Methamphetamine - The “Walk-Away” Drug
Social Work Today
By Sandra Ray
Vol. 4 No. 5 p. 30

Abandoned families, explosive labs, and high-risk sex are part of the tragic face of methamphetamine addiction.

Linda* doesn’t look like a former methamphetamine user. She’s a loving mother of two daughters, married for more than 14 years.

Three years ago, Linda’s life teetered on the brink of disaster. “I started using meth about five years ago. My husband stopped giving me money outside of the household bills thinking that would keep me from buying it. At that point, I decided to make my own so he couldn’t tell I was still getting high.”

When her husband discovered her activities, Linda’s life fell apart. He made her leave the house, filed for divorce and sole custody, and threatened to call the police if she didn’t dispose of her chemicals and laboratory equipment. Linda threw everything away and hit the road. She roamed the streets for 16 months and finally got her life back together.

“My recovery from meth isn’t like anyone else’s,” she says. “I know people who went to treatment and are still on the stuff. I just decided I wasn’t going to let meth take away my family.” Today she stays at home with her children and is finishing her bachelor’s degree in sociology, hoping to eventually be a social worker to help others like herself.

Unfortunately, methamphetamine is not only easy to buy on the street; it can be made largely with common items found on store shelves today. Linda and her family are now back together, yet she knows that it would be all too easy to fall back into that pattern. “I have to stay focused on my family because the memory of that high will stay with me forever. Meth is something you never forget, and I believe it’s the worst drug out there.”

Just the Facts
Unlike cocaine or marijuana, methamphetamine is a powerful man-made stimulant. While most other illicit drugs are plant-based, methamphetamine is manufactured from a mixture of chemicals in clandestine laboratories. The Drug Enforcement Agency reported breaking up more than 16,203 clandestine meth laboratories in 2002 and 2003 (National Clandestine Laboratory Database).

According to the 2000 National Household Survey on Drug Abuse, 4% of the U.S. population reports trying meth at least one time. Also, data from the 2000 Drug Abuse Warning Network indicate that meth use increased 30% between 1999 and 2000. Other common names for methamphetamine include amphetamine, ice, speed, and crystal. Meth is used primarily by smoking, snorting, or injecting it.

Once a drug limited to California and distributed by street biker gangs like the Hells Angels, methamphetamine is now increasingly available across the United States and has made its way up the East Coast into the northern states. Because it’s easily manufactured, bans on bulk-quantity over-the-counter medicines such as Sudafed are more common. Pseudoephedrine, an ingredient in Sudafed, is a precursor of methamphetamine and has led to stiff penalties for possessing it in large quantities. Law enforcement officials in local communities often work in tandem with stores to report suspicious sales of pseudoephedrine products and other key ingredients.

Other substances used in the production of meth can include lithium (commonly obtained from lithium batteries), table salt, car starter fluid, and anhydrous ammonia. When combined, these products create a highly volatile substance that can result in explosions or fires. In addition, the cost to the environment when cleaning up after a meth lab increases law enforcement costs and provides an extra danger to the homes or buildings in the immediate vicinity of the lab. Some communities are now passing ordinances that require sellers to disclose whether or not a property was once a site used in “cooking” or manufacturing methamphetamine.

Effects on the Body
Since methamphetamine is a stimulant, most users find its long-lasting high to be a benefit. Heart rate increases, pupils dilate, and bursts of energy seem to give the user the ability to perform their duties at a higher rate of efficiency. Weight loss can result due to decreased appetite. As the drug starts to lose its potency, users become anxious and start to crave another dose. The “high” or rush from meth can last as long as eight to 12 hours in the body. By contrast, cocaine users report the effect wearing off after 15 to 20 minutes.

After prolonged use, long-term brain damage could begin to set in. Meth increases the release of dopamine, a neurotransmitter involved with regulation of mood and pleasure, in the brain. Some studies indicate that serotonin is also affected, but to what degree is still open to speculation. After prolonged use, there is an increased tendency toward aggressive behavior and auditory and visual hallucinations. Some users experience formication, or the sensation of insects crawling under the skin. Skin problems are also seen in long-term users since they may pick at imaginary sores or insects in an attempt to remove them.

A specific withdrawal syndrome from meth has yet to be identified. What is known is that when individuals stop using the drug, depression, irritability, and fatigue may set in. Some people sleep for days at a time while the body rebounds from a “run” or several days or weeks of being awake as a result of drug use. The cycle starts again when the person uses meth to get away from the depression and stay alert.

Family Effects
Tom Westfall, MA, the director of social services for Yuma County in Colorado, calls meth the “walk-away” drug. He states, “Those who use meth walk away from their families, children, responsibilities, jobs, etc. We are seeing more children go into foster care because of meth; and for many of these parents, they abandon their children there, and our subsidized adoptive caseload has grown significantly.” His responsibilities include removing children from methamphetamine laboratory sites where the agency estimates that approximately 35% of children removed by his agency lived in a home where drugs were manufactured. Westfall belongs to a coalition named Colorado Drug Endangered Children, Inc (www.colodec.org). They seek to improve the awareness of how meth affects children who are either living in homes where clandestine laboratories operate or are in the care of parents addicted to the drug.

A key concern of children removed from manufacturing sites is that their health and psychological welfare are at serious risk. Kathryn Wells, MD, medical director for Denver Family Crisis Center, developed a set of medical protocols when examining a child removed from a laboratory. She’s also worked with Robert B. Palmer, PhD, DABAT, to develop frequently asked questions for the COLODEC Web site for people who may come in contact with children who have been removed from homes where laboratories were operating. She notes, “We don’t yet know enough about long-range effects of laboratory exposure and are now trying to develop a means of tracking these children long term. It is certainly a concern that we have.”

Families often suffer from financial setbacks as users appear willing to sacrifice possessions, housing, and other basic necessities in favor of purchasing the drug. No statistics are available concerning domestic violence incidents in meth homes, making it difficult to predict exactly how much the drug influences these relationships.

Special Challenges in Treatment
Bruce Cooper, LCDC, from Palmer Drug Abuse Program in Midland, TX, comments that as a former drug user, he can still taste the drug 20 years after he stopped abusing it. “There are parts of town that I avoid because I know a lab is operating. The smell of a meth cook is unmistakable. I can’t even watch drug movies because it reminds me of getting high on cocaine or meth.” Now he works to educate youths and young adults about the drug’s dangers, using some of his experiences to underscore research. He doubts that meth’s strong hold on the user comes from it’s man-made components, instead focusing on the intense rush that someone gets by its use. “Any time you have a drug that you can use once and be high for eight hours, there’s a high propensity for addiction.”

Without proper treatment, successful recovery is questionable. Because of the stimulant’s powerful effects, those who enter traditional treatment programs have less than a 30% chance to recover completely.

Ron Jackson, MSW, is the director of Evergreen Treatment Services in Seattle. While his clinic provides methadone treatment as its primary service, he sees methamphetamine dependence as a secondary addiction. “Addiction is a chronic relapsing disorder. Generally a process must take place for a person to be successful with treatment.”

Jackson believes that one reason those individuals in lower socioeconomic classes find meth so attractive is because of its ability to keep someone awake for longer hours. “These individuals need to work several jobs to make ends meet,” he says. Another population in his area that reports high meth addictions is gay men. “Stimulant drugs are used to stimulate sexual behavior. Over time, however, sexual functioning diminishes with chronic use.

“I’m not a believer in instant addiction,” Jackson continues. “It has more to do with how an individual reacts to the drug and what their surrounding environment is like. Some will use it once and never again. Others are not so lucky.”

Jackson notes that in treating meth addictions, counselors and medical officials need to watch for toxic psychosis. “It’s a toxic phenomenon when they are actively taking the drug. It tends to abate after five to 10 days of nonuse. With meth, toxic psychosis doesn’t subside as quickly with some.” He adds that some physicians have reported cases where meth users do not recover from toxic psychosis without the help of antipsychotic medication. Those are the exception rather than the rule, he says.

“As clinicians, we are struggling to get our heads around what will work with methamphetamine. There are no medications for meth or cocaine that are all that effective,” Jackson says. When asked about those with meth addictions leaving a prison system, he thinks this population is especially vulnerable. “They have virtually no chance of staying drug-free without follow-up.”

Whatever the treatment method, the addicted person needs ongoing support from both family and community organizations. Social workers must be aware of supportive agencies that may be able to provide more comprehensive services than programs that work for other addiction populations.

Recovery for the family unit takes an extended period as barriers related to treatment, financial recovery, possible problems with children’s protective services, and other issues need to be simultaneously addressed. Since stress levels can mount quickly in addiction families, clients can benefit from additional case coordination to address the increased tension.

Understanding the effects of methamphetamine and treatment options available in a community can greatly increase the range of options for caseworkers. Using existing resources and compiling a listing of unmet needs can help coalition planners develop new programs to address these service gaps in a way that will benefit the population in need. As the prevalence of methamphetamine abuse/addiction continues, social workers will need to be proactive in identifying clients who can benefit from supportive services for families and intervention methods for addicts.

— Sandra Ray is a Midland, TX-based freelance writer.

*Name changed for confidentiality

Methamphetamine Use Heightening Risks Among Gay Youths
A convincing body of new research suggests that a relatively recent and important risk factor for HIV among men who have sex with men (MSM) is methamphetamine use. Illegal stimulants have become such a commonplace part of the party circuit and gay club life that some treatment centers have seen a 1,000% increase in people presenting for treatment of methamphetamine abuse.

While HIV clinicians have long known the connection between substance abuse and HIV—especially when injectables are used—investigators are building a strong case for paying particular attention to methamphetamine and other stimulants used by MSM. Even when these drugs are not injected, they place users at a high risk of HIV infection, according to several presentations at the July 2002 14th International AIDS Conference in Barcelona, Spain.

“With methamphetamine ... people become uninhibited on the drug, and then it becomes an issue of sexual transmission,” said E. Michael Gorman, PhD, MPH, MSW, a chief investigator of numerous methamphetamine and HIV studies. “They forget; they don’t put on a condom right or don’t use a condom if they think to bring one,” he said.

“What we see is that these drugs cause people to take more risks, cause more partnering, cause more people to have sex, create an insatiable sexual desire, and cause people to do more extreme sex than regular sex,” said Perry N. Halkitis, PhD, assistant professor of applied psychology at New York University. “And if methamphetamine is inserted anally, this is a harsh substance that wears away at the lining of the rectum and increases the possibility of seroconversion...,” Halkitis said, noting that in his research 35% of methamphetamine users reported this practice.

Steve Shoptaw, PhD, principal investigator with the Friends Research Institute in Los Angeles, said, “What we’re finding is that an occasional use of methamphetamine in gay populations is a significant predictor of HIV infection, but when you move up the level of use to dependence, then methamphetamine is an outrageous predictor of infection.”

At a Los Angeles substance abuse treatment center, researchers found that 62% of the gay and bisexual men who presented for methamphetamine treatment were HIV-positive. “The Seattle/King County Health Department in Washington ... found that 60% of gay IDUs [injection drug users] who use methamphetamine were HIV-positive,” Gorman said.

Methamphetamine use and its tie to HIV among MSM is a trend found outside U.S. borders as well. Robert Hogg, PhD, manager of the HIV/AIDS Drug Treatment Program at the British Columbia Center for Excellence in HIV/AIDS and principal investigator of a Vancouver study of HIV and methamphetamine use, said, “We’ve seen an increasing incidence of HIV in this population of MSM, and a lot of that has to do with ... a real increase in barebacking.”

— Source: Centers for Disease Control and Prevention News Update October 2002