Methamphetamine: New Knowledge, Neurobiology and Clinical Issues - PowerPoint PPT Presentation

Loading...

PPT – Methamphetamine: New Knowledge, Neurobiology and Clinical Issues PowerPoint presentation | free to view - id: 5f67f-ZDc1Z



Loading


The Adobe Flash plugin is needed to view this content

Get the plugin now

View by Category
About This Presentation
Title:

Methamphetamine: New Knowledge, Neurobiology and Clinical Issues

Description:

Semel Institute for Neuroscience and Human Behavior. David Geffen School of Medicine ... Cocaine half-life: 1-2 hours. Methamphetamine half-life: 8-12 hours ... – PowerPoint PPT presentation

Number of Views:105
Avg rating:3.0/5.0
Slides: 51
Provided by: Thoma450
Category:

less

Write a Comment
User Comments (0)
Transcript and Presenter's Notes

Title: Methamphetamine: New Knowledge, Neurobiology and Clinical Issues


1
Methamphetamine New Knowledge, Neurobiology and
Clinical Issues
  • Richard A. Rawson, Ph.D
  • Professor
  • Semel Institute for Neuroscience and Human
    Behavior
  • David Geffen School of Medicine
  • University of California at Los Angeles
  • www.uclaisap.org
  • rrawson_at_mednet.ucla.edu
  • Supported by
  • National Institute on Drug Abuse (NIDA)
  • Pacific Southwest Technology Transfer Center
    (SAMHSA)
  • International Network of Treatment and
    Rehabilitation Resource Centres (UNODC)

2
Methamphetamine
  • Methamphetamine is a powerful central nervous
    system stimulant that strongly activates multiple
    systems in the brain. Methamphetamine is closely
    related chemically to amphetamine, but the
    central nervous system effects of methamphetamine
    are greater.

3
Forms of Methamphetamine
Methamphetamine Powder IDU Description
Beige/yellowy/off-white powder
Base / Paste Methamphetamine IDU Description
Oily, gunky, gluggy gel, moist, waxy
Crystalline Methamphetamine IDU Description
White/clear crystals/rocks crushed glass /
rock salt
4
Types of Stimulant Drugs
  • Amphetamine Type Stimulants (ATS)
  • Amphetamine Speed
  • Dexamphetamine Ice
  • Methylphenidate Crank
  • Methamphetamine Yaba
  • Shabu

5
Methamphetamine vs. Cocaine
  • Cocaine half-life 1-2 hours
  • Methamphetamine half-life 8-12 hours
  • Cocaine paranoia 4 -8 hours following drug
    cessation
  • Methamphetamine paranoia 7-14 days
  • Methamphetamine psychosis - May require
    medication/hospitalization and may not be
    reversible
  • Neurotoxicity Appears to be more profound with
    amphetamine-like substances

6
EPHEDRINE
H
H
H
C
C
N
CH
CH
OH
3
3
7
The Methamphetamine Epidemic Admissions/100,000
1992-2003
It keeps going up
8
(No Transcript)
9
National Longitudinal Study of Adolescent Health
(Add Health).
  • In 20012002, 2.8 of young adults reported using
    crystal methamphetamine in the past year.
  • Blacks 0.6 Northeast 1
  • Asians 1.8 Midwest 2.2
  • Hispanics 1.8 South 2.8
  • Whites 3.3 West 5.3
  • Native Americans 12.8

10
Admissions for AI/AN Participants in LA County
11
Primary Admissions For Female AI/AN Participants
in LA County
12
(No Transcript)
13
Effects of Drugs on Dopamine Release
Source Shoblock and Sullivan Di Chiara and
Imperato
14
Prolonged Drug Use Changes the Brain In
Fundamental and Long-Lasting Ways
15
Partial Recovery of Brain Dopamine Transporters
in Methamphetamine (METH) Abuser After Protracted
Abstinence
3
0
ml/gm
METH Abuser (1 month detox)
Normal Control
METH Abuser (24 months detox)
Source Volkow, ND et al., Journal of
Neuroscience 21, 9414-9418, 2001.
16
Their Brains have been
Re-Wired by Drug Use
Because
17
Control gt MA
4
3
2
1
0
18
MA gt Control
19
Defining Domains Executive Systems Functioning
  • a.k.a. frontal lobe functioning.
  • Deficits on executive tasks assoc. w/
  • Poor judgment.
  • Lack of insight.
  • Poor strategy formation.
  • Impulsivity.
  • Reduced capacity to determine consequences of
    actions.

20
Brain Serotonin Transporter Density and
Aggression in Abstinent Methamphetamine
Abusers
  • Sekine, Y, Ouchi, Y, Takei, N, et al. Brain
    Serotonin Transporter Density and Aggression in
    Abstinent Methamphetamine Abusers. Arch Gen
    Psychiatry. 20066390-100.

21
Methamphetamine Use, Self-Reported Violent Crime,
and Recidivism Among Offenders in California Who
Abuse Substances
  • Cartier J, Farabee D, Prendergast M.
    Methamphetamine Use, Self-Reported Violent Crime,
    and Recidivism Among Offenders in California Who
    Abuse Substances. Journal of Interpersonal
    Violence. 200621435-445.

22
Results
  • Those who used MA (81.6) were significantly more
    likely than those who did not use MA (53.9) to
    have been returned to custody for any reason or
    to report committing any violent acts in the 30
    days prior to follow-up (23.6 vs. 6.8,
    respectively)

23
Implications of Results
  • These findings suggest that offenders who use MA
    may differ significantly from their peers who do
    not use MA and may require more intensive
    treatment interventions and parole supervision
    than other types of offenders who use drugs

24
Neural Activation Patterns of Methamphetamine-Depe
ndent Subjects During Decision Making Predict
Relapse
  • Paulus M, Tapert S, Schuckit M. Neural Activation
    Patterns of Methamphetamine-Dependent Subjects
    During Decision Making Predict Relapse. Arch Gen
    Psychiatry. 200562761-768.

25
Results Continued
  • Right insula, right posterior cingulate, and
    right middle temporal gyrus response best
    differentiated between relapsing and nonrelapsing
    participants
  • Cross-validation analysis was able to correctly
    predict 19 of 22 who did not relapse and 17 of 18
    who relapsed
  • Right middle frontal gyrus, right middle temporal
    gyrus, and right posterior cingulate cortex
    activation best predicted time to relapse

26
Implications of Results
  • Neural activation differences are part of a
    system involved with the processing of decision
    making. Attenuated activation may represent
  • Diminished ability to differentiate choices that
    lead to good vs. poor outcomes
  • fMRI may prove to be a useful clinical tool to
    assess relapse susceptibility

27
Methamphetamine Abuse, HIV Infection Causes
Changes in Brain Structure Jernigan,T, et al
American Jnl of Psychiatry Aug 2005
  • Methamphetamine abuse and HIV infection cause
    significant alterations in the size of certain
    brain structures, and in both cases the changes
    may be associated with impaired cognitive
    functions, such as difficulties in learning new
    information, solving problems, maintaining
    attention and quickly processing information.
  • Co-occurring methamphetamine abuse and HIV
    infection appears to result in greater impairment
    than each condition alone

28
Methamphetamine Abuse, HIV Infection Causes
Changes in Brain Structure Jernigan,T, et al
American Jnl of Psychiatry Aug 2005
  • Younger methamphetamine abusers showed larger
    effects in some brain regions.
  • Among HIV-infected individuals, the researchers
    noted a direct association between the severity
    of the infection and greater loss of brain
    matter.
  • In methamphetamine abusers who are also
    HIV-positive, decreased volumes are correlated
    with increased cognitive impairment in one brain
    region, the hippocampus.

29
  • 33 year old man, high on methamphetamine admitted
    to emergency room complaining of severe headache
    in Portland Oregon.
  • X-ray revealed 12, 2 inch nails (6 on each side)
    in his head, administered with aq nail gun.
  • The man at first claimed it was an accident, but
    he later admitted that it was a suicide attempt.
    The nails were removed, and the man survived
    without any serious permanent damage.
  • He was eventually transferred to psychiatric
    care he stayed for almost one month under court
    order but then left against doctors orders

MSNBC-TV
30
MA Psychosis Inpatients from 4 Countries
No. of patients having symptoms ()
Psychotic symptom Lifetime Current
Persecutory delusion Auditory hallucinations Strange or unusual beliefs Thought reading Visual hallucinations Delusion of reference Thought insertion or made act Negative psychotic symptoms Disorganized speech Disorganized or catatonic behavior 130 (77.4) 122 (72.6) 98 (58.3) 89 (53.0) 64 (38.1) 64 (38.1) 56 (33.3) 35 (20.8) 75 (44.6) 39 (23.2) 27 (16.1) 38 (22.6) 20 (11.9) 18 (10.7) 36 (21.4) 19 (11.3) 14 (8.3)
Srisurapanont et al., 2003
31
MA Psychosis
  • 69 physically healthy, incarcerated Japanese
    females with hx MA use
  • 22 (31.8) no psychosis
  • 47 (68.2) psychosis
  • 19 resolved (mean276.2222.8 days)
  • 8 persistent (mean17.610.5 months)
  • 20 flashbackers (mean215.4208.2 days to initial
    resolution)
  • 11 single flashback
  • 9 Recurrent flashbacks
    Yui et al., 2001
  • Polymorphism in DAT Gene associated with MA
    psychosis in Japanese
  • Ujike et al., 2003

32
Prenatal Meth. Exposure
  • Preliminary findings on infants exposed
    prenatally to methamphetamine (MA) and nonexposed
    infants suggest
  • Prenatal exposure to MA is associated with an
    increase in SGA (Small-for-Gestational-Age).
  • Neurobehavioral deficits at birth were identified
    in NNNS (Neonatal Intensive Care Unit Network
    Neurobehavioral Scale) neurobehavior, including
    dose response relationships and acoustical
    analysis of the infants cry (Lester et al.,
    2005).

33
Adolescent Meth. Abuse Treatment Admissions
  • Matrix (Boys) (Girls)
  • 2002 16 63
  • 2003 25 67
  • 2004 22 69
  • Phoenix (Boys) (Girls)
  • 2002 25 43
  • 2003 23 51
  • 2004 27 53

34
My Sexual Pleasure is Enhanced by the use of
(Rawson et al., 2002)
35
My Sexual Performance is Improved by the use of
(Rawson et al., 2002)
36
Female Methamphetamine Users Social
Characteristics and Sexual Risk Behavior
  • Semple SJ, Grant I, Patterson TL Women and
    Health Vol. 40(3), 2004

37
Introduction
  • In San Diego county, a sizable percentage of meth
    users were welfare mothers who lived in
    subsidized housing.
  • The majority of women had started using meth
    during their teenage years and had become
    long-term, chronic users.

38
Introduction
  • Another study reported that womens motivations
    for using meth centered on
  • Weight loss
  • Enhanced self-confidence
  • Increased energy for dealing with demands of
    childrearing and household activities
  • Enhanced sexual pleasure
  • Other studies have also reported that women, like
    men, experience
  • Increased sexual desire and sex drive
  • Prolonged sexual activity associated with meth use

39
Reasons for Meth Use
  • Reasons for using meth were wide-ranging
  • To get high (56)
  • To get more energy (37)
  • To cope with mood (34)
  • To lose weight/feel more attractive (29)
  • To party (28)
  • To escape (27)
  • To enhance sexual pleasure (18)

40
Sexual Partners of Meth-Using Women
  • On average women had 7.8 sexual partners in a
    two-month period (SD10.7, range 1-74).
  • 84 had casual partners during the past two
    months.
  • 90 of all casual partners were reported to be
    meth users.
  • 31 had an anonymous partner in the past two
    months.
  • 76 of anonymous sex partners were meth users.
  • No spouses or live-in partners were reported to
    be HIV-positive.

41
Sexual Risk Behavior
  • Participants engaged in an average of 79.2 sex
    acts over a two-month period.
  • Most sexual activity was unprotected. The
    average number of unprotected and protected sex
    acts over the two-month period was 70.3 and 8.8,
    respectively.
  • In terms of unprotected sex
  • 56 of all vaginal sex acts were unprotected
  • 83 of all anal sex acts were unprotected
  • 98 of all oral sex acts were unprotected

42
Social Networks and Meth Use
  • The influence of social network on the meth use
    of women represents another understudied area of
    research.
  • For the most part, womens sexual partners were
    also meth users. Not surprisingly, the sexual
    enhancement properties of meth make it a drug
    that is used most often with a sexual partner.
  • Research on drug-using women has shown an
    association between partners use of drugs and
    womens experience of physical abuse and sexual
    coercion.

43
Social Networks and Meth Use
  • It is plausible that the drug use behaviors and
    sexual risk practices of some meth-using women
    are influenced by perceived threats from
    drug-using male partners.
  • Data also suggests that women limit their meth
    use to private locations, and use primarily with
    sexual partners and friends.
  • Thus, unless womens meth use is exposed through
    an event, such as an encounter with law
    enforcement, they are likely to remain hidden for
    long periods of time.

44
Treatment
45
Treatment Outcomes for AI/AN in LA County 2005
  • Drug Category Days of Use
  • Admission Discharge
  • Alcohol 14.1 5.4
  • Cocaine 13.1 3.7
  • Heroin 19.1 10.5
  • Methamphetamine 12.0 3.0

46
Methamphetamine Treatment Statistics
  • Drop out rates
  • Retention in treatment rates
  • Re-incarceration rates
  • Other measures of outcome
  • All these measures indicate that MA users
    respond in an equivalent manner as individuals
    admitted for other drug abuse problems.
  • Analysis of data from 3 other large data sets and
    3 clinical trials data sets suggest treatment
    response (using psychosocial treatments) of MA
    and cocaine users is indistinguishable.

47
Why the MA Treatment Does Not Work Perceptions?
  • Many of the geographic regions impacted by MA do
    not have extensive treatment systems for severe
    drug dependence.
  • Medical and psychiatric aspects of MA dependence
    exceeds program capabilities.
  • High rate of use by women, their treatment needs
    and the needs of their children can be daunting.
  • Although some traditional elements may be
    appropriate, many staff report feeling unprepared
    to address many of the clinical challenges
    presented by these patients

48
Special Treatment Consideration Should Be Made
for the Following Groups of Individuals
  • Female MA users (higher rates of depression very
    high rates of previous and present sexual and
    physical abuse responsibilities for children).
  • Injection MA users (very high rates of
    psychiatric symptoms severe withdrawal
    syndromes high rates of hepatitis).
  • MA users who take MA daily or in very high doses.
  • Homeless, chronically mentally ill and/or
    individuals with high levels of psychiatric
    symptoms at admission.
  • Individuals under the age of 21.
  • Gay men (at very high risk for HIV and
    hepatitis).

49
Behavioral/Cognitive Behavioral Treatments
  • Cognitive/Behavioral Therapy-CBT
  • Motivational Interviewing-MI
  • Contingency Management-CM
  • 12-Step Facilitation Therapy
  • Community Reinforcement Approach-CRA
  • Matrix Model of Outpatient Treatment

50
Thank you rrawson_at_mednet.ucla.edu www.uclaisap.org
www.methamphetamine.org
About PowerShow.com