METHAMPHETAMINE ISSUES IN COUNSELING

1
METHAMPHETAMINEISSUES IN COUNSELING
NEW CHOICES, INC PRESENTS

• BY
• W. Tom Mihokanich
• (me-o-con-itch)
• 334-863-2333/334-863-1300
• tomojibcher_at_hotmail.com
• Credits www.pcattc.com and www.samhsa.gov

2
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

3
Cognitive Dysfunction and Change

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

4
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

5
MethamphetaminePsychiatric Consequences

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

6
Treatments for Methamphetamine

• Cognitive Behavioral Therapies
• Contingency Management
• MATRIX Model
• New Medications
• (treatment and overdose)
• are being developed

7
MethamphetamineCounseling

• Utilize visuals
• Videos
• Chalk talks
• Repetition
• Written Exercises
• Cognitive therapy
• Language understood
• Check out thought process as you go

8
Cognitive Therapy

• Automatic Thoughts
• I cannot do anything right
• I fail at everything I do
• I will never get better
• No one can help me
• No one understands me

9
Behavior Therapy

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

10
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

11
Craving Management

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

12
Clinical Challenges for Treatment of
Methamphetamine Addiction

• Poor treatment engagement rates
• High dropout rates
• Severe paranoia
• High relapse rates
• Ongoing episodes of psychosis
• Severe craving
• Protracted dysphoria

Many patients may require medical/psychiatric
supervision and need ongoing treatment with
antipsychotic medications
13
STAGES OF RECOVERY - STIMULANTS
OVERVIEW
DAY 180
DAY 0
DAY 15
DAY 45
DAY 120
Adjustment
Honeymoon
The Wall
Withdrawal
Resolution
14
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
15
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
16
Stages of Recovery - Stimulants
THE WALL STAGE
DAY 45
DAY 120

• Return to Old Behaviors
• Anhedonia
• Anger
• Depression
• Emotional Swings
• Unclear Thinking

• Isolation
• Family Problems
• Cravings Return
• Irritability
• Abstinence Violation

PROBLEMS ENCOUNTERED
17
Stages of Recovery - Stimulants
ADJUSTMENT AND RESOLUTION STAGES
DAY 120
DAY 180

• Relationship Problems
• Boredom
• Career Dissatisfaction
• Lack of Goals

• Guilt and Shame
• Underlying Psycho-pathology May Surface or
  Resurface

PROBLEMS ENCOUNTERED