Methamphetamine: How it Influences the Brain and Behavior of Users

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Methamphetamine How it Influences the Brain and
Behavior of Users

• Richard A. Rawson, Ph.D
• Adjunct Associate Professor
• Semel Institute for Neuroscience and Human
  Behavior
• David Geffen School of Medicine
• University of California at Los Angeles
• www.uclaisap.org
• rrawson_at_mednet.ucla.edu
• Supported by
• National Institute on Drug Abuse (NIDA)
• Pacific Southwest Technology Transfer Center
  (SAMHSA)

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Methamphetamine

• Methamphetamine is a powerful central nervous
  system stimulant that strongly activates multiple
  systems in the brain. Methamphetamine is closely
  related chemically to amphetamine, but the
  central nervous system effects of methamphetamine
  are greater.

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Methamphetamine Speed

• Methamphetamine powder ranging in color from
  white, yellow, orange, pink, or brown.
• Color variations are due to differences in
  chemicals used to produce it and the expertise of
  the cooker.
• Other names shabu, crystal, crystal meth, crank,
  tina, yaba

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Methamphetamine Ice

• High purity methamphetamine crystals or
  coarse powder ranging from translucent to white,
  sometimes with a green, blue, or pink tinge.

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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 - Dental Problems
• - 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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Treatment Options
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CSAT Tip 33

• A useful resource that presents a review of the
  existing knowledge about treatment effectiveness
  with stimulant users.
• Treatments for stimulant dependence with
  empirical support
• Motivational Interviewing
• Cognitive Behavioral Therapy
• 12 Step Facilitation Therapy
• Contingency Management
• Community Reinforcement Therapy
• Matrix Model

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Medications

• Currently, there are no medications that can
  quickly and safely reverse life threatening MA
  overdose.
• There are no medications that can reliably reduce
  paranoia and psychotic symptoms, that contribute
  to episodes of dangerous and violent behavior
  associated with MA use.

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Psychosocial/Behavioral Treatments

• NIDA has also produced several manuals that have
  been empirically tested with stimulant-using
  populations, including
• Cognitive Behavioral Therapy (CBT)
• Contingency Management (CM)

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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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Special treatment consideration should be made
for the following groups of individuals

• Female MA users (higher rates of depression very
  high rates of previous and present sexual and
  physical abuse responsibilities for children).
• Injection MA users (very high rates of
  psychiatric symptoms severe withdrawal
  syndromes high rates of hepatitis).
• 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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Contingency Management

• Preliminary finding appear very positive.
• Powerful tool to improve engagement and retention
  and to reduce MA use

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Matrix Model

• Is a manualized, 16-week, non-residential,
  psychosocial approach used for the treatment of
  drug dependence.
• Designed to integrate several interventions into
  a comprehensive approach. Elements include
• Individual counseling
• Cognitive behavioral therapy
• Motivational interviewing
• Family education groups
• Urine testing
• Participation in 12-step programs

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The CSAT Methamphetamine Treatment Project
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Baseline Demographics
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Changes from Baseline to Treatment-end
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Days of Methamphetamine Use in Past 30 (ASI)
Possible is 0-30 tpaired20.90 p-valuelt0.000
(highly sig.)
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Beck Depression Inventory (BDI) Total Scores
Possible is 0-63 tpaired16.87 p-valuelt0.000
(highly sig.)
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Mean Number of Weeks in Treatment
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Mean Number of UAs that were MA-free during
treatment
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Figure 4. Percent completing treatment, by group
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Figure 6. Participant self-report of MA use
(number of days during the past 30) at
enrollment, discharge, and 6-month follow-up, by
treatment condition
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Urinalysis Results

• Results of Ua Tests at Discharge, 6 months and 12
  Months post admission
• Matrix Group TAU Group
• D/C 66 MA-free 65 MA-free
• 6 Ms 69 MA-free 67 MA-free
• 12 Ms 59 MA-free 55 MA-free
• Over 80 follow up rate in both groups at all
  points

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Prenatal Meth Exposure

• Preliminary findings on infants exposed
  prenatally to methamphetamine (MA) and nonexposed
  infants suggest
• Prenatal exposure to MA is associated with an
  increase in SGA (small for gestational size).
• Neurobehavioral deficits at birth were identified
  in NNNS (Neonatal Intensive Care Unit Network
  Neurobehavioral Scale) neurobehavior, including
  dose response relationships and acoustical
  analysis of the infants cry. Lester et al
  2005

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Methamphetamine

• Methamphetamine and Sex

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My sexual drive is increased by the use of
(Rawson et al., 2002)
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My sexual pleasure is enhanced by the use of
(Rawson et al., 2002)
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My sexual performance is improved by the use of
(Rawson et al., 2002)
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Defining Domains Executive Systems Functioning

• a.k.a. frontal lobe functioning.
• Deficits on executive tasks assoc. w/
• Poor judgment.
• Lack of insight.
• Poor strategy formation.
• Impulsivity.
• Reduced capacity to determine consequences of
  actions.

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Neurocognitive Consequences of Methamphetamine
DependenceAbstinent Users

• Impairments observed in the following domains
• Attention/concentration
• Learning and Memory
• Motor/Psychomotor Speed
• Executive Systems Functioning

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Methamphetamine

• Gender Differences
• Womens Issues
• Craving

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Behavior Symptom Inventory (BSI) Scores at
Baseline
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Beck Depression Inventory (BDI) Scores at Baseline
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Self-Reported Reasons for Starting
Methamphetamine Use
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Methamphetamine

• Route of Administration

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Route of Methamphetamine Administration
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Route of Administration by Site
Plt.05
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Craving by Route
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Treatment Length by Route
Plt.05
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MA-Free Samples by Route
Plt.05
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BSI Psychiatric Symptoms by Route
Plt.05
Positive Symptom Total (PST)
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Hepatitis C by Route
Plt.05