Drug use cravings, obsessions, and trying to get clean…

When I first got sober, everything I thought about had something to do with drugs. It wasn’t just that I always thought of getting high, but everything in my life was tied to drugs, especially crystal meth.

Adi Jaffe playing music now sober

My drug use centered life

I used to make music in my studio, but I was always smoking crystal meth while doing it; I had a few girls I was “seeing,” but I got high with almost all of them (if they weren’t into it, I’d sneak a smoke in the bathroom alone). Every one of my friends was on drugs. I paid my rent with cocaine, made my money from selling anything you could think of, and overall, was simply surrounded by the stuff.

The drug use to craving connection

If you haven’t heard about this yet, memories are reconstructions of the past. When you remember something, your brain doesn’t just pull it out of some secret drawer like you were told when you were a kid. Instead, the different areas of your brain involved in making the memory (like your visual cortex, your olfactory bulb, and your language areas) light up all over again, re-exposing you to those same old thoughts, feelings, and senses.

Knowing that, it’s not surprising that cravings are so difficult to handle. Who wants to re-experience getting high with their best friend, their girlfriend, or in their favorite place over and over while trying to get sober? It’s literally maddening, sometime to the point where you just say “screw it” and run out to do it all over again (as in relapse).

I told my sister the other day that when I think about smoking glass (another name for crystal meth), the thing I miss the most is the white puff of smoke that fills the room. We used to call it “Dragon’s Breath” and I was pretty talented at producing the biggest clouds. It freaked her out a little to know that I could possibly still miss something about meth after everything that happened.

Even though I felt that it was necessary to calm her, I know that the addicts reading these pages know what I’m talking about. Of course I still miss smoking  crystal meth sometimes; Given everything I now know about drugs, which is a lot given the fact that I’ve spent 8 years studying nothing but drugs, I’m surprised I don’t miss the stuff more.

Drug use, reward, and what’s next

Almost every drug I know of eventually gets down to activating your reward center. Meth does so in a way that’s so extreme (like I said in an old post, it literally floods your brain with DA), that I’m surprised I ever managed to come out of it. I definitely know why it felt like such hard work.

So when a craving comes, don’t think of it as a sign that your failing. If that were true, there would be no survivors of addiction. Instead, recognize what your brain is doing, allow it, then think about the changes you’re trying to make. As the memory gets reconstructed, those new aspects you’re thinking about, those that have to do with your recovery and the positive changes you are making, will incorporate themselves into those old memories.

This, along with everything else you’re doing, will make the cravings less and less threatening, allowing you to stay sober even when they come through.

Time to get high- Circadian rhythms and drug use

Contributing Co-Author: Andrew Chen

Like most living creatures, humans have internal biological clocks known as circadian rhythms. These internal cycles synchronize our bodies with the Earth’s 24-hour day/night cycle and prepare us for predictable daily events (1). Circadian rhythms regulate a number of bodily functions including temperature, hormone secretion, bowel movements, and sleep (2). Recent research suggests that drug use may disturb our circadian rhythms, possibly influencing our decisions to take drugs.

Moon

Environmental drivers of drug use

Our biological clocks are set by external cues from the environment, called zeitgebers (3). The most familiar to us are light and food. However, research on rats has shown that opiates, nicotine, stimulants, and alcohol also have the ability to alter the phase of circadian rhythms independent of light or food (1). Drug use has long been associated with major disruptions in the human sleep cycle. Cocaine, crystal meth, and MDMA users often go without sleep for days, and these sleep disruptions can continue long after people stop using drugs. In fact, sleep disturbance outlasts most withdrawal symptoms and places recovering addicts at greater risk for relapse (3).

The rhythm of drug use

Circadian rhythms could also be the reason why people show 24-hour patterns of drug use. A study of urban hospitals found that overdose victims are admitted to hospitals more around 6:30PM than any other time of the day (2). Fluctuations in drug sensitivity, effect, and reward value are believed to be regulated by genes that control circadian rhythms. In other words, our biological clocks are telling us when to get high.

Researchers are just beginning to explore the relationship between circadian rhythms and drug use. Future understanding of this relationship will help us explain how drug addiction develops and develop better ways to treat it. It’s possible that offering specific aspects of treatment as certain point in the circadian rhythm can improve the probability of success.

Citations:

1. Kosobud, A. E. K., Gillman, A. G., Leffel, J. K., Pecoraro, N.C., Rebec, G.V., Timberlake, W. (2007) Drugs of abuse can entrain circadian rhythms, The Scientific World Journal, 7(S2), 203-212

2. McClung, C.A. (2007) Circadian rhythms, the mesolimbic dopaminergic circuit, and drug addiction, The Scientific World Journal, 7(S2), 194-202

3. Gordon, H.W. (2007) Sleep, circadian rhythm, and drug abuse, The Scientific World Journal, 7(S2), 191-193

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.

Triggers and relapse, a craving connection for addicts

I’ve already written about one reason why cravings make quitting difficult (find it here). However, cravings and triggers are not just abstract concepts; they are well known, important players in addiction research and I think they deserve some more attention.

What are triggers?

A trigger can be thought of as anything that brings back thoughts, feelings, and memories that have to do with addiction (like a computer reminding a sex addict of porn). In addiction research, these are often simply called cues. The word comes from learning research in which a reward (or punishment) is paired with something (the cue).

For instance, in Pavlov‘s classic experiment, a dog heard a bell ring right before it would get served its daily portion of meat. The dog quickly learned to associate the bell with food, and would begin salivating as soon as the bell would ring, even before the food was presented. In this case, the bell was the cue, and food the reward it was paired with.

The story in drug addiction is similar. I’m sure many of you can relate to the overwhelming memories and emotions that seem to come out of nowhere when you hear music you used to get high to or pass a street where you used to buy drugs (or sex). Each of those examples is a trigger that is simply bringing about a similar reaction to Pavlov’s dog’s salivation. Seeing these things, or hearing them, creates an immediate response to the reward that it was paired with, the drug!

Triggers, cravings, drugs, and relapse

As if matters needed to be made worse, triggers not only bring about responses that make you think about the drug. In fact, over and over in learning and addiction research, it’s been shown that triggers actually bring back drug seeking, and drug wanting, behavior. As soon as a cue (or trigger) is presented, both animals and humans who have been exposed to drugs for an extended period of time, will go right back to the activity that used to bring them drugs even after months of being without it. In fact, their levels of drug seeking will bounce back as if no time has passed. Sound familiar?!

Given these findings, is it any wonder that cravings bring about relapse in so many addicts who are trying to quit? If simply thinking about, or hearing, something that was always tied to drugs can bring about such a strong response, what is an addict to do?

Is there a solution for addicts??

For now, the simplest way to break the trigger-response connection is simply repeated exposure without the reward. As bizarre as this may seem, staying away from the triggers can make their ability to bring back the old drug-behavior stronger. Obviously, this isn’t something that should be undertaken lightly. I’m currently working on putting together a drug treatment system that specifically addresses these issues so that with help, users can eventually release the hold that triggers have over them.

In the meantime, be honest with those around you, and if you’re seeing a therapist, or a good case manager, tell them about your triggers so that you can hopefully start talking about them, and re-triggering them in a safe environment. As always, feel free to email me with any questions you might have.

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.

Reduce HIV Transmission – Shooting up, clean needles, and addiction treatment

Co-authored by: Jamie Felzer

We’ve talked often on this  site about many of the negative things that often come along with heavy drug use. We’ve not yet talked about any of the factors that make injection drug use even worse. Users inject cocaine, crystal meth, and heroin, or any combination of these.

Shooting up and disease

In addition to all of the other, addiction-relevant, factors we’ve talked about on here, injection drug use brings about the worry of blood borne pathogens, especially HIV and Hepatitis C.  While it may not always be easy to find clean needles or worry about cleaning a needle between uses there are steps that can be taken to reduce the risk of transmission.

1. Get Tested!!  HIV/AIDS testing is available all over the world, often for free.   Having another STD or illness can easily kill someone with AIDS. Know your status!

President Obama just finalized a plan to revoke the 22 year travel ban on those living with HIV/AIDS.  This will significantly reduce the stigma of HIV/AIDS and should bring about more testing centers and education.  See this video to hear Obama.

2. While it may not always be easy, take great care to try to check the needle for visible signs of blood before injecting. If you think the needle may have been used before, clean it with bleach or another disinfectant.

3. Utilize the free clinics around your town that give out free, clean needles.  They are there to help you!!  Use these addiction support centers for clean needles and other equipment (like the bleach I mentioned earlier).

4. Talk about it! Regardless of where you may live, the group of people you hang out, studies have shown that talking about this subject matter increases awareness and can decrease chance of infections.  Being informed is your most important tool. For more info check out AIDS Global Information or AIDS Action.

5. Get help! Treatment options are widely available and they serve as a very effective method for reducing risky behaviors.  We can offer you placement help if you’re in southern California, but even if not SAMHSA has a relatively good addiction treatment locator – Check it out.

Citation:

CAPS Fact Sheet: What are IDU HIV Prevention Needs?