Crystal meth withdrawal – It’s not like heroin, but don’t expect it to be easy

Heroin, or opiate, withdrawal symptoms is the gold standard of addiction withdrawal. Imagine the worst flu of your life, multiply it by 1000, and then imagine knowing that taking a hit of this stuff will make it all better. Think sweats, fever, shaking, diarrhea, and vomiting. Think excruciating pain throughout as your pain sensors get turned back on after being blocked for way too long. Now you have an abstract idea of the hell and it’s no wonder why heroin withdrawal has become the one every other withdrawal is judged against.

Crystal meth withdrawal

Withdrawing from crystal meth use is nothing like opiate withdrawal and there’s no reason that the withdrawal symptoms should be. Opiates play a significant role in pain modulation and opioid receptors are present in peripheral systems in the body, which is the reason for the stomach aches, nausea, and diarrhea. Dopamine receptors just don’t play those roles in the body and brain, so withdrawal shouldn’t be expected to have the same effect.

But dopamine is still a very important neurotransmitter and quitting a drug  that has driven up dopamine release for a long time should be expected to leave behind some pain, and it does.

One of the important functions of dopamine is in signaling reward activity. When a dopamine spike happens in a specific area of the brain (called the NAc), it signifies that whatever is happening at that moment is “surprisingly” good. The parentheses are there to remind you that the brain doesn’t really get surprised, but the dopamine spike is like a reward signal detector, when it goes up, good things are happening.

Well guess what? During crystal meth withdrawal, when a crystal-meth user stops using meth, the levels of dopamine in the brain go down. To make matters worse, the long-term meth use has caused a decrease in the number of dopamine receptors available which means there’s not only less dopamine, but fewer receptors to activate. It’s not a surprise than that people who quit meth find themselves in a state of anhedonia, or an inability to feel pleasure. Once again, unlike the heroin withdrawal symptoms, anhedonia doesn’t make you throw up and sweat, but it’s a pretty horrible state to be in. Things that bring a smile to a normal person’s face just don’t work on most crystal-meth addicts who are new to recovery. As if that wasn’t bad enough, it can take as long as two years of staying clean for the dopamine function of an ex meth-addict to look anything like a normal person’s.

This anhedonia state can often lead to relapse in newly recovered addicts who are simply too depressed to go on living without a drug that they know can bring back a sense of normalcy to their life. The use of crystal-meth causes the sought-after spike in dopamine levels that helps relieve that anhedonic state.

When it comes to more physiological sort of withdrawal symptoms, the meth addict doesn’t have it that bad, I guess. After an extended period of sleep deprivation and appetite suppression that are some of the most predictable effect of meth, the average addict will do little more than sleep and eat for the first week, or even two, after quitting the drug. Many addicts experience substantial weight gain during this period as their metabolism slows and their caloric intake increases greatly. Like everything else, this too shall pass. With time, most addicts’ metabolism return to pre-use levels and their appetite catches up and returns to normal as well. Still, there’s no doubt that a little exercise can help many addicts in early recovery steer their bodies back on track.

There’s some research being talked about around the UCLA circles to see if detoxification from meth may help people do better in treatment for meth addiction by reducing the impact of their withdrawal. Detox before addiction treatment is an accepted fact in opiate and benzodiazepine addiction, but because of the supposedly “light” nature of crystal meth withdrawal, it’s been ignored. Hopefully by now, you realize that was a mistake.

Am I an addict? A simple new test may help us get the answer!

Originally posted on Psychology Today:

One of the biggest problems with addiction is that we never know who is truly an addict. Yes, we have tests and notions, interviews and criteria, but all of those are simply tools we’ve used to get around the problem of not knowing. Well, a recent study by a couple of researchers at Florida State University may help us get a little closer (before you get too excited, read the limitations at the end). My take-home message from this post is familiar: Addiction is a disease, not a question of morality.

Am I An addict? Testing for addiction

One of the major reasons for the push to find the ‘alcoholic gene’ was the hope that, once found, it would let us say, with certainty, who is (and who isn’t) an addict. All those people who simply use drugs and other addictions as an excuse for their horrible behavior would be revealed and all those who truly need help could be identified. But it didn’t quite work out that way.

There is no alcoholic gene. There are a whole bunch of genes that are associated with, and most likely contribute to, the risk of someone becoming an addict. But they vary for different drugs, require some pretty serious testing, and contribute very little (individually) to our ability to categorize people. The same genes that are linked to addiction are also linked to ADHD, anxiety disorders, depression, and on and on…

But wouldn’t it be great if we had a conclusive test? Something that worked to really help us tell the difference between addicts and the rest?

Skin response testing

Electrodermal response modulation (ERM; a fancy name for measuring skin conductance) is a measure of how skin conductance changes in response to predictable versus unpredictable stress.

The connection between addiction and skin response might seem a stretch, but hey, dilated pupils are a sign for sexual attraction so… The idea is that the more prepared the overall system is to deal with predictable stress, the better equipped a person is to handle life stressors. Bad responsivity would mean that the person’s system is not adjusting well to stressors that are predictable, producing too much arousal and discomfort to events they should be prepared for.

So for this study, high ERM good, low ERM bad, got it?

To make a long story short, this recent research shows that low ERM was more common among individuals with addiction than among controls (people with no major mental health issues) and even among individuals with personality disorders.

The good news is that this finding is promising in terms of possible future identification of people who are likely to develop addiction problems. But of course, there are some issues.

Limitations of the study

Since the study used people who were already addicted, it’s impossible for us to know if low ERM exists before addiction develops. If it does, we may be able to identify potential addicts before they become addicted, but if not, it would still be useful to have a test to distinguish current addicts from non-addicts.

Of course, at the moment the test only works by comparing addicted to non-addicted groups – we don’t have norms or cutoff points to tell us on an individual basis who is or isn’t an addict. A lot more research will be required before that would be possible.

This is not the first test that has shown promise in terms of a quick identification test for addiction. There is quite a bit of research showing a relationship between a specific brain wave (called P300) and addiction. the problem is that P300 turned out to be pretty generally associated with what are known as externalizing disorders (like illegal activity, high risk sexual behavior, aggression, etc.). I personally believe that as behavioral addictions (like sex addiction that involves high risk sexual behavior) become more commonly understood, many of those externalizing disorders may be reclassified, making P300 possibly more popular as an addiction measure.

The Bottom Line: So can we tell?

It’s too early to know if ERM will turn out to be a really good marker for addiction, but I’m sure people are hard at work trying to figure that out, so let’s give them some time. Years ago I heard a presentation about people with low variability in heart rate which seemed to suggest something very similar, so I’m hopeful. But to me, there’s a more important take home message:

Once again, this study shows that there are physiological factors to addiction that are far beyond anyone’s actual control. I don’t personally know anyone who can change their skin conductance, and so I’m pretty comfortable saying that addiction is an actual medical condition in so far as it has physical symptoms and some promising treatments.

But then again, I am a scientist…