Methamphetamine - MSNBC Special Report
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Published On: July 31,
2001 Updated On: April 13, 2002
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- MSNBC Special Report
1: Meth's Deadly Buzz - The Hidden Drug Crisis
2: Scourge of the Heartland - Meth Takes Root In Surprising Places
3: Lab-busting in the Northwest - Stalking An Elusive Foe
4: Beating An Addiction To Methamphetamine - Researchers Zero In On Brain
Effects & Treatment Approaches
1: Meth's Deadly Buzz
Hidden Drug Crisis
MSNBC.com Special Report By Jon Bonné
In many ways, methamphetamine
is the crack cocaine of the new millennium. Much like crack, which swept
across the nation in the 1980s and ’90s, methamphetamine use has hit
epidemic proportions in the past several years. Crack plagued inner cities
and the black community; meth is thriving in cities like San Francisco,
sweeping across the Midwest and headed east. It has quietly become
America’s first major home-grown drug epidemic.
WHY THE POPULARITY?
Meth is easy and cheap to produce, and
unlike drugs such as marijuana and cocaine — much of which must be
imported — meth is easily manufactured domestically with common
household items such as batteries and cold medicine. There are retail and
wholesale operators: Small-time meth cooks stash labs everywhere from
mobile homes to car trunks, while Mexican organized crime has streamlined
the high end of the industry in the past few years, supplying both
finished product and the raw materials required for production, called
“cooking” in the drug trade. What was once a regional West Coast
problem can now be found in big cities and small towns alike.
“It covers the whole United States, right
up into Maine,” says Joe Keefe, chief of operations for the Drug
In 1999, more than a million Americans used
meth in just one year, more than used crack and almost three times as many
as used heroin. The allure of the drug — also called crystal, crank and
dozens of other names — is energy, the sort of raw, unbridled, jumpy
rush that comes from supercharging the brain with a dopamine high similar
to a jolt of adrenaline; the same sort of energy that comes from doing
But unlike cocaine, or even crack — which
provides a high of a couple hours at best — meth users can stay up for
eight to 12 hours or more, depending how they ingest the drug: smoking,
snorting, swallowing or injecting it.
Though meth has been around for decades,
the latest crisis has spread among white, often poor, usually rural
Americans. The drug is rampant in small communities with scant health
facilities and few assistance options. “The thing that’s scary about
this to me is that it’s hitting populations that have been previously
unexposed and also have the least resources,” says addiction expert Dr.
David Smith, founder of the Haight
Ashbury Free Medical Clinic in San Francisco.
Meth remains remarkably affordable because
the lasting high of the drug — which costs $20 to $60 or so for a
quarter-gram, a bit more than cocaine — is achieved with small
quantities, which is why it is called “the poor man’s cocaine.”
Traffickers usually move in small circles;
cooks often exchange drugs or give them to friends. Because meth can be
made in a backyard or a bathroom, families often pass around meth-cooking
knowledge in an informal and ever-expanding web of connections.
“If your dad cooks meth in the house,
that’s what you’re going to learn to do,” says Lt. Mel Williams of
the Sioux City, Iowa, police department, which runs one of the nation’s
few local training programs to handle meth.
SEARCH FOR SOLUTIONS
Communities across the country are
struggling with ways to combat this drug epidemic. Some have opted for a
hard-nosed approach — raids of clandestine meth labs, operations that
require special equipment and training for police who must handle the
toxic chemicals used in the cooking process. Others hope to stem the
drug’s social impact and the rising health costs of a deadly addiction.
What remains clear is that officials find
themselves frustrated, both with their slow progress and with an often
contentious relationship with officials in Washington. Though federal
authorities acknowledge the value of what Keefe calls a “holistic”
approach, local authorities often feel burdened with the same stringent
tactics that led to a prolonged fight against crack.
“Each year, they make more arrests, each
year they seize more dope, they seize more guns, execute more search
warrants,” says Capt. Peter Groetken, who heads Sioux City’s detective
force. “It’s not stopping the flow of drugs.”
has gone into communities struggling to cope with the meth crisis to get a
first-hand look at the war on this drug. In this special package:
We go to a drug clinic in San Francisco that has helped meth addicts since
the city’s hippie culture of the 1960s.
We follow along as police in Washington state bust meth cooks.
We meet officials on the front lines of the meth battle in the Midwest,
where the realities of this drug have created a new sort of pragmatism
among even hard-nosed police and prosecutors.
We introduce you to former addicts who describe how they got hooked on
meth — and survived their addictions.
We look at the drug’s physical and psychological effects, and how
doctors bring users back from their jittery, paranoid trips.
a look inside America’s hidden drug epidemic.
2: Scourge of the Heartland
Meth takes root in surprising
Thomas Monaghan doesn’t seem
like much of a radical. But as the U.S. attorney for Nebraska sits in his
corner office in a downtown bank tower, explaining how he’s watched meth
descend like a plague on the nation’s heartland, Monaghan argues
passionately that conventional law enforcement wisdom about fighting the
drug war hasn’t worked.
METH IS too big a problem for Monaghan’s
office to ignore. With 80 percent of his drug cases involving meth, its
impact has been significant enough to make him rethink conventional
tactics. He freely admits that major advances in fighting the drug can
only be accomplished with a balance between fighting supply and reducing
demand. Those views pit him against many of his fellow federal officials,
most notably former U.S. drug czar Gen. Barry McCaffrey.
“The general doesn’t think that money
needs to be spent on demand reduction,” Monaghan says. “He’s just
The federal government — including
McCaffrey and his Office of National Drug Control Policy — haven’t
quite ignored the demand side of the drug equation. In recent years, the
general has done an about-face on strategy, acknowledging the need for
reducing demand. But most federal drug policies are still rooted in the
crack wars of the 1980s and ’90s — which led to jammed prisons and six
of every 10 federal inmates doing time for drug crimes. Supply, as far as
Washington is concerned, is still king.
Monaghan’s conversion, as it were, began
in 1996 during a “road show” around the state. Officials in Nebraska
— and in neighboring states — told him of meth’s skyrocketing appeal
and expressed frustration that few local authorities were aware of the
crisis in their midst.
“This is really the first rural explosion
of a hard drug,” Monaghan says. “We spent a lot of time going around
and saying, ‘Excuse me, we’ve got a meth problem here. Do you even
know what meth is?’”
As Monaghan strategized, Congress passed
Control Act of 1996, which toughened drug sentences and targeted
drug supplies by attempting to stem the availability of ingredients such
as ephedrine. The gap between Washington and the front line kept growing.
A NEW APPROACH
Mindful of that, Monaghan and other
officials in Nebraska retooled the way they handled drug offenses.
Nebraska meth users and small-time dealers get different treatment from
major dealers and traffickers. Violent offenders are targeted for harsh
prosecution, but other offenders may be sentenced to treatment. Special
courts set up to deal only with drugs seek the best solution for each
Monaghan’s office helps coordinate the
efforts of a dozen or so local and state agencies. Those efforts allow his
attorneys to target big fish — moving higher and higher up the meth
supply chain while drug courts try to pry small-time offenders out of the
“It’s really therapeutic
jurisprudence,” says Judy Barnes, who coordinates Omaha’s drug courts.
“It’s a deal for them … but it’s also a deal for society.”
Another crucial component of the drug war
has been education. Because the ingredients to make meth are readily
available, officials put together a campaign to warn retailers about the
potentially illicit uses of products. Posters remind store employees to
watch for large purchases of everything from cold pills to drain cleaner.
Drug education messages left over from the
crack era were retooled with less preachy messages and a tone more
forthright than alarmist. One memorable spot features a teen-age boy
who appears to be dancing at a rave but is actually twitching on a
bathroom floor in an apparent overdose. Broad themes that treated all
drugs as equally harmful were rejected.
“Kids know that that’s not true,”
says Nancy Martinez, who coordinates Monaghan’s local anti-drug efforts.
THE IDEA SPREADS
Other Midwestern officials — including
some very hard-nosed law enforcement officers — are coming to share
Monaghan’s views as they witness their communities in the midst of a
quiet epidemic. Meth is growing exponentially more popular in the
countryside, labs can be easily hidden in rural locations, ingredients are
easy to get and, as Jerry Wells, executive director of the Koch Crime
Institute in Topeka, Kan., points out: “We are in the middle of the
country, so you can distribute to all four corners of the nation.”
This fact hasn’t gone unnoticed by the
federal government, which designated Iowa, Kansas, Missouri, Nebraska and
South Dakota as its High Intensity Drug Trafficking Area, or HIDTA, for
the Midwest. Those states, and surrounding ones like Oklahoma, are
veined with major transportation routes for traffickers coming east from
California and north from Mexico. The impact is clear in cities such as
Des Moines, where 14 percent of the people arrested for any crime in 1999
tested positive for meth.
The Midwest’s meth problem has hit cities
and small towns alike, from the streets of Kansas City to the meat-packing
plants of rural Iowa — and regular use is increasing.
Yet each community’s problem is
different. Missouri, Kansas and central Iowa primarily face problems with
meth labs; Nebraska, South Dakota and western Iowa battle trafficking by
Mexican drug gangs. Rural Missouri counties report a high incidence of
intravenous meth use.
SIOUX CITY TAKES A STAND
Officials throughout the region have
struggled to find a strategy that works. Sioux City, Iowa, about 100 miles
north of Omaha straight up Interstate 29, is the hub of a regional economy
driven by agriculture and meat packing. During the second half of the
1990s, the city of 84,000 also had become a nexus for meth trafficking,
not only because the city had such a large target population but also
because it sat at the intersection of three states — Iowa, Nebraska and
South Dakota. It was a convenient layout for traffickers; crossing state
lines to evade capture was simply a matter of crossing town.
In 1995, police Chief Joe Frisbie and other
local officials set up their Tri-State Drug Task Force, which coordinates
drug work between at least nine agencies from the local police to the
Immigration and Naturalization Service. Task force members are federally
deputized, which allows them to pursue drug crimes across state borders.
Though Mexican drug rings traffic much of
the meth, other parts of Iowa struggle with small-time meth cooks. Most
small cooks produce less than an ounce at a time, but the problem has
grown exponentially. Iowa authorities uncovered two meth labs in 1994; by
1999, they found 803.
“For every one that learns to cook, they
teach 10,” says Marti Reilly, one of the drug task force’s commanders.
“It’s kind of the Amway pyramid thing.”
HELP ON THE LOCAL LEVEL
Since the meth war is especially difficult
for small-town authorities, Sioux City decided to share its expertise. In
a set of squat, undistinguished buildings on a dirt road behind the local
airport, Frisbie’s department set up the Regional Training Center, one
of a handful of training centers in the United States that teaches local
law enforcement to deal with meth.
“If you look at San Diego, San Francisco
or Portland, Ore., and they’re overwhelmed by what’s going on, what do
you think is going on in Hinton, Iowa?” asks Lt. Mel Williams, who runs
the center. “We need to provide them with those same safety and security
A recent course list included
“Identifying and Dealing with the Drug Impaired,” “Survival Spanish
for Law Enforcement Officers” and “Examining Methamphetamine.” More
than 5,000 officers in the region have trained in Sioux City already, and
if they manage the funding, cops from around the country will have the
“The biggest problem we’d had with this
thing is no one’s ever done it before,” Frisbie says. “You have a
lot of officers who don’t understand a lot of things about drugs.”
Frisbie is a cop’s cop; he’s tall and
imposing, with broad features and well-trimmed gray hair. He leaves an
unmistakable impression that he’s committed to a law-and-order approach.
But like Monaghan, Frisbie and his deputies take a practical view on the
fight against meth.
“The only true solution to a problem like
this is demand reduction,” Frisbie argues. “I don’t know if putting
people in jail does a lot for demand reduction.”
3: Lab-busting in the Northwest
an elusive foe
SUMNER, Wash. — Welcome
to Meth country. It’s just past dawn in this farming town of 8,000 in
the shadow of Mount Rainier, and a bust is about to go down. This day’s
target: a suspected methamphetamine cooker who works out of a shack on his
grandmother’s sprawling, cluttered four-acre lot.
IN THE TOWN’S small courtroom, 20 officers are
briefed by sheriff’s Deputy Scott Provost, a member of the sheriff’s
meth lab team in Pierce County, whose 689,000 residents are spread out
from working-class Tacoma to the desolate peaks of the Cascades. Team
members review aerial photos and share details of how the bust will unfold
“Grandma has no idea what’s going on,” Provost
The officers don tactical assault gear — body
armor, headsets and helmets — and prepare to head out. It’s the fifth
lab discovered in Sumner this year, one police officer says, but only
their first bust. “Most of them burn down,” he says.
A convoy of about a dozen vehicles winds its way
across town to the bust site. Deputies leap out and shout “Police!
Search warrant!” as they bust into the backyard shack where the suspect
lives and surround Grandma’s house. The suspect appears taken by
surprise and is quickly cuffed.
The deputies, along with local officers and
DEA agents, fan out across the property, which is covered with overgrowth
and littered with the hulks of rusting trucks and campers. They move
through the high brush in a single file, alert for possible snipers or
hidden evidence. The sheriff’s raid command center, a modified
recreational vehicle with “Pierce County Clandestine Lab Team” painted
on the side, pulls into the driveway to process whatever substances the
Nowhere is the small-lab crisis as acute as
in Washington state, which has the highest per-capita rate of lab busts in
the nation. In 1990, authorities found 38 labs in the state; in 1999, that
number had grown to 789. Of those busts, almost half were in Pierce
County, believed to be the No. 2 county in the nation in meth lab busts.
Meth is fundamentally a homegrown problem.
Though increasing amounts are imported by Mexican drug traffickers or
produced in remote “superlabs,” the average producer in rural America
is still the small-time cook — usually poor and white — with a
dangerous, poorly constructed lab.
The growth of labs has ballooned because
the process of making meth is comparatively simple. Meth’s key precursor
ingredient is ephedrine or pseudoephedrine — basic ingredients in cold
medicine. It can be extracted from over-the-counter pills and cooked down
until it’s chemically transformed into the finished product. Thus, most
meth starts out as cold pills on the shelf of a local convenience store,
easy to find and cheap to buy.
Lab busts, on the other hand, can cost from
$1,000 to $10,000 or more, not including costs to assess environmental
hazards and do additional cleanup. In Pierce County, the cost for a single
cleanup can run as high as $25,000.
Costs are steep because of the toxic nature
of the cooking process. Ingredients such as toluene, a paint
solvent; anhydrous ammonia, often used as fertilizer; and lithium
from batteries can have potentially devastating ecological effects when
leaked into soil or groundwater. Health-care workers face chemical
exposure when treating meth cooks whose clothing is contaminated.
Labs have become so small and so mobile
that many cooks hole up in a motel or a cheap apartment, and cleanup costs
are passed on to the property owner. Some meth cooks keep their children
nearby, potentially exposing them to deadly chemical mixtures; the
state’s Child Protective Services just requested $700,000 to hire social
workers trained to deal with children who’ve grown up around meth.
“You might think of this as a kind of
ecological problem,” says Michael Gorman, who helped run the Alcohol and
Drug Abuse Institute at the University of Washington and studied meth for
the National Institute on Drug Abuse. “I don’t think we really have
the total picture here.”
After the Sumner bust, deputies don
airtight suits and masks to clear out the lab’s contents. On a tarp,
they lay out rusted propane tanks, plastic buckets of chemicals and empty
Every liquid is tested to discover its ingredients,
and each item is checked for fingerprints and documented. The suited
deputies use radios to log the information with the command center.
Then the materials are destroyed. Propane tanks are
taken to a remote shooting range and blown up; compounds are put in a
landfill or incinerated; caustic ingredients are Ph-balanced to neutral.
“Judges don’t want that in their courtroom,”
explains Sgt. David Perry, supervisor of the Pierce County narcotics unit.
A car pulls up. Grandma has arrived. Indeed, she
tells officers she has no idea her grandson allegedly turned her backyard
into a drug lab, and she sits crying in the car as a detective explains.
She can’t return to her home that night, he informs her — not, in
fact, until the health department has made a cleanup assessment and
ensured that the property is safe. The process could take weeks, or even
Most lab sites are a shambles, largely because meth
users have a hard time getting organized and staying focused. The drug
also triggers paranoia and extreme sexual urges, and that accounts for
other items found during busts.
“You’ll find the drugs, you’ll find the guns,
you’ll find filth and you’ll find, a lot of times, pornography,”
says Lt. James Chromey, who runs the Washington State Patrol’s Statewide
Incident Response Team, or SIRT.
WORKING ON ‘CROOK
Pierce County has enough money to run its own meth
team, but most of Washington state relies on Chromey and his SIRT officers
to help clean up their meth problems. Their efforts are crucial in small
towns like Sunnyside, a farm town of 12,000, nestled in the Yakima Valley
just about halfway across the state, a region that produces some of the
nation’s finest wine grapes. The town’s population — 50 percent
Hispanic — demonstrates the confluence that often occurs in meth-prone
areas: Working-class whites, who usually cook their own drugs or buy from
a close-knit circle of acquaintances, mix with Hispanic workers among whom
Mexican drug rings recruit local contacts. High-volume meth production
coordinated by drug rings feeds ever-growing demand, while individual
cooks remain on the industry’s ground floor.
“The local cooks,” Chromey says, “are
Caucasian males, probably 25 to 35 … and unfortunately, most of them are
using while they’re cooking. And they’re making mistakes.”
On a sunny September morning, Chromey and members of
his team sit in a covert field office outside town and track several
suspects. There appear to be no cooking mistakes this day, though an
informant claims one alleged cook was complaining about frequent lab
The officers spend hours waiting and tracking the
suspects’ movements with the aid of a surveillance plane flying overhead
and two patrol snipers who, before the day is over, will have spent 12
hours lying in the high desert nearby, watching the remote lab location.
At last, the snipers call in: The suspects have
begun their cook at a lab in remote Bickleton, Wash., near the Oregon
border. The officers’ convoy heads out on the 25-mile ride to Bickleton
through the desolate Horse Heaven Hills, past miles of burnt scrub and
desert. In such remote locations, local law enforcement is often
hard-pressed to handle meth arrests and Chromey’s assistance is
The caravan turns down a two-mile-long
driveway. A run-down house sits amid piles of trash. In a nearby trailer,
the cops find two suspects engrossed in their work. The third suspect, who
is pregnant, is inside the house on the property and has one child with
her — with five more expected home from school at any moment. The two
alleged cooks are separated from the others; when sheriff’s deputies
arrest them, they use thick rubber gloves and dress the two men in white
The female suspect appears willing to
cooperate and some of the officers allow her to point out where other
materials may be kept. She is nervous and jumpy; several officers insist
she is on a meth high
“This is pretty common,” Chromey says,
surveying the scene. “Six kids living in this house, and she’s
pregnant and she’s cooking meth.”
As authorities make arrangements with Child
Protective Services to take custody of the children, Klickitat County
Sheriff R.E. Kindler points out this is the fifth bust since June in the
county, which has only 19,000 residents. Between 1990 and 1999, only seven
labs were found.
Kindler looks around and sighs.
“Here we got all these little kids,” he
says. “She’s pregnant. That’s what makes me mad.”
in the Haight
Life, death or prison
SAN FRANCISCO — The
irony was that Mark Miller didn’t do drugs. Miller, “better known as
Miss Miller” as he’ll tell you, came to San Francisco to pursue a
career as a dancer. It wasn’t until he was in his late 20s that he first
tried ecstasy. “I actually snubbed people who did drugs and
alcohol,” he says.
THEN ONE WEEKEND in 1994 while partying down in Palm
Springs, Miller tried his first “bump” of methamphetamine. It was a
rush, and he was hooked.
“It made me feel confident, self-assured,” he
says. “Then it took on a whole new meaning to me. I became a partier.”
He haunted the clubs of San Francisco, his nights
filled with drugs like ecstasy, meth and GHB, and with dancing and sex.
The next day, he would often do another hit of speed to recover. Within
two years, Miller had become a porn actor, a stripper and a male
“I was a person of great promiscuity,” he
recalls — one reason he ultimately became HIV-positive.
Miller began to try new ways to do meth, at first
snorting and smoking, then taking it anally. His addiction grew, and he
was thrown out of his apartment and ended up on the streets, searching to
string along his high.
“One time, I was up seven days on speed,” he
remembers. “I was out in public fondling myself.” San Francisco police
found him and took him to the hospital.
“I woke up the next day thinking I was having a
dream,” he says, “when I was living it.”
Even then, Miller kept using meth “every
way imaginable.” By the fall of 1999, he was going through two
quarter-grams a day. Finally, he learned to inject himself with the drug
— and realized he needed help.
“That moment was a moment of clarity to
me,” he remembers, “where I said, ‘Enough. Please, God, help me.
ONE CITY’S LEGACY
Though meth has spread rapidly through
rural America, it remains a crisis in urban centers, especially on the
West Coast. Like other big cities in the West, San Francisco has a major
meth problem. Seen as early as 1978 in the city’s gay bathhouses, it
could keep users up for days on end and enhance sexual pleasure. With the
onset of AIDS, it was a popular but sometimes deadly pleasure and a major
factor in the transmission of HIV, hepatitis B and C and syphilis.
“If you’re at a party where a lot of
people are injecting, when you put your needle down, someone else may pick
it up,” says psychologist Michael Siever, who founded the Stonewall
Project, which offers meth counseling to the city’s gay community.
The city’s meth roots stretch decades. In
1967, a 28-year-old doctor named David Smith who was living in the Haight
Ashbury neighborhood was shocked to find that plans for the Summer of Love
gathering included no contingency to help any of the expected 100,000
stoned kids with medical problems from bad trips to bad hygiene. Fresh out
of medical school, Smith and other young doctors organized the Haight
Ashbury Free Medical Clinic, which offered free services to the flower
children and hippies who came to its door.
Haight Ashbury also had other visitors that
summer, the Hell’s Angels, who had a fondness for a drug then called
crank or speed.
“It was the ‘make love, not war’ era,
so the view was that psychedelic drugs were a route to non-violence,”
Smith recalls. “And then all of a sudden, you started seeing speed and
violence and rip-offs, psychosis and craziness.”
Smith and his team decided to step in. But
it was too late for Haight Ashbury. Speed had come to stay in San
“Speed had destroyed the dream that was
the Summer of Love,” Smith says.
HAND FOR ADDICTS
Some 33 years later, the clinic still helps meth
addicts by offering medical care and residential recovery programs. The
staff believes in harm reduction, which encourages addicts to use clean
needles and condoms during sex. As Dr. Joseph Elson, the clinic’s
medical director, explains: “We tend to be honest and not judgmental.”
Addicts’ medical problems are manifest — from
alarming weight loss (meth users often forget to eat) to skin infections
and abscesses from poor hygiene. Many users also suffer mental problems,
including paranoia and depression. Addicts may develop meth psychosis,
which requires acute detox: several days in isolation to leach the drug
out of the body, often accompanied by drugs to help with tweaking, the
spastic reflexes that often accompany paranoia on the way down from a meth
“What they basically need to do is to
hibernate,” Elson says. ”[We tell them,] ‘Here’s a couple valium.
Go and hibernate for a day or two.’”
Coming down is difficult because meth can take users
to the height of euphoria and sexual frenzy. The typical high lasts 12
hours or longer and some users will sometimes stay up for days, chaining
themselves along with hit after hit. Others will use meth to suppress
appetite or to help them work long hours, hence the drug’s growing
popularity in Silicon Valley.
That’s why Stephanie Lujan tried meth. Growing up
in New Mexico, she managed a fast-food restaurant and occasionally smoked
pot. Her friends got her started on a tempting new drug. The initial rush
was “this very intense surge of electric energy through the body,” she
recalls. “It felt as though your mind was moving faster.
“I felt like I was superhuman because I would
think more, I could accomplish more.”
Lujan, now 31 and a counselor who helps run one of
the clinic’s residential treatment programs, described the elaborate
ritual she and her friends would perform when they did meth. Upon scoring
a bag, she and her friends would admire the size of the “rocks,”
clumps of powdered meth, and would chop the rocks into lines of powder
with a razor blade, much like cocaine. For up to an hour, they would play
intensely with their drugs, cutting and recutting lines of meth to snort.
“I very much enjoyed doing that,” she says.
They would get high and chatter for hours, quickly
jumping from conversation to conversation. If she had to work, the meth
would give her extra energy. The drug’s economics — cheaper than
cocaine — only added to its appeal.
“I was like, ‘Oh my God, you get more bang for
your buck,’” Lujan recalls. “Why would you do something that costs
more and doesn’t last as long?”
Even for moderate users, meth has a steep addiction
curve: It’s remarkably easy to get hooked and painfully hard to get off
it. Almost as soon as the high begins, users start to fear the crash,
especially the tweaking and paranoia. When a user finally comes down, his
or her surroundings seem bleak. As Lujan describes it: “The world was
black and dark and I was totally depressed.”
FEAR OF THE CRASH
Users coming down usually experience depression
and a profound sense of anhedonia, the
complete lack of emotional sensation.
This is when users are most receptive to
treatment. “Nobody wants to face the crash,” says John DiDomenico,
clinical supervisor of Haight Ashbury’s detoxification, rehabilitation
and after-care program. “It’s real easy to grab them at that point.”
Users undergo intensive counseling in
one-on-one and group sessions. The first step, called “early
recovery,” is about helping addicts learn how to stay clean and rebuild
“A lot of what we get into here is,
‘How do I have social relationships? How do I have sex without doing
speed?’” DiDomenico says.
Users also must learn to deal with powerful
“triggers” that can start a craving — anything from a specific
street corner to a particular friend or a bit of drug paraphernalia.
“A lot of times, people can get triggered
at support meetings when they hear stories about using,” says Dr. Robert
Hood, a clinic psychiatrist.
Intensive therapy usually lasts about six
months, but an addict may need more casual group counseling for several
Of course, in rare cases, getting off meth
can be simpler than that. Lujan kicked her meth habit after the third time
she overdosed on it.
“I got so sick that I have not had a
craving for it since,” she says.
Mark Miller’s recovery began in 1999. He
was clean for nine months before having a relapse. Miller went back into
treatment and by late 2000, at age 36, he had been clean again for almost
three months, working at Gold’s Gym and exercising every day. He takes
antidepressant medication, attends church on Sunday and goes to recovery
group meetings almost daily. He is learning to cope with his HIV status,
and hopes within a year to be back out auditioning for dancing roles in
Much of the recovery process, he says, has
been about realizing what meth covered up in his life. Among other things,
he would use it to have copious amounts of sex, and he used sex as a way
to avoid other problems.
“Intimacy is one of my biggest fears,”
he admits. “I feel insecure because I don’t feel worthy of anything in
Miller acknowledges he could easily feel
sorry for himself, but he says part of the healing process has been
learning to cope with how his life has turned out.
“I don’t have to be a crybaby about
it,” he offers, defiantly.
4: Beating An Addiction To Methamhetamine
On Brain Effects & Treatment Approaches
methamphetamine has been around for decades, its abuse was largely
overlooked by doctors until recently. But concern for meth’s rising
popularity has sparked a flurry of research on the drug’s health effects
and possible new ways for treating the addiction.
UNTIL a few years ago, methamphetamine was
considered a regional problem. Largely confined to the West Coast and
Southwest, it was off the radar of federal drug offices in Washington,
D.C. But as the drug swept into rural Midwestern communities in the
mid-1990s, catching hospitals and treatment centers unprepared for its
devastating effects, steps were taken to gain a better understanding of
meth’s toll on the body.
Methamphetamine, like cocaine, is a powerful
stimulant. It produces physiological changes similar to the
fight-or-flight response — it boosts heart rate, respiration, blood
pressure and body temperature. Some people use it for the brief, intense
“rush” it produces when smoked or injected. Others use it for
functional reasons — as an appetite suppressant to lose weight or as an
energy-booster to enable them to work more. When snorted or taken orally
it doesn’t produce an intense “rush” but rather a “high” that
can last more than 12 hours.
Both cocaine and meth boost brain levels of the
neurotransmitter dopamine, which causes feelings of euphoria and increased
energy, but go about it in different ways. Cocaine doesn’t directly
stimulate the release of dopamine; it prevents the normal recycling of the
chemical messenger once it’s released. Meth goes a step further — it
actually gets into the nerve cell where it causes the excessive release of
dopamine. Meth users can quickly become addicted to the spike in dopamine.
Abuse of methamphetamine is linked to several
serious medical complications such as heart damage, stroke and psychosis.
But perhaps the most frightening side effect is long-term neurological
damage unlike anything seen with heroin or cocaine.
While high levels of dopamine in the brain usually
cause feelings of pleasure, too much can produce aggressiveness,
irritability and schizophrenic-like behavior.
“Meth has more long-term, serious effects on the
brain than cocaine,” said Dr. Nora Volkow, senior scientist at Brookhaven
National Laboratories in Upton, N.Y., who has studied the effects of
both cocaine and methamphetamine on the brain for 15 years.
THE BRAIN ON METH
Using brain-imaging techniques, scientists have
discovered that the brains of former chronic users show a significant
decrease in the number of dopamine transporters, a crucial component of a
functional dopamine system.
The most recent development comes from Volkow who,
along with Dr. Linda Chang, collected the first data on what this decline
in dopamine transporters means. They performed brain scans on 15
detoxified, former meth users and found a 24-percent loss in the normal
number of dopamine transporters. This loss of transporters was linked to
slowness in motor skills and poorer performance on verbal and memory
“We found the subjects with the most profound
changes in the transporters were the ones with the most functional
disturbances,” said Volkow, whose research will be published in the
American Journal of Psychiatry in March. “This is the first time anybody
has reported that these neuron losses are functionally significant. It’s
not just that you lose brain cells and you keep living happily ever after;
it translates into a disruption in your performance.”
Signs Of Methamphetamine Abuse
Agitation, excited speech,
decreased appetite, increased physical activity, dilated pupils, and
nausea and vomiting.
Occasional episodes of sudden
and violent behavior, intense paranoia, visual and auditory
hallucinations, and bouts of insomnia.
A tendency to compulsively
clean and groom and repetitively disassemble and sort objects.
National Institute on Drug Abuse
Volkow noted that the same association has been
reported in Parkinson’s disease patients, although they experience a
more drastic loss of transporters.
“We need to look more at how and why it’s having
these long-term effects and whether in fact they are permanent,” said
Timothy Condon, associate director for science policy at the National
Institute on Drug Abuse (NIDA). “As we unravel more about what
functional changes are a result of those brain changes, they will impact
how you go about treating someone.”
Douglas Anglin, director of the UCLA Drug Abuse
Research Center and co-principal investigator of the Methamphetamine
Treatment Project, a group that studies addiction therapies, said:
“This takes us beyond the model of drug treatment to one of brain
But Dr. David Smith, founder and president of the Haight
Ashbury Free Clinics in San Francisco, wants to draw attention away
from methamphetamine’s neurological impact. “Focusing on the
brain damage caused by meth is counterproductive to recovery. It
makes people pessimistic about whether their brains are going to heal. In
treatment, we offer a message of hope, and we have had many meth users who
have achieved full recovery.”
Meth addiction gained a reputation as being
untreatable when the drug began to spread into small communities in the
Midwest. “These rural areas had not been very affected by cocaine or
heroin so when they had to start dealing with meth users they had no idea
what to do with them,” said Richard Rawson, executive director of the Matrix
Institute, a non-profit addiction research organization in Los
Angeles, and co-principal investigator at the Methamphetamine Treatment
Project along with Anglin. “Patients were coming in psychotic, so you
started hearing these horror stories that meth was untreatable. For those
of us who’ve been dealing with heroin and crack users, it was more
Though not impossible, meth addiction is a difficult
disorder to treat, according to Anglin. “There’s not severe physical
withdrawal with methamphetamine, but rather a feeling of anhedonia, an
inability to experience pleasure, that can last for months and which leads
to a lot of relapse at six months,” he said. The anhedonia appears to
correspond with the period when the brain is recovering and producing
abnormally low levels of dopamine.
“When you think of treatment of drugs like
methamphetamine, you have to think of it like fixing a broken leg —
treatment provides a structure to allow their brain chemistry to return to
normal. Their brain is out of tune, it’s not working very well, and it
takes a while to recover,” Rawson said.
Unlike heroin addicts, who can be weaned off the
substance with methadone, there are no pharmacological treatments for
meth. The only currently available treatment is behavioral therapy.
The Matrix model, a method of outpatient
cognitive-behavioral therapy backed by the Center
for Substance Abuse Treatment (CSAT), a division of the federal
Substance Abuse and Mental Health Services Administration, is the only
program with evidence of effectiveness for methamphetamine addiction.
The model, which was first developed in the 1980s as
a cocaine treatment under a NIDA grant, serves as the primary treatment
protocol for a network of clinics in Southern California.
The basic elements of the four- to six-month
approach (a two-month approach is also being developed) consist of a
minimum of three group or individual therapy sessions per week, where
patients are coached through their recovery. They are taught about their
addiction and trained to manage cravings and avoid risky activities, like
drinking alcohol, that could trigger relapse. The method also uses family
therapy, urine testing and 12-step activities.
“We have data from treating several thousand
patients [with the Matrix model],” Rawson said. “Treatment of meth
addiction appears approximately equal to cocaine treatment. Treatment is
about 50 percent to 60 percent drug-free at the end of one year.”
That’s superior to recovery after behavioral therapy for heroin
addiction (without the use of methadone), but not as good as recovery from
alcoholism, according to Rawson. No nationwide statistics on the overall
effectiveness of treatment for meth addiction exist, but as the Matrix
model is a particularly vigorous, well-studied approach, it’s likely
this success rate is higher than average, Rawson noted.
The model is currently being compared to seven other
outpatient treatment methods in the first large clinical trial of
behavioral treatments for meth addiction. The 800-patient randomized study
is being conducted by the Methamphetamine
Treatment Project, an organization funded by CSAT in an effort to
identify the most effective treatment strategies for meth addiction. CSAT
will use the results to issue its national treatment guidelines.
The other treatment approaches being
evaluated vary in length (from one month to six months), intensity (from
one hour per week to 13), population (two are for women only, and racial
makeup varies across centers) and emphasis. All of the programs are based
on the underlying assumption that addiction is a chronic disease. Some
emphasize life skills such as assertiveness; others focus on spirituality;
others on family support. Some are strictly regimented programs; others
are more flexible to a patient’s individual needs.
Though the large clinical trial is not
evaluating any inpatient treatments, some methamphetamine users do enter
28-day residential programs focused on detoxification and self-help
strategies. Originally developed for the treatment of alcoholism in the
1980s, these programs have become a catchall for abusers of various
substances. Additionally, other, more long-term residential programs
(usually about six months) designed primarily for heroin users referred by
the criminal justice system are now being used by meth addicts. CSAT cites
a lack of empirical evidence for these programs for stimulant users;
however, some experts cite supporting clinical experiences with short-term
and long-term residential programs for certain subsets of meth abusers.
In an effort to expand treatment options,
NIDA set up a program last year to develop pharmacological approaches to
“In our pipeline right now, we have about
10 compounds in various stages of clinical trials, most of them very early
on, for methamphetamine addiction,” Condon said. “They’re all
classic medications used in other areas of medicine that we’re testing
as anti-methamphetamine agents.”
Among the drugs being tested:
calcium-channel blockers, a class of drugs used to treat high blood
pressure that may inhibit the excessive release of neurotransmitters and
reduce the “reward” of using methamphetamine; the anti-nausea drug
Zofran, which has been shown to work against relapse in alcoholics;
tyrosine, an amino acid that’s a precursor of dopamine and may increase
production of the neurotransmitter; and several antidepressants.
Antidepressant medications are currently
prescribed for some meth addicts to combat the depressive symptoms
frequently seen in withdrawal, but they are now being studied as
treatments to reduce relapse based on their ability to boost levels of
neurotransmitters associated with pleasure, which are abnormally low in
people who have stopped using meth.
Research is currently being planned on the
anti-smoking/antidepressant drug bupropion, also known as Zyban and
Scientists also plan to test medications that may be
able to reverse some of the neurological damage and cognitive impairment
caused by methamphetamine use. Experts say one of the most promising is
selegiline, a treatment approved for some symptoms of Parkinson’s
disease. Selegiline has neuroprotective effects and has been shown to
reduce HIV-related cognitive deficits. Studies on vitamin E, which is
thought to boost natural protective chemicals in the brain, are also
In addition, NIDA is funding research on the
development of an antidote for methamphetamine that would be used in
overdose situations. The hope is that a compound could leach meth out of
the tissues, decreasing concentrations of the drug in the body.
Theoretically, this would reduce the duration of the high and some of the
adverse effects. However, such a treatment is years away from being tested
in people, according to NIDA.
But as researchers churn away on potential
treatments of the future, thousands of people are addicted to
methamphetamine right now and aren’t taking advantage of the available
behavioral treatments, said CSAT director Dr. Westley Clark.
A survey of primary care doctors suggests many of
them are reluctant to talk with their patients about drug abuse. The
findings, published recently in the Archives of Internal Medicine, showed
that about one-third of the 1,080 doctors surveyed said they don’t
routinely ask new patients if they use drugs, and 15 percent said they do
not generally suggest interventions for drug-abusing patients.
“We need to educate primary-care providers about
the early signs of substance abuse. And we need to make sure that
treatment is available,” Clark said. “Before treatment can be
effective, we need to get people into it.”
Resources Mentioned In
Haight Ashbury Free
Institute on Drug Abuse (NIDA)
Listing Of Attorney Generals Involved In Meth Enforcement
Other Articles On Methamphetamine
Site Map For Other Drugs Of Abuse)
Methamphetamine - MSNBC Special Report