handbook 1
Written by Richard Rawson, Ph.D. Marisa Murgatroyd Edited by Emily Meyers Kris Langabeer Technial Input from Larissa Mooney, M.D. Designed by Steven Kelly Cindy Phillips Special Thanks to Laboratory of Neuro Imaging, UCLA 2009 Eyes of the World Media Group, Inc. All rights reserved. No part of this book may be used or reproduced in any manner whatsoever without written permission from the publisher, except in the case of brief quotations embodied in critical articles and reviews. www.methinsideout.com 2 3
ABOUT Meth Inside Out Meth Inside Out is a groundbreaking video-based treatment curriculum on methamphetamine addiction and recovery. The series is designed to equip meth users, their families, and the professionals who assist them with a solid understanding of the biological basis of addiction, effective tools for recovery, and, most importantly, hope for the future. Presented by UCLA Integrated Substance Abuse Programs, a leading research institution on the topic of methamphetamine, and Eyes of the World Media Group, this researchbased series presents the most up-to-date information in a compelling and easy-to-understand format. Meth Inside Out emphasizes the human impact of addiction by sharing personal stories of users and their families. Shot in high definition with state-of-the-art graphics, the series is designed to engage and inspire viewers. Created for maximum flexibility, the curriculum is designed to meet the needs of treatment centers, correctional facilities, community centers, social service agencies, and universities. The series is composed of 3 episodes, which can be used individually or as a set. Handbooks allow counselors to maximize the educational potential of each episode. meth inside out episodes Episode 1 Human Impact Human Impact provides an eye-opening introduction to meth s impact on individuals, families, and communities across the globe. Focuses on the magnitude and consequences of use, including physical and mental health problems, job loss, violence, incarceration, and effects on children. Explores motivations for use and examines why women and gay men are disproportionately affected, and how specialized treatment can benefit these groups. Concludes with concrete solutions. Episode 2 Brain & Behavior Brain & Behavior equips viewers with an understanding of how meth changes the brain and, consequently, behavior. 3D animations, accessible explanations, and personal accounts help viewers understand complex scientific concepts. Users learn how to better cope with the stages of meth addiction and recovery by gaining an understanding of the biological underpinnings of the high, tolerance, craving, paranoia, aggression, anhedonia, and healing. Episode 3 Windows to Recovery Windows to Recovery explores effective treatment practices across program types and settings. This episode empowers the viewer by providing actionable information and concrete tools for recovery, including creating structure, participating in sober activities, avoiding high-risk situations, and coping with craving. Windows to Recovery reveals that treatment is not a quick fix, but a set of activities leading to long-term changes in lifestyle, thinking, and behavior. The episode shows, without a doubt, that recovery is within reach. 4 5
foreword table of contents Meth Inside Out: Human Impact is the first episode of a 3-episode series that presents critical information about methamphetamine addiction and recovery to treatment professionals, users in recovery, and the families of users. This episode is also appropriate for a broader audience of students, educators, policy makers, and other professionals. In Human Impact, viewers learn about: the magnitude and impact of meth use around the world. reasons for and consequences of use among people of all backgrounds, focusing on heavily affected groups. the cost of use to individuals, families, and communities, with emphases on physical and mental health and the link between meth and criminal behavior. successful treatment and prevention interventions. This Handbook and DVD includes many statistics on meth use. For specific references, please visit www.methinsideout.com. About Meth Inside Out Meth Inside Out Episodes Foreword Chapter 1: Global Problem Chapter 2: Why Meth? Chapter 3: Who s Affected Chapter 4: Women at Risk Chapter 5: Gay Men & Meth 4 5 6 8 10 12 14 15 Information as a Part of Treatment When people in treatment realize that their inability to control their impulses to use meth may be the result of changes in the brain rather than a fundamental character flaw, they can begin to accept their addiction and take charge of their lives. Providing this information in a clear, accessible, and engaging way is a powerful treatment tool. When people addicted to meth enter treatment, it is important to help them and their families understand meth addiction and what to expect in recovery. Well-informed patients understand the goals of recovery and can more effectively participate in their own treatment. Providing accurate information facilitates treatment efforts by allowing patients to understand the biological basis of their addiction and recovery. When family members understand addiction and recovery, they can be a major part of a patient s support system, rather than angry, confused bystanders. Chapter 6: Physical Impact Chapter 7: Broken Ties Chapter 8: The Cost Chapter 9: Solutions Resources 16 18 20 22 23 6 7
1. Asia Two thirds of all users (roughly 16 million people) live in East and Southeast Asia, with epidemic levels in Japan, Thailand, Indonesia, Cambodia, and the Philippines. Meth-producing superlabs flourish throughout Asia, and over 60% of the meth seized worldwide is found in Asia. In Japan, more than 80% of all drug arrests are for meth. Rates of use in the Philippines are as high as 10% of the population aged 10 to 44. 1 Global Hot Spots Meth is a public health problem on a global scale. About 25 million people use meth and other amphetamines worldwide. This is more than the total number of cocaine and heroin users combined, making meth the world s fastest-growing illegal drug problem. WORLDWIDE USE 25 MILLION USERS WORLDWIDE MORE THAN HEROIN AND COCAINE COMBINED 2. North America One fifth of all users (roughly 5 million people) live in North America. Meth is the dominant stimulant in the United States, though overall use has begun to decline since the mid-2000s. Lab seizures and precursor laws, which limit access to the ingredients used to produce meth, have reduced meth production in the United States, but superlabs in northern Mexico have sprung up to meet the demand. In 2004, the Canadian Addictions Survey found that 6.4% of Canadians reported lifetime use of meth. 3. Africa, Oceania, and Europe Additional hot spots of meth use are South Africa, Australia, New Zealand, and parts of Europe such as the Czech Republic. South Africa has become a new hub for meth production as imports of pseudoephedrine (a key ingredient in meth) jumped more than 1,300% between 2004 and 2005. PERCENTAGE OF METH AND AMPHETAMINE USE BY REGION METH/AMPHETAMINE 8 3 15 COCAINE HEROIN 11 8 Asia Africa oceania north America europe south America 55 8 9
4. Weight Loss In a culture obsessed with body image, it is no surprise that many women and some men experiment with meth because it reduces appetite and leads to dramatic weight loss. No one takes their first dose of meth with the intention of becoming an addict. But once they experience the euphoria, the improved mood, and the increased energy, many people find themselves wanting more and more and, before they know it, they can t stop and their lives are spinning out of control. 2 Reasons for Use There is no single reason why people make the decision to try meth. There are many. Some seem simple: curiosity, peer pressure, the desire to fit in, or lack of awareness about the dangers of meth. These are the same reasons that many people experiment with alcohol, cigarettes, and other drugs. However, there are a few specific reasons why people select meth. 1. Increased Energy Some people turn to meth for energy to keep up with the high societal demands for productivity. Among some professions, meth has long been used to combat fatigue and increase energy. Truck drivers, construction workers, waiters and waitresses, and individuals in similar occupations often initially take meth as a way to improve their work performance. Women are particularly vulnerable, as they struggle to balance work and family responsibilities. 2. Enhanced Sex Meth is often associated with sexual behavior and the enhancement of sexual experiences. While this association is particularly important among gay and bisexual men and other men who have sex with men, it is also true for heterosexual users of meth, including many women. 3. Relief from Negative Emotional States The acute effects of meth also improve mood, reducing depression, hopelessness, and the effects of trauma. Since rates of depression and trauma are higher among women than men, many women use meth to relieve these emotions. 10 11
4. Adolescents 3% of students in the United States have experimented with meth by the time they finish high school. Those who start using as teenagers are more likely to become addicted and use for longer. 3 5. Gay & Bisexual Men As the meth epidemic has unfolded over the past 25 years, the groups that have been most severely impacted by meth have been gay and bisexual men and other men who have sex with men (MSM), and male-to-female (MTF) transgenders. (Read more in Chapter 5: GAY MEN AND METH.) Demographics of Use Back in the early 1980s, when the only meth cookers were bikers in California and the major meth consumers were truck drivers, the typical user was a white male. There is no longer a typical meth user. Meth is an equal opportunity drug. Five million people of all backgrounds use meth in the United States and no group is immune to meth addiction. However, some groups are more at risk than others: 1. Women In previous epidemics of drugs, including cocaine and heroin, men have made up 65% 70% of all users. Meth is the only illegal drug that women use as much as men. (Read more in Chapter 4: WOMEN AT RISK.) 2. Native Americans and Native Hawaiians As meth spread throughout the United States, meth production and use hit Native American communities throughout the West especially hard. Native Hawaiian populations have also been heavily affected. These two groups have the highest per capita use among ethnic groups in the United States. 3. Hispanics Hispanic groups in the Western and Midwestern United States have seen a dramatic impact from meth over the last decade. These groups make up 19% of all primary meth treatment admissions in the United States. Young Hispanic women have been especially drawn to meth. The demands of raising kids, maintaining a career, and having responsibility for a household often make meth seem like a useful way to reduce fatigue and fulfill these many demands. 12 13
4 5 Impact on Women Higher levels of depression and physical and sexual abuse, the desire to be thin, and the need for extra energy have opened the doors to meth use for many women. Many women are introduced to meth by spouses and boyfriends, but once they experience the effects, addiction takes over. This can lead to prostitution and other forms of sexual abuse. Meth also increases the likelihood of domestic violence and self-injury. Impact on the Family Meth devastates the lives of women and their families like no other drug. Addicted mothers often neglect, abuse, or expose their children to potentially dangerous situations. Other women unintentionally get pregnant and find themselves unable to stop using, resulting in more complications during pregnancy, higher rates of premature delivery, and babies with lower birth weight. Many women who are addicted to meth lose custody of their children, overwhelming the resources of child welfare agencies. Women in recovery often endure years of heartache and struggle in the fight to get their children back. It is crucial that pregnant women and women with children have ready access to treatment to minimize harm to their family. Women-Specific Treatment Specialized treatment programs for women provide a safe, supportive environment to work through the intense feelings of guilt and shame that they often experience. Since many women have endured serious trauma before or during their use, therapies such as Seeking Safety, a manual-guided cognitive behavioral treatment that can help such women work through these experiences, should be part of their treatment programs. Prevalence of Meth Use Meth use is so prevalent among gay and bisexual men and other men who have sex with men (MSM), as well as among male-to-female (MTF) transgenders, that it may seem hard to avoid. It is especially appealing because it reduces the feelings of shame and isolation that some men may experience. It also lowers inhibitions and dramatically enhances sexual pleasure. Within these groups, meth has been clearly identified as a drug that promotes high-risk sexual behavior. A sizable subculture has emerged around men who have sex with men and meth, revolving around nightclubs, bathhouses, and websites devoted to party n play (the use of meth combined with sex). Risk of Sexually Transmitted Diseases Tina, the common name for meth in the gay community, has had a tremendous negative influence on the effort to slow the spread of HIV, syphilis, and other sexually transmitted diseases. Many of the men infected with HIV during the past decade have been meth users. From a public health perspective, no other group has been as devastated by the meth problem. Gay-Specific Treatment Men who have sex with men should have access to specialized treatment that addresses their use in the context of their sexual identity and behavior. Gay-specific treatment allows men to be more open and honest about their use and the things they did on meth, without the fear of being judged. Specialized programs have been shown to reduce high-risk sexual behaviors and infection. 14 15
Impact on the Cardiovascular System Some of the most severe physical impacts of meth use occur in the cardiovascular system or heart. Meth use temporarily elevates heart rate and blood pressure. Long-term use may result in inflammation of the heart, arrhythmias (irregular heart beat), heart attack, and stroke even in young people. 6 Impact on the Brain 1. Psychiatric Effects Meth causes psychiatric symptoms that may persist for weeks, months, and sometimes permanently after stopping use. Problems may include anxiety, insomnia, depression, irritability, paranoia, hallucinations, suicidal thoughts, and psychosis. While most symptoms fade after a few days off meth, the recovery process carries its own set of symptoms, including extreme drug cravings and symptoms of depression such as anhedonia, poor concentration, and low energy. One third of meth users in treatment have attempted suicide at least once, and one third of users who experience psychosis during use report symptoms lasting more than 6 months into abstinence. 2. Neurocognitive Effects Meth use commonly results in cognitive deficits involving memory, attention, impulse control, and executive function (the ability to organize thoughts and activities, prioritize, manage time, and make decisions). Most of these functions can be regained with time off meth. Infectious Diseases Long-term meth use is associated with elevated rates of infectious diseases including human immunodeficiency virus (HIV), and hepatitis B and C. Reasons for the heightened risk of infectious diseases among meth users include: increase in high-risk sexual behaviors injection drug use and needle sharing Dental Problems A severe dental condition known as meth mouth is common among meth users, especially those who smoke meth. Symptoms include tooth fracture, disease, and decay. Doctors think this condition results from a number of factors including poor dental hygiene, dry mouth, and bruxism (the clenching and grinding of teeth). Skin Problems Most skin problems resulting from meth use are self-inflicted. These include abscesses and infection from repeated injection, accidental burns from manufacturing meth, and picking and scratching behaviors while on meth that can lead to scarring. 3. Disruption of Emotional Reactivity Meth use dramatically affects how people feel by overstimulating the emotional control centers of the brain. During recovery, as these brain areas normalize, many people experience an emotional flatness or anhedonia. At the same time, feelings of irritability and anxiety can make life difficult. Over time, these feelings fade, but they often pose a challenge during the first 6 months of recovery. 16 17
7 Meth Destroys Relationships Meth users isolate themselves from their families and friends as their lives start to revolve around the drug. In the search to get and use more meth, addicts break promises again and again. They spend money on meth that the family needs to survive, sometimes even stealing from those they love to fuel their addiction. They become incapable of being good parents, partners, and friends, and trust is gradually destroyed. Meth breaks up families and relationships, as users behave in ways that are hard to forgive. Parents hurt their children by neglecting or abusing them, and missing large periods of their lives. Effective meth treatment involves loved ones through family education groups, family therapy, and couples counseling. With time and effort, many relationships can be restored. 18 19
Need for Treatment 8 Cost of Addiction Many meth users don t have access to treatment. Program capacity is limited in most communities, especially for the residential treatment needed by severely addicted users. And often, the treatment that is available does not meet ALL the client s needs, such as medical and psychiatric care, and employment and family counseling. Programs are underfunded and many counselors don t receive training in the most valuable, evidence-based therapies. Effective treatment saves money and lives. An untreated addict can cost taxpayers more than 4 times as much as the cost of treating an individual in residential treatment. RELATIVE YEARLY COST 9 Meth use has consequences on almost all aspects of society. It breaks up families, ruins communities, strains social services, fills jails, and bleeds taxpayers. The economic cost of meth use in the United States is over $20 billion a year. This enormous price includes loss of productivity and quality of life; the cost of crimes, medical expenses, foster care, treatment, and incarceration; and toxic waste and injuries caused by meth production. Meth and Crime Since meth users act violently and commit crimes to sustain their addiction, they inevitably come into contact with the criminal justice system. Common meth-related crimes include burglary, fraud, identity theft, and domestic violence. The following statistics, compiled from the 2005 study released by the National Association of Counties, The Criminal Effect of Meth on Communities, show just how damaging meth can be: 60% of county officials maintain that meth is the largest drug problem in their county 50% of law enforcement agencies say that 1 in 5 current inmates are there because of meth-related crimes 17% report that more than half their population is incarcerated because of meth 70% write that robberies and burglaries have increased because of meth 62% note an increase in domestic violence because of meth untreated Addict 21 Residential treatment 20 21
RESOURCES UCLA Integrated Substance Abuse Programs (UCLA ISAP) UCLA ISAP has steadily established its presence as a major entity in the drug abuse research community, both domestically and internationally. The group continues to advance the knowledge base on drug problems and to improve the delivery of drug abuse treatment services through an array of projects. National Institute on Drug Abuse (NIDA) NIDA s mission is to lead the nation in bringing the power of science to bear on drug abuse and addiction, treatment, and policy. 9 Addiction as a Public Health Problem There is no single solution for the meth epidemic. It is often perceived as a criminal justice problem due to the large cost and visibility of crimes committed by meth users. While users need to be held accountable for their crimes, putting people in prison does not cure addiction; 70% 90% of meth users who leave prison without receiving treatment repeat the cycle of addiction and reincarceration within one year of release. An overemphasis on incarceration can obscure the fact that meth addiction is at its core a public health problem. People who abuse meth have a chronic brain disease that can be managed with effective treatment. In-prison programs, drug court, and legislation that redirects drug offenders into treatment can produce far better results than simply filling prisons with meth users. When effective treatment is available, meth users respond at rates comparable to or higher than those who use alcohol, cocaine, or heroin. Successful Interventions The good news is that the meth problem has begun to recede, at least in the United States. In many communities, the availability of meth has decreased dramatically and there appear to be fewer new users. This is largely due to the combined efforts of prevention campaigns, community action, and precursor laws that regulate the ingredients used to produce meth. Still, this problem won t go away overnight. Continued prevention, treatment, legislative, and community efforts are needed to secure the gains that have been made. Substance Abuse and Mental Health Services Administration (SAMHSA) SAMHSA, which is part of the United States Department of Health and Human Services, has sharply focused its mission on building resilience and facilitating recovery for people with or at risk for mental health or substance use disorders. RAND Drug Policy Research Center RAND s recently published The Economic Cost of Methamphetamine Use in the United States, 2005, is the first effort to place a price tag on meth use in the United States. California Methamphetamine Initiative The Me Not Meth campaign is a statewide effort created by the California Department of Alcohol and Drug Programs to reduce meth use in California. Montana Meth Project The Montana Meth Project is a large-scale prevention program aimed at significantly reducing first-time meth use through public service messaging, public policy, and community outreach. New England ATTC The Addiction Technology Transfer Center Network The New England ATTC provides addiction specialists and other mental health professionals, as well as other interested persons throughout the world, with convenient, easy-to-access cyber classrooms in which they can be kept abreast of the latest advances in addiction treatment and prevention. MethResources.gov The ANTI-METH Campaign This campaign aims to prevent meth use, dispel the myth that meth treatment does not work, and get people who need help with meth abuse into treatment. It includes resources for enforcement, public safety, prevention, education, treatment, health, youth, businesses, retailers, and policy makers. Western District University of Wisconsin Methamphetamine Toolkit Resources This excellent site provides a wide spectrum of information through links broken down into categories. U.S. Department of Justice Cops Office Tools For Combating Meth Tools for Combating Meth contains practical guidebooks that address issues such as clandestine drug labs, drug dealing in open-air markets and privately owned apartment complexes, and identity theft. The Matrix Institute on Addictions The Matrix Model, an intensive outpatient treatment for meth users, was developed by the Matrix Institute with an awareness of the diversity of factors that contribute to drug and alcohol problems. Friends Research Institute, Inc. Friends Research Institute provides free drug counseling as part of a research study for gay and bisexual men who use methamphetamine. The Institute created and published the gay-specific treatment manual, Getting Off: A Behavioral Treatment Intervention for Gay and Bisexual Male Methamphetamine Users. Hazelden A national nonprofit organization that helps people reclaim their lives from the disease of addiction. National Association of Counties (NACo) NACo is committed to raising public awareness about and helping counties respond to the nation s methamphetamine epidemic. National Alliance For Drug Endangered Children This alliance supports a nationwide network of professionals serving drug endangered children by providing referrals to experts, updated research on topics concerning drug endangered children, and best practice information. United States Department of Justice Meth Awareness General information site on meth, addiction, law enforcement, and treatment. University of Utah Genetics Learning Science Center A site dedicated to helping people understand how genetics affect their daily lives, including the genetics of addiction. Treatment4Addiction.com An online community and informational resource for individuals with a common goal of living a healthy addiction-free lifestyle. 22 23
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