breaking the ice (nicole lee)
DESCRIPTION
Keynote address from ReGen's Innovation in Action Seminar: Developing therapeutic responses to methamphetamine use and dependence (#iAOD14) Slides accompany livestreamed video of Nicole's presentation: http://www.youtube.com/watch?v=cuV56kuvKYoTRANSCRIPT
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Breaking the Ice
Solutions to the unique challenges of methamphetamine for treatment settings
Dr Nicole Lee Associate Professor, NCETA
Director, LeeJenn Health Consultants
March 2014
E n a b l i n g C h a n g e
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E n a b l i n g C h a n g e
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E n a b l i n g C h a n g e
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Risks & Harms
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E n a b l i n g C h a n g e
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E n a b l i n g C h a n g e
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‘Amphetamines’
Methamphetamine
Powder/Pills
Base
Ice
Amphetamine Dexamphetamine Other
pharmaceuticals…
E n a b l i n g C h a n g e
20
10
ND
SH
S
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de
Gra
aff
& B
run
o, 2
01
3 (
IDR
S)
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E n a b l i n g C h a n g e
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Using speed Not dependent
Swallowing, snorting Working
Young Mental health
Sleep problems
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Occasional users Regular
users
Using crystal meth
Dependent
Smoking or injecting
Mental health
Sleep, nutrition issues
Brain changes
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Dopamine
E n a b l i n g C h a n g e
Limbic system
(emotional, social and memory) Frontal lobe
(thinking, planning decision making)
Dopamine
pathways
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www.methinsideout.com
E n a b l i n g C h a n g e
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Dopamine
The dopamine system ‘wears
out’ and the brain can’t
produce enough on its own
Flat, depressed, unmotivated
High levels of
dopamine linked to
psychosis
Dopamine regulates thinking processes such as
attention and working memory, planning, decision
making, emotion regulation
Hard to concentrate, pay attention and store
things in memory, plan, make good decisions and
regulate emotions
Dopamine regulates
motivation and the reward
system of the brain
Cravings
Need more dopamine (relapse)
Depression
E n a b l i n g C h a n g e
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Noradrenaline Arousal, mood, concentration,
attention, learning and
memory
Activates the flight or fight system
Anxious, jumpy and hypervigilant (flight)
Suspicious and aggressive (fight)
Serotonin Regulates mood (optimism), focus,
appetite, sleep, cognition, perception,
motor coordination, temperature
regulation, pain control, sexual behaviour
Flat, depressed, unfocused, negativity, edgy
Low levels of energy, motivation and
interest, unusual exhaustion at odd times of
the day, inability to attend to specific tasks
E n a b l I n g C h a n g e
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Cognitive deficits
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Decision making
Impulse control Emotion regulation
Focus, attention and concentration
Memory
Planning ability Flexible thinking
Mood
Energy levels
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+ Getting to appointments (memory, planning)
Completing tasks (focus, planning)
Taking on new information (attention, memory)
Thinking about consequences (planning, decision making)
Goal setting and working towards goal (planning)
Stopping inappropriate behaviour (impulsivity)
Switching from one topic to another (flexible thinking)
Unexpected outbursts (emotion dysregulation, impulsivity)
E n a b l i n g C h a n g e
Impaired functioning
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E n a b l i n g C h a n g e
Long term and regular users
Significant brain changes that result in:
• Strong cravings
• Variable motivation
• Impaired ability to manage emotions
• Impaired thinking processes
• High risk of relapse
• Long recovery/withdrawal time
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Cravings
Focus on managing cravings early
Motivation fluctuates
Closely monitor motivation
Motivational interviewing
Empathy
Relapse
Focus on the behavioural relapse prevention,
especially Psychoeducation about impairments,
focus on structure
Emotion regulation Assess and monitor closely
Eat well
Exercise daily
Behavioural activation
Evidence based therapy if needed
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Cognitive changes More frequent shorter sessions (attention)
Repetition (memory)
Use written materials (memory)
Slower pace (concentration)
Essential material and concrete skills (abstraction)
Long recovery time Extended withdrawal time
Assertive follow-up
Priority on treatment retention
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E n a b l i n g C h a n g e
Withdrawal
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E n a b l I n g C h a n g e
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Other drugs Methamphetamine
7 day withdrawal 10-14 day withdrawal
Withdrawal starts on cessation Account for 3 day crash
Waiting times for appointments Immediate appointments
1 hour counselling sessions Shorter more frequent sessions
Groups Specific meth groups?
Psychoeducation Nutrition and sleep hygiene
Light follow-up Assertive follow-up
Talking Written materials
Appointments Regular appointments
E n a b l i n g C h a n g e
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E n a b l I n g C h a n g e
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+ Keep in touch
1300 988 184
[email protected]/[email protected]
sign up at www.leejenn.com.au
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E n a b l I n g C h a n g e