Methamphetamine

Summary

• Mix of substance use disorders and mental health disorders
• Treatment should be well planned and client-centered

The term co-occurring disorders or COD means having at least one mental illness along with one or more substance use disorder. But there is nothing simple about having this condition. The two or more disorders will negatively impact each other. This requires that each disorder be treated separately but also at the same time. Recovery is not an easy process, but it is a goal that can be reached.

Types of COD

Substance use disorder can occur along with any mental illness. Some of the more common mental health issues linked with COD include:

• Depression
• Anxiety
• Schizophrenia
• Bipolar disorder
• Post-traumatic stress disorder (PTSD)
• Obsessive-compulsive disorder (OCD)

Other disorders related to mood, anxiety, sleep, eating, and personality also often occur with COD.

Some common classes of substance use disorders include:

• Alcohol
• Nicotine
• Caffeine
• Cannabis
• Cocaine
• Amphetamines
• Sedatives
• Opioids

People with COD can have any mixture of substance use disorders and mental health disorders, but at least one of each.

Risks of COD

People with COD have certain higher risks than people with a single disorder. They also tend to be in poorer health and have a greater chance of relapse. Some of this is due to not taking or responding to treatment as well. The time and cost involved in this treatment is also higher.

Among these increased risks are:

• Violence
• Physical illness
• Psychosis
• Hospitalization
• Homelessness
• Unemployment
• Incarceration
• HIV/AIDS

Screening for COD

About half of all people with severe mental illnesses also have substance use disorders. The rate of people with substance use disorders who have mental illnesses is even higher. Despite these facts, screening for COD can be a challenge. A mental health service may not be able to spot substance use disorder. A substance use treatment center may not be able to spot mental illness. The screening process should decide whether or not the person needs to be further assessed. This assessment is then performed by a mental health doctor or other trained health care worker.

Treatment and recovery

Treatment for COD must target each disorder by itself and at the same time. This may occur in one setting or a number of settings. Treatment should be well planned and client-centered. This means the person with COD needs to be involved with all aspects of care. The type of care will depend on the types of substance use and mental disorders. It should also be tailored to the person’s unique needs and goals.

COD takes a toll on those who have it and on those around them. Coping skills must be taught to the individual as well as to her support group. Progress may be slow and sometimes hard to measure. The chance of relapse seems to always be right around the corner. Setbacks should be met with support rather than blame. The person will respond to praise much more than to guilt. Recovery is a long process that will require a group effort. It is not an easy task but it is well worth it.

Resources

Alcoholics Anonymous
www.aa.org

Narcotics Anonymous
www.na.org

National Alliance on Mental Illness
www.nami.org

Substance Abuse and Mental Health Services Administration
www.samhsa.gov

By Kevin Rizzo

©2022 Carelon Behavioral Health

Summary

Recovery from meth addiction is hard work, but there are people who have succeeded. Recovery takes:

• A multidisciplinary approach
• A lifetime commitment
• Hard work

Success in drug rehabilitation is counted in small steps. Each step is a victory over monumental forces, moving a person toward a new, healthier life.

Addiction starts innocently, usually around age 14, when a young person starts experimenting. At that age, teens are testing the waters of adulthood. Many have problems with their parents, as they learn how to grow out from under their parents’ protective wings. Some are bullied, or are turned away by those they want as friends.

Teens sometimes yearn for the freedom age will bring, but also fear the responsibilities that face them.

“The kids I worry about are the ones who are depressed or bullied,” said drug counselor William Shryer. “So many young people do not receive proper guidance from parents or other adults, so they turn into aimless wanderers and get addicted. Instead, they need to be learning how to get their lives in order, and how to take on the responsibilities of adulthood.”

“How a person gets addicted is complex,” explains Jenny Karstad, Addiction Treatment Counselor for an inpatient facility in New England. “Parents often blame themselves for their kid’s addiction, or they do just the opposite and deny any responsibility. By the time young people come to us for help, many of their families have written them off.”

Treatment counselors will tell you that addiction is the same, whether it is to alcohol, heroin, or meth. However, crystal methamphetamine brings special problems along with an extraordinary high. Someone addicted to alcohol or heroin can rid himself of the substance through carefully managed detoxification, but meth makes physical changes to the brain and body that last a long time, slowing down the rehab and recovery processes.

Richard Rawson, M.D., Associate Director of the UCLA Integrated Substance Abuse Programs, explained why those processes are difficult for people dealing with meth addiction, in the “Frontline” series “Meth and the Brain”:

“The difficult part with methamphetamines isn’t stopping, it’s not relapsing,” Rawson said.

“Methamphetamine actually will sit [in the brain] for eight to 12 hours … [while it] destroys the nerve terminals. Now, luckily for meth users they regrow, however the bad news is they take quite some time. The reward center of the brain has essentially been damaged. Other areas of the brain are also affected. Meth users in early recovery really don’t have the ability to make good decisions. Individuals do stupid things that end up with them relapsing and going back to using. It’s a wonder any meth users ever get better, but in fact they do.”

Those who beat it may take the long road back, finding other addictions along the way. Families generally need to be involved in the process, so they can learn how to change the home environment in a way that will help their loved one.”

Here are two success stories. Both people were addicted to meth. They started using drugs as teens, got addicted and fell into dangerous lifestyles. In each case, the paths downhill and uphill were not straight ones, and both men have yet to reach their destination. But they are pointed in the right direction, with a good chance at enjoying sober, healthy, and happy—or at least, normal—lives.

Trading up

Walter Barrera was mad when his father left his family in war-torn El Salvador to go to the U.S. to work. At a young age, Walter was sexually molested. By age 16, he and his father were reunited when the entire family moved to suburban Washington, D.C. Walter completed high school there, and also started using party drugs on weekends with his friends.

Eventually he found meth, and addiction set in quickly. Urged by his family, Walter went to a residential treatment program in California, but returned home addicted to crack cocaine. His life continued to go downhill. He was robbed and injured, stole money to pay for drugs, and eventually ended up in jail.

By 2006, Walter was ready to try to beat addiction, once again. He voluntarily entered the La Casa in-patient treatment program in D.C., where he lived for two months. Every night he dreamed about drugs, and longed for the day when he could get out to find some.

But the treatment began to work, in spite of his longings for drugs. Little by little, he found ways to fight against the pull of addiction. He worked one on one with a counselor, setting short-term and long-term goals for himself. He also attended daily group sessions.

One day, a representative from a self-help organization spoke to his group about running. Barrera was not impressed, but the runner explained that athletes build skills the same way addicted people build lives without drugs:

Running a marathon may look like an impossible goal, she said, but it’s not. Plenty of people have done it. They started slowly, then took one step at a time. Eventually, they were running long distances.

And, that is exactly what Walter did. At first, it was hard for him to run a block, let alone a mile. His body complained, but he kept pushing. He ran one, then two, then three miles. He gave up cigarettes and started going to church. He lost weight, started working out, and working in a restaurant. Walter told people he felt better about himself, and they noticed the difference. Over time, he gained the trust of the staff at La Casa, who allowed him more and more freedom to pursue running.

Walter said running brings him closer to peace than he has ever been. He puts everything he learned at La Casa to use, by setting mileage goals, keeping himself healthy, and finding inner peace while he is close to nature, while running.

But, everything in his life was not rosy. He still needed to learn responsibility. In 2011, he did just that when he turned himself in to serve a short prison sentence for an outstanding warrant. This time, he dreamed about running.

Today, he is a super-long-distance runner. To train, he pushes himself to run more than 100 miles a week. When he runs less, he doesn’t feel good, so his desire for the runner’s euphoria drives him to meet his goals.

He has a job, shares a house with roommates, and is involved in a church, where he gets support he needs.

In the past year, Walter’s recovery story has been told repeatedly in newspapers, magazines, and on television. He is a hero and idol for many in the recovery community.

Addiction counselors are not so quick to applaud, however. They insist that it is dangerous to substitute one addiction for another. The goal of rehabilitation and recovery is to learn how to cope with life’s difficulties, setbacks, boredom, and ups and downs, without being high from drugs or even from sports.

“You have to have a balance. Without it, your life is always going to be up and down,” says Gabrielle McCraney, Program Director at La Casa.

“What if he sprains an ankle and can’t run?” commented Shryer, upon hearing Walter’s story.

In a story in The Washington Post, Walter responded to those concerns.

“I’m a new person. I’m a new creation,” he says. “I don’t think I run to stay sober. I do it just to have fun, to feel like myself—something I didn’t do for so long.”

Back from the brink

Nic Sheff grew up in California, the son of a writer and artist. At age 11, he started drinking. Then he tried marijuana. By the time he got to high school, he was using drugs daily, including meth, but he hid his problem from his parents.

In spite of his addiction, he got into college and that’s when his drug use became obvious. His father spoke to doctors and arranged for treatment. Nic went, and then went back to using. This process repeated for years. At one point, his family took out a second mortgage to pay for an expensive residential program.

Although Nic said he wanted to get clean, nothing worked. He turned to shoplifting, drug dealing, and prostitution to pay for drugs and to escape his parents. He stole from them, as well as from friends. Although he went home for periods of time, for a while, he mostly experienced homelessness.

In his book, Tweak: Growing Up On Methamphetamines, Nic looks back on those years:

“And though I have done many shameful things, I am not ashamed of who I am. I am not ashamed of who I am because I know who I am. I have tried to rip myself open and expose everything inside—accepting my weaknesses and strengths—not trying to be anyone else. ‘Cause that never works, does it?”

Nic’s father, David Sheff, never gave up on him, although he came close. David Sheff tells the story from his perspective in his best-selling book Beautiful Boy: A Father’s Journey Through His Son’s Addiction.

Addiction is a family problem, says William Shryer. When helping people deal with addiction, Shryer reminds people, “You may think that your use only affects you, but it affects everyone around you. People don’t want to offend you or drive you away, but you need to do something about this problem because you are killing us all!”

And, Nic nearly did. Not only did he come close to death, members of his family suffered, mightily.

Why couldn’t he stop? Like many people with addiction, Nic always believed he could, if he really wanted to. He thought he could beat meth, but meth was getting the better of him. It was not until he found out more about himself and the way his mind operated, that he could stay in treatment long enough to make a difference.

One treatment program discovered that Nic has bipolar disorder and attention-deficit/hyperactivity disorder. These problems often go hand and hand with alcohol or substance use disorder, according to Shryer.

He explains that many people get addicted to drugs, inadvertently, because they self-medicate with drugs or alcohol to compensate for an underlying, undiagnosed illness. They sense there is something amiss, but do not know what it is. Because meth is a stimulant, it helps a person with those problems feel better, so they take it and get addicted.

Once Nic was treated for bipolar disorder, it was easier for him to stay in a rehabilitation program for meth. He was in an interdisciplinary program, which means it used a variety of means to help him, including medicine, one-on-one therapy and counseling, group sessions, goal setting, 12-step techniques, mentoring, good nutrition, and physical activity. It took more than two years of hard work and the expertise of many professionals to help Nic, but he finally stabilized his life. He has had relapses, but now sees recovery as an ongoing, lifelong process.

He chronicled that treatment in his book, We All Fall Down: Living with Addiction.

Today, Nic is a columnist for the addiction and recovery website The Fix and writes about addiction. He is especially interested in writing for and speaking to young people about his own story. He volunteers for an organization that helps teenagers battling addiction.

Speaking about his own recovery on The Fix, he wrote, in a February 2013 column:

“It wasn’t just the medication, of course. It was therapy, meds, 12-step stuff, and my outpatient program, too. With all of those things, my emotions stopped controlling my life and I was able to have a real, healthy, honest relationship. I’m now married. I work a steady job. I have a great relationship with my family. I have friends … My life is now completely different. Bipolar disorder is very real for me. But it’s also completely manageable.”

Resources

“Walter Barrera’s 12-million Step Recovery Program” by Kent Babb, The Washington Post. May 24, 2013.

To hear Walter Barrera tell his own story, watch a video of a Washington Post reporter’s interview with him at Running from Addiction.

HBO series, “Addiction.” www.hbo.com/addiction/thefilm

Clean: Overcoming Addiction and Ending America’s Greatest Tragedy by David Sheff. Eamon Dolan/Houghton Mifflin Harcourt, 2013.

Tweak: Growing Up on Methamphetamines by Nic Sheff. Atheneum Books for Young Readers, 2009.

We All Fall Down: Living With Addiction by Nic Sheff. Little, Brown Books for Young Readers, 2011.

By Paula Hartman Cohen

©2013-2019 Carelon Behavioral Health

Source: Gabrielle McCraney, Program Director, La Casa Transitional Rehabilitation Program, Washington, D.C.; Jenny Karstad, M.A., L.A.D.C., Addiction Treatment Counselor for Inpatient and Outpatient Recovery, Brattleboro Retreat, Brattleboro, VT; William J. Shryer, D.C.S.W., L.C.S.W., Clinical Director, Diablo Behavioral Healthcare, Danville, CA

Reviewed by Paulo R. Correa, M.D., Associate Medical Director, Beacon Health Options

Summary

• There is a high rate of depression and alcohol use.
• Bipolar disorder and marijuana use co-occur frequently.
• Schizophrenia and tobacco use is very common.

Co-occurring disorders (COD) means having at least one mental illness and one or more substance use disorder. The substance use can be any drug or drugs. The mental illness can be any mental disorder. There are many types of COD. Some, though, are more common than others.

Depression and alcohol use

Depression is a mental illness that is often ignored. Sometimes it is from some other health issue. Symptoms can be weight loss, lack of sleep and lack of energy.

A third of people with low spirits also have a substance or alcohol use disorder. Many people drink as a way of dealing with depression. While it may give short-term help, drinking makes things worse in the long run. It can even cause a person to feel even lower. Alcohol use often hinders a person’s mental health care. The person who is drinking is less likely to stick to her doctor’s plan. She may forget to take her pills and miss doctor visits.

Alcohol use has its own set of risk factors. Short-term can include bad judgment and motor skills as well as more risk taking. This can lead to alcohol-linked car crashes, injuries and death. Long-term issues can include liver and heart disease.

Bipolar disorder and marijuana use

A person with bipolar disorder has mood swings that get in the way of his normal life. These mood shifts can cause problems at home, at school, or at work. The low stages are much like states of depression. The difference is that people with bipolar disorder also have high stages called mania. Mania symptoms include high energy, rapid thoughts and speech, and reckless actions.

As with depression, there is a high rate of alcohol use among people who have bipolar disorder. Studies show an even higher rate of marijuana use among these same people. Marijuana is believed to be a trigger for those who are prone to the disease. It is not known if marijuana is a cause of the illness. It does appear to make the risk of getting such disorders higher.

Schizophrenia and tobacco use

Schizophrenia is a long-term mental illness that touches millions of adults. It upsets a person’s thinking, which can cause strange outward actions. People with the illness often hear voices. They may also see things that aren’t really there. These voices and visions are very real to the person. This can cause great fear within the person. It can also cause other people to be fearful of them and to stay away from them.

It is very common for people with schizophrenia to also use tobacco. Smokers with this illness have a greater dependence and a harder time quitting. When they do stop smoking, the withdrawal symptoms are worse than for those without the disease. The link between these disorders is thought to be the central nervous system. People with schizophrenia can have a hard time with memory and staying focused. Nicotine may make them feel better, but the long-term hazards of smoking greatly offsets any benefit.

Treating COD

No matter what type of COD you have, you should be treated for each issue separately. This is because one will affect the other. Treatment will most likely be talk therapy as well as taking meds. A 12-step program might be needed for substance use issues. Treatment may be long-term, but if you stick with it, you will get better.

Resources

Alcoholics Anonymous
www.aa.org

Depression and Bipolar Support Alliance
www.dbsalliance.org

Mental Health America
www.mentalhealthamerica.net

Narcotics Anonymous
www.na.org

National Alliance on Mental Illness
www.nami.org

National Institute of Mental Health
www.nimh.nih.gov

Substance Abuse and Mental Health Services Administration
www.samhsa.gov

By Kevin Rizzo

©2014-2019 Carelon Behavioral Health

Source: National Center for Biotechnology Information, www.ncbi.nlm.nih.gov/pmc/articles/PMC2215390/ www.ncbi.nlm.nih.gov/pmc/articles/PMC2811144/ and www.ncbi.nlm.nih.gov/pubmed/21288470; National Institute of Mental Health, www.nimh.nih.gov/health/publications/bipolar-disorder/complete-index.shtml; National Alliance on Mental Illness, www.nami.org; Mental Health America, www.nmha.org/conditions/co-occurring-disorders-and-depression

Reviewed by Sanjay Vaswani, M.D., C.M.Q., D.F.A.P.A., Regional Medical Director, Beacon Health Options

Summary

• Treatment should be client-centered.
• You may also need help with housing, child care, or finding a job.
   

Having a mental illness or a substance use disorder can be hard to deal with. Having both is even harder. Studies show that people with co-occurring disorders (COD) are less likely to comply with or respond to treatment. This puts them at a greater risk for relapse. They are also more likely to become violent, experience homelessness, or go to jail. The risk of getting AIDS and other illnesses is higher as well.

There is hope though. You can improve with proper treatment. This means being treated for both issues separately but at the same time. This is because the disorders not only co-exist, but they also co-affect each other. For instance, someone with depression may drink alcohol to try to feel better. A person who drinks may do so because he feels depressed. If only one issue is being addressed, the other issue can disrupt its treatment.

Before you can begin feeling better, you must first realize the need for treatment. You may not want to admit to your family or yourself that you have a mental illness. You may be afraid to tell your doctor or your boss about your substance use. You may be trying to hide one or both issues from your friends or co-workers. Maybe you simply are not sure if you have any serious issues or not.

Signs of mental illness

The symptoms of mental illness will vary depending on the disease. Often a person may not realize she is impaired. This is true whether it is the onset of a disease or a relapse. It is therefore good to have friends or family nearby looking out for you.

Some of the signs that could indicate a mental illness include:

• Extreme moodiness
• Depression
• Nervousness
• Paranoia
• Withdrawal
• Apathy
• High-risk taking
• High sensitivity
• Extreme irritation
• Inattention
• Trouble with eating or sleeping
• Sexual dysfunction

Signs of substance use disorder

Substance use disorder can have some of the same symptoms of mental illness. Some other signs that you may have a substance use disorder include:

• Getting drunk or high regularly
• Drinking or doing other drugs by yourself
• Driving while drunk or high
• Building up a tolerance to alcohol or other drugs
• Hiding or lying about drinking or taking other drugs
• Withdrawing from friends or hobbies to get drunk or high
• Going to work or school high or drunk
• Missing work or school because of drugs or alcohol
• Passing out or being hung over often

If you think your drinking or drug use may be an issue, get help right away. Do not try to carry the burden all by yourself. Seek out a trusted friend or loved one. Speak to a pastor or counselor. Then find a substance use treatment center and get involved in a 12-step program.

Client-centered treatment

To be successful, both disorders should be treated at the same time. Once you have reached out for help, you must stay involved in the treatment process. This means being active in the planning and decision making. Other people can give you advice but you should make your own choices. This will help empower you to better promote your own recovery.

Talk therapy will be a big part of your treatment. This may include one-on-one, group and family counseling. A 12-step program may be needed for help with substance use issues. Social skills and stress coping skills should be addressed. You may also need help with housing, child care or finding a job. Though you have the lead role, you will need the support of many others. Welcome the input from your doctor or health care worker, as well as family and friends. Realize that they all want what is best for you.

Be aware that recovery may take months or even years. Your progress may be slow at times and there could be setbacks. Do not lose hope. Instead, focus on short-term goals and ask for extra support. Distance yourself from negative influences and surround yourself with positive people. Believe that if you stay on course with your treatment, you can and will get better.

By Kevin Rizzo

©2014-2021 Carelon Behavioral Health

Source: Substance Abuse and Mental Health Services Administration; National Alliance on Mental Illness, www.nami.org; Mental Health America, www.mentalhealthamerica.net/conditions/co-occurring-disorder-and-youth

Summary

• Attend doctor appointments and support group meetings.
• Help her establish daily routines for eating, sleeping, and taking pills.
• Praise her successes and don’t dwell on her failures.

No one likes to see someone they care about go through hard times. A friend with a substance use disorder is hard to be around. A child with a mental illness is tough on the whole family. If you know someone with both issues, then you know it is even harder. As taxing as it may be, your support is a vital part of their recovery.

Identify the issues

The first step is to realize there is a co-occurring disorder (COD). Your friend or loved one may be in denial about her own situation. Her doctor or health care worker may not be aware of the other issue either. Therefore, the person is only getting treated for one issue. This is less than ideal since the two conditions affect each other. For instance, someone being treated for depression may drink alcohol to try to feel better. A person attending Alcoholics Anonymous meetings may continue drinking because she feels depressed. If only one issue is being addressed, the other issue can get in the way of its treatment. For treatment to work, it must be given for both disorders at the same time.

You may know your friend or loved one better than anyone. Therefore, you may be the first one to notice when he isn’t acting like himself. Watch out for sudden changes that may indicate mental illness or substance use or both.

Some of these changes may include:

• Extreme moodiness, touchiness or irritation
• High-risk drinking
• Violence
• Depression
• Apathy
• Inattention
• Nervousness
• Paranoia
• Withdrawal
• Eating, sleeping, or sexual troubles

Ways to promote recovery

When someone you care about has COD, you may feel helpless. This is a normal feeling, but it is far from the truth. Not only can you help, but your friend or loved one needs your help. Helping does not mean taking on the burden yourself. It does not mean you become the person’s enabler or watchdog either. A person with COD has to first be willing to get help. Recovery is hard work and no one can do the work for her. Your job is to show your support throughout the process. This means during both the good times and the bad times.

Sometimes, the best way to help someone with COD is just to be there for him. This allows your friend or loved one to open up about his struggles. You don’t need to have all the answers. You just need to give encouragement and support. Listen to him, and let him know he is not alone.

Here are other ways to help a friend or loved one recover:

• Go with her to doctor appointments.
• Attend support group meetings.
• Help her establish daily routines for eating, sleeping, and taking pills.
• Praise her successes and don’t dwell on her failures.
• Be patient with her.
• Encourage her by staying positive yourself.
• Invite her to partake in healthy activities.
• Stay informed about the disorders.
• Don’t ignore thoughts of suicide—call their doctor or 911.

Resources

Alcoholics Anonymous
www.aa.org

Narcotics Anonymous
www.na.org

National Alliance on Mental Illness
www.nami.org

National Institute of Mental Health
www.nimh.nih.gov

Substance Abuse and Mental Health Services Administration
www.samhsa.gov

By Kevin Rizzo

©2014-2019 Carelon Behavioral Health

Source: Substance Abuse and Mental Health Services Administration; National Institute of Mental Health, www.nimh.nih.gov/health/topics/schizophrenia/index.shtml

Reviewed by Sanjay Vaswani, M.D., C.M.Q., D.F.A.P.A., Regional Medical Director, Beacon Health Options

Summary

• Screening for both issues can be difficult
• Certain mental illnesses occur more commonly with substance use disorders
• Alcohol and nicotine are common drugs linked with COD

Checking for a mental illness is often fairly clear-cut. That is because a lot of research has been done to make this process better. The same can be said for substance use disorders. We now know a great deal more about this field than we ever did before.

It is harder to screen for more than one issue at the same time. One reason for this is a lack of dual training. A mental health service may not be able to spot a substance use disorder. A substance use treatment center may not be able to spot a mental illness. So just how does one know if he has a co-occurring disorder (COD)?

COD means having at least one mental illness and one or more substance use disorder. The substance use can be any drug or drugs. The mental illness can be any mental disorder, but some are more common with COD.

Depression and COD

Depression is a mental illness that is often ignored. Sometimes it is the result of another health matter. Symptoms can be weight loss, lack of sleep, and lack of energy. These signs are also common among other health issues. Studies show that a third of people with depression also have a substance use disorder.

Bipolar disorder and COD

Roughly 60 percent of people with bipolar disorder also have a substance use issue. It is thought that these two disorders affect the same chemicals in the brain. Studies suggest that people with this illness may try to medicate themselves through alcohol use. It is also believed that bipolar disorder may be a risk factor for substance use. Marijuana use can be very common with this disorder.

Schizophrenia and COD

Substance use disorder happens quite often with schizophrenia. Drinking and drug use can also mask some of its symptoms. This is true both during times of use as well as times of withdrawal. Marijuana use can even make the symptoms worse.

Obsessive-compulsive disorder and post-traumatic stress disorder also happen often with COD. Other disorders linked to mood, anxiety, sleep, eating, and personality can be common as well.

Substance use disorders and COD

Any drug can be the source of a substance use disorder. This can range from caffeine and nicotine to cocaine and heroin. When the drug use causes harm or makes normal living hard it is a disorder. Social, legal, and physical problems are often the result.

Alcohol and nicotine are among the most common drugs linked with COD. These types of addictions are very hard to break, but it can be done. Recovery requires a strong support group. Substance use must be treated apart from, but at the same time as, mental disorders.

Signs of substance use disorder

Substance use disorder has a broad range of symptoms based on the drug or drugs. Many of these are the same as those for a mental illness. Here is a list of some of the more common signs to look for:

• Moodiness
• Nervousness
• Touchiness
• Low spirits
• Numbness
• Forgetfulness
• High-risk taking
• Withdrawal

You may not realize that your drinking or substance use is an issue. You may be in denial about your need for help. Here are some other signs that you may have a substance use disorder:

• Getting drunk or high all the time
• Drinking or doing other drugs by yourself
• Driving while drunk or high
• Building up a tolerance to drinking or other drugs
• Hiding or lying about drinking or taking other drugs
• Withdrawing from friends or hobbies to get drunk or high
• Going to work or school high or drunk
• Missing work or school because of drugs or drinking
• Passing out or being hung over often

Get treatment

If you think you may have COD you should tell your doctor right away. You can then be evaluated to see if you need to be looked at further. If you do have COD, early care will help with your recovery. You should also notice feeling much better when you are being treated for both issues. With the right help and support, people can and do recover.

Resources

Alcoholics Anonymous
www.aa.org

Depression and Bipolar Support Alliance
www.dbsalliance.org

Mental Health America
www.mentalhealthamerica.net

Narcotics Anonymous
www.na.org

National Alliance on Mental Illness
www.nami.org

National Institute of Mental Health
www.nimh.nih.gov

Substance Abuse and Mental Health Services Administration
www.samhsa.gov

By Kevin Rizzo

©2014-2019 Carelon Behavioral Health

Source: Substance Abuse and Mental Health Services Administration; Mental Health America, www.nmha.org/conditions/co-occurring-disorders-and-depression and www.mentalhealthamerica.net/conditions/co-occurring-disorder-and-youth; National Alliance on Mental Illness, www.nami.org; National Institute of Mental Health, www.nimh.nih.gov/health/publications/bipolar-disorder/complete-index.shtml

Reviewed by Sanjay Vaswani, M.D., C.M.Q., D.F.A.P.A., Regional Medical Director, Beacon Health Options

Summary

Take the first steps toward recovery:

• Get expert advice.
• Locate a program.
• Sit in on an open AA/NA meeting.

If you are going to solve a problem, you first must admit that it exists. You must know, deep down, that yes, you do have a problem and yes, you really want to do something about it.

If you use crystal methamphetamine, you may use it exclusively or with other drugs, including alcohol. Meth is an especially toxic drug, but all drugs are harmful and hard to give up. If you are addicted to meth, you need to work on addiction to all of the substances you are using.

Even though all illegal drugs—and alcohol—are addicting, not everyone who uses them gets addicted. Some people have no problem walking away from drugs. Others, especially those with underlying mental health issues, get addicted to drugs very easily.

How do I know if I am addicted?

If you already use meth—either alone, with alcohol or other drugs—and are wondering if you are addicted, you probably are. To help you decide, ask yourself:

• Am I using meth as often as I can, maybe every day?
• Do I worry about running out of the drug?
• Do I need meth to help me when I am down, or having problems?
• Am I spending a lot of time and money getting meth?
• Am I doing things I normally would not do to get drugs, such as stealing or lying?
• Have I dropped out of school, my family, my job, or my circle of friends?
• Am I taking risks I normally would not take, such as having unprotected sex?
• Have I tried to stop using meth and failed?
• Do I need more of the drug to get or stay high?
• Do I worry about getting arrested, injured, or overdosing?

Positive answers should tell you that it is time to get the help you need to stop.

What can I do to stop?

People who tell you to “just stop,” do not understand drug addiction. Drug addiction is a disease, not a sign of moral failure.

Look at it this way:

If you break your arm, a doctor sets your broken bone. You might also need to take medication or get physical therapy to speed healing. Finally, you will want to do something to prevent you from breaking anything else.

Addiction treatment follows the same pattern. You might need detoxification to get the drug out of your system; rehabilitation to help you build new, healthy lifestyle patterns; and a recovery program to help you keep sober.

In other words, you treat an addiction to drugs the same way you would treat any other disease.

The first step you take will probably be the hardest. No doubt, there are things you do not want to talk about with anyone. Try not to think about them. Focus, instead, on what you need to do right now to take a positive step toward change.

Psychologist William Shryer sees many young people who got into drugs as a way to self-medicate, or fix, themselves. They sensed there was something wrong with them, without knowing what it was. Shryer says many people who use drugs have had depression, bipolar disorder, anxiety, or attention-deficit/hyperactivity disorder for years, without knowing it. Their parents or teachers never noticed, so they never got the treatment they needed.

“When they are teenagers or in their 20s, when the responsibilities of adulthood and getting their life in order comes crashing down on them, they wander aimlessly into drugs and get addicted,” he said. “Meth makes them feel whole, at first.

“Most people addicted to meth are not happy about it. They just don’t know where to start to get their life back.”

But, with help from professionals, many do get their lives back, even though they once saw themselves as lost causes.

Nic Sheff, a person who used meth for a long time, describes his passage from addiction to sobriety in his very candid book, We All Fall Down: Living With Addiction. Until he got treatment for meth addiction, he never knew he had bipolar disorder. Proper mental health treatment made it much easier for him to avoid drugs.

Drug treatment and recovery programs vary in the way they operate. Some involve medication or other medical care in a hospital setting. Others let you live on your own or in a group while you work every day with professionals on getting well. Most incorporate into their program the model of the 12-step program used to treat alcohol addiction or eating disorders, and expect you to continue working with a similar program after you leave. Some models are faith-based, but most are not. At least one California program is free for teenagers, but that is not the rule. Most health insurance covers some level of drug treatment.

Meth addiction is especially hard to overcome, and recovery from meth can take longer than recovery from other substances because the drug changes the way a brain works. It will take time for your brain and the rest of your body to heal, maybe as long as a year. As you heal physically, you will use that time to learn how to live successfully without drugs.

The best programs will kick-start change in your life through a variety of methods: one-on-one counseling, group interaction, goal setting, family therapy for those willing to do it, and sometimes sports or service projects. Little by little, you will build a structure for a healthy life. These programs have helped millions of people who want to get help, just like yourself.

Shryer is a big believer in the power of sobriety programs. “Nothing beats a good self-help group,” he says.

Whatever method you choose, remember what addiction counselor Jenny Karstad reminds people who have the courage to turn their lives around through treatment.

“You are not to blame for your disease. You didn’t cause it, you can’t control it, and you can’t cure it by yourself,” she says.

While you are still hungry to make changes in your life, find a program that will work for you.

If you think you are ready to start, here are some first steps to take:

• Educate yourself. Read everything you can find (start with the resource list below).
• Talk to an expert. Call a national helpline or a local chapter of Alcoholics Anonymous (AA, a good place to start for any addiction) or Narcotics Anonymous (NA).

“Helplines are often staffed by people in recovery,” explains Karstad, “so they can give you a good idea of what treatment might look like.”

• If you feel comfortable, talk to your family doctor and ask for advice.
• Attend an AA or NA meeting to get an idea of what is involved in recovery. You do not have to talk. You can sit in the back and listen. You can even attend recovery meetings online (go to http://aa-intergroup.org/ for AA, http://narecoverychat.net/ for NA or www.smartrecovery.org for Smart Recovery)
• Check your health insurance plan to see what is covered.
• Search for a licensed treatment center with a certified drug treatment staff. (Use the SAMHSA locator below.)
• Start making lifestyle changes on your own. Change friends. Stay away from people who use. Do not drink alcohol or smoke marijuana. Eat healthy foods. Get the sleep you need. Start taking care of your body.
• Take pride in every small step you take in this process, but do not expect miracles from yourself or anyone else.

Know that you will have good days and bad. Nothing will be easy, but it will get easier, over time.

Note: If you are in a crisis, you should get immediate medical attention and/or detoxification before you look into a program.

Resources

Clean: Overcoming Addiction and Ending America’s Greatest Tragedy by David Sheff. Eamon Dolan/Houghton Mifflin Harcourt, 2013.

Seeking Drug Treatment: Know What to Ask, www.drugabuse.gov/publications/seeking-drug-abuse-treatment/additional-resources

Substance Abuse and Mental Health Services Administration Treatment Locator: www.findtreatment.samhsa.gov, (800) 662-HELP

UCLA Integrated Substance Abuse Programs, www.uclaisap.org

We All Fall Down: Living With Addiction by Nic Sheff. Little, Brown Books for Young Readers, 2011.

By Paula Hartman Cohen

©2013-2019 Carelon Behavioral Health

Source: Jenny Karstad, M.A., L.A.D.C., Addiction Treatment Counselor for Inpatient and Outpatient Recovery, Brattleboro Retreat, Brattleboro, VT; Gabrielle McCraney, Program Director, La Casa Transitional Rehabilitation Program, Washington, D.C.; William J. Shryer, D.C.S.W., L.C.S.W., Clinical Director, Diablo Behavioral Healthcare, Danville, CA

Reviewed by Paulo R. Correa, M.D., Associate Medical Director, Beacon Health Options

Summary

Meth can:

• Change your brain
• Damage your body
• Control your actions

Some people call crystal meth a “dragon,” for good reason.

When people talk about meth, they most often mean crystal methamphetamine, an illegal, strong, and addictive drug made by turning household chemicals into a crystal-like powder.

Methamphetamine is a type of amphetamine (also called speed)—a legal drug sometimes prescribed in small doses by doctors treating people with depression, attention deficit disorder, and other health problems.

Doctors never prescribe crystal meth. It is made strictly for illegal drug use.

What does it look like?

Crystal meth is a white, odorless, bitter powder or an off-white clear rock that melts easily in water or alcohol. It also can be made into a waxy solid called glass. A person can drink it, snort it, smoke it, or inject it.

What is it made of?

All crystal meth is manmade. It is based on a common item in sinus and asthma drugs, called ephedrine. That drug is cooked with other items, such as lye, anhydrous ammonia (found in fertilizers, refrigerators, and air conditioners), iodine, car-battery acid, red phosphorous found on match heads, ether, mercury, sodium, acetone, paint thinner, drain cleaner, brake fluid, lighter fluid, and lithium from small batteries. Most of these items are easy to find in homes, stores, or on farms.

Some meth comes into the U.S. from other countries, but a lot of it is made in small local labs built in homes, garages, warehouses, or vacant buildings. Federal officials found more than 11,000 meth labs in the United States in 2010.

To prevent vapors from escaping the lab, people may cover or tape up windows, which can lead to a violent explosion or fire. Those making the drug breathe in unsafe fumes and touch chemicals that can eat away their skin. The chemicals are so unsafe that, long after the lab closes, neighbors and people who live or work in that space can be hurt by what is left behind.

Substances used to make meth will even kill grass and other plants near a lab. Only trained and licensed experts wearing hazmat suits can safely, and legally, clean up these sites.

Police often find labs after they burn or explode. But sometimes a lab goes unnoticed, and then someone buys the property, years later. The new owner may not realize what he has bought until children start showing signs of nerve damage, skin rashes, breathing issues, or learning problems. The unseen and odorless residue left behind on the walls, floors, countertops, and the soil around a meth lab is very harmful to children and pregnant women.

Who uses it?

According to a United Nations report, amphetamines are the most used hard drug in the world, with 37 million users throughout the globe in 2015. And among amphetamines, methamphetamine represents the greatest global health threat, with the use growing. There are 1.4 million people using meth spread from coast-to-coast in the U.S., but it is most used in western or Central Plains states. People living in the U.S. who use meth tend to be in their teens, 20s or early-30s, male and white.

What it does

Once in your body, meth changes your brain chemistry, feelings, perceptions, and personality. Even a small amount can have a lasting impact.

At first, you may be dazzled by the high, as it makes colors brighter, sounds more beautiful and lets thoughts race through your mind. It amplifies sexual desire and pleasure. But after you use it for a while, that rush swings the other way, leaving you struggling to get back to the state of mind you had before using meth.

A meth high can last for six-24 hours. Some people are so excited by the drug that they stay awake for days, then sleep for days, as well. While they are high, people using meth often do not eat, so they lose a lot of weight. They may have hallucinations or times of rage. A kind person may turn violent and commit crimes he would never do when sober.

Long-term effects

Meth latches on to a person quickly because it changes brain chemistry. Chemicals fire up nerve endings, amplifying sensory information. But, with use, meth changes that same brain tissue, little by little, leaving you no way to feel good without using more.

Since it takes over the body as well as the mind, rehab specialists say a meth habit is very hard to reverse. The healing time is longer and harder than it is for other drugs. Some people may experience brain damage, kidney damage, depression, or full-blown psychosis, plus unattractive looks from lost teeth, weakened muscles, and skin problems.

However, people can and do recover. It helps to be actively involved in your recovery process and to have a recovery and wellness plan. There is hope for recovery from an addiction to meth.

Resources

Substance Abuse and Mental Health Services Administration
www.samhsa.gov/atod/stimulants
(800) 662-4357

National Institute on Alcohol Abuse and Alcoholism
www.niaaa.nih.gov
(301) 443–3860

National Institute on Drug Abuse
www.drugabuse.gov/publications/research-reports/methamphetamine/letter-director
(301) 443–1124

National Institute of Mental Health
www.nimh.nih.gov
(866) 615–6464

Award-winning HBO series, “Addiction.’ www.hbo.com/addiction/thefilm/

Tweak: Growing Up on Methamphetamines by Nic Sheff. Atheneum Books for Young Readers, 2009.

Drug Facts: Methamphetamine, National Institute on Drug Abuse
www.drugabuse.gov/publications/drugfacts/methamphetamine

The Meth Epidemic, “Frontline,” produced by WGBH-Boston for PBS. 2011. www.pbs.org/wgbh/pages/frontline/meth

World Drug Report 2012, United Nations Office on Drugs and Crime.
www.unodc.org/documents/data-and-analysis/WDR2012/WDR_2012_web_small.pdf

World Drug Report 2017, United Nations Office on Drugs and Crime.
www.unodc.org/wdr2017/field/Booklet_1_EXSUM.pdf

By Paula Hartman Cohen

©2013-2019 Carelon Behavioral Health

Source: Jenny Karstad, M.A., L.A.D.C., Addiction Treatment Counselor for Inpatient and Outpatient Recovery, Brattleboro Retreat, Brattleboro, VT; William J. Shryer, D.C.S.W., L.C.S.W., Clinical Director, Diablo Behavioral Healthcare, Danville, CA.

Reviewed by Paulo R. Correa, M.D., Associate Medical Director, Beacon Health Options

Summary

Be a good friend:

• Listen.
• Don’t preach.
• Take quick action in crisis.

It is tough to watch a friend in trouble. You worry because drugs are so powerful, so scary. But what can you do about it?

If you offer to help, will you make him mad and lose him as a friend?

If you ignore the problem, can you live with yourself if something bad happens—if she overdoses, takes her life, or hurts someone else?

Drug addiction is serious business and calls for a serious response. Not only is your friend at high risk for severe health problems, she is at high risk for suicide, for committing or being the victim of a violent crime, for incarceration, and for losing her friends, family, and job. Clearly, if she ever needed help, she needs it now.

Actually, she needs at least two kinds of help:

• Assurance that those who love her will not desert her
• Professional guidance from people with years of rigorous training in the complex field of drug rehabilitation and recovery

You cannot cure her addiction but, with a little skill and understanding, you might give her the support she needs to move in the direction of getting help.

What to do and say

Here are a few helpful things you can do, until he gets into a treatment program or while she is in recovery:

1. Don’t judge. Drug addiction is a disease, not a moral problem. Your friend needs medical help.
2. Be a good role model. Follow good hygiene, sleep, and nutrition practices.
3. Get her into healthy surroundings. Don’t meet your friend in a bar or any place where people drink or use drugs. Go to the park, movies, beach, or a family restaurant instead.
4. Let your friend talk, and talk, and talk.
5. Don’t ask too many questions or analyze the situation.
6. Do not make jokes about drugs or alcohol. Humor legitimizes aberrant behavior.
7. Stress that a drug problem is nothing in which to be ashamed.
8. Help her ask for help. Offer to find places to get help, such as support groups, local helplines, and treatment programs.
9. Offer to go with your friend on the first visit, if he likes.
10. Be positive. There are millions of people who have overcome problems with drugs.
11. Remind her that she is not alone, and may have more people who love her than she realizes.
12. Help him find joy and build self-esteem in places and situations that do not involve drugs or alcohol.
13. Ask, what can I do for you as a friend? You might want to help her develop a crisis plan and discuss it together. Tell her you will check in on her every now and then.

Feelings count

Sometimes people who try to help end up making a mess of the situation. Here are few things you should never say:

• Why can’t you just stop?

Drug addiction calls for medical intervention, not tough love.

• Here is what you should do.

Don’t preach. She will not listen.

• How could you do something like this?

Again, stay away from moralizing.

• Do you know how much your drug use hurts your family?

Yes, he knows and feels very guilty.

Accept your friend and the situation at face value. Be her lifeline, not a superhero. Do not make demands.

Do not be surprised if he refuses your help or says there is nothing you can do.

Psychologist Marybeth Wish recommends you respond to a refusal with something like this: “If I were in your situation, this is what I would want from my friends—understanding and acceptance. I would want you to love me for what I am. I would also want you to show you care by keeping in touch with me often, with phone calls, lunches, dinner dates, emails. Can we work on something like that?”

Try not to get discouraged. Do not give up trying to help your friend. Be prepared to stay in touch with her until she is well into coping with her meth problem.

Be as positive as possible. “Say, ‘look, there will be times in our friendship when I am going to need your help, so please help me keep our friendship strong by allowing me to help you,’” Marybeth Wish suggests.

In an emergency

One note: substance use disorders may be involved in at least half of all suicides and suicide attempts. If you believe your friend may need immediate help to prevent suicide, call (800) 273-TALK (8255) or (800) SUICIDE (784-2433) any time, any day. Or go to www.suicide.org online. These 24-hour-a-day suicide prevention lifelines are free services, available to anyone. All calls are confidential.

Resources

Mental Health America
www.mentalhealthamerica.net

National Suicide Prevention Lifeline
www.suicidepreventionlifeline.org
(800) 273-TALK

By Paula Hartman Cohen

©2013-2019 Carelon Behavioral Health

Source: Isaiah Bingham, B.S.W., Q.M.H.P., M.S.W., A.C.S.W., Lead Social Worker/Case Manager, The Next Step Program, Norfolk, VA; Susan Rose Blauner, Author, Public Speaker, and suicide prevention specialist, Greenfield, MA; Scott Haltzman, M.D., Clinical Assistant Professor, Brown University Department of Psychiatry and Human Behavior; Jenny Karstad, M.A., L.A.D.C., Addiction Treatment Counselor for Inpatient and Outpatient Recovery, Brattleboro Retreat, Brattleboro, VT; LeslieBeth Wish, Ed.D., M.S.S., Psychologist, Licensed Clinical Social Worker and Co-director of The Counseling Network of the Special Operations Warrior Foundation, Sarasota, FL

Reviewed by Paulo R. Correa, M.D., Associate Medical Director, Beacon Health Options

Summary

Before forming an opinion about someone with substance use problems, consider these common myths.

“Those who overuse substances have a moral flaw.”

“People with alcohol and substance use disorders don’t want to quit—if they did, they would just stop using.”

“Locking up all the people who overuse substances will solve the problem.”

These and many other myths about drug use add to the problem. The stigma tied to drug use discourages treatment for addiction and limits chances for work, housing, and social relationships. Although drug use has a deep, harmful impact on society, it is not an insurmountable problem. Become part of the answer by helping to stop stigma.

Identifying the problem

Most American families have been touched in some way by a loved one with problems with drugs or drinking. According to the Substance Abuse and Mental Health Services Administration (SAMHSA) National Survey on Drug Use & Health, 24.6 million Americans aged 12 or older said they had used an illicit drug during the month before the survey.

Unfortunately, many people who have problems with drug use will come across stigma that hinders them from integrating back into society. Police, the legal system, ER staff, and even family members and friends can keep the stigma going, and stigma limits the attention and resources dedicated to solving problems linked to substance use. “Stigma is about discrimination,” says Ivette Torres, Director of Consumer Affairs for SAMHSA’s Center for Substance Abuse Treatment.

Separating myth from fact

Stigma comes from the myths about drug use. Before forming an opinion about someone with substance use problems, think over these common myths:

Myth: Those who overuse substances have a moral flaw—they could will themselves to stop using if they wanted to quit.

Fact: One common and false stereotype about people with substance use disorders is that they are all social misfits and outcasts. “Stigma can also get at the idea that the person is weak of character or untrustworthy,” explains Jim Beek, a SAMHSA information officer. In reality, “normal” people deal with drug use issues, which can touch whole families. Drug and alcohol dependence meet the standards for treatable, chronic health issues; dependence is not simply a matter of choice. “One of the biggest and most pervasive myths is that … a user can stop using alcohol or drugs by willing themselves to,” agrees Torres. “Society at large has to accept addiction treatment and begin to look at it as a public health issue.”

Myth: Addiction is not reversible: Once an addicted to a substance, it is always that way.

Fact: Many people don’t realize how helpful programs and services can be in treating substance use disorder. In fact, drug addiction treatment works as well as established medical treatments for other illnesses such as diabetes and asthma, the Physician Leadership on National Drug Policy has reported. Another study found that for each dollar invested in treatment, taxpayers saved $7 in future costs, according to the National Institute on Drug Abuse.

Unfortunately, the shame tied to being labeled or viewed negatively by others can keep people from seeking care. “Stigma is a factor,” Torres notes. “That’s why you see so many individuals speaking out, saying, ‘Recovery is possible. I am an example of that.’’’ And luckily, new choices, such as the prescription addiction treatment drug buprenorphine, can help stop the stigma linked to lining up outside a clinic.

Myth: Harsher criminal penalties for using drugs or increasing efforts to cut off the drug supply will solve the problem.

Fact: This common wisdom is at odds with research showing the effectiveness of treatment. And, keep in mind that there is no “silver bullet” when it comes to solving drug use problems. While a blend of things such as treatment, parental influence, and education programs can help, taken alone, “get tough” approaches don’t address the underlying social and family issues linked to drug use.

You can help

While views about people with drug problems and treatments have gotten better, we still have a long way to go toward skillfully addressing these issues. You can help by facing your own attitudes. If you know someone who may have a drug problem, treat him with concern, dignity, and respect. Rather than turning your back or getting angry, offer your support.

Resources

National Institute on Drug Abuse
www.drugabuse.gov

Physician Leadership on National Drug Policy
www.plndp.org

Substance Abuse and Mental Health Services Administration
www.samhsa.gov/

By Kristen Knight

©2022 Carelon Behavioral Health

Summary

Watch for:

• Changes in behavior
• Physical deterioration
• Outbursts and moodiness

Although drug addiction is more common in the United States than cancer, stroke, or HIV/AIDS, fewer people are addicted to methamphetamine than to most of the drugs people use, including marijuana, heroin, and cocaine. Still, meth is a drug that wrecks many minds, bodies, careers, and families.

Almost half of U.S. children younger than 18 have tried marijuana or other drugs, but most do not become addicted. However, one in 12 over the age of 12, will. About five percent of high school students admit to using meth.

No one sets out to become addicted to a drug or alcohol. They start with a single sip or puff. Some will never do it again; others will do it occasionally. Some will never stop.

Meth is a very powerful stimulant. It is relatively inexpensive and easy to use. You can dissolve it in water or alcohol, then sip, smoke, snort, or inject it. It produces an extraordinary high, almost instantly. Over time, meth changes the way a person’s brain works in a way that makes it almost impossible to feel the way the person used to feel before using meth.

When you start to get dependent on meth, you will not only feel high but jittery. In fact, you might not be able to sit or stand still. Even if you have always been shy, words will pour from your mouth, and you might repeat what you say over and over, for no reason. You might have a tic, a chronic cough, or runny nose. You will have so much energy, you will not want to sleep, eat, or bother taking care of yourself. Old friends might ask why you are so moody or say you look different, because you are and you do. And, you may not notice it, but your blood pressure, temperature, and heart rate will be higher than usual.

What should I look for?

If you suspect a friend or loved one may be using some type of drug, look for these signs:

• A sudden change in their usual behavior
• Frequent mood swings—grumpy one minute, then cheery the next
• Avoids family, friends, or co-workers for no apparent reason
• Unusual carelessness or sloppy appearance
• Loss of interest in hobbies, sports, or other favorite activities
• Changed sleeping pattern; up at night and sleeping during the day
• Red or glassy eyes
• Sniffly or runny nose

If your loved one is a teenager, here are a few additional signs that she may be using drugs:

• Problems in school—a sudden, negative change in behavior, grades, attendance, activities
• Lack of energy and motivation
• Loss of interest in appearance
• Strong demands for privacy
• Loss of money, or signs of money or valuables missing
• Lying, especially about where she has been or with whom
• New friends replacing long-time relationships
• Unexplained disappearances

Am I addicted?

If you use meth and are wondering if you are addicted, you probably are. To help you decide, here are a few questions to ask yourself:

1. Am I using meth as often as I can, maybe every day?
2. Do I worry about running out of the drug?
3. Do I need meth to help me when I am down or having problems?
4. Am I spending a lot of time and money on getting meth?
5. Am I doing things I normally would not do to get drugs, such as stealing or lying?
6. Have I dropped out of school, my family, my job, or my circle of friends?
7. Am I taking risks I normally would not take, when I use meth?
8. Have I tried to stop using meth and failed?
9. Do I need more and more of the drug to reach the level I used to reach?
10. Am I afraid of getting arrested or injured in some way, because I use meth?

Positive answers should tell you that it is time to get the help you will need to stop.

Resources

National Institute on Drug Abuse
www.drugabuse.gov

Mental Health America
www.mentalhealthamerica.net

National Institute on Drug Abuse
www.drugabuse.gov/drugs-abuse/methamphetamine
http://teens.drugabuse.gov

By Paula Hartman Cohen

©2013-2019 Carelon Behavioral Health

Source: Jenny Karstad, M.A., L.A.D.C., Addiction Treatment Counselor for Inpatient and Outpatient Recovery, Brattleboro Retreat, Brattleboro, VT; William J. Shryer, D.C.S.W., L.C.S.W., Clinical Director, Diablo Behavioral Healthcare, Danville, CA

Reviewed by Paulo R. Correa, M.D., Associate Medical Director, Beacon Health Options

Summary

In a crisis:

• Act fast.
• Be honest about your condition.
• Follow a crisis plan.

If you use crystal methamphetamine, you can expect to develop some serious health problems at some point. It does not matter if you use only meth, use it with other drugs or alcohol, or use it every day or once a week. Over time, the drug will change the way your brain works and have an impact on your body.

 Meth:

• Raises blood pressure, heart rate, and temperature
• Raises blood sugar, which can lead to diabetes or diabetic coma
• Causes damage to lungs and kidneys
• Can cause uterine bleeding and urinary tract infections
• Causes constipation and diarrhea
• Causes hallucinations and/or complete psychotic breakdowns
• Erodes tooth enamel, weakens gums, and causes tooth loss
• Sears lungs, if smoked
• Dries out nasal passages, if snorted
• Weakens the heart, kidneys, and immune system
• Can cause violent rages, aggression, or thoughts of super-human ability
• Can set off thoughts of suicide
• Can cause death from overdose

If you are involved in the manufacture of meth, you are at high risk of burns from touching toxic chemicals, of damage to your lungs from breathing fumes, of nerve damage from anything you touch in the lab, or of death from fire or explosion.

What can happen?

If you use meth for a long time, you may get one or more of these very serious health problems. If so, you need to act quickly and responsibly. Your life or the life of others may be at stake.

Since you use meth and you may be with other people who use drugs at the time of the crisis, you might worry that you could be arrested if you seek medical care for yourself or someone else. That is possible. At least eight states—New York, Rhode Island, Colorado, Illinois, Florida, Connecticut, Washington, and New Mexico—have shield laws that would protect you from arrest. Washington, D.C., hospitals follow rules that allow people to get medical help for drug crises without fear of arrest, and so do hospitals in some other states without shield laws. New Jersey is considering a shield law, but until it has one, some hospitals follow the practice anyway.

An overdose can kill. So can a heart attack, stroke, or kidney failure. If you are using meth, you take a chance for a medical crisis, overdose, or arrest every time you use it.

Prepare for a crisis

You need to decide in advance how you will handle a crisis. You also need to ask someone to be your point person, if you need one. Ask a good friend or family member to be your advocate in case of an emergency. This is something everyone should do.

In a crisis:

1. Go to an emergency room if you are able to walk by yourself.
2. If you cannot walk, call 911 and wait for an ambulance.
3. If you are with someone experiencing a crisis, do not try to revive that person yourself unless you are certified in CPR. Wait for medical help.
4. Carry your own crisis contact information on you. Include phone numbers of whom to contact, as well as your medical history information, medications, the name of your doctor, insurance provider, and anything else that might be important. Put it on a card and keep it in a place you or someone else can get to, quickly.
5. If a doctor asks you if you use drugs, be honest about what you use. Without all information, the doctor cannot make a good assessment of your situation or needs.
6. Follow the medical advice you are given.

Get care quickly

Author David Sheff wrote about his son Nic’s methamphetamine use in Beautiful Boy: A Father’s Journey through His Son’s Addiction. Nic had crisis after crisis, and Sheff wrote about one event in particular, in a newspaper article:

“Nic was rushed to the emergency room, where he was resuscitated. When I spoke to a doctor there, I was told that if another 15 minutes had passed before Nic got to the ER, he wouldn’t have survived. My son has now been sober for five years. I don’t know who called the paramedics, but not a day goes by when I don’t thank him.

Other parents haven’t been so lucky.”

Maybe you feel you are not ready to commit to substance use disorder treatment. Don’t let that get in the way of quick medical treatment for overdose, stroke, heart failure, or breathing problems. You can’t even start to think about drug treatment until you have taken care of other serious health issues.

Doctors recognize drug addiction as a disease, requiring medical treatment. Their job is to help you get well. When you need their help, do not wait to ask for and get it.

Resources

Mental Health America
2000 N. Beauregard St., 6th floor
Alexandria, VA 22311
(800) 969-6642
www.nmha.org

“Calling 911 Shouldn’t Lead to Jail” by David Sheff. The New York Times, April 28, 2013. www.nytimes.com/2013/04/29/opinion/calling-911-shouldnt-lead-to-jail.html?

Maine Department of Health and Human Services, www.maine.gov/dhhs/samhs/mentalhealth/rights-legal/crisis-plan/home.html

By Paula Hartman Cohen

©2013-2019 Carelon Behavioral Health

Source: Jenny Karstad, M.A., L.A.D.C., Addiction Treatment Counselor for Inpatient and Outpatient Recovery, Brattleboro Retreat, Brattleboro, VT

Reviewed by Paulo R. Correa, M.D., Associate Medical Director, Beacon Health Options

Summary

Meth is dangerous because it:

• Is highly addictive
• Changes the brain
• Causes risky behavior

One piece of crystal meth may look small, but it has a huge impact on a person’s mind and body, even after one use.

In fact, methamphetamine is so strong, few people are satisfied using it once or twice. Not everyone gets hooked on it the first time, because the causes of addiction are complex. Some people are more likely to get hooked on pleasurable things—like alcohol, gambling, drugs, sex, eating, or shopping—than others. But anyone who gets caught up in those pleasures should never try meth. Not even one time.

Nic Sheff wrote a book about his longtime experience with the drug. He started using alcohol, marijuana, and other drugs before he was 14 years old (the average age for starting drug use in those who become hooked), so by the time he was out of high school, he was looking for something different.

“When I took those off-white crushed shards up that blue, cut-plastic straw, well, my whole world pretty much changed after that,” Sheff says in his book Tweak: Growing Up on Methamphetamines. “There was a feeling like, my God, this is what I’ve been missing my entire life. It completed me. I felt whole for the first time.”

Who would not want to repeat an experience like that?

What meth does

In the short term, here are some of the drug’s effects:

• Strong positive reaction to surroundings—colors are brighter, music is sweeter, smells are unusually strong, and the person may feel very much at peace with himself and others.
• Energy and alertness—meth makes it easy to stay awake and alert for a long time.
• More confidence—shyness goes away.
• More desire for excitement and sex—meth is a staple at parties built on drugs and anonymous sexual encounters.

Our brains are very complex organs that get information, and then tell us what to do with it. Sometimes we react right away to those signals without thinking, such as when we touch a hot stove. Other times, we mull over the information, and then act on it very deliberately.

You could say the receiving part of the brain has two doors, one marked go and the other marked stop. When we get positive signals—such as the sight of a sunset, or the sound of music we like—the go door opens wide to get a bigger signal. If the signal is unsafe or harmful, our brain tells us to close the stop door, to keep us from harm.

In very basic terms, meth opens the go door wide, over and over, but stops us from closing the stop door. The thinking part of our brain does not have the chance to make the choice. The chemicals in the drug make the choice for us. That is simply how addiction works.

Of all the drugs a person can use, including alcohol, methamphetamine is very likely to make us go back, time and again, to do something we know is bad for our body and mind, but we want to use it anyway.

“It’s like I‘m being held captive by some insatiable monster that will not let me stop. All my values, all my beliefs, everything I care about, they all go away the moment I get high,” says Sheff.

Meth fires up the brain by amplifying each signal that comes in. It can do that because it is very close, chemically, to dopamine, one of the natural fuels our brain runs on. Unlike the chemicals we are born with, meth burns out nerve endings so that the only way we can feel normal is to use more and more of the drug.

Long-term effects

Over time, here are some of the things meth will do to a person. Someone who uses meth will experience:

• Aggressive, violent behavior—he may do something out of character, such as start a fight, steal, lie, or attack strangers for no reason
• Big changes in sleep patterns—sometimes a person using meth will stay up for days or sleep for days
• Loss of appetite and weight—people who have used meth for a long time are often very skinny
• High blood pressure, which can lead to kidney failure, heart attack, or stroke
• High blood sugar, which might lead to diabetes
• Irregular heartbeats, bad chest pains, or other heart problems
• Depression or flat emotions, putting her at risk for suicide
• Meth mouth—a mixture of gum disease, tooth decay, mouth sores, and tooth loss brought on by the harmful ingredients in meth
• Skin infections and unusual skin color, often pale grey or yellow
• Muscle wasting—this adds to the skinny and misshapen appearance
• Nose problems, including sinus infections and nose bleeds
• Trouble breathing because of a chronic cough or bronchitis
• Urinary tract infections, diarrhea, or constipation
• Sexual problems
• Muscle twitches and tics
• No control over repetitive motions
• Psychosis, hallucinations, mental breakdowns that can take years to recover from
• Birth defects, if a mother uses meth during pregnancy

Where does meth come from?

Some meth comes into the U.S. from other countries but much of it is made in small local labs built in homes, garages, warehouses, or vacant buildings.

To prevent vapors from escaping the lab, people who make it sometimes cover over or tape up windows. This can cause a violent explosion or fire. While they are working, they breathe in unsafe fumes and touch chemicals that can eat away their skin. These chemicals are so unsafe that, long after the lab closes, whatever is left behind can harm neighbors or anyone who lives or works in that space. Meth ingredients will even kill grass and other plants near a lab. Only trained and licensed experts wearing hazmat suits are allowed to clean up these sites.

Police often find labs after they burn or explode. But sometimes a lab goes unnoticed and someone buys the property years later. The new owner may not realize what he has bought until people living there show signs of nerve damage, skin rashes, breathing problems, or learning disabilities. The invisible and odorless residue left behind on the walls, floors, countertops, and soil around a meth lab is bad for everyone, but especially children and pregnant women.

Resources

Drug Facts: Methamphetamine, National Institute on Drug Abuse, www.drugabuse.gov/publications/drugfacts/methamphetamine

Hazards of Illicit Methamphetamine Production and Efforts at Reduction: Data from the Hazardous Substances Emergency Events Surveillance System, Centers for Disease Control and Prevention. www.atsdr.cdc.gov/ntsip/docs/Meth%20Production.pdf

Tweak: Growing Up on Methamphetamines by Nic Sheff. Atheneum Books for Young Readers, 2009.

By Paula Hartman Cohen

©2013-2019 Carelon Behavioral Health

Source: Gabrielle McCraney, Program Director, La Casa Transitional Rehabilitation Program, Washington, D.C.; William J. Shryer, D.C.S.W., L.C.S.W., Clinical Director, Diablo Behavioral Healthcare, Danville, CA

Reviewed by Paulo R. Correa, M.D., Associate Medical Director, Beacon Health Options