The Many Faces of Methamphetamine: Addiction, The Family and The Community

1. The Many Faces of Methamphetamine: Addiction, The Family and The Community Cardwell C. Nuckols, PhD cnuckols@elitecorp.org

2. High Rates of Trauma • 44% of women and 24% of men entering treatment for methamphetamine addiction report childhood sexual abuse • 32% of women and 34% of men report childhood physical abuse • 56% reported parental alcohol and/or drug problems • Multigenerational Brown University Digest of Addiction Theory and Application. May 2004

3. Good News • Early Life Developmental Trauma is treatable • Multigenerational patterns of disorganized attachment can be broken • Establishing a “helping” or therapeutic relationship is most important variable • Spiritual “connectedness”

4. Bottom Line It’s All About Food, Water and Sex!

5. The Rat Brain • What “turns on” the dopamine in a rats brain….. • SEX-200% increase in dopamine • COCAINE-300% increase in dopamine • METHAMPHETAMINE-1100% increase in dopamine • This explains why rats will kill themselves to get more drug-especially methamphetamine

7. Key Points • Address Protracted Recovery Period • Address Continuum of Care • Understand Age of Onset and its Relationship to Trauma History, Psychiatric Symptomatology and Prognosis • Utilize Research to Develop Guidelines for Prevention and Intervention • Methamphetamine Addiction Should be Treated in a CD Environment

8. Key Points • Understand When the Need is “Habilitation” and not “Rehabilitation” • Understand When in the Course of Recovery is the Proper Time for Vocational and/or Educational Opportunities • Better Prepare the Client to Understand the Relationship Between Methamphetamine Addiction and Relapse From Marijuana and Alcohol.

9. Key Points • Reevaluate our Educational Processes • Develop a System of “Wrap Around” Services That Create Hope and Opportunity • Relate to the Client in Such a Way That We Help Them Better Understand Reward and Reinforcement in Early Recovery

12. Frontal (Executive) Cortical Functions • Focus attention • Prioritize • Exclude extraneous information • Suppress primitive urges • Reduce impulsivity

13. Frontal Cortex (FC) • Decisions like choosing immediate gratification (using methamphetamine to satisfy craving) vs. healthy choices are made in the FC. • Addicts tend to make choices without regard for punishment or harm • Habit and compulsion overrides recognition of harm associated with repeated error

14. Non-Addict Response • “This is dangerous” • Prefrontal cortex • Sends inhibitory signals to the Ventral Tegmental Area (VTA) • Reduces dopamine release • No repetitive methamphetamine use pattern • No reinforcement of pleasure

15. Addict Response Pattern • “Got to have more” • Cognitive Deficit Model • Abnormalities in prefrontal cortex • Compromised ability to send inhibitory signal to VTA • Chronic alcoholics have reduced GABA • Neurochemical used in the inhibitory process • Meth and Coke may damage this brain loop • Frontostriatal loop

16. End Organ Toxicity • Central Nervous System • Cardiovascular System • Pulmonary System • Renal System • Hepatic • Fetal Development

17. Central Nervous System • Acute psychosis • Chronic psychosis • Strokes • Seizures

18. Cardiovascular System • Myocardial Infarctions • Arrhythmias • Cardiomyopathy

19. Pulmonary System • Acute Pulmonary Congestion • Chronic Obstructive Lung Disease

20. Renal/Hepatic Failure • Renal failure • Hepatic Failure

21. Fetal Development • Exposure early in pregnancy • Fetal death • Small size for gestational period • Exposure later in pregnancy • Learning Disabilities • Poor social adjustment

22. Childhood Exposure • 80-90% of children found in homes where methamphetamine is being manufactured will test positive for the drug. Some are barely over one year old. • Due to inhaled fumes • Direct contact with the drug • Second hand smoke • Direct ingestion

23. Childhood Exposure • Social workers now accompany law enforcement during lab seizures where children are involved. • Allowing children to be in such an environment is considered neglect and/or child abuse. • Parents may be charged with second-degree criminal mistreatment

24. Childhood Exposure • Children are uniquely susceptible because their brains are still developing (lead poisoning) and because the are very curious • Children have greater skin surface area per pound

25. Lab Seizure Locations • Most common locations • Single family houses • Apartments • Mobile homes • Vehicles • Garages • Trailers • Motels/hotels • Businesses

26. Stove Top Labs • Cookers make small amounts using household equipment and chemicals • The active ingredient • Ephedrine or pseudoephedrine • Chemical ingredients • Trichloroethane (gun scrubber) • Ether (engine starter) • Methanol (gasoline additive) • Gasoline • Kerosene

27. Stove Top Labs • Chemical ingredients • Lithium (camera batteries) • Anhydrous ammonia (farm fertilizer) • Red phosphorus (matches) • Iodine (veterinarian product) • Muriatic acid • Campfire fuel • Paint thinner

28. Stove Top Labs • Chemical ingredients • Acetone • Sulfuric acid (drain cleaner) • Table salt/rock salt • Sodium hydroxide (lye) • Sodium metal (can be made from lye) • Alcohol (rubbing/gasoline addictive)

29. Household Equipment • Coffee filters • Rubber gloves • Tempered glass baking dishes • Glass or plastic jugs • Bottles • Measuring cups

30. Household Equipment • Funnels • Blenders • Hotplate • Strainer • Propane cylinder • Aluminum foil

31. Toxicity • For every unit of methamphetamine manufactured, there exists 5 times that amount in toxic waste • This waste is dumped in streams, sewers, fields • Environment is contaminated especially groundwater

32. Toxicity • Toxic gases permeate the walls and carpets making homes and buildings uninhabitable. • The cost to the taxpayer to clean these sites is between $2000 and $4000. • Sometimes these gases explode and cause fires.

33. Tolerance • Brain cells gradually become less responsive • More is needed to stimulate the VTA brain cells • To cause more release of dopamine in the NAc • To produce reward comparable to earlier experiences

34. Stimulant Toxicity • Increased levels of Norepinephrine and Dopamine • Hyper-arousal • Pleasure • Paranoia • Increased levels of Serotonin • Reduced hunger • Difficulty sleeping

36. Stimulant Crash • Reduced levels of Norepinephrine and Dopamine • Dysphoria • Depression • Anhedonia • Reduced levels of Serotonin • Mood swings • Sleep disturbances

37. Craving Management (Situational & Emotional Triggers) • Situational triggers • Environment (People, Places And Things) • Initially drug causes release of dopamine • After addiction, situations that have a high probability of use cause dopamine release • Emotional triggers • Internal (Hungry, Angry, Lonely, Tired, Reward and Bored)

39. Most Common Craving Triggers • In presence of: • Alcohol and drugs • Alcohol and drug users • Places where used to use or purchase • Negative feeling states particularly anger but also: • Boredom • Loneliness • Fear • Anxiety

40. Most Common Craving Triggers • Positive feeling states • Physical pain • Use of mood-altering prescription drugs • Suddenly having a lot of cash • Complacency • Insomnia • Sexual functioning

41. Craving Management • Psychotherapy • Behavior Therapy • Structure • Recovery Foundation Program • Changing patterns • Safety Plan • Pharmacological • Acute • Maintenance

42. Changing Patterns 31 yo Nicki-a recovering methamphetamine addict- just got her first paycheck. She cashed her check and cruised thru the neighborhood where she used to score dope. Rock music blared from her speakers. Soon she was thinking, "I worked hard all week. I deserve a little fun.”

43. Behavioral Foundation Program • In an inpatient setting the patient schedule serves this purpose • On an outpatient basis or upon discharge from inpatient a recovery plan or contract is appropriate • Remember that most addicts have little or no recent experience living a drug free lifestyle

44. Behavioral Foundation Program

45. Behavioral Foundation Program • Carter is 24 yo and just getting out of treatment for alcohol and methamphetamine addiction • His early A/D history included…. • Started drinking on Friday nights with friends in high school • Turned-on to methamphetamine and marijuana by friends on weekends • Started to buy methamphetamine to sell from a distributor on Wed nights

46. Using Early Drug History

47. Behavioral Safety Plan • CT: “Last night I had a dream that I was getting ready to get high on ‘crystal’-it was all on the table in front of me. It was like five minutes before I knew it was a dream.” • TH: “Congratulations on not using, tell the group what you did to deal with the craving.” • CT: “ I went into the kitchen and wrote in my journal everything that happened. Then I said a prayer.”

48. Behavioral Safety Plan • TH: What else could you have done? • CT: “I know that I can always call my sponsor or my lover. I can also read from a book that I have on recovery or a book of affirmations that I like.” • TH: “That’s great. Now let’s make a safety plan from what you have discovered.”

49. Behavioral Safety Plan On 3x5 Index Card

50. Behavioral Safety Plan On 3x5 Index Card • TH: “On the back of the index card, come up with a saying or a prayer that gives you strength.” • CT: “ I have always liked ‘Lord help me to be the best possible person I can be today’.”