Methamphetamine and the brain what do we know
Download
1 / 61

Methamphetamine and the Brain: What do we know? - PowerPoint PPT Presentation


  • 140 Views
  • Uploaded on

Beth Rutkowski, M.P.H. Pacific Southwest Addiction Technology Transfer Center UCLA Integrated Substance Abuse Programs [email protected] UCEDD ID Grand Rounds, March 22, 2006 11:00 a.m. – 12:00 p.m. Methamphetamine and the Brain: What do we know?. Forms of Methamphetamine.

loader
I am the owner, or an agent authorized to act on behalf of the owner, of the copyrighted work described.
capcha
Download Presentation

PowerPoint Slideshow about ' Methamphetamine and the Brain: What do we know?' - ismael


An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.


- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -
Presentation Transcript
Methamphetamine and the brain what do we know

Beth Rutkowski, M.P.H.

Pacific Southwest Addiction Technology Transfer Center UCLA Integrated Substance Abuse Programs

[email protected]

UCEDD ID Grand Rounds, March 22, 2006

11:00 a.m. – 12:00 p.m.

Methamphetamine and the Brain: What do we know?


Forms of Methamphetamine

Methamphetamine Powder

Users’ Description: Beige/yellowy/off-white powder

Base / Paste Methamphetamine

Users’ Description: ‘Oily’, ‘gunky’, ‘gluggy’ gel, moist, waxy

Crystalline Methamphetamine

Users’ Description: White/clear crystals/rocks; ‘crushed glass’ / ‘rock salt’


Primary amphetamine methamphetamine teds admission rates 1992 per 100 000 aged 12 and over

> 58

35 - 58

12 - 35

< 12

No data

Primary Amphetamine/Methamphetamine TEDS Admission Rates: 1992(per 100,000 aged 12 and over)

SOURCE: 2002 SAMHSA Treatment Episode Data Set (TEDS).


Primary amphetamine methamphetamine teds admission rates 1997 per 100 000 aged 12 and over

> 58

35 - 58

12 - 35

< 12

No data

Primary Amphetamine/Methamphetamine TEDS Admission Rates: 1997(per 100,000 aged 12 and over)

< 12

SOURCE: 1997 SAMHSA Treatment Episode Data Set (TEDS).


Primary amphetamine methamphetamine teds admission rates 2002 per 100 000 aged 12 and over

< 12

35 -58

200 or more

150-199

100-149

12 - 35

58-99

Primary Amphetamine/Methamphetamine TEDS Admission Rates: 2002(per 100,000 aged 12 and over)

SOURCE: 2002 SAMHSA Treatment Episode Data Set (TEDS).


Primary amphetamine methamphetamine teds admission rates 2003 per 100 000 aged 12 and over

< 12

35 -58

200 or more

150-199

100-149

12 - 35

58-99

Primary Amphetamine/Methamphetamine TEDS Admission Rates: 2003(per 100,000 aged 12 and over)

SOURCE: 2003 SAMHSA Treatment Episode Data Set (TEDS).


A Major Reason People

Take a Drug is they Like

What It Does to Their Brains




Initially, A Person Takes A Drug

Hoping to Change their Mood,

Perception, or Emotional State

Translation---

…Hoping to Change their Brain


FOOD

SEX

200

200

NAc shell

150

150

DA Concentration (% Baseline)

100

100

15

% of Basal DA Output

10

Empty

Copulation Frequency

50

Box

Feeding

5

0

0

Scr

Scr

Scr

Scr

0

60

120

180

Bas

Female 1 Present

Female 2 Present

Mounts

Time (min)

Sample

Number

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

Intromissions

Ejaculations

Source: Di Chiara et al.

Source: Fiorino and Phillips

Natural Rewards Elevate Dopamine Levels


Effects of Drugs on Dopamine Release

COCAINE

1500

1000

500

0

METHAMPHETAMINE

Accumbens

400

Accumbens

DA

300

DOPAC

HVA

% of Basal Release

% Basal Release

200

100

0

0

1

2

3hr

Time After Methamphetamine

Time After Cocaine

250

ETHANOL

NICOTINE

250

Accumbens

Dose (g/kg ip)

200

Accumbens

200

0.25

Caudate

0.5

150

% of Basal Release

1

% of Basal Release

2.5

150

100

0

1

2

3 hr

100

0

0

0

1

2

3

4hr

Time After Ethanol

Time After Nicotine

Source: Shoblock and Sullivan; Di Chiara and Imperato


But Then…

After A Person Uses Drugs

For A While,

Why Can’t They Just Stop?


Their Brains

have been

Re-Wired

by Drug Use

Because…


Prolonged Drug Use Changes

the Brain In Fundamental

and Long-Lasting Ways



Decreased dopamine transporter binding in meth users resembles that in parkinson s disease patients
Decreased dopamine transporter binding in METH users resembles that in Parkinson’s Disease patients

Source: McCann U.D.. et al.,Journal of Neuroscience, 18, pp. 8417-8422, October 15, 1998.


Control resembles that in > MA

4

3

2

1

0


5 resembles that in

4

3

2

1

0

MA >

Control


2.0 resembles that in

1.8

1.6

1.4

1.2

1.0

7

8

9

10

11

12

13

2

1.8

1.6

1.4

1.2

1

16

14

12

10

8

6

4

Dopamine Transporters in

Methamphetamine Abusers

Motor Activity

(Bmax/Kd)

Dopamine Transporter

Normal Control

Time Gait

(seconds)

Memory

Dopamine Transporter

Bmax/Kd

Methamphetamine Abuser

Delayed Recall

p < 0.0002

(words remembered)


Cognitive impairment in individuals currently using methamphetamine

Cognitive Impairment in Individuals Currently Using Methamphetamine

Sara Simon, Ph.D.

VA MDRU

Matrix Institute on Addictions

LAARC




Longitudinal memory performance
Longitudinal Memory Performance requiring perceptual speed

number correct

test


How much does the brain heal

How much requiring perceptual speeddoes the brain heal?


Pet scan of long term meth brain damage
PET Scan of Long-Term Meth Brain Damage requiring perceptual speed


Partial Recovery of Brain Dopamine Transporters in Methamphetamine (METH)

Abuser After Protracted Abstinence

3

0

ml/gm

METH Abuser

(1 month detox)

Normal Control

METH Abuser

(24 months detox)

Source: Volkow, ND et al., Journal of Neuroscience 21, 9414-9418, 2001.


Partial recovery of brain metabolism in methamphetamine meth abuser after protracted abstinence
Partial Recovery of Brain Metabolism Methamphetamine (METH)in Methamphetamine (METH) Abuserafter Protracted Abstinence

70

0

µmol/100g/min

Control Subject

(30 y/o, Female)

METH Abuser

(27 y/o, Female)

3 months detox

METH Abuser

(27 y/o, Female)

13 months detox

Source: Wang, G-J et al., Am J Psychiatry 161:2, February 2004.



Methamphetamine acute physical effects
Methamphetamine Methamphetamine (METH)Acute Physical Effects

IncreasesDecreases

Heart rate Appetite

Blood pressure Sleep

Pupil size Reaction time

Respiration

Sensory acuity

Energy


Methamphetamine acute psychological effects

Increases Methamphetamine (METH)

Confidence

Alertness

Mood

Sex drive

Energy

Talkativeness

Decreases

Boredom

Loneliness

Timidity

MethamphetamineAcute Psychological Effects


Methamphetamine chronic physical effects
Methamphetamine Methamphetamine (METH)Chronic Physical Effects

- Tremor - Sweating

- Weakness - Burned lips; sore nose

- Dry mouth - Oily skin/complexion

- Weight loss - Headaches

- Cough - Diarrhea

- Sinus infection - Anorexia


Methamphetamine chronic psychological effects
Methamphetamine Methamphetamine (METH)Chronic Psychological Effects

- Confusion - Irritability

- Concentration - Paranoia

- Hallucinations - Panic reactions

- Fatigue - Depression

- Memory loss - Anger

- Insomnia - Psychosis


Other problems
Other problems Methamphetamine (METH)

  • Eye ulcers

  • Over-heating

  • Rhabdomyolysis

  • Obstetric complications

  • Anorexia / weight loss


Severe weight loss/anorexia Methamphetamine (METH)


Faces of methamphetamine speed bumps
Faces of Methamphetamine Methamphetamine (METH)Speed Bumps

Images courtesy Multnomah County Sheriff’s Office


METH Use Leads to Severe Tooth Decay Methamphetamine (METH)

Source: Richards, JR and Brofeldt, BT, J Periodontology,

August 2000.

“METH Mouth”

Source: The New York Times, June 11, 2005.


Methamphetamine psychiatric consequences
Methamphetamine Methamphetamine (METH)Psychiatric Consequences

  • Paranoid reactions

  • Permanent memory loss

  • Depressive reactions

  • Hallucinations

  • Psychotic reactions

  • Panic disorders

  • Rapid addiction



www.drugabuse.gov Methamphetamine (METH)


Treatment medical behavioral

Drugs Methamphetamine (METH)

Sedatives

Stimulants

Opioids

Alcohol

Medical Treatment

Yes

No

Yes

Yes

Treatment: Medical & Behavioral

Behavioral Treatment

Yes

Yes

Yes

Yes


Matrix model treatment
MATRIX MODEL TREATMENT Methamphetamine (METH)

Primary Manifestation of

Withdrawal Stage

Behavioral

Cognitive

Confusion

Inability to

Concentrate

Behavioral

Inconsistency

Emotional

Relationship

Depression/Anxiety-

Self-Doubt

Mutual Hostility-

Fear


Stages of recovery stimulants
STAGES OF RECOVERY - STIMULANTS Methamphetamine (METH)

OVERVIEW

DAY

180

DAY

0

DAY

15

DAY

45

DAY

120

Adjustment

Honeymoon

The Wall

Withdrawal

Resolution


Stages of Recovery - Stimulants Methamphetamine (METH)

WITHDRAWAL STAGE

DAY

0

DAY

15

  • Medical Problems

  • Alcohol Withdrawal

  • Depression

  • Difficulty Concentrating

  • Severe Cravings

PROBLEMS

ENCOUNTERED

  • Contact with Stimuli

  • Excessive Sleep


Matrix model treatment key concept structure
Matrix Model Treatment Methamphetamine (METH)Key Concept: Structure

  • Self-designed structure (scheduling)

  • Eliminate avoidable triggers

  • Makes concrete the concept of “One day at a time”

  • Reduces anxiety

  • Counters the addict lifestyle

  • Provides basic foundation for ongoing recovery


Matrix model treatment1

Recreational/Leisure Methamphetamine (METH)

Activities

Treatment Program Activities

12-Step Meetings

School

Sports

Being with Drug-free Friends

Time Scheduling

Exercise

Work

Family-related Events

Church/Synagogue

Island Building

MATRIX MODEL TREATMENT

STRUCTURE


Stages of Recovery - Stimulants Methamphetamine (METH)

HONEYMOON STAGE

DAY

15

DAY

45

  • Over-involvement With Work

  • Overconfidence

  • Inability to Initiate Change

  • Inability to Prioritize

  • Alcohol Use

  • Episodic Cravings

  • Treatment Termination

PROBLEMS

ENCOUNTERED


PROTRACTED ABSTINENCE Methamphetamine (METH)

Return to Old Behaviors

Anhedonia

Anger

Depression

Emotional Swings

Unclear Thinking

Isolation

Family Problems

Cravings Return

Irritability

Abstinence Violation

THE WALL


Lack of Goals Methamphetamine (METH)

Guilt and Shame

Relationship Problems

Boredom

ADJUSTMENT/RESOLUTION

Underlying Psychopathology May Surface or Resurface

Career

Dissatisfaction


Achieving a balanced life
Achieving a Balanced Life Methamphetamine (METH)

Sleep

Work

Leisure

Relationships

Recovery Activities


Limitations on current treatments
Limitations on Current Treatments Methamphetamine (METH)

  • Training and development of knowledgeable clinical personnel are essential elements to successfully address the challenges of treating MA users.

  • Training alone is insufficient if the funding necessary to deliver these treatment recommendations is not available.

  • Treatment funding policies that promote short duration or non-intensive outpatient services are inappropriate for providing adequate funding for MA users.


Successful outpatient treatment predictors
Successful Outpatient Treatment Predictors Methamphetamine (METH)

  • Durations over 90 days (with continuing care for another 9 months).

  • Techniques and clinic practices that improve treatment retention are critical.

  • Treatment should include 3-5 clinic visits per week for at least 90 days.

  • Employ evidence based practice (e.g., CBT, CM, Community Reinforcement Approach, Motivational Interviewing, Matrix Model).

  • Family involvement and 12-step program appear to improve outcome.

  • Urine testing (at least weekly is mandatory)


Special treatment consideration should be made for the following groups of individuals
Special Treatment Consideration Should be Made for the Following Groups of Individuals:

  • MA users who take MA daily or in very high doses.

  • Homeless, chronically mentally ill and/or individuals with high levels of psychiatric symptoms at admission.

  • Individuals under the age of 21.

  • Gay men (at very high risk for HIV and hepatitis).


The End Following Groups of Individuals:

For more information, please contact Beth Rutkowski

at 310-445-0874 x376 or [email protected]

www.uclaisap.org or www.psattc.org


ad