Beth Rutkowski, M.P.H. finnerty@ucla
description
Transcript of Beth Rutkowski, M.P.H. finnerty@ucla
Beth Rutkowski, [email protected]
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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Source: Di Chiara et al.Source: Di Chiara et al.
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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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AccumbensAccumbens COCAINECOCAINE
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ETHANOL
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NICOTINENICOTINE
Time After Methamphetamine
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METHAMPHETAMINE
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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
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Delayed Recall(words remembered)
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Memory
Cognitive and
Memory Effects
Differences between Stimulant and Comparison Groups on tests requiring
perceptual speed
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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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Word Recall** Picture Recall**Comparison (n=80) Meth (n=80)
Longitudinal Memory Performance
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Word Recall WordRecognition
Picture Recall PictureRecognition
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Learningand
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Frequency of Impairment by Neuropsychological Domain
Attention/Psychomotor
Speed
WorkingMemory
Fluency Inhibition
Executive Systems Function
Control > MA
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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)
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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
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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
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Stages of Recovery - StimulantsWITHDRAWAL STAGE
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•Medical Problems
•Alcohol Withdrawal
•Depression
•Difficulty Concentrating
•Severe Cravings
•Contact with Stimuli•Excessive SleepPROBLEMS
ENCOUNTERED
Stages of Recovery - StimulantsHONEYMOON STAGE
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•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
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•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
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•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 [email protected]
www.uclaisap.org or www.psattc.org