“METHAMPHETAMINE USE: REASONS, RISKS, AND PRACTICAL INTERVENTIONS”: “METHAMPHETAMINE USE: REASONS, RISKS, AND PRACTICAL INTERVENTIONS” presented by: Neva Chauppette, Psy.D. P.O. Box 6234, Woodland Hills, CA 91365-6234 CA Psychologist License # PSY14524 (818) 680-0234 (voicemail/pager)- (818) 439-7080 (cell) - (818) 703-1854 (fax) NCHAUPPETT@aol.com (E-Mail)


Slide2: ROUTES OF ADMINISTRATION FIVE ROUTES LISTED IN DESCENDING ORDER: 1) Inhaling -- (7 to 10 seconds) 2) Injecting -- (15-30 secs.) intravenously (IV or slamming) (3-5 mins.) intramuscular (IM or muscling) (3-5 mins.) subcutaneously (skin popping) 3) Snorting -- (3-5 minutes) mucosal exposure 4) Contact -- (3-5 minutes) "dropping acid" (10-15 minutes) morphine suppositories 5) Oral -- (20-30 minutes)


ICE (aka crystal, meth, ice, JIB, glass, Tina, P, etc.): ICE (aka crystal, meth, ice, JIB, glass, Tina, P, etc.) Classification: Central Nervous System stimulant type: Synthetic Illegal. It is a freebase form of methamphetamine. It is odorless, colorless, resembles rock salt or a chip of ice or quartz rock.


ICE (aka crystal, meth, ice, JIB, glass, Tina, P, etc.): ICE (aka crystal, meth, ice, JIB, glass, Tina, P, etc.) Method of use: Inhaled by smoking Duration of action: 8 – 24 hours Detection in urine screening: 48-72 hours – 2-3 days


ICE (aka crystal, meth, ice, JIB, glass, Tina, P, etc.): ICE (aka crystal, meth, ice, JIB, glass, Tina, P, etc.) At a low dose: Increased alertness, wakefulness, elevation of mood, mild euphoria, increase in athletic performance, decrease in fatigue, increased energy, or may cause increased irritability, restlessness, insomnia, anxiety, panic.


ICE (aka crystal, meth, ice, JIB, glass, Tina, P, etc.): ICE (aka crystal, meth, ice, JIB, glass, Tina, P, etc.) At a high dose: Euphoria, can induce a pattern of psychosis marked by confused, disorganized behaviors, irritability, fear, paranoia, hallucinations, increased aggressiveness and antisocial behaviors. Note: Violence and hostility are more severe.


ICE (aka crystal, meth, ice, JIB, glass, Tina, P, etc.): ICE (aka crystal, meth, ice, JIB, glass, Tina, P, etc.) Physical symptoms: Puts body in “overdrive”, increased pulse, blood pressure, respiration, and temperature, and dilate pupils. Can cause a stroke, heart attack, or kidney failure.


ICE (aka crystal, meth, ice, JIB, glass, Tina, P, etc.): ICE (aka crystal, meth, ice, JIB, glass, Tina, P, etc.) Withdrawal symptoms: Disorientation, confusion, apathy, irritability, itching, depression that may be so severe that suicide occurs. Long periods of sleep and increased appetite occurs because while the user was on a “run” taking drugs for one or more days they did not sleep or eat.


ICE (aka crystal, meth, ice, JIB, glass, Tina, P, etc.): ICE (aka crystal, meth, ice, JIB, glass, Tina, P, etc.) In some cases more severe with hallucinations, paranoid ideation and toxic psychosis. Recovery from psychosis may be complete; for some, however, there has been no improvement after 2 years with medications. Overdose: Agitation, hostility, hallucinations, convulsions, high temperature, possible death.


POWDER(aka Crank, speed, glass, hot ice, among other slang terms): POWDER (aka Crank, speed, glass, hot ice, among other slang terms) Classification: Central Nervous System Stimulant Type: Synthetic Illegal - Methamphetamine is amphetamine to which 1 methyl group has been added thus it is more potent and can cross the blood brain barrier more rapidly than amphetamine. May be cut with toxic substances like cyanide or strychnine


POWDER(aka Crank, speed, glass, hot ice, among other slang terms): POWDER (aka Crank, speed, glass, hot ice, among other slang terms) Method of use: Intravenous, snorting Duration of Action: 4-6 hours Detection in Urine Screening: 48-72 hours after use (2-3 days)


POWDER(aka Crank, speed, glass, hot ice, among other slang terms): POWDER (aka Crank, speed, glass, hot ice, among other slang terms) At a low dose: Increased alertness, wakefulness, elevation of mood, mild euphoria, increase in athletic performance, decrease in fatigue, increased energy, or may cause increased irritability, restlessness, insomnia, anxiety, panic.


POWDER (aka Crank, speed, glass, hot ice, among other slang terms): POWDER (aka Crank, speed, glass, hot ice, among other slang terms) At a high dose: Euphoria, can induce a pattern of psychosis marked by confused, disorganized behaviors, irritability, fear, paranoia, hallucinations, increased aggressiveness and antisocial behaviors.


POWDER (aka Crank, speed, glass, hot ice, among other slang terms): POWDER (aka Crank, speed, glass, hot ice, among other slang terms) Physical symptoms: Puts body in “overdrive”, increased pulse, blood pressure, respiration, and temperature, and dilate pupils. Can cause a stroke, heart attack, or kidney failure.


POWDER(aka Crank, speed, glass, hot ice, among other slang terms): POWDER (aka Crank, speed, glass, hot ice, among other slang terms) Withdrawal symptoms: Disorientation, confusion, apathy, irritability, itching, depression that may be so severe that suicide occurs. Long periods of sleep and increased appetite occurs because while the user was on a “run” taking drugs for one or more days they did not sleep or eat. Overdose: Agitation, hostility, hallucinations, convulsions, high temperature, possible death.


Slide16: Chronic methamphetamine abusers exhibit symptoms that can include violent behavior, anxiety, confusion, and insomnia. They also can display a number of psychotic features, including paranoia, auditory hallucinations, mood disturbances, and delusions (for example, the sensation of insects crawling/running on the skin – also known as formication). The paranoia can result in suicidal and homicidal thoughts.


DENTAL HEALTH: DENTAL HEALTH Reduced blood supply causes tissues to break down With repeated shrinking, the blood vessels don’t recover and tissues die Causes dry mouth. Saliva neutralizes acids in the mouth. Less saliva means more acid. Acid eats away at the minerals in tooth enamel and cause holes or weak spots that turn into cavities.


RESPIRATORY SYSTEM: RESPIRATORY SYSTEM Crystal relaxes air passages and opens them up This increases the intake of oxygen so that the body can fight harder or run faster Materials used to cut crystal can block blood vessels in the lungs Long term use can permanently reduce the amount of air the lungs can take in


CIRCULATORY SYSTEM: CIRCULATORY SYSTEM The “rush” and “high” begin when the drug reaches the brain The heart beats faster and harder Veins and arteries constrict (get smaller) Smaller veins and arteries reduce blood flow and increase blood pressure


CIRCULATORY SYSTEM: CIRCULATORY SYSTEM The blood clots more easily to stop bleeding. (The body has the perception that it might be hurt/injured) Issues to consider: Heart beat gets out of rhythm High blood pressure can lead to increased risk of heart attack Germs (from injecting) can infect the lining of the heart (endocarditis)


KIDNEYS: KIDNEYS The kidneys filter the blood and get rid of fluid wastes through urine. Crystal is filtered by, then excreted through the kidneys. They also balance the acid level in the body’s fluids. Issues to consider: Crystal constricts blood vessels in the kidneys With less blood flow, the kidneys produce less urine


KIDNEYS: KIDNEYS Issues to consider: Toxic wastes get recycled back into the bloodstream When toxic blood reaches the brain, the person can get headaches and get confused Urine becomes very concentrated and sits in the bladder. This can result in bladder infections. The kidneys can get inflamed.


Slide27: CO-OCCURRING PSYCHIATRIC DISORDERS


BULIMIA: BULIMIA Why an eating disorder? Need for control Excessively preoccupied with body size and shape Meets the individual’s needs (inappropriate desired results of body size/shape) in an accelerated, often dangerous way.


BULIMIA: BULIMIA Bulimia is characterized by a secretive cycle of binge eating followed by purging. Bulimia includes eating large amounts of food--more than most people would eat in one meal--in short periods of time, then getting rid of the food and calories through vomiting, laxative abuse, or over-exercising.


BULIMIA: BULIMIA Symptoms include: Repeated episodes of binging and purging Feeling out of control during a binge and eating beyond the point of comfortable fullness Purging after a binge, (typically by self-induced vomiting, abuse of laxatives, diet pills and/or diuretics, excessive exercise, or fasting) Frequent dieting Extreme concern with body weight and shape


Slide31: SEX ADDICTION


Ten Signs of Sexual Addiction: Ten Signs of Sexual Addiction Out of control behavior escalating frequency escalating dangerousness


Ten Signs of Sexual Addiction: Ten Signs of Sexual Addiction Consequences - escalating and compounding consequences impaired or decreased job performance due to preoccupation, absenteeism STD, unwanted pregnancies


Ten Signs of Sexual Addiction: Ten Signs of Sexual Addiction possible arrests - lewd/lascivious conduct marital/monogamous relationships are jeopardized/lost


Ten Signs of Sexual Addiction: Ten Signs of Sexual Addiction Inability to stop - self perpetuation of behavior once guilt and shame are fused Self-destructive or high risk - as frequency of "using" goes up, so too does the need for drama; danger to add to the "rush"


Ten Signs of Sexual Addiction: Ten Signs of Sexual Addiction Effort/desire to limit the sexual behavior - limit sexual behavior to only certain types, with certain partners, etc. Sexual obsession/fantasy - when things are uncomfortable or problematic, this is the mental place sex addicts go to


Ten Signs of Sexual Addiction: Ten Signs of Sexual Addiction Increased amounts - it is equivalent to physiological need (tolerance) and the desire to achieve the same effect can only be reached with increasing frequency, intensity, etc. of acts Mood swings - sex is used as a fix to alter "bad" mood states but ultimately is bad itself due to the guilt/shame


Ten Signs of Sexual Addiction: Ten Signs of Sexual Addiction Increased time - preoccupation with obtaining, using and recovering from sexual fix Neglect - as disease progresses, so does the pervasiveness of the neglect


PSYCHOSIS: PSYCHOSIS The essential features of a substance-induced psychotic disorder are prominent hallucinations or delusions that are judged to be due to the direct physiological effects of a substance (i.e., methamphetamine).


PSYCHOSIS: PSYCHOSIS Psychotic disorders can occur in association with intoxication with various types of substances such as alcohol, amphetamine and related substances (methamphetamine); cannabis, cocaine, hallucinogens, inhalants; opiods, sedatives, hypnotics, and anxiolytics.


PSYCHOSIS: PSYCHOSIS Psychotic disorders can occur in association with withdrawal from the following classes of substances: alcohol, sedatives, hypnotics, and anxiolytics. For example, smoking a high dose of cocaine may produce psychosis within minutes, whereas days or weeks of high dose alcohol or sedative use may be required to produce psychosis. Hallucinations may occur in any modality.


PSYCHOSIS: PSYCHOSIS Psychotic disorders induced by intoxication with methamphetamine and cocaine share similar clinical features. Persecutory delusions may rapidly develop shortly after use of the drug. Distortion of body image and misperception of people’s faces may occur. The hallucination of bugs or vermin crawling in or under the skin (formication) can lead to scratching and extensive skin damage.


PSYCHOSIS: PSYCHOSIS Substances such as methamphetamine have been reported to evoke temporary psychotic states that can sometimes persist for weeks or longer despite abstinence and treatment with neuroleptics.


PSYCHOSIS: PSYCHOSIS For drugs of abuse, there must be evidence from history, physical examination, or laboratory findings of intoxication or withdrawal. Once initiated, the psychotic symptoms may continue as long as the substance use continues. Because the withdrawal state can vary, the onset of psychotic symptoms can occur up to 4 weeks after the cessation of substance use (American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition. Washington, DC, American Psychiatric Association)


TREATMENT INTERVENTIONS: TREATMENT INTERVENTIONS Cognitive behavioral interventions: At this time the most effective treatments for methamphetamine addiction are cognitive behavioral interventions. These approaches are designed to help modify the patient's thinking, expectancies, and behaviors and to increase skills in coping with various life stressors.


TREATMENT INTERVENTIONS: TREATMENT INTERVENTIONS Support groups: Recovery support groups also appear to be effective adjuncts to behavioral interventions that can lead to long-term drug-free recovery.


TREATMENT INTERVENTIONS: TREATMENT INTERVENTIONS Pharmacological approaches: There are currently no particular pharmacological treatments for dependence on amphetamine or amphetamine-like drugs such as methamphetamine. The current pharmacological approach is borrowed from experience with treatment of cocaine dependence.


TREATMENT INTERVENTIONS: TREATMENT INTERVENTIONS Medications for cocaine dependence: Amantadine (Symmetrel) and propranolol (Inderal) appear promising for the treatment of patients who present with cocaine withdrawal symptoms. This may have indications for treatment of methamphetamine dependence.


TREATMENT INTERVENTIONS: TREATMENT INTERVENTIONS Antedepressant medications are helpful in combating the depressive symptoms frequently seen in methamphetamine users who recently have become abstinent.


TREATMENT INTERVENTIONS: TREATMENT INTERVENTIONS Overdose: There are some established protocols that emergency room physicians use to treat individuals who have had a methamphetamine overdose. Because hyperthermia and convulsions are common and often fatal complications of such overdoses, emergency room treatment focuses on the immediate physical symptoms. Overdose patients are cooled off in ice baths, and anticonvulsant drugs may be administered also.


STAGES OF CHANGE MODEL: STAGES OF CHANGE MODEL  Precontemplation  may/may not be aware of need to change; avoids topic; knows little about it   Contemplation  considers increasing the advantages and decreasing the disadvantages of change   Preparation  making a commitment to change and creating a plan   Action  implementing the plan; revising the plan as needed; may relapse   Maintenance continue to make significant changes (that were implemented during the action stage); the changes becomes more habitual; implement strategies to assist in the prevention of slips or relapse Relapse part of the change process; can be used as a learning tool via behavioral analysis Adapted from Prochaska and DiClemente, 1984,2002


RESOURCES: RESOURCES  http://www.crystalmeth.org/ Crystal Meth Anonymous is a fellowship of men and women for whom all drugs, specifically Crystal Meth, have become a problem. The only requirement for membership is a desire to stay clean and lead a sober life. There are no dues or membership lists – each group is expected to be self-supporting through its own contributions.  http://www.soberrecovery.com/links/crystalmeth.html Drug Addiction Alcoholism Help and Information -- Dual Diagnosis | Sober Living | Bi-Polar | Opiate Detox--12 Step Groups | Troubled Teens | Treatment Programs


RESOURCES: RESOURCES http://www.drug-rehabilitation.com/resources.htm Support Systems Homes drug and alcohol rehabilitation programs offer a wide range of substance abuse treatment services. Accredited, state licensed alcohol and drug detoxification, residential drug and alcohol treatment, day and outpatient substance abuse treatment programs, and have 18 sober living environments located throughout California.


RESOURCES: RESOURCES  http://www.crystalrecovery.com  http://www.drugandalcoholrehab.net/methamphetamine.htm Methamphetamine addiction treatment centers and methamphetamine rehabilitation programs offering comprehensive rehabilitation programs for methamphetamine addiction and methamphetamine abuse.


RESOURCES: RESOURCES National Council on Sexaholics Anonymous Sexual Addiction & P.O. Box 300 Compulsivity Simi Valley, CA 93062 770-989-9754 (805) 581-3343 or www.ncsac.org (213) 480-1096 Sex & Love Addicts Recovering Couples Anonymous Anonymous P.O.Box 338, New Town Branch c/o General Services Norwood, MA 02062 P.O. Box 11872 323) 957-4881 St. Louis, MO 63105 www.slaafws.org (314) 830-2600 (toll-free: 877-742-7349 ext.1234) www.sexhelp.com Culver City: 310-322-7857 (Dr. Patrick Carnes) www.recovering-couples.org


RESOURCES: Recovery Online www.onlinerecovery.org/index.html www.cybersexualaddiction.com Sex Addicts Anonymous P.O. Box 70749 Houston, TX 77270 (713) 869-4902 or (213) 896-2964 loc www.sexaa.org S-Anon International Sexual Compulsives Anonymous 170 Sunset Blvd. # 520 4391 Sunset Blvd. Suite P.O. Box 5117 Los Angeles, CA 90029 Sherman Oaks, CA 91413 (310) 859-5585 (818) 990-6910 www.sca-recovery.org www.sanon.org RESOURCES