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Methamphetamine and the Brain: What do we know?

Beth Rutkowski, M.P.H. Pacific Southwest Addiction Technology Transfer Center UCLA Integrated Substance Abuse Programs finnerty@ucla.edu UCEDD ID Grand Rounds, March 22, 2006 11:00 a.m. – 12:00 p.m. Methamphetamine and the Brain: What do we know?. Forms of Methamphetamine.

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Methamphetamine and the Brain: What do we know?

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  1. Beth Rutkowski, M.P.H. Pacific Southwest Addiction Technology Transfer Center UCLA Integrated Substance Abuse Programs finnerty@ucla.edu UCEDD ID Grand Rounds, March 22, 2006 11:00 a.m. – 12:00 p.m. Methamphetamine and the Brain: What do we know?

  2. Forms of Methamphetamine Methamphetamine Powder Users’ Description: Beige/yellowy/off-white powder Base / Paste Methamphetamine Users’ Description: ‘Oily’, ‘gunky’, ‘gluggy’ gel, moist, waxy Crystalline Methamphetamine Users’ Description: White/clear crystals/rocks; ‘crushed glass’ / ‘rock salt’

  3. > 58 35 - 58 12 - 35 < 12 No data Primary Amphetamine/Methamphetamine TEDS Admission Rates: 1992(per 100,000 aged 12 and over) SOURCE: 2002 SAMHSA Treatment Episode Data Set (TEDS).

  4. > 58 35 - 58 12 - 35 < 12 No data Primary Amphetamine/Methamphetamine TEDS Admission Rates: 1997(per 100,000 aged 12 and over) < 12 SOURCE: 1997 SAMHSA Treatment Episode Data Set (TEDS).

  5. < 12 35 -58 200 or more 150-199 100-149 12 - 35 58-99 Primary Amphetamine/Methamphetamine TEDS Admission Rates: 2002(per 100,000 aged 12 and over) SOURCE: 2002 SAMHSA Treatment Episode Data Set (TEDS).

  6. < 12 35 -58 200 or more 150-199 100-149 12 - 35 58-99 Primary Amphetamine/Methamphetamine TEDS Admission Rates: 2003(per 100,000 aged 12 and over) SOURCE: 2003 SAMHSA Treatment Episode Data Set (TEDS).

  7. A Major Reason People Take a Drug is they Like What It Does to Their Brains

  8. dopamine reservoir synapse

  9. Methamphetamine

  10. Initially, A Person Takes A Drug Hoping to Change their Mood, Perception, or Emotional State Translation--- …Hoping to Change their Brain

  11. FOOD SEX 200 200 NAc shell 150 150 DA Concentration (% Baseline) 100 100 15 % of Basal DA Output 10 Empty Copulation Frequency 50 Box Feeding 5 0 0 Scr Scr Scr Scr 0 60 120 180 Bas Female 1 Present Female 2 Present Mounts Time (min) Sample Number 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 Intromissions Ejaculations Source: Di Chiara et al. Source: Fiorino and Phillips Natural Rewards Elevate Dopamine Levels

  12. Effects of Drugs on Dopamine Release COCAINE 1500 1000 500 0 METHAMPHETAMINE Accumbens 400 Accumbens DA 300 DOPAC HVA % of Basal Release % Basal Release 200 100 0 0 1 2 3hr Time After Methamphetamine Time After Cocaine 250 ETHANOL NICOTINE 250 Accumbens Dose (g/kg ip) 200 Accumbens 200 0.25 Caudate 0.5 150 % of Basal Release 1 % of Basal Release 2.5 150 100 0 1 2 3 hr 100 0 0 0 1 2 3 4hr Time After Ethanol Time After Nicotine Source: Shoblock and Sullivan; Di Chiara and Imperato

  13. But Then… After A Person Uses Drugs For A While, Why Can’t They Just Stop?

  14. Their Brains have been Re-Wired by Drug Use Because…

  15. Prolonged Drug Use Changes the Brain In Fundamental and Long-Lasting Ways

  16. PET Scan of Long-Term Impact of Methamphetamine on the Brain

  17. Decreased dopamine transporter binding in METH users resembles that in Parkinson’s Disease patients Source: McCann U.D.. et al.,Journal of Neuroscience, 18, pp. 8417-8422, October 15, 1998.

  18. Control > MA 4 3 2 1 0

  19. 5 4 3 2 1 0 MA > Control

  20. 2.0 1.8 1.6 1.4 1.2 1.0 7 8 9 10 11 12 13 2 1.8 1.6 1.4 1.2 1 16 14 12 10 8 6 4 Dopamine Transporters in Methamphetamine Abusers Motor Activity (Bmax/Kd) Dopamine Transporter Normal Control Time Gait (seconds) Memory Dopamine Transporter Bmax/Kd Methamphetamine Abuser Delayed Recall p < 0.0002 (words remembered)

  21. Cognitive Impairment in Individuals Currently Using Methamphetamine Sara Simon, Ph.D. VA MDRU Matrix Institute on Addictions LAARC

  22. Differences between Stimulant and Comparison Groups on tests requiring perceptual speed

  23. Memory Difference between Stimulant and Comparison Groups

  24. Longitudinal Memory Performance number correct test

  25. How much does the brain heal?

  26. PET Scan of Long-Term Meth Brain Damage

  27. Partial Recovery of Brain Dopamine Transporters in Methamphetamine (METH) Abuser After Protracted Abstinence 3 0 ml/gm METH Abuser (1 month detox) Normal Control METH Abuser (24 months detox) Source: Volkow, ND et al., Journal of Neuroscience 21, 9414-9418, 2001.

  28. Partial Recovery of Brain Metabolism in Methamphetamine (METH) Abuserafter Protracted Abstinence 70 0 µmol/100g/min Control Subject (30 y/o, Female) METH Abuser (27 y/o, Female) 3 months detox METH Abuser (27 y/o, Female) 13 months detox Source: Wang, G-J et al., Am J Psychiatry 161:2, February 2004.

  29. Effects of Methamphetamine and Treatment Implications

  30. MethamphetamineAcute Physical Effects IncreasesDecreases Heart rate Appetite Blood pressure Sleep Pupil size Reaction time Respiration Sensory acuity Energy

  31. Increases Confidence Alertness Mood Sex drive Energy Talkativeness Decreases Boredom Loneliness Timidity MethamphetamineAcute Psychological Effects

  32. MethamphetamineChronic Physical Effects - Tremor - Sweating - Weakness - Burned lips; sore nose - Dry mouth - Oily skin/complexion - Weight loss - Headaches - Cough - Diarrhea - Sinus infection - Anorexia

  33. MethamphetamineChronic Psychological Effects - Confusion - Irritability - Concentration - Paranoia - Hallucinations - Panic reactions - Fatigue - Depression - Memory loss - Anger - Insomnia - Psychosis

  34. Other problems • Eye ulcers • Over-heating • Rhabdomyolysis • Obstetric complications • Anorexia / weight loss

  35. Severe weight loss/anorexia

  36. Faces of MethamphetamineSpeed Bumps Images courtesy Multnomah County Sheriff’s Office

  37. METH Use Leads to Severe Tooth Decay Source: Richards, JR and Brofeldt, BT, J Periodontology, August 2000. “METH Mouth” Source: The New York Times, June 11, 2005.

  38. MethamphetaminePsychiatric Consequences • Paranoid reactions • Permanent memory loss • Depressive reactions • Hallucinations • Psychotic reactions • Panic disorders • Rapid addiction

  39. Outpatient Treatment for Methamphetamine Abuse

  40. www.drugabuse.gov

  41. Drugs Sedatives Stimulants Opioids Alcohol Medical Treatment Yes No Yes Yes Treatment: Medical & Behavioral Behavioral Treatment Yes Yes Yes Yes

  42. MATRIX MODEL TREATMENT Primary Manifestation of Withdrawal Stage Behavioral Cognitive Confusion Inability to Concentrate Behavioral Inconsistency Emotional Relationship Depression/Anxiety- Self-Doubt Mutual Hostility- Fear

  43. STAGES OF RECOVERY - STIMULANTS OVERVIEW DAY 180 DAY 0 DAY 15 DAY 45 DAY 120 Adjustment Honeymoon The Wall Withdrawal Resolution

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