focused. The use of more proactive

structured role-play groups (people, places, and things groups) allow the

patients to practice solving real life experiences that they will encounter

in their recovery. Also, these groups create enough excitation to keep the

clients focused and doing the work of their own recovery. As previously

mentioned, psychological testing has revealed that some methamphetamine

addicts have an Alzheimer-like early profile and suffer from mental

confusion and restlessness during early recovery

(http://www.lec.org/DrugSearch/Documents/Meth.html). Their abbreviated

attention span is not conducive to a long video or didactic presentation.

Didactic sessions or videos that are not over 15-20 minutes in length and

followed by a questionnaire that asks the substance abuser what they thought

about the material, what they learned, and how their future behavior will

change, allows the clinician to appropriately assess what the client learned

and its impact on their recovery. Simple educational sessions that deal with

issues such as " how to participate in treatment " or " how to find a self-help

meeting " may elicit the best results.

 

Environmental reward

Many of those with methamphetamine addiction entering treatment today

started using alcohol and other drugs at a very early age - often as young

as 10 years old (Nuckols, 1993). They may often come from homes and

environments where there is little overt support for recovery and from

families where abuse and neglect exist. Even though they may present in

mature older bodies these individuals may be very developmentally immature.

This and the toxic effects of the drug contribute to the fact that

interventions such as process groups and 60-minute didactics have proven

ineffective. Generally, these individuals have a difficult time choosing a

sponsor or a self-help meeting because they have no internalized model of

what a healthy sponsor should look like and have little experience in

picking out positive recovery-oriented groups.

 

Driven by reward

The following scenario illustrates an all too real life example: William is

a 29-year-old methamphetamine addict. He comes from a home where there was

absentee parenting and has survived on his own from an early age. He began

drinking and smoking marijuana when he was 10 years old and by the age of 13

had progressed to methamphetamine and other drugs. From age 13 until the

present his history of drug use has been uninterrupted with the exception of

three incarcerations, one of which was juvenile and the other two while an

adult. Charges ranged from distribution of a controlled substance to

breaking and entering. William has no high school diploma and no vocational

resume although he is intelligent and capable. Upon his release from prison

five days ago he was told to get a job and act responsibly. As he stands on

a street corner waiting for a truck to take him to his minimum wage labor

position he looks across the street. On the opposite corner are old

acquaintances nicely dressed, listening to music and selling " dope. " How

long will William stand on his side of the street before crossing over?

 

William, like many others, needs hope and opportunity. An addicted

individual's brain is often driven by reward. Where is the reward for

William? He is a multi-system and multi-problem individual needing recovery

connections and housing. He could profit from vocational counseling,

enhanced education, and other " wrap around " services. Ultimately, William

needs a group of people or a person who can model more socially productive

behavior, be there for him when he is down, and serve as a role model.

Although the emphasis may be on his treatment needs, William's recovery

needs are just as great.

 

There is a difference between treatment and recovery. Treatment is necessary

but not sufficient. Recovery is the successful reintegration back into the

community, home, school, and job. Furthermore, in many cases the notion of

rehabilitation is not a viable option. The goal of rehabilitations is to

return an individual to some level of former optimal functioning. In so many

cases those with methamphetamine addiction may need habilitation-job

training, educational resources, and other services necessary to create

opportunities to enhance personal self-esteem and to prosper in the world.

 

Cardwell C. Nuckols, PhD, is an internationally recognized expert in the

areas of behavioral medicine and addictions treatment. He has authored

numerous books, videos, and audio tapes series including the book titled

Healing an Angry Heart (Health Communications, Inc.) and the video Chalk

Talk on Drugs with Father Martin (Kelly).Joseph T. Kane, MDiv, is the

Training Director for Training Resources, a Division of the Iowa Substance

Abuse Program Director's Association. He has a MDiv from the University of

St. Mary of the Lake and has served the substance abuse field for over 15

years.

 

References

Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition.

American Psychiatric Association, Washington, DC, 1994.

Methamphetamine Fact Sheet.

http://www.lec.org/DrugSearch/Documents/Meth.html

National Institute on Drug Abuse. Methamphetamine: Abuse and Addiction.

Research Report Series, 2000, page 1-5.

http://www.nida.nih.gov/ResearchReports/Methamph2

..html

National Institute on Drug Abuse. Methamphetamine: Abuse and Addiction.

Research Report Series, 2000, page

3.http://www.nida.nih.gov/ResearchReports/Methamph2.html

Nuckols, Cardwell C. and Curran, Joan. ÒMethamphetamine.Ó Employee

Assistance Magazine, Winter Edition, 1997.

Nuckols, Cardwell C. (1993). The Young Chronic Alcoholic and Addict. TAB

Books/McGraw Hill.Office of Applied Studies, Substance Abuse and Mental

Health Services Administration. Treatment Episode Data Set (TEDS), Table

3.1a, 4.16.01.