The document discusses the special needs of methamphetamine addicts, focusing on the effects of the drug on reward pathways and associated psychiatric risks such as acute and chronic depression, and various forms of psychosis. It highlights cognitive impairments, cravings, and the heightened risk of sexual behaviors among users. The information underscores the need for addressing cravings promptly to prevent adverse outcomes like 'crashing.'

1. SPECIAL NEEDS OF METHAMPHETAMINE ADDICTS Presented by: J. Randall Webber, M.P.H. Southwestern Illinois Correctional Center June 19, 2007

5. Normal Functioning in the Reward Pathways Natural reinforcers related to survival (food, water, sex) cause a release of dopamine into the synapse

6. Dopamine Levels in the Shell of the Nucleus Accumbens (% of baseline)

7. Dopamine Levels in the Shell of the Nucleus Accumbens (% of baseline)

9. Dopamine Levels in the Shell of the Nucleus Accumbens (% of baseline)

10. Dopamine Levels in the Shell of the Nucleus Accumbens (% of baseline)

11. Dopamine Levels in the Shell of the Nucleus Accumbens (% of baseline)

12. PSYCHIATRIC RISKS ASSOCIATED WITH THE USE OF METHAMPETAMINE Acute depression (“the crash”) Chronic depression/anhedonia Acute stimulant psychosis Persistent stimulant psychosis Psychotic “flashbacks”

13. Differences Between Methamphetamine and Alcohol-Marijuana Abusers

14. ANHEDONIA= The inability to derive pleasure from previously pleasurable activities

15. AMPHETAMINE PSYCHOSIS: Onset of methamphetamine psychosis can be from 2-48 hours after the initial dose. Onset appears as a result of acute intoxication. While psychosis may appear during the withdrawal period, it is not a true withdrawal sign. Generally associated with chronic, high dosage use. More likely to occur in IV users and smokers.

16. AMPHETAMINE PSYCHOSIS: SYMPTOMS Suspiciousness Irritability Delusions of persecution and/or grandeur Ideas of reference Visual, auditory and/or tactile hallucinations (latter = formication) Hyperactivity

17. AMPHETAMINE PSYCHOSIS: SYMPTOMS Agitation Aggressiveness. Depression, sometimes severe, may also be present. Closely resembles paranoid schizophrenia.

18. AMPHETAMINE PSYCHOSIS Once an individual has suffered a CNS stimulant psychosis, s/he is more likely to experience the same outcome in the future. Psychotic symptoms generally disappear as abstinence continues, and rarely persist beyond 24 hours after the cessation of drug use. If psychotic signs persist beyond 24-48 hours, additional psychiatric consultation is advised .

19. COGNITIVE IMPAIRMENT: SUMMARY Actively using MA addicts demonstrate impairments in The ability to manipulate information The ability to makes inferences The ability to ignore irrelevant information The ability to recall information

20. Memory Difference between Stimulant and Comparison Groups

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

22. DRUG HUNGER Craving Jonsing Tweaking

23. DRUG HUNGER Acute-Immediately after “high” wears off Baseline-Will begin after client has rested Evoked-Produced by triggers/cues

24. Craving Needs to be Addressed Immediately Trigger Thought Craving Use

25. Can Unaddressed Craving Produces a “High”? Dopamine levels in the reward circuit are increased by thoughts of using. If craving is not addressed soon enough, the client will “crash” if s/he does not use.

26. “Crashing from Craving” Positive Mood Negative Mood

27. Methamphetamine Methamphetamine and Sex

28. Sexuality/HIV risk Compared to non-methamphetamine users, methamphetamine users: Have more sexual partners (Among heterosexuals) have increased incidence of anal intercourse Less likely to use condoms More likely to engage in prostitution or sexual bartering Have sex with a known i.v. drug user Have a sexually-transmitted disease

29. My Sexual Drive is Increased by the Use of:

30. My Sexual Pleasure is Enhanced by the Use of:

31. My Sexual Performance is Improved by the Use of: