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Beth Rutkowski, M.P.H. finnerty@ucla

Medical Realities of Methamphetamine Use and Recovery. Beth Rutkowski, M.P.H. finnerty@ucla.edu Pacific Southwest Addiction Technology Transfer Center UCLA Integrated Substance Abuse Programs. Consequences to the Brain. FOOD. SEX. 200. 200. NAc shell. 150. 150.

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Beth Rutkowski, M.P.H. finnerty@ucla

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  1. Medical Realities of Methamphetamine Use and Recovery Beth Rutkowski, M.P.H. finnerty@ucla.edu Pacific Southwest Addiction Technology Transfer Center UCLA Integrated Substance Abuse Programs

  2. Consequences to the Brain

  3. FOOD SEX 200 200 NAc shell 150 150 DA Concentration (% Baseline) 100 100 15 % of Basal DA Output 10 Empty Copulation Frequency 50 Box Feeding 5 0 0 Scr Scr Scr Scr 0 60 120 180 Bas Female 1 Present Female 2 Present Mounts Time (min) Sample Number 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 Intromissions Ejaculations Source: Di Chiara et al. Source: Fiorino and Phillips Natural Rewards Elevate Dopamine Levels

  4. Effects of Drugs on Dopamine Release COCAINE 1500 1000 500 0 METHAMPHETAMINE Accumbens 400 Accumbens DA 300 DOPAC HVA % of Basal Release % Basal Release 200 100 0 0 1 2 3hr Time After Methamphetamine Time After Cocaine 250 ETHANOL NICOTINE 250 Accumbens Dose (g/kg ip) 200 Accumbens 200 0.25 Caudate 0.5 150 % of Basal Release 1 % of Basal Release 2.5 150 100 0 1 2 3 hr 100 0 0 0 1 2 3 4hr Time After Ethanol Time After Nicotine Source: Shoblock and Sullivan; Di Chiara and Imperato

  5. PET Scan of Long-Term Impact of Methamphetamine on the Brain

  6. Decreased dopamine transporter binding in METH users resembles that in Parkinson’s Disease Control Meth PD Source: McCann U.D.. et al.,Journal of Neuroscience, 18, pp. 8417-8422, October 15, 1998.

  7. 2.0 Motor Activity 1.8 1.6 1.4 (Bmax/Kd) Dopamine Transporter 1.2 1.0 7 8 9 10 11 12 13 Normal Control Time Gait (seconds) 2 Memory 1.8 1.6 1.4 Dopamine Transporter Bmax/Kd 1.2 1 16 14 12 10 8 6 4 Methamphetamine Abuser Delayed Recall p < 0.0002 (words remembered) Dopamine Transporters in Methamphetamine Abusers

  8. Cognitive and Memory Effects

  9. Differences between Stimulant and Comparison Groups on tests requiring perceptual speed

  10. Memory Difference between Stimulant and Comparison Groups

  11. Longitudinal Memory Performance number correct test

  12. Control > MA 4 3 2 1 0

  13. 5 4 3 2 1 0 MA > Control

  14. How much does the brain heal?

  15. PET Scan of Long-Term Meth Brain Damage

  16. Partial Recovery of Brain Dopamine Transporters in Methamphetamine 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.

  17. 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 161:2, February 2004.

  18. Acute and Long-Term Effects of the Methamphetamine Abuse A Quick Review:

  19. MethamphetamineAcute Physical Effects Increases • Heart rate • Blood pressure • Pupil size • Respiration • Sensory acuity • Energy Decreases • Appetite • Sleep • Reaction time

  20. Increases Confidence Alertness Mood Sex drive Energy Talkativeness Decreases Boredom Loneliness Timidity MethamphetamineAcute Psychological Effects

  21. Long-Term Effects of Methamphetamine

  22. MethamphetamineChronic Physical Effects • Tremor • Weakness • Dry mouth • Weight loss • Cough • Sinus infection • Sweating • Burned lips; sore nose • Oily skin/complexion • Headaches • Diarrhea • Anorexia

  23. MethamphetamineChronic Psychological Effects • Confusion • Concentration • Hallucinations • Fatigue • Memory loss • Insomnia • Irritability • Paranoia • Panic reactions • Depression • Anger • Psychosis

  24. Local Infections

  25. Speed Bumps Abscesses

  26. Faces of Methamphetamine Images courtesy Multnomah County Sheriff’s Office

  27. Meth Mouth • Rotting of teeth around the gums • Process may involve lack of saliva production or qualities of methamphetamine or its constituents • Smoking/snorting problems • Bruxism; Rampant caries http://www.msnbc.msn.com/id/8770112/site/newsweek/

  28. Methamphetamine and Sex

  29. Behavioral Disruption Cognitive Disruption Emotional Disruption Family/Relationship Disruption MATRIX MODEL TREATMENT Components of Stimulant Addiction Syndrome

  30. STAGES OF RECOVERY - STIMULANTS OVERVIEW DAY 180 DAY 0 DAY 15 DAY 45 DAY 120 Adjustment Honeymoon The Wall Withdrawal Resolution

  31. 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

  32. 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

  33. 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

  34. 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

  35. 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.

  36. Successful Outpatient Treatment Predictors • Employ evidence-based practices[i.e., CBT, CM, Community Reinforcement Approach, Motivational Interviewing, Matrix Model]. • Family involvement and 12-step programs appear to improve outcome. • Urine testing (at least weekly is recommended)

  37. 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.

  38. Special treatment consideration should be made for the following groups of individuals: • 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).

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

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