Methamphetamine and the Brain: What do we know

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• Methamphetamine and the Brain What do we know?

Beth Rutkowski, M.P.H. Pacific Southwest
Addiction Technology Transfer Center UCLA
Integrated Substance Abuse Programs finnerty_at_ucla.
edu UCEDD ID Grand Rounds, March 22,
2006 1100 a.m. 1200 p.m.
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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
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Primary Amphetamine/Methamphetamine TEDS
Admission Rates 1992(per 100,000 aged 12 and
over)
SOURCE 2002 SAMHSA Treatment Episode Data Set
(TEDS).
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Primary Amphetamine/Methamphetamine TEDS
Admission Rates 1997(per 100,000 aged 12 and
over)
lt 12
SOURCE 1997 SAMHSA Treatment Episode Data Set
(TEDS).
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Primary Amphetamine/Methamphetamine TEDS
Admission Rates 2002(per 100,000 aged 12 and
over)
SOURCE 2002 SAMHSA Treatment Episode Data Set
(TEDS).
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Primary Amphetamine/Methamphetamine TEDS
Admission Rates 2003(per 100,000 aged 12 and
over)
SOURCE 2003 SAMHSA Treatment Episode Data Set
(TEDS).
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A Major Reason People Take a Drug is they Like
What It Does to Their Brains
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dopamine reservoir
synapse
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Methamphetamine
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Initially, A Person Takes A Drug Hoping to
Change their Mood, Perception, or Emotional State
Translation---
Hoping to Change their Brain
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Natural Rewards Elevate Dopamine Levels
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Effects of Drugs on Dopamine Release
Source Shoblock and Sullivan Di Chiara and
Imperato
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But Then
After A Person Uses Drugs For A While, Why Cant
They Just Stop?
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Their Brains have been
Re-Wired by Drug Use
Because
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Prolonged Drug Use Changes the Brain In
Fundamental and Long-Lasting Ways
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PET Scan of Long-Term Impact of Methamphetamine
on the Brain
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Decreased dopamine transporter binding in METH
users resembles that in Parkinsons Disease
patients
Source McCann U.D.. et al.,Journal of
Neuroscience, 18, pp. 8417-8422, October 15, 1998.
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Control gt MA
4
3
2
1
0
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MA gt Control
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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 lt 0.0002
(words remembered)
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Cognitive Impairment in Individuals Currently
Using Methamphetamine

• Sara Simon, Ph.D.
• VA MDRU
• Matrix Institute on Addictions
• LAARC

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Differences between Stimulant and Comparison
Groups on tests requiring perceptual speed
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Memory Difference between Stimulant and
Comparison Groups
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Longitudinal Memory Performance
number correct
test
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How much does the brain heal?
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PET Scan of Long-Term Meth Brain Damage
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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.
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Partial Recovery of Brain Metabolism 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 1612,
February 2004.
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Effects of Methamphetamine and Treatment
Implications
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MethamphetamineAcute Physical Effects

• Increases Decreases
• Heart rate Appetite
• Blood pressure Sleep
• Pupil size Reaction time
• Respiration
• Sensory acuity
• Energy

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MethamphetamineAcute Psychological Effects

• Increases
• Confidence
• Alertness
• Mood
• Sex drive
• Energy
• Talkativeness

• Decreases
• Boredom
• Loneliness
• Timidity

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MethamphetamineChronic Physical Effects

• - Tremor - Sweating
• - Weakness - Burned lips sore nose
• - Dry mouth - Oily skin/complexion
• - Weight loss - Headaches
• - Cough - Diarrhea
• - Sinus infection - Anorexia

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MethamphetamineChronic Psychological Effects

• - Confusion -
  Irritability
• - Concentration - Paranoia
• - Hallucinations - Panic
  reactions
• - Fatigue -
  Depression
• - Memory loss - Anger
• - Insomnia -
  Psychosis

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Other problems

• Eye ulcers
• Over-heating
• Rhabdomyolysis
• Obstetric complications
• Anorexia / weight loss

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Severe weight loss/anorexia
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Faces of MethamphetamineSpeed Bumps

• Images courtesy Multnomah County Sheriffs Office

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METH Use Leads to Severe Tooth Decay
Source Richards, JR and Brofeldt, BT, J
Periodontology, August 2000.
METH Mouth
Source The New York Times, June 11, 2005.
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MethamphetaminePsychiatric Consequences

• Paranoid reactions
• Permanent memory loss
• Depressive reactions
• Hallucinations
• Psychotic reactions
• Panic disorders
• Rapid addiction

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Outpatient Treatment for Methamphetamine Abuse
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www.drugabuse.gov
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Treatment Medical Behavioral

• Drugs
• Sedatives
• Stimulants
• Opioids
• Alcohol

• Medical Treatment
• Yes
• No
• Yes
• Yes

• Behavioral Treatment
• Yes
• Yes
• Yes
• Yes

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MATRIX MODEL TREATMENT
Primary Manifestation of Withdrawal Stage
Behavioral
Cognitive
Confusion Inability to Concentrate
Behavioral Inconsistency
Relationship
Emotional
Depression/Anxiety- Self-Doubt
Mutual Hostility- Fear
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STAGES OF RECOVERY - STIMULANTS
OVERVIEW
DAY 180
DAY 0
DAY 15
DAY 45
DAY 120
Adjustment
Honeymoon
The Wall
Withdrawal
Resolution
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Stages of Recovery - Stimulants
WITHDRAWAL STAGE
DAY 0
DAY 15

• Medical Problems
• Alcohol Withdrawal
• Depression
• Difficulty Concentrating
• Severe Cravings

• Contact with Stimuli
• Excessive Sleep

PROBLEMS ENCOUNTERED
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Matrix Model TreatmentKey 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

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MATRIX MODEL TREATMENT
STRUCTURE
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Stages of Recovery - Stimulants
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
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PROTRACTED ABSTINENCE
Return to Old Behaviors Anhedonia Anger Depression
Emotional Swings Unclear Thinking Isolation Family
Problems
Cravings Return Irritability Abstinence Violation
THE WALL
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Lack of Goals Guilt and Shame
Relationship Problems Boredom
ADJUSTMENT/RESOLUTION
Underlying Psychopathology May Surface or
Resurface
Career Dissatisfaction
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Achieving a Balanced Life
Sleep
Work
Leisure
Relationships
Recovery Activities
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Limitations on Current Treatments

• 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.

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Successful Outpatient Treatment Predictors

• 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)

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Optimal candidates for Outpatient Treatment
Include

• Those who do not inject MA.
• Those without chronic mental illness and those
  without significant psychiatric symptoms at
  admission.
• Those who are using MA less than daily at
  admission.
• Those under legal supervision (especially drug
  court).
• Older individuals (over 21)Those who are not
  disabled.
• Those who have a stable living situation (without
  active drug users).

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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).

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The End
For more information, please contact Beth
Rutkowski at 310-445-0874 x376 or
finnerty_at_ucla.edu www.uclaisap.org or
www.psattc.org