methamphetamine: how it influences the brain and behavior of users richard a. rawson, ph.d adjunct...
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Methamphetamine: How it Methamphetamine: How it Influences the Brain and Influences the Brain and
Behavior of Users Behavior of Users Richard A. Rawson, Ph.DRichard A. Rawson, Ph.D
Adjunct Associate ProfessorAdjunct Associate ProfessorDepartment of Psychiatry and Biobehavioral SciencesDepartment of Psychiatry and Biobehavioral Sciences
David Geffen School of MedicineDavid Geffen School of MedicineUniversity of California at Los AngelesUniversity of California at Los Angeles
MethamphetamineMethamphetamine
Methamphetamine is a powerful central Methamphetamine is a powerful central nervous system stimulant that strongly nervous system stimulant that strongly activates multiple systems in the brain. activates multiple systems in the brain. Methamphetamine is closely related Methamphetamine is closely related chemically to amphetamine, but the chemically to amphetamine, but the central nervous system effects of central nervous system effects of methamphetamine are greater. methamphetamine are greater.
Methamphetamine: SpeedMethamphetamine: Speed Methamphetamine powder ranging in color from Methamphetamine powder ranging in color from
white, yellow, orange, pink, or brown. white, yellow, orange, pink, or brown. Color variations are due to differences in chemicals Color variations are due to differences in chemicals
used to produce it and the expertise of the cooker. used to produce it and the expertise of the cooker. Other names: shabu, crystal, crystal meth, crank, tina, Other names: shabu, crystal, crystal meth, crank, tina,
yabayaba
Methamphetamine: IceMethamphetamine: Ice
High purity High purity methamphetamine methamphetamine crystals or coarse crystals or coarse powder ranging from powder ranging from translucent to white, translucent to white, sometimes with a sometimes with a green, blue, or pink green, blue, or pink tinge. tinge.
MethamphetamineMethamphetamineA Brief HistoryA Brief History
18871887 19191919 19321932
Amphetamine developedAmphetamine developed
Methamphetamine developedMethamphetamine developed
Amphetamine & Amphetamine & methamphetamine used as methamphetamine used as decongestantdecongestant
MethamphetaminesMethamphetaminesA Brief HistoryA Brief History
WW II Extensive use by:WW II Extensive use by:
- RAF fighter pilots- RAF fighter pilots
- German Panzer - German Panzer troopstroops
- Japanese workers - Japanese workers
- Led to Kamikaze - Led to Kamikaze feverfever
According to surveys and estimates by WHO According to surveys and estimates by WHO and UNDCP, methamphetamine is the most and UNDCP, methamphetamine is the most widely used illicit drug in the world except for widely used illicit drug in the world except for cannabis.cannabis.
World wide it is estimated there are over 42 World wide it is estimated there are over 42 million regular users of methamphetamine, as million regular users of methamphetamine, as compared to approximately 15 million heroin compared to approximately 15 million heroin users and 10 million cocaine usersusers and 10 million cocaine users
Scope of the Methamphetamine Scope of the Methamphetamine Problem WorldwideProblem Worldwide
IHS-Wide Outpatient Encounters for IHS-Wide Outpatient Encounters for Amphetamine Related Visit by Calendar YearAmphetamine Related Visit by Calendar Year
The Eastward Spread The Eastward Spread of Methamphetamineof Methamphetamine
Methamphetamine: A Growing Menace Methamphetamine: A Growing Menace in Rural Americain Rural America
In 1998, rural areas In 1998, rural areas nationwide reported 949 nationwide reported 949 methamphetamine labs. methamphetamine labs.
Last year, 9,385 were Last year, 9,385 were reported. reported.
This year, 4,589 rural labs This year, 4,589 rural labs had been reported as of had been reported as of July 26.July 26.
Source: El Paso Intelligence Center (EPIC), Source: El Paso Intelligence Center (EPIC), U.S. DEAU.S. DEA
Meth Lab SeizuresMeth Lab Seizures A small percentage of labs seized are labeled “Super Labs” and A small percentage of labs seized are labeled “Super Labs” and
are capable of producing over 10 lbs per batch. are capable of producing over 10 lbs per batch. Super Labs are operated by Mexican National Drug Trafficking Super Labs are operated by Mexican National Drug Trafficking
Organizations (MNDTO’s), and supply the majority of meth to Organizations (MNDTO’s), and supply the majority of meth to the market.the market.
Stove Top LabsStove Top Labs
The active ingredient in making The active ingredient in making methamphetamine is ephedrine or methamphetamine is ephedrine or pseudoephedrine, commonly found in over pseudoephedrine, commonly found in over the counter cold remedies.the counter cold remedies.
Toxic Effects of Toxic Effects of Methamphetamine ManufacturingMethamphetamine Manufacturing
FiresFires ExplosionsExplosions Toxic gasesToxic gases Toxic wastesToxic wastes
Toxic Effects of Toxic Effects of Methamphetamine ManufacturingMethamphetamine Manufacturing
ManufacturersManufacturers Law enforcement Law enforcement
officersofficers BystandersBystanders
ChildrenChildren Children who live in and around the area of the Children who live in and around the area of the
meth lab become exposed to the drug and its meth lab become exposed to the drug and its toxic precursors and byproducts.toxic precursors and byproducts.
80-90% of children found in homes where there 80-90% of children found in homes where there are meth labs test positive for exposure to meth. are meth labs test positive for exposure to meth. Some are as young as 19 months old.Some are as young as 19 months old.
ChildrenChildren
Children can test positive for Children can test positive for methamphetamine by:methamphetamine by: Having inhaled fumes during the Having inhaled fumes during the
manufacturing process manufacturing process Coming into direct contact with the drugComing into direct contact with the drug Through second-hand smoke.Through second-hand smoke.
Cardiovascular problemsCardiovascular problems
↑ ↑ heart rateheart rate Palpitations Palpitations Arrhythmia Arrhythmia ↑ ↑ blood pressureblood pressure Chest Pain Chest Pain
Acute Coronary Acute Coronary Syndrome Syndrome
Valve thickening Valve thickening
Neurological problemsNeurological problems
Seizures Seizures Stroke Stroke Cerebral Cerebral
hemorrhage hemorrhage Cerebral vasculitis Cerebral vasculitis
MydriasisMydriasis
Respiratory problemsRespiratory problems
Dyspnea Dyspnea
Pulmonary Pulmonary
hypertension hypertension
Pleuritic chest pain Pleuritic chest pain
Other problemsOther problems
Eye ulcers Eye ulcers
Over-heatingOver-heating Rhabdomyolysis Rhabdomyolysis Obstetric complications Obstetric complications
Anorexia / weight loss Anorexia / weight loss
Tooth wear, cavitiesTooth wear, cavities ““Speed bumps”Speed bumps”
TraumaTrauma
Interpersonal Interpersonal traumatrauma AssaultAssault GunshotGunshot KnifeKnife
Motor VehiclesMotor Vehicles Suicide attemptsSuicide attempts
MethamphetamineMethamphetamineAcute Physical EffectsAcute Physical Effects
- - IncreasesIncreases --DecreasesDecreases
Heart rate Heart rate AppetiteAppetite
Blood pressure Blood pressure Sleep Sleep
Pupil size Pupil size Reaction Reaction timetime
RespirationRespiration
Sensory acuitySensory acuity
EnergyEnergy
MethamphetamineMethamphetamineAcute Psychological EffectsAcute Psychological Effects
IncreasesIncreases Confidence Confidence Alertness Alertness MoodMood Sex driveSex drive EnergyEnergy TalkativenesTalkativenes
ss
DecreasesDecreases BoredomBoredom LonelinessLoneliness TimidityTimidity
MethamphetamineMethamphetamineChronic Physical EffectsChronic Physical Effects
-- Tremor Tremor - Sweating- Sweating- Weakness - Weakness - Burned lips; - Burned lips;
sore nosesore nose- Dry mouth - Dry mouth - Oily - Oily
skin/complexionskin/complexion- Weight loss - Weight loss - Headaches- Headaches- Cough - Cough - Diarrhea- Diarrhea- Sinus infection - Sinus infection - Anorexia- Anorexia
MethamphetamineMethamphetamineChronic Psychological EffectsChronic Psychological Effects
- - Confusion - IrritabilityConfusion - Irritability
- Concentration - Paranoia- Concentration - Paranoia
- Hallucinations - Panic - Hallucinations - Panic reactionsreactions
- Fatigue - Depression- Fatigue - Depression
- Memory loss - Anger- Memory loss - Anger
- Insomnia - Psychosis- Insomnia - Psychosis
MethamphetamineMethamphetaminePsychiatric ConsequencesPsychiatric Consequences
Paranoid reactionsParanoid reactions Permanent memory lossPermanent memory loss Depressive reactionsDepressive reactions HallucinationsHallucinations Psychotic reactionsPsychotic reactions Panic disordersPanic disorders Rapid addictionRapid addiction
A Major Reason People Take a Drug is they Like
What It Does to Their Brains
A Major Reason People Take a Drug is they Like
What It Does to Their Brains
Methamphetamine abusers haveMethamphetamine abusers have abnormal brain activity. abnormal brain activity.
00
5050
100100
150150
200200
00 6060 120120 180180
Time (min)Time (min)
% o
f B
asal
DA
Ou
tpu
t%
of
Bas
al D
A O
utp
ut
NAc shellNAc shell
EmptyEmpty
BoxBox FeedingFeeding
Source: Di Chiara et al.Source: Di Chiara et al.
FOODFOOD
100100
150150
200200
DA
Co
nce
ntr
ati
on
(%
Bas
elin
e)D
A C
on
cen
tra
tio
n (
% B
asel
ine)
MountsMountsIntromissionsIntromissionsEjaculationsEjaculations
1515
00
55
1010
Co
pu
latio
n F
req
ue
nc
yC
op
ula
tion
Fre
qu
en
cy
SampleNumberSampleNumber
11 22 33 44 55 66 77 88 99 1010 1111 1212 1313 1414 1515 1616 1717
ScrScrScrScrBasBasFemale 1 PresentFemale 1 Present
ScrScrFemale 2 PresentFemale 2 Present
ScrScr
Source: Fiorino and PhillipsSource: Fiorino and Phillips
SEXSEX
Natural Rewards Elevate Dopamine Natural Rewards Elevate Dopamine LevelsLevels
Natural Rewards Elevate Dopamine Natural Rewards Elevate Dopamine LevelsLevels
00100100200200300300400400500500600600700700800800900900
1000100011001100
00 11 22 33 44 5 hr5 hr
Time After AmphetamineTime After Amphetamine
% o
f B
as
al
Re
lea
se
% o
f B
as
al
Re
lea
se
DADADOPACDOPACHVAHVA
AccumbensAccumbens AMPHETAMINEAMPHETAMINE
00
100100
200200
300300
400400
00 11 22 33 44 5 hr5 hrTime After CocaineTime After Cocaine
% o
f B
as
al
Re
lea
se
% o
f B
as
al
Re
lea
se
DADADOPACDOPACHVAHVA
AccumbensAccumbensCOCAINECOCAINE
00
100100
150150
200200
250250
00 11 22 33 44 5hr5hrTime After MorphineTime After Morphine
% o
f B
as
al
Re
lea
se
% o
f B
as
al
Re
lea
se
AccumbensAccumbens
0.50.51.01.02.52.51010
Dose (mg/kg)Dose (mg/kg)
MORPHINEMORPHINE
00
100100
150150
200200
250250
00 11 22 3 hr3 hrTime After NicotineTime After Nicotine
% o
f B
as
al
Re
lea
se
% o
f B
as
al
Re
lea
se
AccumbensAccumbensCaudateCaudate
NICOTINENICOTINE
Source: Di Chiara and ImperatoSource: Di Chiara and Imperato
Effects of Drugs on Dopamine LevelsEffects of Drugs on Dopamine LevelsEffects of Drugs on Dopamine LevelsEffects of Drugs on Dopamine Levels
Prolonged Drug Use ChangesProlonged Drug Use Changesthe Brain In Fundamentalthe Brain In Fundamentaland Long-Lasting Waysand Long-Lasting Ways
Prolonged Drug Use ChangesProlonged Drug Use Changesthe Brain In Fundamentalthe Brain In Fundamentaland Long-Lasting Waysand Long-Lasting Ways
CompulsiveDrug Use
(Addiction)
CompulsiveDrug Use
(Addiction)
VoluntaryDrug Use
VoluntaryDrug Use
Control > MA
4
3
2
0
1
MA > Control
5
4
2
0
1
3
Treatment Length by RouteTreatment Length by Route
0
1
2
3
4
5
6
7
8
9
10L
en
gth
in
Tre
atm
en
t (w
ks)
IN
SM
IDU
P<.05
Treatment Completion by RouteTreatment Completion by Route
0
0.1
0.2
0.3
0.4
0.5
0.6
0.7P
rop
ort
ion
of
Co
mp
leti
on
IN
SM
IDU
P<.05
MA-Free Samples by RouteMA-Free Samples by Route
0
0.1
0.2
0.3
0.4
0.5
0.6
0.7%
of
MA
-fre
e U
A (
3 w
ks)
IN
SM
IDU
P<.05
BSI Psychiatric Symptoms by RouteBSI Psychiatric Symptoms by Route
0
5
10
15
20
25
30
IN SM IDU
BL PST
TX-End PST
6-Mo PST
12-Mo PST
P<.05Positive Symptom Total (PST)
Depression Symptoms by Depression Symptoms by RouteRoute
0
24
6
810
12
14
1618
20
IN SM IDU
Dep
ressio
n S
co
res (
BD
I)
Baseline
Tx-End
6-Month
12-Month
P<.05
Psychopathology and RoutePsychopathology and Route
IDUs > likely to have a psychiatric IDUs > likely to have a psychiatric disability.disability.
IDUs > likely to have prior hospitalizations IDUs > likely to have prior hospitalizations for psychiatric problems for psychiatric problems
Hepatitis C by RouteHepatitis C by Route
21.05
10
57
22
0
10
20
30
40
50
60%
Pre
vela
nce
IN (n=38)
SM (n=202)
IDU (n=72)
Total (n=314)
P<.05
Women and MethWomen and Meth
Meth and Women: Meth and Women:
Typical gender ratio of heroin users in Typical gender ratio of heroin users in treatment : treatment : 3 men to 1 woman3 men to 1 woman
Typical gender ratio of cocaine users in Typical gender ratio of cocaine users in treatment : treatment : 2 men to 1 woman2 men to 1 woman
Typical gender ratio of methamphetamine Typical gender ratio of methamphetamine users in treatment : users in treatment : 1 man to 1 woman *1 man to 1 woman *
**among large clinical research populationsamong large clinical research populations
Drug Use by GenderDrug Use by Gender
14.9
63.7
85.1
36.3
0
10
20
30
40
50
60
70
80
90
Meth Other
Males
Females
0%10%20%30%40%50%60%70%80%
* p< .001
female
male
Self-Reported Reasons for Starting Methamphetamine Use
0%
5%
10%
15%
20%
25%
30%
35%
40%
*to lose weight *to relieve depression
*p< .001
Male
Female
Self-Reported Reasons for Starting Methamphetamine Use
My sexual My sexual drivedrive is increased by the use of … is increased by the use of …
18.1 20.5
43.9
70.655.3
11.1
85.3
55.6
0102030405060708090
100
Per
cent
Res
pond
ing
"Yes
"
opiates alcohol cocaine meth
Primary Drug of Abuse
malefemale
(Rawson et al., 2002)
My sexual My sexual pleasurepleasure is enhanced by is enhanced by the use of …the use of …
16.0 18.224.4
38.244.7
11.1
73.5 66.7
0102030405060708090
100
Per
cent
Res
pond
ing
"Yes
"
opiates alcohol cocaine meth
Primary Drug of Abuse
malefemale
(Rawson et al., 2002)
My sexual My sexual performanceperformance is improved by is improved by the use of …the use of …
19.115.9
24.432.4
18.411.1
58.8 61.1
0102030405060708090
100
Per
cent
Res
pond
ing
"Yes
"
opiates alcohol cocaine meth
Primary Drug of Abuse
malefemale
(Rawson et al., 2002)
CSAT Methamphetamine Treatment Project: CSAT Methamphetamine Treatment Project: Cross-Site Sample Description Cross-Site Sample Description
1,016 clients1,016 clients Average age was 32.8 yearsAverage age was 32.8 years 55% female55% female 60% Caucasian60% Caucasian 12.2 years of education on average12.2 years of education on average 16% currently married16% currently married 31% awaiting charges, trial, or sentencing31% awaiting charges, trial, or sentencing
Methamphetamine Use HistoryMethamphetamine Use History
Avg. years of lifetime use:Avg. years of lifetime use: 7.547.54
Avg. days used in past 30:Avg. days used in past 30: 11.5311.53
Percent that usually smoked:Percent that usually smoked: 65%65%
Violence Issues in LifetimeViolence Issues in Lifetime
78% experienced violence78% experienced violence 39% experienced sexual abuse39% experienced sexual abuse 81% experienced one or the other81% experienced one or the other 36% experienced both36% experienced both
Psychological Issues in LifetimePsychological Issues in Lifetime
60% depressed60% depressed 56% anxiety56% anxiety 45% memory problems45% memory problems 43% violence control problems43% violence control problems 34% suicidal thoughts34% suicidal thoughts 32% received medication32% received medication 9% memory problems9% memory problems
Gender Differences in Violence Gender Differences in Violence HistoryHistory
(% Ever)Female(85%)
Male(70%)
Partner 80% 26%
Friend 16% 38%
Other 14% 43%
Gender Differences in Partner Gender Differences in Partner ViolenceViolence
Female Male
Ever threatened 63% 26%
Ever Isolated 65% 37%
Ever Afraid 27% 10%
Gender Differences in Sexual Gender Differences in Sexual Abuse HistoryAbuse History
(% Ever)Female (58%) Male
(16%)
Parent 14% 4%
Sibling 22% 6%
Partner 32% 7%
Analyses reveal that a history of physical or sexual Analyses reveal that a history of physical or sexual violence (controlling for gender) is significantly violence (controlling for gender) is significantly
related to a number of negative outcomes. related to a number of negative outcomes.
These results suggest the importance of These results suggest the importance of understanding client background factors before understanding client background factors before
they enter treatment.they enter treatment.
0.00
0.20
0.40
0.60
0.80
1.00
1.20
1.40
1.60
Somat
izatio
n
Obsess
ive-
Compul
sive
Inte
rpers
onal S
ensi
tivity
Depress
ion
Anxiet
y
Hostili
ty
Phobic A
nxiety
Parano
id Id
eatio
n
Psychotic
ism
all significant at p< .001
Mea
n B
SI
Sco
re
Female
Male
Behavior Symptom Inventory (BSI) Scores at Baseline
0.00
2.00
4.00
6.00
8.00
10.00
12.00
14.00
16.00
18.00
20.00
Female Male
p < .001
Me
an
BD
I Sc
ore
Beck Depression Inventory (BDI) Scores at Baseline
ImplicationsImplications
Physical and sexual violence is related to Physical and sexual violence is related to psychological problems and drug use psychological problems and drug use pattern differencespattern differences
Different types of traumas may have Different types of traumas may have different outcomes and may affect people different outcomes and may affect people in different waysin different ways
A history of trauma may be related to A history of trauma may be related to treatment engagement and outcome treatment engagement and outcome