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

Pacific Southwest Addiction Technology Transfer Center UCLA Integrated Substance Abuse Programs

Medical Realities of Methamphetamine Use and

Recovery

Consequences to the Brain

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5050

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00 6060 120120 180180

Time (min)Time (min)

% o

f B

asal

DA

Ou

tpu

t%

of

Bas

al D

A O

utp

ut

NAc shellNAc shell

EmptyEmpty

BoxBox FeedingFeeding

Source: Di Chiara et al.Source: Di Chiara et al.

FOODFOOD

100100

150150

200200

DA

Co

nce

ntr

ati

on

(%

Bas

elin

e)D

A C

on

cen

tra

tio

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% B

asel

ine)

MountsMountsIntromissionsIntromissionsEjaculationsEjaculations

1515

00

55

1010

Co

pu

latio

n F

req

ue

nc

yC

op

ula

tion

Fre

qu

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cy

SampleNumberSampleNumber

11 22 33 44 55 66 77 88 99 1010 1111 1212 1313 1414 1515 1616 1717

ScrScrScrScrBasBasFemale 1 PresentFemale 1 Present

ScrScrFemale 2 PresentFemale 2 Present

ScrScr

Source: Fiorino and PhillipsSource: Fiorino and Phillips

SEXSEX

Natural Rewards Elevate Natural Rewards Elevate Dopamine LevelsDopamine Levels

Natural Rewards Elevate Natural Rewards Elevate Dopamine LevelsDopamine Levels

Source: Shoblock and Sullivan; Di Chiara and Imperato

Effects of Drugs on Dopamine ReleaseEffects of Drugs on Dopamine Release

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Time After CocaineTime After Cocaine

% o

f B

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lea

se

% o

f B

as

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lea

se

DADADOPACDOPACHVAHVA

AccumbensAccumbens COCAINECOCAINE

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0 1 2 3 4hrTime After Ethanol

% o

f B

as

al

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lea

se

0.250.512.5

Accumbens

0

Dose (g/kg ip)

ETHANOL

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Time After NicotineTime After Nicotine

% o

f B

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AccumbensAccumbensCaudateCaudate

NICOTINENICOTINE

Time After Methamphetamine

% B

as

al

Re

lea

se

METHAMPHETAMINE

0 1 2 3hr

1500

1000

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0

Accumbens

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

Source: McCann U.D.. et al.,Journal of Neuroscience, 18, pp. 8417-8422, October 15, 1998.

Decreased dopamine transporter binding in METH users resembles that

in Parkinson’s Disease

Control Meth PD

Dopamine Transporters in Methamphetamine Abusers

p < 0.0002p < 0.0002

Normal Control

Methamphetamine Abuser

7 8 9 10 11 12 131.0

1.2

1.4

1.6

1.8

2.0

Time Gait (seconds)

Dop

amin

e T

rans

port

er(B

max

/Kd

)

Motor Activity

468101214161

1.2

1.4

1.6

1.8

2

Delayed Recall(words remembered)

Dop

amin

e T

rans

port

erB

max

/Kd

Memory

Cognitive and

Memory Effects

Differences between Stimulant and Comparison Groups on tests requiring

perceptual speed

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Mea

n Ti

me

Digit Symbol** Trail Making A* Trail Making B**

Comparison (n=80) Stimulant (n=80)

Memory Difference between Stimulant and Comparison Groups

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Mea

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Word Recall** Picture Recall**Comparison (n=80) Meth (n=80)

Longitudinal Memory Performance

test

num

ber

corr

ect

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Word Recall WordRecognition

Picture Recall PictureRecognition

control

baseline

3 mos

6 mos

% I

mpair

ed

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60

0

10

20

30

40

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60ControlsMA Users

Learningand

Memory

Frequency of Impairment by Neuropsychological Domain

Attention/Psychomotor

Speed

WorkingMemory

Fluency Inhibition

Executive Systems Function

Control > MA

4

3

2

0

1

MA > Control

5

4

2

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1

3

How much does the brain heal?

PET Scan of Long-Term Meth Brain Damage

Partial Recovery of Brain Dopamine Transporters in MethamphetamineAbuser After Protracted Abstinence

Normal Control METH Abuser(1 month detox)

METH Abuser(24 months detox)

0

3

ml/gm

Source: Volkow, ND et al., Journal of Neuroscience 21, 9414-9418, 2001.

Control Subject(30 y/o, Female)

METH Abuser(27 y/o, Female)3 months detox

METH Abuser(27 y/o, Female)13 months detox

µmol/100g/min

70

0

Partial Recovery of Brain Metabolism in Methamphetamine (METH) Abuser

after Protracted Abstinence

Source: Wang, G-J et al., Am J Psychiatry 161:2, February 2004.

Acute and Long-Term Effects of Acute and Long-Term Effects of the Methamphetamine Abusethe Methamphetamine Abuse

A Quick Review:

MethamphetamineAcute Physical Effects

Increases Heart rate Blood pressure Pupil size Respiration Sensory acuity Energy

Decreases Appetite Sleep Reaction time

MethamphetamineAcute Psychological Effects

Increases Confidence Alertness Mood Sex drive Energy Talkativeness

Decreases Boredom Loneliness Timidity

Long-Term Effects of Methamphetamine

MethamphetamineChronic Physical Effects

Tremor Weakness Dry mouth Weight loss Cough Sinus infection

Sweating Burned lips; sore

nose Oily skin/complexion Headaches Diarrhea Anorexia

MethamphetamineChronic Psychological Effects

Confusion Concentration Hallucinations Fatigue Memory loss Insomnia

Irritability Paranoia Panic reactions Depression Anger Psychosis

Local InfectionsLocal Infections

Speed BumpsSpeed Bumps

AbscessesAbscesses

Faces of Methamphetamine

Images courtesy Multnomah County Sheriff’s Office

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/

Methamphetamine and Sex

MATRIX MODEL TREATMENT

Behavioral Disruption

Emotional Disruption

Cognitive Disruption

Family/RelationshipDisruption

Components of Stimulant

Addiction Syndrome

STAGES OF RECOVERY - STIMULANTS

OVERVIEW

Withdrawal

Honeymoon

The Wall

Adjustment

Resolution

DAY

0

DAY

15

DAY

45

DAY

120

DAY

180

Stages of Recovery - StimulantsWITHDRAWAL STAGE

DAY

0

DAY

15

•Medical Problems

•Alcohol Withdrawal

•Depression

•Difficulty Concentrating

•Severe Cravings

•Contact with Stimuli•Excessive SleepPROBLEMS

ENCOUNTERED

Stages of Recovery - StimulantsHONEYMOON STAGE

DAY

15

DAY

45

•Over-involvement With

Work

•Overconfidence

•Inability to Initiate

Change

•Inability to Prioritize

•Alcohol Use

•Episodic Cravings

•Treatment

Termination

PROBLEMSENCOUNTERED

Stages of Recovery - StimulantsTHE 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

PROBLEMSENCOUNTERED

Stages of Recovery - StimulantsADJUSTMENT 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

PROBLEMSENCOUNTERED

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.

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)

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.

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).

For more information, please contact Beth Rutkowski

at 310-445-0874 x376 or finnerty@ucla.edu

www.uclaisap.org or www.psattc.org