Methamphetamine and the Brain: What do we know? Beth Rutkowski,
M.P.H. Pacific Southwest Addiction Technology Transfer Center UCLA
Integrated Substance Abuse Programs [email protected] UCEDD ID
Grand Rounds, March 22, 2006 11:00 a.m. 12:00 p.m. Slide 2 Forms of
Methamphetamine Methamphetamine Powder Users Description:
Beige/yellowy/off-white powder Base / Paste Methamphetamine Users
Description: Oily, gunky, gluggy gel, moist, waxy Crystalline
Methamphetamine Users Description: White/clear crystals/rocks;
crushed glass / rock salt Slide 3 Primary
Amphetamine/Methamphetamine TEDS Admission Rates: 1992 (per 100,000
aged 12 and over) 35 - 58 12 - 35 < 12 No data > 58 SOURCE:
2002 SAMHSA Treatment Episode Data Set (TEDS). Slide 4 < 12 35 -
58 12 - 35 < 12 No data > 58 Primary
Amphetamine/Methamphetamine TEDS Admission Rates: 1997 (per 100,000
aged 12 and over) SOURCE: 1997 SAMHSA Treatment Episode Data Set
(TEDS). Slide 5 < 12 12 - 35 58-99 35 -58 150-199 200 or more
100-149 Primary Amphetamine/Methamphetamine TEDS Admission Rates:
2002 (per 100,000 aged 12 and over) SOURCE: 2002 SAMHSA Treatment
Episode Data Set (TEDS). Slide 6 Primary
Amphetamine/Methamphetamine TEDS Admission Rates: 2003 (per 100,000
aged 12 and over) < 12 12 - 35 58-99 35 -58 150-199 200 or more
100-149 SOURCE: 2003 SAMHSA Treatment Episode Data Set (TEDS).
Slide 7 A Major Reason People Take a Drug is they Like What It Does
to Their Brains A Major Reason People Take a Drug is they Like What
It Does to Their Brains Slide 8 Slide 9 Slide 10 Slide 11 Slide 12
synapse dopamine reservoir Slide 13 Slide 14 Slide 15
Methamphetamine Slide 16 Initially, A Person Takes A Drug Hoping to
Change their Mood, Perception, or Emotional State Initially, A
Person Takes A Drug Hoping to Change their Mood, Perception, or
Emotional State Translation--- Hoping to Change their Brain Slide
17 0 0 50 100 150 200 0 0 60 120 180 Time (min) % of Basal DA
Output NAc shell Empty Box Feeding Source: Di Chiara et al. FOOD
Natural Rewards Elevate Dopamine Levels Slide 18 Source: Shoblock
and Sullivan; Di Chiara and Imperato Effects of Drugs on Dopamine
Release 0 0 100 200 300 400 Time After Cocaine % of Basal Release
DA DOPAC HVA Accumbens COCAINE 100 150 200 250 01234hr Time After
Ethanol % of Basal Release 0.25 0.5 1 2.5 Accumbens 0 Dose (g/kg
ip) ETHANOL 0 0 100 150 200 250 0 0 1 1 2 2 3 hr Time After
Nicotine % of Basal Release Accumbens Caudate NICOTINE Time After
Methamphetamine % Basal Release METHAMPHETAMINE 0123hr 1500 1000
500 0 Accumbens Slide 19 After A Person Uses Drugs For A While, Why
Cant They Just Stop? After A Person Uses Drugs For A While, Why
Cant They Just Stop? But Then Slide 20 Their Brains have been
Re-Wired by Drug Use Their Brains have been Re-Wired by Drug Use
Because Slide 21 Prolonged Drug Use Changes the Brain In
Fundamental and Long-Lasting Ways Slide 22 PET Scan of Long-Term
Impact of Methamphetamine on the Brain Slide 23 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 patients Slide 24 Control
> MA 4 3 2 0 1 Slide 25 MA > Control 5 4 2 0 1 3 Slide 26
Dopamine Transporters in Methamphetamine Abusers p < 0.0002
Normal Control Methamphetamine Abuser 78910111213 1.0 1.2 1.4 1.6
1.8 2.0 Time Gait(seconds) Dopamine Transporter (Bmax/Kd)
46810121416 1 1.2 1.4 1.6 1.8 2 Delayed Recall (words remembered)
Dopamine Transporter Bmax/Kd Motor Activity Memory Slide 27
Cognitive Impairment in Individuals Currently Using Methamphetamine
Sara Simon, Ph.D. VA MDRU Matrix Institute on Addictions LAARC
Slide 28 Differences between Stimulant and Comparison Groups on
tests requiring perceptual speed Slide 29 Memory Difference between
Stimulant and Comparison Groups Slide 30 Longitudinal Memory
Performance test number correct Slide 31 How much does the brain
heal? Slide 32 PET Scan of Long-Term Meth Brain Damage Slide 33
Partial Recovery of Brain Dopamine Transporters in Methamphetamine
(METH) Abuser 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. Slide 34 Control Subject (30 y/o, Female) METH Abuser (27
y/o, Female) 3 months detox METH Abuser (27 y/o, Female) 13 months
detox mol/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. Slide 35
Effects of Methamphetamine and Treatment Implications Slide 36
Methamphetamine Acute Physical Effects Increases Decreases Heart
rate Appetite Blood pressure Sleep Pupil size Reaction time
Respiration Sensory acuity Energy Slide 37 Methamphetamine Acute
Psychological Effects Increases Confidence Alertness Mood Sex drive
Energy Talkativeness Decreases Boredom Loneliness Timidity Slide 38
Methamphetamine Chronic Physical Effects -Tremor - Sweating -
Weakness - Burned lips; sore nose - Dry mouth - Oily
skin/complexion - Weight loss - Headaches - Cough - Diarrhea -
Sinus infection - Anorexia Slide 39 Methamphetamine Chronic
Psychological Effects - Confusion - Irritability - Concentration -
Paranoia - Hallucinations - Panic reactions - Fatigue - Depression
- Memory loss - Anger - Insomnia - Psychosis Slide 40 Other
problems Eye ulcers Over-heating Rhabdomyolysis Obstetric
complications Anorexia / weight loss Slide 41 Severe weight
loss/anorexia Slide 42 Faces of Methamphetamine Speed Bumps Images
courtesy Multnomah County Sheriffs Office Slide 43 Source: The New
York Times, June 11, 2005. METH Mouth METH Use Leads to Severe
Tooth Decay Source: Richards, JR and Brofeldt, BT, J
Periodontology, August 2000. Source: Richards, JR and Brofeldt, BT,
J Periodontology, August 2000. Slide 44 Slide 45 Methamphetamine
Psychiatric Consequences Paranoid reactions Permanent memory loss
Depressive reactions Hallucinations Psychotic reactions Panic
disorders Rapid addiction Slide 46 Outpatient Treatment for
Methamphetamine Abuse Slide 47 www.drugabuse.gov Slide 48
Treatment: Medical & Behavioral Drugs Sedatives Stimulants
Opioids Alcohol Medical Treatment Yes No Yes Behavioral Treatment
Yes Slide 49 MATRIX MODEL TREATMENT Primary Manifestation of
Withdrawal Stage BehavioralCognitive RelationshipEmotional
Behavioral Inconsistency Confusion Inability to Concentrate
Depression/Anxiety- Self-Doubt Mutual Hostility- Fear Slide 50
STAGES OF RECOVERY - STIMULANTS OVERVIEW Withdrawal Honeymoon The
Wall Adjustment Resolution DAY 0 DAY 15 DAY 45 DAY 120 DAY 180
Slide 51 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 Slide 52 Matrix Model Treatment Key Concept:
Structure Self-designed structure (scheduling) Eliminate avoidable
triggers Makes concrete the concept of One day at a time Reduces
anxiety Counters the addict lifestyle Provides basic foundation for
ongoing recovery Slide 53 MATRIX MODEL TREATMENT STRUCTURE
Treatment Program Activities Recreational/Leisure Activities
12-Step Meetings School SportsBeing with Drug-free Friends Time
SchedulingExercise WorkFamily-related Events Church/SynagogueIsland
Building Slide 54 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 Slide 55 Return
to Old Behaviors Anhedonia Anger Depression Emotional Swings
Unclear Thinking Isolation Family Problems Cravings Return
Irritability Abstinence Violation Slide 56 Relationship Problems
Boredom Lack of Goals Guilt and Shame Career Dissatisfaction
Underlying Psychopathology May Surface or Resurface Slide 57
Achieving a Balanced Life Work Recovery Activities Sleep Leisure
Relationships Slide 58 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. Slide 59 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. Employ evidence based practice
(e.g., CBT, CM, Community Reinforcement Approach, Motivational
Interviewing, Matrix Model). Family involvement and 12-step program
appear to improve outcome. Urine testing (at least weekly is
mandatory) Slide 60 Optimal candidates for Outpatient Treatment
Include: Those who do not inject MA. Those without chronic mental
illness and those without significant psychiatric symptoms at
admission. Those who are using MA less than daily at admission.
Those under legal supervision (especially drug court). Older
individuals (over 21)Those who are not disabled. Those who have a
stable living situation (without active drug users). Slide 61
Special Treatment Consideration Should be Made for the Following
Groups of Individuals: 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).
Slide 62 For more information, please contact Beth Rutkowski at
310-445-0874 x376 or [email protected] www.uclaisap.org or
www.psattc.org
