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The Clear and Growing Problem of Crystal Methamphetamine Addiction

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The Clear and Growing Problem of Crystal Methamphetamine Addiction

 

June 6, 2011

Petros Levounis, MD, MA

 

Director, The Addiction Institute of New York; Associate Chair for Clinical Services, Department of Psychiatry & Behavioral Health, and Chief, Division of Addiction Psychiatry, St. Luke’s & Roosevelt Hospitals; Associate Clinical Professor of Psychiatry, Columbia University College of Physicians & Surgeons

 

First published in Psychiatry Weekly, Volume 6, Issue 12, June 6, 2011

This interview was conducted on April 18, 2011 by Lonnie Stoltzfoos

 

Introduction

Crystal methamphetamine seems to have two distinct populations of users in the US. The increasingly accessible stimulant, manufactured in illicit ad hoc chemical labs, is especially problematic in rural states in the southwest and northwest of the US, and in large urban centers. Also known as “ice,” “Tina,” or just crystal meth, its use in the rural areas is most prevalent in young people 18–25 years old; in the urban centers, among the gay male community.

The underlying reasons for initial use of crystal meth may also vary subtly between the rural and urban populations, according to Dr. Petros Levounis, an addiction specialist. Broadly speaking, crystal meth is used in rural populations primarily for recreational and stimulant purposes; in the urban gay populations, it is associated with sex and the club scene. These descriptions can certainly apply to the entire spectrum of users, however, and are not exclusive to either group.

Trajectory, and Best Case Recovery Scenario

Successful treatment of crystal meth addiction can and does happen. Currently, there are no pharmacotherapies indicated for treatment of crystal meth addiction. Treatment programs must take into account some characteristics of crystal meth addiction that differ from general substance use trajectories, according to Dr. Levounis.

“A lot of crystal meth trafficking happens on the Internet, and especially in conjunction with soliciting sex partners through forums and websites dedicated to that purpose,” says Dr. Levounis. “This is where we see the perfect storm of the Internet, drug trafficking, and sex come together. The crystal meth addict will soon experience any number of consequences: difficulty performing or showing up at work; medical consequences, including dental erosion and possible HIV transmission; legal consequences; psychological or spiritual desperation; and alienating oneself from loved ones.

“Occasional and recreational crystal meth use was acceptable in the overall party scene and the urban gay community until recently,” he continues. “Now, thanks to prevention campaigns, it is less acceptable, which is good, but there are worries that these campaigns have driven the epidemic further underground and will inhibit intervention efforts.”

The year-long Matrix Model program for methamphetamine and cocaine addiction introduces recovering crystal meth addicts to group psychotherapy, family involvement, and addresses comorbid psychiatric disorders, such as anxiety, depression, and PTSD. Dr. Levounis says that the contingency management approach is also particularly useful for treating crystal meth addiction. Contingency management does not take a punitive approach to continued use after treatment initiation, in contrast to classic addiction treatment. Rather, contingency management attempts to reward and reinforce positive signs of recovery such as showing up for treatment, and for negative urine toxicology examinations.

The duration of treatment is an especially important factor in crystal meth addiction treatment because of “The Wall,” a sudden renewal of craving around 45 days post-cessation.

“The first 2 weeks of withdrawal are pretty tough,” says Dr. Levounis. “That phase is followed by the ‘honeymoon period’ where the patient feels good; it is tempting for the clinician to graduate the patient because everything is going so well. Then patients often hit ‘The Wall.’ This happens during recovery from other drugs of abuse as well, but we don’t see it there as powerfully as we see it with crystal meth. We therefore recommend that treatment for crystal methamphetamine last, at the very least, 3 months to ensure support through ‘The Wall’ period. Treatment duration of 12 months or beyond is more adequate, overall.”

Conclusions

The Matrix Model and contingency management both have ample clinical evidence to support their efficacy in addiction medicine.

“In the absence of an FDA-approved pharmacotherapy for cocaine or crystal methamphetamine addiction, the elusive holy grail of my field, I prefer to channel my efforts into psychosocial interventions that work,” says Dr. Levounis. “That route also does not give patients false hope about an easy fix.”


Disclosure: Dr. Levounis reports no affiliations with, or financial interests in, any organization that may pose a conflict of interest.