Abstract. The purposes of this descriptive research were to study brain organicity in amphetamine

Transcription

1 The Study of Organic Brain in Amphetamine Dependence by Using the Wechsler Adult Intelligence Scale-Third-Edition Vichien Sriputhon* and Sucheera Phatthrayuttawat** Abstract Objective: Method: Results: Key words: The purposes of this descriptive research were to study brain organicity in amphetamine dependence by using the Wechsler Adult Intelligence Scale-Third-Edition (WAIS-III) The samples were 70 seaman undergoing rehabilitation at Abphagarakiatiwongse Hospital Sattahip, Naval Base. Chonburi Province for 45 days starting data collection from August-November It was found that factors relating to amphetamine use, namely, frequency, quantity and duration of amphetamine use have a negative correlation with all aspects of brain organicity, namely Verbal IQ, Performance IQ, Full Scale IQ, Verbal Comprehension Index, Perceptual Organization Index, Working Memory Index and Processing Speed Index, at the statistically significant level of.01. The study of individual factors found that amphetamine dependences with different levels of education will have different mean brain organicity scores in all aspects with a.05 significance. Those with mothers with a history of drug addiction had different mean brain organicity scores that those with mothers without a history of drug use in terms of Verbal IQ and Full Scale IQ, whilst the history of drug use in the father was not a significant factor. Additionally, it was found that dependences who gave the reason of increasing work productivity for their initial exposure to the drug had different mean brain organicity scores than other groups in terms of Processing Speed Index at the statistically significant level of.05. The suggestion from the research is to compare amphetamine dependences with a non-drug-using-control or dependences of other drugs in order to see more clearly the differences in brain organicity, which will provide valuable data for use in planning rehabilitation programs for drug addicts in the future. Amphetamine, Organic Brain, Frequency, Quantity, Duration * M.Sc. (Clinical Psychology) ** Thesis Advisors

2 ªï Ë 38 Ë 1 - ÿπ π Introduction The most problematic form of drug addiction in Thailand is amphetamine dependence, which during the last ten years can be seen that the types of drug have had a tendency to change dramatically. Between 1990 and 1996, it was found that heroin was the drug of choice, but from 1997 to 2001 heroin saw a constant decline in usage, whereas amphetamine use increased steadily, increasing from 34 percent in 1997 to 66 percent in This change reflects social, economic, and values changes especially clear amongst adolescence. 1,2 From a survey conducted by ABAC poll among students from sixth grade to university in 2001, it was found that approximately 27 million people were linked to amphetamine use, 900,000 users, and 300,000 addicts. Another survey with a sampling size of 5,591 people in 2001 conducted by Chulalongkorn University Social Research Institute, found that 4.3 percent admitted to having used amphetamines before, both male and female started use between the ages of 18 and 24 3,4, an age group which is considered highly vulnerable. Drug use is the leading cause of numerous tragedies and accidents as a result of the drugûs effect of inhibiting conscious thought. Additionally, the drugs affect mental functions permanently causing drug-using youths to become lower quality human resources or become a social burden, an obstacle to nation development in the future. 5 Amphetamines are mental stimulants that have been abused in many ways, which present both physical and emotional dangers, due mainly to the mode shift of consumption from eating to smoking, with a 98 percent tendency rate, which is the mode by which amphetamines can very quickly affect the brain, causing severe addiction and danger to the brain. Heavy and long-term users will suffer from the lose of brain tissue especially in limbic systems and prefrontal lobe, which serves as the bodyûs command center, thus causing accidents, and erroneous thoughts and decisions. 5 The study of Ernst, Chang et al. 6 found that amphetamine dependences suffer from degeneration, because amphetamines destroy brain cells. The amount of damage is determined by the amount, frequency and duration of usage, corresponding with the study of Buffenstein et al. which found that amphetamine users have abnormalities of focal perfusion deficits in frontal, parietal and temporal lobe. 7 Additionally, Alasdair, William et al. found that in long-term amphetamine users, brain cells have been destroyed causing cognitive impairment in terms of attention, memory and executive functions. 8 This corresponds with the study of Thomas 9 who studied cognitive function amongst amphetamine dependences and found that dependences have abnormalities in learning, delayed recall, processing speed and working memory. Amphetamines not only causes brain organicities, it also causes dependences to develop behavioral problems such as forgetting treatment appointments, low motivation for treatment, resisting treatment such as regularly arriving late for sessions or displaying distaste for sessions which also shows that the patient have irregularities in strategies of planning and linking perceptions there are important factors to consider when planning the treatment, because these behavioral problems may affect the therapy process. 10 From the study of Ari, Thomas. et al. 11 who stated that neuro-cognitive impairment will lead to problems in daily or professional life, as well as have high risks of relapse addiction. Aside from this, they also stated that there should be studies concerning factors relating to usage such as quantity, frequency and duration in order to better understand dependences and to serve as information in order to plan therapies appropriate to individuals. A study on the factors relating to amphetamine use will be beneficial in better informing about factors that include the mental abnormalities in amphetamine dependences as well as better understand behaviors that are obstacle to therapy as a result of brain abnormalities. This

3 32 ǵǹ information can then be used in diagnosing and evaluating diseases. Furthermore, the data from this study can be beneficial to the rehabilitation and development of the abilities of amphetamine dependences, to teach them hot to best utilize their abilities to their fullest potential and able to cooperate in the treatment as well able to appropriate adapt and assimilate into society. Objective 1. To study and compare brain organicity of amphetamine dependences with differing individual factors namely domicile, level of education, profession, history of drug use in parents and initial reason of first exposure. 2. To study and compare brain organicity of amphetamine dependences with differing factors relating to amphetamine use namely mode of consumption, addictive substances used, and patterns of drug use. 3. To study the correlation between the factors relating to drug use to amphetamine use mainly age of initial exposure, quantity, frequency and duration of use. Materials and Methods Participants were 70 seaman military who are amphetamine dependences undergoing treatment at Abphagarakiatiwongse Hospital Sattahip Naval Base, Chonburi province starting data collection from August-November All participants were amphetamine dependences according to the DSM-IV, had 21 years and older, minimum primary school education, no visual auditory impairment, no psychosis from other causes such as schizophrenia, or other brain organicities and volunteers to participate in the study. Potential participants were exclusion criterion if they had aggressive and violent behavior, not cooperate with the investigation or mentally retarded. Materials are the followings; 1. The Questionnaires for demographic data and factors relating to the use of amphetamines 2. The Wechsler Adult Intelligence Scale- Third-Edition (WAIS-III) measuring brain organicity in 7 areas namely Verbal IQ, Performance IQ, Full Scale IQ, Verbal Comprehension, Perceptual Organization, Working Memory and Processing Speed. All data were analyzed using the SPSS version 11 in Windows, using frequency, percentage, mean, standard deviation, Pearson product moment correlation coefficient(r), t-test and One-Way ANOVA Result and Discussion The result of which researcher has separated into the 3 following parts; Part 1 : Demographic Data The amphetamine dependences are mostly from the northeast, followed by the central region, and the lowest is the west, with 27.1 percent, 24.3 percent, and 1.4 percent respectively. Most have middle school education, 44.3 percent, with a large amount working as laborer prior to their military service, 32.9 percent percent have fathers who have used drugs before and only 11.4 percent of mothers have quitted before. The most popular reason for first exposure was curiosity followed by peer pressure and increase work productivity, equivalent to 75.7, 67.1 and 15.7 respectively. Most consume amphetamines by smoking the pill by burning the end of a lead paper, followed by smoking via water, and other additives, such as cigarettes, alcohol and cannabis, in that order. Part 2 : Correlation between Factors Relating to Amphetamine Use and Various Brain Orgnicities The result of study found that the correlation between factors relating to amphetamine use and various brain organicities. It can be found that factors relating to amphetamine use, in terms of age of first

4 ªï Ë 38 Ë 1 - ÿπ π exposure has no correlation with brain organicity, but instead found a significant negative correlation with the duration of use at.01 (p<.01, r = -.719), which shows that amphetamine dependences who began using amphetamines at a very young age have a tendency to use it for longer. Conversely, amphetamine dependences that began usage at an older age had the tendency to have a short duration of usage. The result of which showed in Table 1. Part 3 : Comparison between Individual Factors and Brain Organicity When comparison between individual factors and brain organicity, it was found that the differing level of education results in different brain organicities, as for profession, and history of drug in father showed no differences in every aspect of brain organicity. At the same time, dependences with mothers that have a history of drug use and use of amphetamines to boost work productivity have some different brain organicity. The result of which showed in Table 2. Table 1 Correlation between factors relating to use and various brain organicities VIQ PIQ FSIQ VCI POI WMI PSI Age of first exposure Frequency Quantity Duration = There were correlated to brain organicity = There were not correlated to brain organicity Table 2 Characteristic that were studied and compared with various brain organicities VIQ PIQ FSIQ VCI POI WMI PSI Mode of consumption Other addictive substances Pattern of usage Profession Level of education History of drug use in father History of drug use in mother Using drugs to increase productivity = There were different to brain organicity = There were not different to brain organicity

5 34 «µ«π This study found that factors in terms of quantity, frequency, and duration had a negative correlation with brain organicity, specifically Verbal IQ, Performance IQ, Full Scale IQ, Verbal Comprehension Index, Perceptual Organization Index, Working Memory Index and Processing Speed Index. The study showed that amphetamine dependences with high frequency, quantity and duration will have a negative effect on the Full Scale IQ, which in turn reduces learning skills, in terms of Verbal IQ, and Verbal Comprehension Indexes, such as having problems in using words or language in solving problems, having difficulty language articulation in verbal communication. Additionally, amphetamines also affect Performance IQ and Perceptual Organization Indexes, that is dependences have problems in perceiving, connecting, as well as problems with eye - hand coordination, which may affect the treatment. For example, a dependence that scored low in this area when compared to other areas, may inhibit the dependence from receiving the things from the lesson or treatment effectively, because the dependence does not understand the lesson, which the therapist must be aware of and pay more attention when observing dependences with low scores. Furthermore, the study also found that amphetamines affect the Working Memory Index, both in terms of attention and maintaining that attention that is amphetamine dependences will have bad memory and find it difficult in extracting what is learnt to solve problems in daily life. If an abnormality develops in this skill area, it will have a negative effect on the daily life and therapy such as the amphetamine dependence is unable to remember the contents of the dayûs lessons or forget necessities when leaving the house. Lastly, amphetamines also have a negative effect on the Processing Speed Index, which causes the amphetamine dependence to have reduced cognitive speed, as well as the ability to distinguish what is important in a visual input, that is the dependence will have lower eye-hand coordination and agility as well. This research found that amphetamine dependences that began using amphetamines to increase work productivity will have brain organicity in the areas of Processing Speed Index, probably as a result that laborers using amphetamines to prolong their ability to work, and after sometime, may affect visual-motor functioning. Saming Goacharoen 12 stated that when there is a need to prolong work, the laborer chooses amphetamines, the result that follows is an increase in quantity and frequency, until sometimes an injection is needed, which causes physical complication such as abnormal movement or repetitive movements of the hear, arms and legs; the most common being head shaking. Pannapa Kitiratpibul 13 stated that if there is repetitive use of amphetamines over a long period of time, it will cause the level of the drug in the blood stream to increase steadily, and the potency of the drug is prolonged, which reduces neurotransmitters in the cells, whereby inhibiting the body from synthesizing a sufficient supply, which in turn causes the dependence to become slow and irresponsive. Therefore if the dependenceûs profession deals with speed such as driving or constantly deals with machinery, they may easily cause accidents, because the Processing Speed skills have been reduced. This corresponds with the study Songsom Peungpong 14 who found that people who have used amphetamines for a long time will score below average in terms of the Working Memory and Processing Speed Indexes with 1 S.D. Similarly the study of Wilson et al. 15 found that people who have used amphetamines for a longtime, have dopamine in the striatal such as the nucleus accumbens, caudate, putamen reduced by percent. Ornstein et al. 16 who studied cognitive dysfunction in chronic amphetamine and heroin found that chronic amphetamine occurs as a result of cognitive dysfunction in term of verbal fluency, spatial recognition, planning, spatial working

6 ªï Ë 38 Ë 1 - ÿπ π memory and visuospatial strategy tasks, which corresponds with the study of Pascual, Dhuna and Anderson 17 who found that people who use stimulant type drugs for a longtime, such as amphetamines or cocaine, will induce cerebral atrophy, where the symptoms are especially prominent in the frontal and temporal lobes. The frontal lobe is responsible for executive functioning and general intellectual functioning or Full Scale IQ such as cognition, planning, and decision making. 18 The temporal lobe is mainly responsible for language comprehension or Verbal Comprehension Index, auditory sensation and longterm memory etc. 10 A study on the long-term exposure to amphetamines in lab mice, found clear reductions in the transporter of dopamine and serotonin, which causes dysfunction in terms of motor performance or Performance IQ and learning. 19 Therefore, longterm amphetamine use will cause these various functions of the brain to clearly dysfunction. Nevertheless, the results of this research corresponds with the study of Ernst, Chang et al. 6 who found that amphetamine dependences have reduced levels of N-acetyl-aspartate which indicates the state of brain deterioration. Similarly, the study of Buffenstein et al. 7 who found that amphetamine users will develop abnormalities in the brain in the frontal, parietal and temporal lobes, which corresponds with Thomas and Linda 20 who found that whether these abnormalities will become very severe or somewhat severe is related to factors of quantity, frequency and duration of use, because amphetamines will increase the synaptic activity of biogenic amines such as norepinephrine, dopamine and serotonin to above normal levels 9, causing the user to develop euphoria. When these are secreted continuously for a longtime, it will reduce the number of neurotransmitters in the cells. The body is unable to synthesize enough causing brain abnormalities. 15 This corresponds with the 2006 study of Alasdair et al. 8 who studied the dopamine levels of amphetamine dependences using positron emission tomography (PET), and found that the secretion of dopamine in the bitofrontal cortex, dorsolateral prefrontal cortex, striatum, nucleus accumbens and amygdale is reduced which causes cognitive impairment and lead to severe mental symptoms. A 2003 study by Ari, Thomas and Michael 11 who studied neurocognitive impairment in 27 amphetamine dependences who are in the initial phase of amphetamine abstinence (5-14 days) compared to a control group of 18, and found that the amphetamine dependences had impairments in terms of attention, psychomotor speed, verbal learning, memory and executive function, which corresponds with another study in 2005 by Thomas 9 who studied the cognitive in cannabis dependences and amphetamine and methamphetamine dependences using the brain imaging technique and neuropsychological test, and found that the amphetamine dependence group had abnormalities in learning delayed recall, processing speed and working memory, which cannabis dependences had abnormalties in attention and memory. Additionally, this corresponds with the study of McKetin and Mattick 21 who studied the impairments in terms of attention and memory in amphetamine dependences compared with a nondrug-using-control using the Wechsler Memory Scale- Revised (WMS-R), which separated the amphetamine dependences into two groups namely the low and high, and found that the high group scored lower than the control in terms of verbal memory, attention, concentration and delayed recall. Thus it can be seen that amphetamines clearly have a detrimental effect on various brain organicities in accordance with the assumption. Conclusion The purpose of this research was to study brain organicity in amphetamine dependence by using the Wechsler Adult Intelligence Scale-Third-Edition (WAIS-III), using a sample group of 70 militaries

7 36 «µ«π undergoing rehabilitation at Abphagarakiatiwongse Hospital Sattahip, Naval Base. Chonburi Province for 45 days. The results revealed that the amphetamine have an effect on brain organicities in amphetamine dependences, Studies of the frequency, quantity and duration of amphetamine use have a negative correlation with all aspects of brain, amphetamine were significantly impaired in overall intellectual functioning, speech, language skill, working memory, performance, perceptual organization and processing speed, possibly from neurotoxicity. Furthermore, amphetamine not only cause brain organicities, it also cause dependences to develop behavioral problems, specially for therapeutic process such as patient have irregularities in strategies of planning and association perception, which the therapist must be awareness. Acknowledgement The researcher wish to acknowledge Assoc.Prof. Sucheera Phatthrayuttawat, my advisor who provide helpful comments on an earlier version manuscript, CAPT. Vichai Manusirivithaya and CAPT. Thanarak Eosanurak for their invaluable assistance of this study. Furthermore, This study was support by graduate thesis scholarship from Faculty of Medicine Siriraj Hospital, Mahidol University. References 1. ÿ æ µ «ß ÿ. «π Õß å «Ÿâ ß π«ë Ë «âõß π ËÕß «Õߪí À ÿ æ µ ß µ «. ÿß æœ: π ß π ßæ æåõß å ß Àå À ºà π» ; µõπ πæß»å. â ( Õ øµ π) Õ. ÿã ß å «2546;47: «ß ÿ. π«ß ªØ µ ß π æµ ÕßÀπà«ß π ÿ π à«π Ÿ æ.» ÿß æœ: ßæ æåõß å ß Àå À ºà π» ; À Õ à Õß å «æµ π ß π ªÑÕß π ª ª æµ «ß ÿµ. π æ â æµ æ.» ««Õπµ «π Ë«ª». ÿß æœ:»ÿπ å«æµ π« µ å æ å ÿã ß å À «; Õ æ æ æ å. «Ÿâ ËÕß â. ÿß æœ: ßæ æå..æ.; Ernst T, Chang L., Leonido LM, Speck O. Evidencefor long-term neurotoxicity associated with methamphetamine abuse: a 1H MRS study. Neurology 2000;54(6): Buffenstein A, Heaster J, Ko P. Chornic Psychotic Illness from Methamphetamine. Am J Psychiatry 1999;156(4): Alasdair MB, William JP, William M, Allen ET, Donna JL, William GH, et al. The need for speed : an update on methamphetamine addiction. J Psychiatry Neurosci 2006;31(5): Thomas L. Cognitive Consequences of cannabis use : comparison with abuse of stimulants and heroin with regard to attention, memory and executive functions. Phar, biochembeh 2005;81: Terri FJ. Neurocognitive Functioning Substance Abuse Clients: Assessment and Treatment Implications. New York: Center for Substance Abuse Treatment; Ari DK, Thomas FN, Michael Methamphetamine Dependence Associated With Neurocognitive Impairment in the Initial Phases of Abstinence. J Neuropsychiatry Clin Neurosci 2003;15: ß à. À «π «ªìπæ / æ. æ æå Èß Ë 1. ÿß æœ:»ÿπ åæ «æ» µ å ßæ ; æ π ÿåπ µµ µπ æ Ÿ å. â. ««πª ÿß. 2542;15:37-49.

8 ªï Ë 38 Ë 1 - ÿπ π àõß æ Ëßæß»å. ª π «πåªí Wechsler Adult Intelligence Scale-Third-Edition (WAIS- III) «å âõ πõ π π π ª â. «µ«π. 2549;37(1): Willson JM, Kalasinsky KS, Leveg AI, et al. Striatal Dopamine Nerve Terminal Markes in Humans Chronic Methamphetamine Users. Nat med 1996;2: Ornstein TJ, Iddon JL, Baldacchino AM, Sahakian BJ, London M, Everitt BJ, et al. Profile of cognitive dysfunction in chronic amphetamine and heroin abusers. Neuropsychopharmacacology 2000;23(2): Barbara SM. Elizabeth EE. Addiction : A Comprehensive Guidebook. New York: Oxford University Press Inc; Sim T, Simon Sl, Domier CP, Richardson K, Rawson RA, Ling W. Cognitive deficits among methamphetamine users with attention deficit hyperactiveity disorder symptomatology. J Addict Dis 2002;21(1): John CM. Brust. Neurological Aspects of Substance Abuse. 2 nd ed. USA: Elsevier Inc; ßæ å æ å «ß ÿ. µ ºŸâµ æµ. ÿß æœ: «Õ π µõ åª Èπµ Èß ; McKetin R, Mattick RP. Attention and Memory in Illicit amphetamine use: Comparison with non-drug-using control. Drug and Alcohol Dependence 1998;50: àõ» æ æ ß Õß π ÿà ºŸâµ Õ øµ π â Õ «πåªí «Õ å À ºŸâ À à Ë 3 (WAIS-III) Ÿ * ÿ ÿµ«µπå** * «.. ( µ«π ) æ» µ å» æ À «À ** «ÿ «π æπ å, Ph.D. (Psychology) «µ ÿª ß å: «Èßπ È ªìπ «ß æ ËÕ» æ æ ß Õß π ÿà ºŸâµ Õ øµ π â Õ «πåªí «Õ å À ºŸâ À à (WAIS-III) : ÿà µ «Õ à ß ªìπæ À ˵ Õ øµ π Ë â Ë ßæ Õ µ «ß»å.. ßÀ«ÿ ªìπ «45 «π π«π 70 π Á âõ Ÿ â Õ âõ Ÿ à«π ÿ Õ «πåªí «Õ å À ºŸâ À à (WAIS-III) À«à ß Õπ ßÀ -惻 π 2549 º» : æ «à ªí Ë Ë «âõß â Õ øµ π â à «Ë, ª «Ë â Õ øµ π «æ π å ß æ æ ß Õß π ÿ â π â à â π Verbal IQ, Performance IQ, Full Scale IQ, Verbal Comprehension Index, Perceptual Organization Index, Working Memory Index Processing Speed Index Õ à ß π Ë.01» ªí à«π ÿ æ «à ºŸâµ Õ øµ π Ë» µà ß π ππ Ë æ æ ß Õß µ µà ß π ÿ â πõ à ß π ß µ Ë.05 à«πºÿâµ Ë ª «µ â æµ ππ Ë æ æ ß Õß µ µà ß ÿà µ Ë à ª «µ â æµ π â π Verbal IQ Full Scale IQ π ˺Ÿâµ Ë ª «µ â æµ æ æ ß Õß à µ µà ß π πõ π È ßæ «à ºŸâµ Ë Àµÿº Ë Õ â æ ËÕ ß π â Èπ ππ Ë æ æ ß Õß µ µà ß ÿà Õ Ëπ π â π Processing Speed Index Õ à ß π ß µ Ë.05 âõ πõ π ß π« ª ÿà µ Õ øµ π ÿà πª µ À Õ ÿà Ë â æµ π Õ Ëπ â«æ ËÕ â ÀÁπ «µ µà ß ßæ æ ß Õß π Èπ Õ π â âõ Ÿ Ë ªìπª πå æ ËÕπ ª â π «ß ºπ ºŸâµ æµ µàõ ª : Õ øµ π, æ æ ß Õß, «Ë, ª, «