The Ice Storm: Methamphetamine Revisited

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The Ice Storm Methamphetamine Revisited

• Cardwell C. Nuckols MA, PhD
• cnuckols_at_elitecorp.org

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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

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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)

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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

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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

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Craving Management

• Psychotherapy
• Behavior Therapy
• Structure
• Recovery Foundation Program
• Changing patterns
• Safety Plan
• Pharmacological
• Acute
• Maintenance

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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.

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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

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Behavioral Foundation Program
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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

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Using Early Drug History
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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.

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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 Thats great. Now lets make a safety plan
  from what you have discovered.

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Behavioral Safety Plan On 3x5 Index Card
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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.

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Behavior Therapy

• Understand and Change Negative Behavior
• Positive Reinforcing Behaviors
• New Social Environment
• New Friends
• New Activities
• Setting Limits
• Staff as Parental Unit

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Setting Limits

• Key part of establishing alliance
• Strict-Authoritarian
• Loose-No Control

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Behavior Therapy

• Based on ego-strength or level of developmental
  maturity
• Problem solving
• Experiential role-play
• PPT group
• Contingency management
• Voucher-based system

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Personality Immaturity
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Treatment Approaches
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Behavioral Role Play-People, Places and Things
Group
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Group Based On Ego-Strength

• Five Phases
• Introduction
• Safe Emergency
• Behavioral Role Play
• Assignment
• What happened today in group and what did you
  learn
• Closing

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Group Example

• Introduction- Drop The Rock
• Safe Emergency-Perform group exercise
• Behavioral Role Play- People, Places and Things
• Assignment- What Did You Learn About Yourself
• Closing-Serenity Prayer

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Behavioral Contingency Contracting

• Negative Contingency
• Example-holding a letter to the Board of Nursing
  to be sent if client relapses
• Positive Contingency
• Examples
• Voucher Systems
• Other Rewards

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Contingency Contracts

• Successful in reducing illicit drug use
• Encouraging results in treatment of alcoholism
• Most effective when used with urine testing with
  reward or negative consequence tied to urinalysis

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Cognitive Dysfunction and Change

• Frontal cortex vs. midbrain
• Approximately 50 entering treatment suffer from
  cerebral (cognitive) dysfunction
• Less likely to attend continuing care
• Less likely to be employed
• Often mistaken as resistant or unmotivated
• Less able to absorb information
• Stimulant addicts look like they have
  degenerative brain disease

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Cognitive Dysfunction and Change

• Executive and visuospatial functioning problems
  include
• Recent memory
• Abstraction
• Problem solving
• Cognitive flexibility
• Planning
• Rapid Response

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Cognitive Dysfunction-Stimulant Addicts

• Long term stimulant abuse causes damage to
  dopamine producing cells and leads to reduced
  levels
• Stimulant addicts may suffer from poor attention
  and compromised fine motor skills

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Cognitive Dysfunction and Change

• Recovery in neuropsychological functioning
• Most of treatment is during time of greatest
  dysfunction
• Recovery is
• Time-dependent
• Due to sustained abstinence
• Experience-dependent
• Active rehabilitation or repetitive behavior

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Cognitive Rehabilitation

• Repetitive recovery-oriented behaviors
• Repetitive recovery-oriented thoughts

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Education

• Why give a methamphetamine addict a 60 minute
  didactic or video?
• A new format
• 15-20 minute simple didactic
• How to participate in treatment
• 10 minute questionnaire
• 30 minute discussion group

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10 Minute Questionnaire
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Environment

• Living in an enriched environment may reduce
  animals self-administration of drugs
• Animal studies suggest that environmental
  conditions may affect the activity of dopamine

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Meth Hurts Moms and Kids

• Obstetrician-gynecologist Mary Holley, M.D., who
  founded Mothers Against Methamphetamine said the
  following
• Were seeing devastation. Infant mortality is
  high. The kids who are born wont feed. Theyre
  underweight. Theyre sick. They are going to have
  ADHD almost guaranteed, and they grow up in a
  home with an addicted mother who doesnt care
  about them.

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Environment

• Case Management
• Multisystem Therapy
• Wrap around services
• Family and childcare services
• Housing/Transportation services
• Financial and legal services
• AIDS and medical services
• Addiction and mental health services
• Vocational and educational services

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Spirituality

• 2 major reviews of the literature
• National Institute for Healthcare Review (1996)
• Good evidence that involvement in AA is
  associated with enhanced outcomes in both
  inpatient and outpatient care
• NIAAA and Fetzer Institute (1999)
• Strong support for the protective nature of
  spirituality and religion (110 studies) of AA
  involvement (51 studies) and spiritual/religious
  intervention (26 studies)

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Spirituality In Addiction Recovery

• Spirituality refers to the unique and intense
  experience of a reality greater than oneself or
  an experience of connection with the totality of
  things. Religion is an organized social structure
  in which spiritual experiences are shared,
  ritualized and passed on to future generations

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Spirituality In Addiction Recovery

• An individual does not have to be religious in
  order to have a spiritual experience. The
  benefits of spirituality include humility, inner
  strength, sense of meaning and purpose in life,
  acceptance of self and others, sense of harmony
  and serenity, gratitude and forgiveness.