Harm reduction – Why the bad press for addiction treatment that works?!

October 31st, 2010

How many of you think that giving a crystal meth user condoms will increase their drug use? Probably not many. What if instead the question had to do with giving that same user clean needles rather than having them share a dirty one? Or having him reduce his drug use instead of stopping completely? I bet there would be a little more disagreement there.

Some of you may have heard of the harm-reduction approach to drug abuse counseling and treatment, but many of you likely haven’t because the term itself is essentially taboo in the United States. The idea is to approach the patient (or client) without the shaming or expectations of abstinence that normally come with drug treatment. Instead, the counselors hope to reduce as much of the negative things associated with the drug use.

For example, almost all drug injecting users end up with hepatitis C due to dirty-needle sharing. As in the above example, harm reduction practitioners would seek to provide users with clean needles, thereby reducing needle sharing and the transmission of disease. Risky sexual behavior is often associated with methamphetamine, and crack use; instead of targeting the use itself, often, interventions attempt to reduce unprotected sex, reducing HIV transmission in the process.

Harm reduction has many supporters, but unfortunately, there are at least as many people who are against it. The claim is that harm reduction doesn’t stop drug use, and that we shouldn’t be in the business of making drug use easier. In fact, though they have no data to support it, some people argue that giving users clean needles is likely to exacerbate their drug use. My argument is that life as a drug user is pretty difficult as is, and if we can provide a way to show drug addicts that people actually care about their well-being, we might help some of them see the light.

Even more to the point, my thinking is that HIV, Hepatitis C, and other conditions often helped by harm-reduction, have to be considered as additional societal costs of drug abuse. If harm reduction helps us tackle those collateral costs, I’m all for it as an additional tool.

The bottom line is this: If we can use multiple tools to solve a problem, why limit ourselves unnecessarily to only one? If harm reduction helps, why not use it in conjunction with abstinence treatment?

As I’ve mentioned in previous posts, it’s time for us to stop resorting to ridiculous moral judgments and start focusing on solving the problem. If we can help an addict use less, use fewer drugs, or use more responsibly, I say we should go for it!!!

Posted in:  Drugs, Education, For others, Opinions, Sex, Tips, Treatment Tags: clean needles, cocaine, condom, condoms, cost, crystal meth, drug, drug abuse, drug use, harm, harm reduction, harm reduction help, hepatitis, heroin, HIV, meth, needle sharing, reduction, Speed, syringe, use, users clean needles

Simply Sober Won’t Do – From Crystal Meth Addict to Scholar

August 29th, 2010

This is a “reprint” of an article I recently wrote for a NY publication called Spotlight On Recovery:

For an addict, the prospect of no longer using whatever it is that gets them through each day is daunting. There’s a comfort in knowing what life is going to look like even if all it entails is dragging yourself out of bed, taking a drink, smoke, or hit of crystal meth, and going on with a day focused only on managing the disaster. The dark cloud that surrounds us is obscured by our drug of choice; it’s what makes the days tolerable.

The first step of recovery – Addiction treatment sets the table

Some of us are sent into treatment by family members or jurists, while others recognize the problem themselves and decide to take the first step into addiction treatment on their own. However we get there, getting into addiction treatment is only the first step; often it’s not even the one that gets us clean. Whether you recover by yourself or with help, whether you got it done your first time or your twelfth, if you’ve managed to stop using, you’ve come up against the ultimate challenge: What now?!

For me, the most difficult aspect of steering my life in the right direction was simply learning how to live. True, I’d been doing it for 24 years by that day, but my life involved constant escape, discomfort, and boredom. When I stopped smoking crystal meth, getting over the fatigue, hunger, and even my non-existent libido (all part of my withdrawal) was easy when compared with the simple challenge of what to do every day.

You see, I smoked crystal meth for 5 years (and before that came alcohol, weed, cocaine, and a slew of other drugs). I smoked meth when I was in a good mood, when I was upset, when I was bored, sad, tired, or alert. With the one common denominator in my life now gone, I wasn’t even sure how to simply pass the time. True, rehab had groups, it had meetings, and it gave me an opportunity to discover myself. But, while all those were helpful, for me, it was the time in between all those that was a challenge.

Learning to live without drugs – Finding purpose in recovery

My inability to fill my time with anything other than thoughts of using got me tossed out of my first rehab. Going back to work in my studio, I couldn’t help but look for some left behind treasures; I found a bag of meth, filled a pipe, and threw out three months of sobriety without a second thought.

My second attempt at getting sober was more successful, not only because I’d learned from my mistake. I’d made mistakes before but never learned a thing. The difference was that this place made us all do chores. They made us work. They made us recognize, and then follow through, on what it meant to be a normal, functioning, member of society. As I got a better and better grasp on life as a non-user, I realized that for me, simply staying sober was never going to cut it.

I’m a doer. I need to get things accomplished in order to feel satisfied. When it came to my drug life, I got things done by becoming a pretty successful drug dealer as well as a less successful, but working, musician. Now, I needed to find another channel for my energy, one that didn’t center around filling a meth pipe.

12-Step meetings did the trick for a little while. Having a place to go where I didn’t have to be ashamed of my past made it easier for me to get adjusted to sober life. Still, within months, I was getting restless again, and for me, that’s a sign of trouble. I was looking for something to do that would pose a challenge, giving me something else to focus on than the gap left in my life.

My purpose – To learn about addiction and help others

I’d always been good at school. Even in the throws of my crystal-meth addiction, I managed to perform well enough in class. That was the reason for my looking into academics as my healthy way out. I mulled over the possibilities with my parents. I was a pre-med student in college and thought about medical school. My dad, a physician himself, wasn’t excited about the idea. Understandably, he wasn’t quite ready to believe that I could follow through on such a challenge. I hadn’t done anything to give him a reason to believe yet.

I decided to start more gradually, and applied for a Master’s program in psychology at a state school in California. Psychology was my undergraduate major, which made the application a little bit easier, but getting myself ready for a life I’d left so far behind was scary.

No matter how dark, there’s a charm in the aimless nature of drug addiction; the focus is simple, the goals, close at hand, and the reward, immediate. What I was embarking on now was some nebulous, long term contest that could end up any which way. I wasn’t sure I was ready for the uncertainty. Still, within minutes of sitting down in that first summer class, I knew I’d made the right decision.

Now that I was sober, I liked the daily routines I’d run away from so many years before. When class was finished every day, I was happy to dive into the work, proving to myself that I could do well here again, that I could reach my goal of getting a Master’s degree after more than 5 years as a daily crystal-meth user-dealer. I did well in that program and started looking into psychology research about addiction. I’d slowly moved away from the rooms of AA, and looking into the psychology of addiction allowed me to stay close to the reasons why I was taking this new path. It also allowed me to work with others who’d had similar experiences to my own without focusing on the past as much as AA meetings did.

I performed so well in the program that I started looking into further schooling, eying the outstanding program at UCLA, my alma mater. The UCLA psychology graduate program is the best in the country and one of the best in the world. Feeling a bit like a novice climber taking on Everest, I set my sights high and went for it. I gathered recommendations; I made phone calls, set up interviews, and worked my full court press. After working tirelessly for more than six months, the good news came in. I was ecstatic. Then I was scared. Quickly, I realized that for me, challenge is food. I need to feel like I’m working toward something to quiet the restlessness in my head.

I know now, having researched addiction for the past 9 years, that addicts have personalities that make them search out challenges, make them need a rush, that leave them unable to sit still. For some of us, it manifests as Attention Deficit problems, but even for the others, for whom the challenge doesn’t quite reach clinical levels, the underlying restlessness is still a constant factor.

In our past lives, that restlessness left us searching for a way to pass the time. Drugs did that reasonably well for me while filling my life with distractions that moved me away from everything that was important. In my new life, I made sure that the challenges were worthwhile; I got involved in sports, rechanneling my need for achievement not only into school, but into fitness as well.

It has taken me years to balance my life, and the struggle is ongoing. I still have classmates, as well as my wife, reminding me sometime that I need time off once in a while to smell the roses. They’re right, and I try, but for me, staying busy is the rose. Without my endless work, I’m afraid I’d lose my grip.

So no matter how long ago it was that you seemed to have lost your passion, if you want to make life without drugs worthwhile, it’s crucial that you find it again now. Simply being clean of drugs is not the end-all. In fact, being drug free merely offers us the means to rediscover the life we left behind.

Posted in:  Addiction Stories, Drugs, For addicts, Tips Tags: addiction, challenge, crystal meth, life, meth, PhD, Sex, teaching, treatment, weed

About Addiction: Kombucha, Alcoholism, Drug Crime, mental health, and the Law

July 12th, 2010

These are the newest links about alcohol, drug crime and mental health. Let us know what you think and leave us your feedback!

Kombucha, Alcohol content, and teens

The New York Times: Some Kombucha drinks may have elevated alcohol content, with specific varieties reaching as high as 3% alcohol by volume, as high as some beers, and much higher than the legal limit on non-alcoholic drinks of 0.5%.

preventionworksct: Hospital emergency room visits linked to underage drinking almost double during the July 4 holiday weekend. Daily underage drinking-related visits are 87 percent higher during the July 4 holiday weekend than on an average day in July.

Caron: Good intentions of parents may unintentionally contribute to teenage alcohol abuse when mixed messages are presented. An expert suggests that substance abuse should be discussed before a kid reaches his or her teens.

Science Daily: Teens tend to increase their alcohol consumption in summer. Experts suggest parents monitor their children.

Drug Crime & Law

UPI: In Mexican drug smuggle, increasingly more teenagers are used to smuggle drugs across the U.S. border into Arizona. In 2009, 130 minors were arrested while allegedly trying to smuggle drugs across the border through entry ports from Sonora, Mexico, into Arizona.

Politica AP: Since the 2006 passage of an anti-methamphetamine law, the number of crystal meth lab cleanups nationwide has decrease. Investigators link the decline to the law that made it harder to buy chemicals used in this drug production.

About addiction and mental health

Reuters: There is an association between marijuana use and increased risks of depression and anxiety disorders. It is though unclear whether marijuana use itself, or some other factor, accounts for this connection.

Health Day: What works to treat adult addicts may not work for the younger population. According to experts, illnesses that start earlier in life are harder to treat than illnesses developed during adult life.

Posted in:  Alcohol, Drugs, Education, Links, Marijuana, Meth Tags: Alcohol, alcoholism, crime, crystal meth, Drugs, Kombucha, law, marijuana, mental health, mental illness, meth, parental influence, parents, teen alcoholism, teenage alcoholism, teens

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

May 8th, 2010

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.

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.

Posted in:  Addiction Stories, Cocaine, Drugs, Drugs, Education, Meth, Treatment Tags: cocaine, craving, crystal, crystal meth, drug use, memories, meth, music, recovery, relapse, sober

Time to get high- Circadian rhythms and drug use

May 1st, 2010

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.

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

Posted in:  Cocaine, Drugs, Education, Meth, Opiates Tags: circadian, circadian rhythm, cocaine, Food, light, MDMA, meth, nicotine, sleep, withdrawal

ADD and ADHD medications: Lessons from a crystal meth experiment

April 11th, 2010

I’ve recently completed a study that I presented at the Society For Neuroscience (SFN) meeting in DC. The study was actually aimed at looking at the usefulness of two medications in interfering with the rewarding qualities of methamphetamine. The thinking was the if we could figure out a way to interfere with crystal meth being perceived as rewarding by the brain, we may be able to help addicts from continued use after a relapse.

Two prescription stones but only one hits crystal meth

The two medications are atomoxetine and bupropion, though you may know them as Strattera and Wellbutrin or Zyban. Their mechanisms of action are similar, but distinct enough that we wanted to test them both. The results of the study, in one sentence, were that atomoxetine (or Strattera), but not bupropion (or Zyban) succeeded in eliminating animals’ preference for meth if given along with it. The implication is that in the future, these, or other, similar, medications, may be given to newly recovering addicts. The hope would be that by taking the drug, they may be somewhat protected in the case of a relapse. If they don’t enjoy the drug during the relapse, they may have a better chance of staying in treatment.

More to these medications than meets the eye

I learned some other interesting things while preparing, and then carrying out, the study. While Zyban could, by itself, be liked by the animals, Strattera did not seem to produce any sort of preference. Given the common use of these drugs in the treatment of ADHD, the difference may be very important. As you may recall, I’ve talked before about the connection between impulse control problems and being predisposed to developing addiction. Given this relationship, it would seem that we’d want to be especially careful about using drugs that can cause abuse with this population. Many of the stimulants used to treat ADD and ADHD can indeed lead to abuse, as their effects are very similar to speed, or crystal meth (Adderall and Ritalin come to mind). Zyban’s abuse liability is definitely lower, given the greatly reduced preference animals develop for it. Still, it seems that Strattera’s abuse potential is almost zero. In trial after trial, animals given atomoxetine fail to show a preference for the drug.

To my mind, this means that as long as it’s successful in treating the attention problems, atomoxetine is the better candidate. All in all, I’d think the first choice should be the one that helps the symptoms of ADHD while having a reduced likelihood of dependence. Obviously, if the drug is not able to treat the problem, other options should be selected, but it seems to me that given the known relationship between attention deficit problems and addiction, the question of abuse liability should play a significant role in the selection of medication.

Once again, this doesn’t mean that all users of Adderall, Ritalin, or the other stimulant ADHD medications will develop an addiction to their prescription. In fact, we know that rates of addiction to prescriptions are generally relatively low. Nevertheless, I’d consider ADHD patients a vulnerable population when it comes to substance abuse so I say better safe than sorry.

Posted in:  Education, Medications, Treatment Tags: ADD, Adderall, ADHD, atomoxetine, bupropion, crystal meth, impulsivity, meth, relapse, Ritalin, strattera, treatment, zyban

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

April 3rd, 2010

Heroin, or opiate, withdrawal symptoms are 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.

Withdrawal from crystal meth addiction

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? When a crystal-meth addict stops taking 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. Detox before addiction treatment is an accepted fact in opiate and benzodiazepine addiction, but because of the supposedly “light” nature of meth withdrawal, it’s been ignored. Hopefully by now, you realize that was a mistake.

Posted in:  Drugs, Education, Meth, Opiates, Prescription Tags: addict, addiction, crystal, crystal meth, diarrhea, dopamine, dopamine receptors, dopamine spike, eat, exercise, fever, flu, meth, meth addict, opiate, pain, shake, sleep, withdrawal, withdrawal symptoms