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October 18, 2018

Methamphetamine, brain chemistry and treatment outcomes

Methamphetamine, brain chemistry and treatment outcomes

Data from the most recent AIHW survey shows that in 2016, 1.4% of the Australian population had used meth/amphetamine in the past year.1 But within that cohort, people using the crystal form of methamphetamine are the most likely to be using on a weekly or daily basis. The more often a drug is used, the more likely it is that the person using will experience harms from that use – including dependency.
Some researchers have also highlighted that survey data – especially when looking at heavy drug use – may be an underestimation of drug use behaviour.2

The efficacy of treatment programs

In Australia, just under half of people found in possession of small amounts of methamphetamine are referred to treatment or education programs.1 While this is positive, specialised treatment options for methamphetamine are limited, and available programs may lack the intensive psychological and behavioural management necessary to support people through recovery.3

For those looking to end methamphetamine dependence, the ‘gold standard’ is generally considered to be long-term residential treatment coupled with ongoing counselling. But even with this ‘gold standard’ treatment, relapse rates are high.

One Australian study found that of people who enter treatment for methamphetamine use, about half will need to re-enter numerous times before they successfully reduce their use.2 Even if treatment is initially successful, a person still has a high likelihood of relapsing in subsequent years, with more people likely to relapse within the three years after treatment than in the three months immediately after.2

To understand why relapse rates are so high we need to remember how drug use affects the brain.

It’s more than just the drug

In the previous article, we talked about neurotransmitters like dopamine and the role that they play in dependency. And methamphetamine in particular creates unnaturally high levels of dopamine, fuelling the cycle of drug taking and chemical reward in the brain.

The brain learns to positively associate other things with that methamphetamine-produced dopamine spike too, for example the people who are around when someone is using, the places they’re in, and the tools they use to take it. This includes the mental state someone is in when using – for example, if they’re taking methamphetamine to cope with stress.4,5

These associations in the brain mean that even years later, seeing an old friend someone used to take the drug with, or a picture of the drug in the news, or feelings of stress can trigger intense cravings to take the drug again.

A person’s ability to regulate their emotions is also tied to dopamine and can be negatively affected by methamphetamine use.6,7 This could affect their ability to make key decisions about their recovery and can be further impacted by having experienced psychosis and having pre-existing mental health issues.

The impact on mental illness

These high rates of relapse are also impacted by the complex relationship between mental illness and methamphetamine use. For example, the risk of experiencing a psychotic episode while using methamphetamine is increased by a pre-existing mental health issue. And some people with pre-existing mental health issues may be using methamphetamine as a coping mechanism to deal with that very mental health issue – and inadvertently making it worse.

This can result in someone simultaneously struggling with a drug dependency and a mental health issue, known as a dual diagnosis.

Around three-quarters of people dependent on methamphetamine also experience mental health issues. Someone with a dual diagnosis can be a complex case for treatment, and current treatment facilities are not designed for people with one. Sadly, this means that sometimes the people who need help the most are the least likely to get it.

Stigma prevents help-seeking

Even when people may want to get help with their dependency, there can be multiple barriers to them accessing treatment.

Stigma is the most common reason someone doesn’t access treatment.8

Concerns about privacy are another common reason that keeps people from asking for help.8 We need to be addressing the stigma, and the fear of exposure, that is often attached to being a person who’s dependent on a drug so that they are more likely to reach out when they’re looking to make a change. And communities – individuals and organisations – have a big role to play in reducing stigma.

What communities can do

It’s important that we keep expanding our understanding of how to help people struggling with or dependent on methamphetamine, including how to reduce the stigma surrounding dependence. But there is more that can be done to prevent people from becoming dependent in the first place.

The Alcohol and Drug Foundation believes that preventing harms before they happen is critical to building a healthier Australia – and communities are central to prevention efforts.

The Australian Government is also supporting prevention. In the National Drug Strategy 2017-2026, one of the priority actions is to “develop new and innovative responses to prevent uptake, delay first use and reduce alcohol, tobacco and other drug problems”.9

This is exactly what our Local Drug Action Team (LDAT) program aims to do. Using the best available evidence about what works and what doesn’t, the ADF supports LDATs to develop innovative responses that are locally tailored and community-driven to prevent the uptake of alcohol and other drugs like methamphetamine.

References
  1. Australian Institute of Health and Welfare 2017. National Drug Strategy Household Survey 2016: detailed findings. Canberra: AIHW.
  2. Degenhardt, L, Larney, S, Chan, G, Dobbins, T, Weier, M, Roxburgh, A, Hall, WD & McKetin, R, 2016, ‘Estimating the number of regular and dependant methamphetamine users in Australia, 2002-2014’ The Medical Journal of Australia, 204 (4), Parch 2016.
  3. McKetin, R., Sutherland, R., Ross, J., Najman, J., Mamun, A., Baker, A., Mattick, R., Rosenfeld, J. 2010. ‘Methamphetamine treatment evaluation study (MATES): Three year outcomes from Sydney site’, NDARC Technical Report No. 312. Sydney: NDARC
  4. Volkow, ND., Koob, GF., McLellan, Thomas A. 2016. ‘Neurobiological Advances from the Brain Disease Model of Addiction.’ New England Journal of Medicine, Vol. 374.
  5. Burkett, JP., Young, LJ. 2012. ‘The behavioral, anatomical and pharmacological parallels between social attachment, love and addiction.’ Psychopharmacology, Vol. 224, pp. 1-26.
  6. Homer, B.D., Solomon, T.M., Moeller, R.W., Mascia A, DeRaleau, L & Halkitis, P.N. (2008). Methamphetamine Abuse and Impairment of Social Functioning: A Review of the Underlying Neurophysiological Causes and Behavioral Implications. Psychological Bulletin, Vol. 134, no. 2, 301-310.
  7. Paulus, M. P., Hozack, N. E., Zauscher, B. E., Frank, L., Brown, G. G.,Braff, D. L., et al. (2002). Behavioral and functional neuroimaging evidence for prefrontal dysfunction in methamphetamine dependent subjects. Neuropsychopharmacology, 26(1), 53–63.
  8. Cumming, C., Troeung, L., Young, JT., Kelty, E., Preen, DB. 2016. ‘Barriers to accessing methamphetamine treatment: A systematic review and meta-analysis’, Drug and Alcohol Dependence, vol. 186, pp. 263-273.
  9. Department of Health. 2017. ‘National Drug Strategy 2017-2026’. Commonwealth of Australia.