By Chris Woolston, M.S.
As the epidemic of meth use spreads across the country, researchers have learned two lessons countless times: Meth ruins lives. Treatment works. Users who seek treatment and commit themselves to recovery have an excellent chance at success.
The challenge of withdrawal
Meth is a stimulant that hooks users with feelings of euphoria and bursts of energy. It can also cause extreme agitation, hallucinations, and delusions, as well as strong feelings of paranoia and aggression that make users more susceptible to violence and even suicide.
Long-term users are also vulnerable to serious health problems, including heart trouble, stroke, aortic dissection, and severe tooth decay from a combination of factors that can include teeth grinding, dry mouth, oral exposure to toxic chemicals, and a craving for sugary drinks. Because meth causes the sympathetic nervous system to go into overdrive and damage organ systems, many chronic meth users may have a wasted appearance and look years, even decades, older than they really are.
Equally disturbing, recent studies suggest regular meth use may do lasting harm to the brain. Meth destroys dopamine receptors, making it harder and harder for users to experience pleasure. As reported in Current Opinion in Psychiatry, memory and other thinking skills tend to keep deteriorating for months after a person quits using. Eventually, most people who try meth decide that the highs aren't worth the lows. Of the approximately 13 million Americans who have tried meth at least once in their lives, only about 5 percent currently use the drug.
If a person keeps taking meth, addiction often follows. The body becomes accustomed to the drug, and quitting becomes a monumental task -- for both the user and the people around him. At this point, willpower or good intentions alone may not be enough to break the habit. When addiction sets in, professional help may be the best way out.
It's not that the rush of the drug is so irresistible. The real obstacle to recovery is the misery that goes along with withdrawal. Giving up meth may leave people facing months of depression, anxiety, confusion, and perhaps even bouts of psychosis. Helping them weather this rough patch is the key to treatment.>
The most successful treatment programs take a multipronged approach to recovery. According to the National Institute on Drug Abuse, the gold standard for treatment is the Matrix Model, an intensive four-month program that has helped tens of thousands of users of meth or cocaine in the last few decades. During the Matrix Model's program, clients see counselors several times each week for intensive therapy sessions. The goal is to help recovering addicts cope with their depression and anxiety while teaching them how to avoid relapse. Participants learn how they've become addicted to the drug, how they've been affected, how to avoid using the drug, and what to do if they return to it. Most of the therapy takes place in groups, but clients also see counselors one-on-one; they're encouraged to bring family members to speak with the counselors as well.
When the four months are up, users go through another nine months of social support group sessions with other people trying to break the habit. A six-month follow-up study of 978 recovering meth addicts found that more than 60 percent of those who completed the program managed to quit the drug.
One of the most important goals of treatment is helping patients identify and avoid "triggers," the people, places, things, and situations that can ignite a sudden craving for meth. Recovering addicts have found that going to places where they used to get high or hanging out with friends who still use meth are often surefire recipes for relapse. Some triggers aren't quite so obvious. If a person used to get high every payday, just the sight of a large wad of cash might overwhelm his desire to stay off the drug.
Positive reinforcement is another pillar of treatment. Whether it's a simple word of encouragement or prizes such as movie tickets or dinner vouchers, rewards can help recovering addicts stay on track. As reported in the American Journal of Psychiatry in 2006, even small incentives can significantly increase the chances that a person in recovery will stay drug-free for longer periods.
Recovering addicts need ways to withstand the depression and anxiety that plague them during withdrawal. Preliminary research suggests that antidepressant medications such as bupropion may help to improve mood and reduce cravings, but it's too soon to know how effective they might be in helping people avoid a drug relapse. That's why most treatment programs rely heavily on cognitive behavioral therapy, a drug-free approach to depression and anxiety that helps push aside negative, self-destructive thoughts while giving the recovering addict practical advice for avoiding relapse. For example, clients are reminded that strong, unpredictable emotions are a natural part of recovery and not a sign of failure. They're also encouraged to talk with a supportive friend or counselor if they feel their resolve slipping.
Before treatment even starts, clients are asked to sign a statement declaring that they won't use any substances, including alcohol. As noted in a handout given to clients, recovering meth addicts who continue to drink are eight times more likely to take up meth again. Alcohol weakens willpower, and bars and bar-goers are often powerful triggers for meth use. If needed, clients can receive extra counseling to help them quit drinking.
Quitting alcohol and avoiding other meth triggers usually requires wholesale lifestyle changes. For this reason, recovering addicts generally don't get far without help from family and close friends. The best treatment programs -- including the Matrix approach -- involve family members or partners in some therapy sessions. Close relatives are taught that their emotional support can make the difference between success and failure. They also learn how to help clients avoid the triggers that can lead to relapse. Above all, they learn that they must avoid alcohol or other drugs when they're with the client. A client living with someone who refuses to quit drinking or using meth may have to move out, at least for a while.
When outpatient approaches don't work
What to do about the 40 percent of meth users unable to kick the addiction with the aid of Matrix? Methamphetamine is such a pernicious addiction, according to literature from the UCLA Integrated Substance Abuse Programs, that inpatient hospitalization may be necessary "to treat long-term meth dependence, at least in initial stages of detoxification."
One drug used to treat alcoholism shows promise, according to one small study. Researchers at UCLA found that in people who were treated at a hospital for meth addiction and took the drug Naltrexone saw a significant reduction in their cravings for methamphetamine.
But inpatient methamphetamine treatment is important for people who need round-the-clock supervision and extra structure. It's easier to stop using a drug if you're removed from tempting (and possibly hazardous) situations. The problem, according to UCLA substance abuse literature, is that "medically managed inpatient care is expensive, and widespread meth abuse has appeared in impoverished populations with very limited access to such inpatient resources."
Better access to in-patient treatment would help patients at the highest risk. Hypothetically, so would drugs that could help patients through recovery -- but unfortunately, as literature from the UCLA substance abuse program notes, "there are no medications that can reliably reduce the paranoia and psychotic symptoms that frequently contribute to episodes of dangerous and violent behavior associated with meth use."
More options for treatment -- and better access to it -- will make it easier to beat the addiction. More than 11 million Americans have already given up the drug, and there will always be room for more.
National Institute on Drug Abuse. Methamphetamines. What treatments are effective for people who abuse methamphetamines? https://www.drugabuse.gov/publications/research-reports/methamphetamine/what-treatments-are-effective-methamphetamine-abusers
Rawson RA, et al. A multi-site comparison of psychosocial approaches for the treatment of methamphetamine dependence. Society for the Study of Addiction.
Ray, LA, et al. The Effects of Naltrexone on Subjective Response to Methamphetamine in a Clinical Sample: a Double-Blind, Placebo-Controlled Laboratory Study, Neuropsychopharmacology. April 15, 2015 http://www.nature.com/npp/journal/v40/n10/full/npp201583a.html
UCLA Integrated Substance Abuse Programs. Methamphetamine: treatment.
U.S. Department of Health and Human Services. Matrix intensive outpatient treatment for people with stimulant use disorders: Client's Handbook.
U.S. Department of Health and Human Services. Matrix intensive outpatient treatment for people with stimulant use disorders: Counselor's treatment manual.
U.S. Department of Health and Human Services. Matrix intensive outpatient treatment for people with stimulant use disorders: Counselor's family education manual.
Knowledge Application Program, Substance Abuse Mental Health Services Administration. The Methamphetamine Treatment Project.
Newton TF, et al. Bupropion reduces methamphetamine-induced subjective effects and cue-induced craving. Neuropsychopharmacology, (7):1537-44..
National Alliance on Mental Illness. Cognitive-behavioral therapy.