METHAMPHETAMINE: The Good, The Bad, And The Toxic

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Gregory McBride
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1 METHAMPHETAMINE: The Good, The Bad, And The Toxic

2 In the beginning Stay awake The GOOD Chemically close to Ritalin attention improvements, learning Weight loss Feel in control of life, time Feel productive Enhanced sexual drive, stamina, response

3 The BAD Nothing lasts forever Aggression Paranoia, Hallucinations Anxiety, Depression Sleeplessness Physical health issues Sexual dysfunction

4 The TOXIC Addiction takes over life Loss of job, family, normal life Long-term or permanent brain damage Delusions violence! Delirium violence! Death

5 METH 101: A Quick Overview Of The Descent Into Madness

6 What is a Drug? A drug is a pleasure producing chemical. Drugs activate or imitate chemical pathways in the brain associated with feelings of wellbeing, pleasure, and euphoria.

7 Addiction Biology Principles D & A activate the pleasure-producing chemistry of the brain and circuits that govern calm and alertness. Over-stimulation NEUROADAPTATION; interferes w/ normal experience of pleasure, calm and alertness. Addiction = disease re: pleasure-producing brain chem. Overstimulation neuroadaptation = disease mechanism Abuse to addiction? Tolerance and withdrawal. > Neuroadaptation: cessation of drug leads to inversion of the high ; sobriety is pleasureless, anxious, sleepless and without energy.

8 Your brain on drugs

9 Definition of methamphetamine A potent nervous system stimulant, with euphoric, excitatory, and vasoconstricting effects.

10 Stimulant Effects Improves mood Increases interest/alertness Increases confidence Increases sex drive Interferes with sleep Increases anger and aggression Activates flight or fight system Pupils Dilate Increases heart rate & blood pressure

11 Stimulant Withdrawal Dysphoria Boredom Lack of Energy Depression Anxiety Sleep disorder Hypofrontality

12 Definition of Addiction 1. Compulsion: loss of control 2. Continued use despite adverse consequences 3. Craving: daily symptom of the disease 4. Denial / hypofrontality : distortion of cognition caused by craving

14 RISK OF ADDICTION? Positive Reinforcement and Negative Alleviation: If, in addition to producing pleasure (positive reinforcement), a drug is more addicting if it relieves negative states: boredom, anxiety, depression or stress (negative alleviation).

15 Who are our clients? [Generally] People in need of NEGATIVE STATE ALLEVIATION! Childhood trauma Undiagnosed mental illness (e.g. Depression, ADD) Stressed out Bored, anxious, in pain

16 How did they get there? Bio-Psycho-Social Model Predisposition Genetics (re: addiction) Childhood Sexual Abuse Mental Illness Acquired Hypofrontality - in utero alcohol/drug exposure - low birth weight - perinatal asphyxia - head injury The Drug + Circumstances of First Use Enabling System

18 Attention Deficit Disorder & Addiction Prospective four-year study of 15 year-old boys. 75% Un-medicated ADD boys started abusing alcohol/drugs (N=19) 25% Medicated ADD boys started abusing alcohol/drugs (N=56) 18% (Controls) Non-ADD boys started abusing alcohol/drugs (N=137) 84% Risk Reduction when ADD treated with medications. Adapted from Biederman J, et al. Pharmacotherapy of attention-deficit/hyperactivity disorder reduces risk for substance use disorder. Pediatrics 104(2):20, 1999

20 Methamphetamine: Progression to Addiction Monday Tuesday Wednesday Thursday Friday Saturday Sunday Low Intensity use Low Intensity use Low Intensity use 1st and 2nd Months Used Drug offered by Friend Able to sleep nights Copyright Revenant Technical and Dr. Alex Stalcup 2006

21 Methamphetamine: Progression to Addiction Monday Tuesday Wednesday Thursday Friday Saturday Sunday Low Intensity use Low Intensity use Copyright Revenant Technical and Dr. Alex Stalcup rd Month Appearance of a Regular Pattern Consecutive days of use Looks forward to use Begins to equate use with sex

24 Methamphetamine: Progression to Addiction Monday Tuesday Wednesday Thursday Friday Saturday Sunday Low Intensity use Dysphoria Middle Intensity use Low Intensity use 4th Month Regular Pattern of Use Stays up all Night Weight Loss Irritable before and after use Drug purchase and use is planned Parenting is impaired Copyright Revenant Technical and Dr. Alex Stalcup 2006

25 Methamphetamine: Progression to Addiction Monday Tuesday Wednesday Thursday Friday Saturday Sunday Medium Intensity use Low Intensity use High Intensity use Medium Intensity use Dysphoria Crash Dysphoria 5th Month Regular Heavy Use Episodes of paranoia Drug is smoked or injected Chronic Irritability Unable to Parent Copyright Revenant Technical and Dr. Alex Stalcup 2006

26 Client Relationship? When is your client sober? When can he meaningfully understand his case? assist your preparation? make intelligent choices?

27 When is METH use relevant? Anytime you would consider evidence of any other intoxication Specific intent crimes With the intent to For the purpose of State of Mind issues Malice Aforethought Willful, Wanton, Reckless Disregard

28 An Aside: Manufacturing Issue? Not so common w/ Superlab phenom Consider duress if you represent a cooker or look-out or deliverer Very violent people make others, usually addicts, do the dirty work often under threat of violence

29 Toxic Psychosis DELUSIONS usually of the paranoid type HALLUCINATIONS usually auditory, occurring with or without intact reality testing; may also be visual DISORGANIZATION of speech and behavior. TANGENTIAL, DIGRESSIVE, ELLIPTICAL ( tweaker talk )

30 UNCONSCIOUSNESS? What if your client used so much methamphetamine that he was beyond psychosis? Perhaps he really doesn t recall everything that happened

31 Intoxication Delirium Delirium = semi-conscious state Consciousness and awareness are profoundly disturbed Awareness dissociated from the environment Person is internally preoccupied

33 CALCRIMS No. 625, Voluntary Intoxication: Effects on Homicide Crimes No. 626, Voluntary Intoxication Causing Unconsciousness: Effects on Homicide Crimes

34 We d like to call an expert witness re: SPEED SEX WHAT THE? [Nearly verbatim judicial response.]

35 Meth as Public Health Issue Research started w/connection to HIV First connection between meth and sex researched in gay community Noted risky or uncommon behaviors Research in heterosexual community had similar findings Women using meth + sex in higher # s

36 This is a big reason it s hard to stop using meth When quitting any habit, need to avoid trigger If sexual activity is trigger to avoid, who wants that? Add depression, lack of energy and recipe for relapse

37 USE BY VICTIM If victim a meth user: May be voluntary participant in risky behavior May be paranoid, delusional, too Others may not know of addiction, particularly if female [ hockey moms, CEO s, etc.]

38 Utah Meth PSA:

39 Recent Case Capital Case GF victim beaten to death by BF of 12 years; some prior violence between them Prior to death, hx of shooting meth and: 1. Erotic asphyxaphilia 2. Anal sexual behavior 3. Rough sexual behavior 4. Use of pornography w/sex 5. Unusual implement

40 End.

Substance and Alcohol Related Disorders. Substance use Disorder Alcoholism Gambling Disorder

Substance and Alcohol Related Disorders Substance use Disorder Alcoholism Gambling Disorder What is a Substance Use Disorder? According to the DSM-5, a substance use disorder describes a problematic pattern