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.

Thinking straight might help: Modafinil in early recovery from crystal meth addiction

I’ve mentioned before that I believe medications can be a very helpful tool in early recovery, especially for specific individuals who need help getting over the initial, most difficult, period (look here).

If you take a look at my first post about meth and its effects on the brain, you’ll read that crystal meth use can negatively affect the function of a neurotransmitter called dopamine. One of the dopamine’s important roles in the brain has to do with impulse inhibition and control over behavior.

The role of impulse control in early recovery trouble

With a reduced capacity for behavioral control, it’s no surprise that people in early recovery find it especially hard to resist urges to use again. When you consider that it’s already been shown that addicts are more likely to have impulse control problems, like ADD/ADHD, the role of impulsivity becomes even more important for understanding addictions. Having less control over a preoccupation that results in obsessive-thoughts and compulsive-actions means that slips, or relapses, are an almost expected outcome.

If we could only figure out how to give people better control over their impulses, we’d possibly better equip them to prevent their own relapses.

ADHD medication for crystal meth addiction help

Well, a number of drugs used for ADHD have been researched as possible aids for addicts, and it seems like Modafinil (marketed as Provigil) may help with exactly the cognitive deficits that seem to trip meth (and cocaine) addicts in early recovery up. In fact, the results seem to be strong enough to warrant the initiation of some larger scale investigations. This, along with previous findings that reported relatively low abuse-potential for modafinil suggest that this may indeed prove to be a useful medication.

No one is saying that this is the pill that will cure addiction, or even that a pill like that is going to be found. But hopefully, along with other medications (like Bupropion), the number of tools in the proverbial toolbox of addiction specialists will continue to increase, allowing them to better treat a larger proportion of those suffering from addiction.

Citations:

Jasinski, D. R & Kovacevic-Ristanovic, R. (2000). Evaluation of the Abuse Liability of Modafinil and Other Drugs for Excessive Daytime Sleepiness Associated with Narcolepsy. Clinical Neuropharmacology, 23, 149-156.

Ling, W., Rawson R., & Shoptaw, S. (2007). Management of methamphetamine abuse and dependence. Current Psychiatry Reports, 8, 345-354.

A perfect little game that teaches all about drug use and addiction

No matter how much work I put into it, I don’t think I’ll be able to come up with a cuter, more fun, or more educational way to teach you all about what drugs do in the brain than the game on this site (click the link). It’s like you get to do your own, harmless, version of animal research (I wish it was really that easy).

However, if after playing this adorable little game you still have questions, come right back and ask them here. I’m sure I’ll be able to expand on whatever you learned at this great University of Utah website.

When you fall… Failing at rehab and trying again

When my life started seriously veering off track, a few of my friends sat me down and told me that they want to help me. At the time, drugs were paying my rent, and they literally offered me their couch to help me lower my cost of living. They were good friends and they really meant it. I didn’t take them up on it; I thought I was fine.

My first try at rehab

Fast forward 4 years, and my first attempt at rehab. I still didn’t really think I needed help, but my lawyer insisted that unless I wanted to spend the rest of my life behind state-sponsored bars, I should give this thing a try. I went in as a way out. I’d been living on drugs, mostly crystal meth, for the previous 5 years or so. I was a daily user, everyone I knew used, I was paying my rent with ounces of coke, but somehow, I thought everything was going well.

Two months or so after entering rehab, sitting at my recording studio pretending to work, I ran across a baggie that had apparently been left behind. It took me less than 15 minutes to find something to smoke it with.

I only used a little bit that day. I’d been off the stuff for almost 3 months, and I didn’t need a lot to get high. I also wanted to save enough for my next “workday.” I was back to using daily within 5 minutes. By New Year’s Eve that year, I was smoking with an ex-customer in the corner of her bedroom before her guests showed up for the yearly party. I ended the night bored at an ecstasy party with half-naked friends giving each other backrubs. This time, I knew something was wrong.

Another attempt at rehab

Needless to say, I got kicked out of that rehab facility. I spent the following two weeks sleeping on a friend’s couch looking for another treatment option. It was on my way to a meeting at noon on a sunny day in Santa Monica that I saw where I really was. Passing a homeless vagabond on the promenade, I did a double take. I knew the guy; we used to party together. I’m one misstep away from being homeless. I need help.

As I write this today, I am five years into a well-respected graduate program in psychology. I’m writing a book about my experiences, and by the time it comes out, I’ll have a Dr. posted in front of my name. But that wasn’t always my story, and as recently as 5 years ago, it was the unlikely ending to my tale.

Addiction demoriliizationThe reason I’m sharing it with you here is because I want you to know that there is no magic number. There’s no right way to find your escape from the life, and there’s no necessary mindset when you try to save yourself. No one knows what is going to work for you yet. We’re working hard on figuring out a way to tailor treatment to specific people based on their drug use, their family history, their genes, and anything else we can think of. As of right now, we have no better answer than this:

Keep trying. No matter how many times you fall down, pick yourself up again. If AA doesn’t work for you, try something else. There are options, a lot of them. If you don’t know about any others, ask me, ask anyone. If you keep trying, keep believing in yourself, keep giving yourself a chance, you’ll find the way out eventually.

Until then, keep your head above water and come back here to learn more. As always, feel free to email me with any questions. I’ll keep answering.

Smoking cigarettes just makes it better… The enhancement effect of nicotine

A recent study by a Kansas state researcher (find it here) reports that part of the power of nicotine may be in its enhancement of other experiences that go hand in hand with it.

While the online source I included suggests that nicotine’s effect may be only in this indirect enhancement, my reading of the article proved that in fact, at high doses, nicotine alone provided the same effects all by itself.

Nicotine as an enhancer

My dissertation is actually going to be based on a nicotine experiment, so this is a topic I know quite a bit about now. As this recent study reports, it seems that animals are rarely willing to work for nicotine alone, something I found surprising at first. I mean, given how many people are addicted to cigarettes, I thought this stuff would be an easy sell. Instead, it’s taken quite a bit of work to figure out how exactly to make nicotine rewarding enough without making its effects almost too much to bare initially. As someone who used to smoke and remembers the nausea I felt the first time I tried, I understand.

Even still, I’ve had to play around quite a bit to make my my nicotine worthy of lever presses and nose-pokes. I now firmly believe that nicotine addiction has quite a bit to do with the context, behaviors, and other factors associated with smoking.

Is nicotine different from alcohol, meth, and cocaine?

So, much like the previous post I put up regarding the finding that drinking enhances people’s enjoyment when they smoke, it seems that not-surprisingly, the same thing happens the other way around – Smoking makes drinking better.

In truth, this isn’t all that surprising, there has been a lot of research showing that many drugs make the animals in research do more of other things they like. This has been shown for crystal meth, cocaine, and a number of other stimulants, and I wouldn’t be surprised if the same is true for other drugs. The thing that makes nicotine a little different is that it is almost never rewarding all by itself. Well, at least in the lab…

Citation:

Nadia Chaudhri, Anthony R. Caggiula, Eric C. Donny, Sheri Booth, Maysa Gharib,Laure Craven, Matthew I. Palmatier, Xiu Liu & Alan F. Sved (2007) Self-administered and noncontingent nicotine enhance reinforced operant responding in rats: impact of nicotine dose and reinforcement schedule.Psychopharmacology, 190, pg. 353–362

Meth + Viagra = HIV and STDs?? Sex marathons and their danger

Co-authored by: Jamie Felzer

Sex marathons…what does that sound like to you?  Lots of sex, with multiple partners, for an extended period of time? Bingo! Come on down and collect a prize!!!

Why sex marathons can be dangerous

The combination of crystal meth and Viagra can leave users at a very high risk for contracting sexually transmitted infectionsSex marathons are where people have sex for a prolonged period of time, and often do so with multiple partners where they may seldom use protection.  Clearly this could cause some potential dangers.   All these dangers CAN be prevented (by using condoms, lubrication, and strict hygiene).  What makes these activities even more dangerous is the addition of crystal meth to help participants stay up for these long sex marathons and the prescription drug, Viagra to make sure they can perform sexually during these marathons. Put those two ingredients together and you have a powerfully volatile cocktail.

A collection of studies have been conducted with both hetero- and homosexual males involving the combination of these substances.  It was shown that those who generally used Meth were more likely to have sex, have sex with multiple partners and also more frequently not use protection. Particularly worrisome was the finding that homosexual men who used Meth and were HIV positive were the least likely to use condoms and were also the most depressed. members of this population often had 10 or more sex partners, thus quickly promoting the spread of STDs including HIV (if protection is not used).

Protection is VITAL in combating the spread of HIV

Taken together, these studies reveal that the consumption of Viagra is highly associated with insertive sexual behaviors.  This means that heterosexual men on Viagra more often partake in anal sex and homosexual men on Viagra more often partake in insertive sexual behaviors rather than receptive sexual behaviors. All insertive sexual behaviors have a high chance of causing the transmission of STDs because of the high amount of blood flow and low amount of protective tissues that reside in that area of the body.

Remember the ways of contracting HIV: Anal sex, vaginal sex, IVs and any other form of infectious blood mixing, and mother to child transmission.

Those who used a cocktail of Viagra, Meth and poppers (a form of Nitrates) increased the risk of contracting HIV, Syphilis and Hepatitis B over 100%!! While these drugs can sometimes be used without major complications, the concoction of them together creates a dangerous mix that puts everyone involved at a higher risk of contracting blood-borne diseases.  So, participate in sex marathons at your own risk but no matter what know your status and be sure to use protection!  Regardless of what the studies show, you can beat statistics by using caution during sex.

Citations:

Fisher, Dennis G; Reynolds, Grace L; Napper, Lucy E. Current Opinion in Infectious Diseases. Issue: Volume 23(1), February 2010, p 53–56.

Fisher, D. G., Malow, R., Rosenberg, R., Reynolds, G. L., Farrell, N., & Jaffe, A. (2006). Recreational Viagra use and sexual risk among drug abusing men. American Journal of Infectious Diseases, 2, 107-114.

How I cleaned up my act and dealt with my crystal meth addiction

I keep referring to the fact that I don’t believe in quick fixes for addiction.

My crystal meth addiction

Partially, this is due to research I’ve been exposed to that shows changes in the brain that are very long lasting. As I’d mentioned in an earlier post about crystal meth use, it can take as long as 2 years of staying clean for dopamine function in the brain to return to anything near normal levels, and though we don’t have any clear answers on this yet, the function that does return is most likely not the same as that which was lost.

But it’s also due to my own experience. I used a lot of meth for more than 4 years. It started out with $40 bags (a quarter gram) and eventually grew to almost daily 8-ball use (3.5 grams,), which I could only afford because I was selling pounds of the stuff. I’m sometimes surprised that my brain still functions at all, let alone at the levels it needs to for the things i’m doing now. Still, my memory has suffered and the jury on whether my ADD had worsened due to it or not is still out.

When I got clean, it took me more than 2 years of no substance use whatsoever to get to the point where I felt I was “back to normal.” There were certainly stages of improvement along the way, but I literally had to learn how to live without drugs. It wasn’t easy.

Filling up the necessary recovery time

As you’ll find out continuously throught this blog, my road wasn’t without it’s share of bumps either. I got kicked out of my first rehab for using after about 3 months of staying clean and though my second try was successful, it was far from easy and the struggles taught me a lot about myself and what I am capable of.

I’ve included, and will keep writing, a series of posts about rechanneling addictive personality tendencies into more constructive activities that can help in getting through the tough periods of readjustment. I can say that for me, it was this rechanneling that made it possible to get through my days.

Be it my schooling, working out, or my newfound passion for gardening (on my tiny patio), finding new ways to occupy my restless mind have proven indispenseble for my new, improved life. While I might not have been preparing for it, there’s been a quiet in my mind I didn’t even know before…

Read the upcoming posts for ideas on what you can do to rechannel your energy into things that will improve, not destroy, your life…