LOVE IN THE TIME OF CRYSTAL METHAMPHETAMINE

1. LOVE IN THE TIME OFCRYSTAL METHAMPHETAMINE World Psychiatric Association Athens, Greece March 15, 2005 Petros Levounis, M.D. Director, The Addiction Institute of New York Chief, Division of Addiction Psychiatry at St. Luke’s and Roosevelt Hospitals www.AddictionInstituteNY.org

5. OUTLINE • The Biology of Methamphetamine • Epidemiology • The Crystal-HIV Connection • Treatment • The Public Health Campaign

6. 1. THE BIOLOGY OF METHAMPHETAMINE

7. Effects of Drugs on Dopamine Levels 250 ETHANOL Accumbens Dose (g/kg ip) 200 0.25 0.5 1 2.5 % of Basal Release 150 0 1 2 3 hr 0 1 2 3 4 5 hr 100 0 0 1 2 3 4hr Time After Ethanol COCAINE AMPHETAMINE Accumbens 1100 Accumbens 400 1000 900 DA 800 DA 300 700 % of Basal Release 600 % of Basal Release 500 200 400 300 100 200 100 0 0 0 1 2 3 4 5 hr Time After Amphetamine Time After Cocaine NICOTINE 250 Accumbens 200 DA 150 % of Basal Release 100 0 Time After Nicotine Source: Di Chiara and Imperato

8. COCAINE Inhibits the reuptake of synaptic dopamine METH Inhibits the reuptake of synaptic dopamine Promotes dopamine release COCAINE vs. METH [1]

9. COCAINE Metabolizes rapidly Effects last 1-2 hours Withdrawal can last 1-2 days METH Metabolizes slowly Effects last several hours Withdrawal can last several days COCAINE vs. METH [2]

10. 2. EPIDEMIOLOGY

11. STATISTICS • In 2002: • 12 million US residents used methamphetamine at least once in their lifetime. • 600,000 US residents used methamphetamine in the past month. • 18,000 ER drug mentions (13,500 in 2000) • In 2003: • 6% of 12th graders had used methamphetamine in their lifetime.

12. DEMOGRAPHICS • 1980s: West and Southwest Blue collar workers • 1990s: Midwest Gay men, athletes, students • 2000s: East • 2004: Epidemic proportions in the NYC Gay Community

13. 3. THE CRYSTAL – HIV CONNECTION

14. THE BASIC PATHWAY 1. Crystal intoxication 2. Extreme sexual arousal 3. Decreased inhibitions/judgment Plus Increased sensation seeking 4. Unsafe sex/barebacking 5. HIV transmission

15. CRYSTAL & SILDENAFIL • The “crystal dick” problem • In 1998, Viagra became commercially available. • Since 1999, new diagnoses of HIV in men having sex with men have increased almost 18%.

16. CRYSTAL & THE INTERNET • Sex, both virtual and real, both safe and unsafe, is only a click away. • Lingo: • PNP = Party (drugs) and Play (sex) • Chem Friendly = Drugs • Barebacking = BB = Unprotected anal sex • In the Raw = Unprotected anal sex • Manhunt.com, Gay.com, Gaydar.com, Match.com, etc., etc., etc.

17. 4. TREATMENT

18. NIDA RECOMMENDATIONS • Cognitive Behavioral Therapy (CBT) • The Matrix Model • Relapse Prevention • Methamphetamine recovery support groups • Motivational Interviewing • CSAT TIP #33, available from www.samhsa.gov

19. PSYCHOPHARMACOLOGY • No proven psychopharmacological interventions that reduce cravings associated with stimulants. • ? Vigabatrin • Gamma-Vinyl GABA [GVG] • 16/18 subjects tested negative for methamphetamine during the last six weeks of the trial. (Synapse. 2004;55:122-125)

20. Dr. Jeffrey Guss:Sex Like You Can’t Imagine

21. CRYSTALPSYCHOTHERAPY • “There is pressure to show how life can be exciting in sobriety. Sobriety for the patient becomes a dreary foreign land, to which he feels exiled, sent away from the marvelous party by his own doing, and resenting the look of the new landscape. He wonders if the therapist’s life is one worth identifying with.”

22. 5. THE PUBLIC HEALTH CAMPAIGN

23. THE BASIC MESSAGE

24. SCARE TACTICS

25. THE FACTS

26. CRYSTAL GUIDE BOOK

27. THE MESSAGE IN SPANISH

28. CRYSTAL FREE AND SEXY

29. HARM REDUCTION • Harm Reduction as Moderation Management • Harm Reduction as Reduction of Medical Consequences • The curse of the word “Abstinence”

30. CRYSTAL CLEAR PROJECT at The Addiction Institute