Methamphetamine: How it Influences the Brain and Behavior of Users

1. 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@mednet.ucla.edu Supported by: National Institute on Drug Abuse (NIDA) Pacific Southwest Technology Transfer Center (SAMHSA)

2. 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.

3. 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

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

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

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

7. MethamphetamineChronic Physical Effects - Tremor - Sweating - Weakness - Burned lips; sore nose - Dry mouth - Oily skin/complexion - Weight loss - Headaches - Cough - Dental Problems - Sinus infection - Anorexia

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

9. Treatment Options

10. 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

11. 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.

12. 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)

13. 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.

14. 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).

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

17. 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

19. Baseline Demographics

20. Changes from Baseline to Treatment-end

21. Days of Methamphetamine Use in Past 30 (ASI)

22. Beck Depression Inventory (BDI) Total Scores

27. 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

28. 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 infant�s cry. Lester et al 2005

29. Methamphetamine Methamphetamine and Sex

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31. My sexual pleasure is enhanced by the use of �

32. My sexual performance is improved by the use of �

34. 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.

35. Neurocognitive Consequences of Methamphetamine Dependence:Abstinent Users Impairments observed in the following domains: Attention/concentration Learning and Memory Motor/Psychomotor Speed Executive Systems Functioning

36. Methamphetamine Gender Differences Women�s Issues Craving

40. Methamphetamine Route of Administration

41. Route of Methamphetamine Administration Smoking (SM) was the most common route of MA administration (n=632, 65%), followed by injecting (IDU) (n=228, 23.4%) and intranasal (IN) (n=113, 11.6%). Smoking (SM) was the most common route of MA administration (n=632, 65%), followed by injecting (IDU) (n=228, 23.4%) and intranasal (IN) (n=113, 11.6%).

42. Route of Administration by Site

43. Craving by Route Results showed that MA cravings at treatment entry significantly differed by route of administration, with INs reporting the lowest level of craving: 63% of IN users reported having no craving for MA at baseline, while (53%) of SMs and (49%) of IDUs reported having no cravings at baseline (x2=6.266, p=.044). These data are consistent with anecdotal reports by participants that snorting is associated with less craving than smoking or injecting routes. Results showed that MA cravings at treatment entry significantly differed by route of administration, with INs reporting the lowest level of craving: 63% of IN users reported having no craving for MA at baseline, while (53%) of SMs and (49%) of IDUs reported having no cravings at baseline (x2=6.266, p=.044). These data are consistent with anecdotal reports by participants that snorting is associated with less craving than smoking or injecting routes.

44. Treatment Length by Route Results show that the average number of weeks retained in treatment differed significantly by route of administration, with IDUs and SMs having shorter mean lengths of stay in treatment (5.6 and 6 weeks) than INs (9 weeks). Results show that the average number of weeks retained in treatment differed significantly by route of administration, with IDUs and SMs having shorter mean lengths of stay in treatment (5.6 and 6 weeks) than INs (9 weeks).

45. MA-Free Samples by Route Results also showed that the percentage of participants who provided MA-free samples for at least three consecutive weeks was highest for INs compared to SMs and IDUs (.61+49, .40 +49, and .35 +.48; F=11.376; p=.000). Results also showed that the percentage of participants who provided MA-free samples for at least three consecutive weeks was highest for INs compared to SMs and IDUs (.61+49, .40 +49, and .35 +.48; F=11.376; p=.000).

46. BSI Psychiatric Symptoms by Route Results from the BSI show that IDUs were more psychologically impaired across all nine dimensions and three global indices of the BSI before entering treatment and after exiting tx compared to SMs and INs The Brief Symptom Inventory (BSI) is a 53-item self-report symptom inventory used to assess psychological symptoms across nine dimensions and three global indices of distress. The nine symptom dimensions include: somatization, obsessive-compulsive, interpersonal sensitivity, depression, anxiety, hostility, phobic anxiety, paranoid ideation, and psychoticism, and the three global indices include: the Global Severity Index (measuring overall psychological distress level), the Positive Symptom Distress Index (measuring the intensity of symptoms), and the Positive Symptom Total (measuring the number of self-reported symptoms).Results from the BSI show that IDUs were more psychologically impaired across all nine dimensions and three global indices of the BSI before entering treatment and after exiting tx compared to SMs and INs The Brief Symptom Inventory (BSI) is a 53-item self-report symptom inventory used to assess psychological symptoms across nine dimensions and three global indices of distress. The nine symptom dimensions include: somatization, obsessive-compulsive, interpersonal sensitivity, depression, anxiety, hostility, phobic anxiety, paranoid ideation, and psychoticism, and the three global indices include: the Global Severity Index (measuring overall psychological distress level), the Positive Symptom Distress Index (measuring the intensity of symptoms), and the Positive Symptom Total (measuring the number of self-reported symptoms).

47. Hepatitis C by Route To date, three-year follow-up medical testing data reveal that approximately 28 of the 979 MA users are carriers of the Hepatitis C virus. Results showed that these rates of Hepatitis C significantly differed by route of administration, such that the majority of Hepatitis C cases were diagnosed among injectors (74.1%; n=21, compared to smokers (22.2%; n=6) and intranasal users (3.7%; n=1).To date, three-year follow-up medical testing data reveal that approximately 28 of the 979 MA users are carriers of the Hepatitis C virus. Results showed that these rates of Hepatitis C significantly differed by route of administration, such that the majority of Hepatitis C cases were diagnosed among injectors (74.1%; n=21, compared to smokers (22.2%; n=6) and intranasal users (3.7%; n=1).