Crystal meth interviews reveal its impact on HIV positive men

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1 CATIE-News CATIE s bite-sized HIV and hepatitis C news bulletins. Crystal meth interviews reveal its impact on HIV positive men 15 April 2009 Crystal meth, also known as ice or Tina, is a form of the stimulant methamphetamine. Smoking crystal meth results in a rapid accumulation of this drug in the brain. In turn, this triggers an intense high. Users also feel an increased sense of the following: alertness energy well-being Stimulated by the high concentration of crystal meth, brain cells release large amounts of neurotransmitters, which are probably responsible for many of the drug s initially pleasurable effects. However, the release of these neurotransmitters dopamine, norepinephrine and serotonin stimulates the cardiovascular system, raising blood pressure and increasing heart rate. At high doses, crystal meth can cause heart attacks. The high concentration of crystal meth in the brain has the potential to cause addiction and brain damage. Users of crystal meth can experience temporary lasting hours or days delusions and hallucinations and, less commonly, incoherent speech. Delusions often involve feelings of being persecuted. As a result, people experiencing crystal meth related psychosis can become agitated, emotionally unstable and even hostile. A major challenge to helping crystal meth addicts recover is that this drug appears to diminish their capacity to have insight into their condition. Moreover, withdrawal symptoms in people trying to quit crystal meth are unpleasant and can include the following: a profound lack of energy difficulty falling asleep irritability changes in appetite loss of interest in regular everyday activities anxiety depression an intense craving for crystal meth Another challenge, according to Stephen Kish, PhD, a researcher who studies addiction issues at the University of Toronto, is that the memories of addiction might be hard-wired and involve actual structural changes to brain [cells] that make addiction resistant to [treatment]. Experiments in animals suggest that crystal meth weakens the immune system. Like many illicit substances, crystal meth impairs judgment and critical thinking. As a result, there have been reports of crystal meth users engaging in unsafe behaviours and becoming infected with HIV and other sexually transmitted infections. Although there is ongoing research, there is so far no approved therapy for treating crystal meth addiction. Helping users recover from addiction involves the use of psychological therapy. Despite its highly addictive potential, some people still manage to find crystal meth alluring. So researchers at

2 Stanford University, California, have interviewed HIV positive men who used crystal meth to try to find out more about their reasons for using this drug. Their findings, appearing in the April 2009 issue of the journal Qualitative Health Research, provide valuable insight into the world of crystal meth and suggest new avenues to explore when helping people recover from this drug. Study details The research team recruited 22 HIV positive men whom they described as follows: 45% were at least 45 years old 75% used crystal meth within the past 30 days 45% used crystal meth within the past week 68% had attended college or university 73% were currently single The proportion of people in major ethno-racial groups was as follows: 32% White 32% Hispanic 23% Black Results family context Nearly half of participants mentioned that they had parents or siblings who also used illicit substances. In some cases, participants disclosed that they had become alcoholics at an early age. Here is what one man said: My family situation was very dark. There was a lot of physical, mental and emotional abuse. Lots of divorce, lots of alcoholism. You cope with what you learned how to cope with, even if you didn t know that s what you were doing. For me, my drinking and drugs came along. Catching up with reality According to the research team, several participants were older men who had been living with HIV for more than 10 years. The team noted that for these men the transition from being an active part of a community that values youth, beauty and prolific sex to dealing with issues of ageing and wanting to settle down with one person has been difficult. One of the participants had this lament: My life is winding down it s the ageing thing it s the AIDS. It s transitioning from one partner to another. I mean, I m transitioning, but I m doing it kicking and screaming all the way. Perceived help Many of the participants felt as if crystal meth had helped them or continued to help them find relief from the following feelings: anxiety depression grief loneliness poor self-esteem not feeling attractive Several participants felt that crystal meth helped them connect to other people even if only through sex. In addition to these effects, crystal meth users reported other consequences of using this drug, which they appreciated:

3 increased ability to focus increased energy so they could carry out their daily activities Sex and meth Although crystal meth has a reputation among some gay men for enhancing sexual pleasure, not all the men interviewed used crystal meth for this purpose. However, among those who did, here are some of the reasons: it was they only way that they could have sex with their partners it allowed some men to have frequent and more powerful sex A slippery slope Some of the men noted that initially they had used crystal meth only occasionally to relieve anxiety or because they perceived that its use increased their desirability only to find themselves using it more frequently and, as the research team stated, seeing it steadily creep into every part of their lives. The horror of addiction All participants were aware of what the researchers called the overall destructiveness that is often a consequence of crystal meth addiction. Here are some examples of this from the men in the study: Using meth destroyed my life. I had a long-term relationship. I had a home, a steady job. And thanks to crystal meth I have none of those. Another man said this: The drug takes you over so much that you do lose who you are, you forget who you are... Many of the participants reported feelings of depression, anxiety and paranoia after using crystal meth. All of these men had been using this substance to relieve the following feelings: depression trauma shyness loneliness poor self-esteem These men also found that using crystal meth made their health worse in at least one of the following ways: played a role in their acquisition of HIV infection weakened their immune system reduced their motivation to care for themselves reduced their motivation to take anti-hiv medications as directed Meth and relationships The study team noted that for several men using meth was the only way to connect, to have sex or other positive interactions [with other people]. Yet many men saw that over time their use of crystal meth became a barrier to having lasting and happy relationships. The researchers also found that a common theme in their interviews was the disclosure of violence in the men s relationships as a result of exposure to crystal meth. A disconnect with values Most participants noted core values with which they identified, including the following: honesty generosity

4 acting ethically commitment spirituality being responsible self-exploration and [positive] growth However, only some of the men noticed that substance use in general and crystal meth use in particular clashed deeply with these stated values. Trying to escape Nearly all of the men had tried to break free from the grip of crystal meth, but only a few were able to stay methfree for more than one year. This supports the findings from previous research that this drug can be deeply addictive. Among the men who tried to quit, those who had been successful found at least one of the following drastic changes helpful: moving to another city making a new network of friends and acquaintances reconnecting to their family Reflecting on his escape from crystal meth addiction, one of men said this: Developing a support network and keeping away from the places I had used and the people who I had used with, keeping away from them was the number one thing that helped me stay clean. Many of the men who tried to quit were motivated by at least one of these factors: the realization that meth use was degrading their health losing friends and loved ones because of their behaviour having a loved one die because of substance use Discontent A large proportion of the men felt that moving from full-time employment to being on disability support had played a role in their descent into addiction. Specifically, the men noted that being on disability resulted in a gradual loss of meaning and purpose in life. Crystal meth was used by a lot of the men in this study to relieve what the research team called the burdens of their lives. The men did this despite acknowledging that this fix from crystal meth was temporary. Specific reasons for using crystal meth in this way were as follows: living with HIV/AIDS being on disability severe depression despair The men who used crystal meth to relieve these feelings told the research team that they were self-medicating. Changing views? The research team wrote that there is a common assumption that substance use and abuse is necessarily counter to a person s values and would detract from life meaning. However, the findings revealed in the in-depth interviews suggest that the men were using crystal meth to fulfill some of their goals, such as: increasing their connection to people trying to recover from depression having enough energy to carry out the activities needed for everyday life

5 These findings suggest that the men who used crystal meth in this study may have had complex underlying needs involving profound mental health and psychosocial issues. The Stanford research team suggests that crystal meth treatment programs may need to find new ways through which people see themselves and from which they can make different [and healthy] choices. The researchers encouraged crystal meth treatment programs to not just deal with problematic behaviour but to do the following: understand the context in which such behaviour was derived incorporate what a person values and finds meaningful in his or her life into changing behavioural choices help reconnect people to having a valued and meaningful life treatment should occur in a non-judgmental setting help to deal with issues of gay identity and its relation to the use of crystal methamphetamine The issue of fatigue was raised by participants in this study. Other studies have confirmed that fatigue can be a problem in HIV infection. This may be related to depression and anxiety, hormonal deficiencies, anemia or other issues that require medical investigation. Hopefully, the findings and suggestions from this study will be used to help strengthen programs to discourage and treat crystal meth use. REFERENCES: Sean R. Hosein 1. Chartier M, Araneta A, Duca L, et al. Personal values and meaning in the use of methamphetamine among HIVpositive men who have sex with men. Qualitative Health Research Apr;19(4): Urbina A, Jones K. Crystal methamphetamine, its analogues and HIV infection: medical and psychiatric aspects of a new epidemic. Clinical Infectious Diseases Mar 15;38(6): Koblin BA, Husnik MJ, Colfax G, et al. Risk factors for HIV infection among men who have sex with men. AIDS Mar 21;20(5): Day JJ, Carelli RM. Methamphetamine induces chronic corticostriatal depression: too much of a bad thing. Neuron Apr 10;58(1): Bamford NS, Zhang H, Joyce JA, et al. Repeated exposure to methamphetamine causes long-lasting presynaptic corticostriatal depression that is renormalized with drug readministration. Neuron Apr 10;58(1): Kaye S, McKetin R, Duflou J, et al. Methamphetamine-related fatalities in Australia: demographics, circumstances, toxicology and major organ pathology. Addiction Aug;103(8): Darke S, Kaye S, McKetin R, et al. Major physical and psychological harms of methamphetamine use. Drug and Alcohol Review May;27(3): Kaye S, McKetin R, Duflou J, et al. Methamphetamine and cardiovascular pathology: a review of the evidence. Addiction Aug;102(8): Kish SJ. Pharmacologic mechanism of crystal meth. Canadian Medical Association Journal Jun 17;178(13): Kish SJ, Fitzmaurice PS, Boileau I, et al. Brain serotonin transporter in human methamphetamine users. Psychopharmacology (Berl) Mar;202(4): Coutinho A, Flynn C, Burdo TH. Chronic methamphetamine induces structural changes in frontal cortex neurons and upregulates type I interferons. Journal of Neuroimmune Pharmacology Dec;3(4): Frankel PS, Alburges ME, Bush L, et al. Brain levels of neuropeptides in human chronic methamphetamine users. Neuropharmacology Sep;53(3):

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