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Methamphetamine: The Methamphetamine: The Nature of the National Nature of the National
EpidemicEpidemic
Richard A. Rawson, Ph.DRichard A. Rawson, Ph.DAdjunct Associate ProfessorAdjunct Associate Professor
Semel Institute for Neuroscience and Human BehaviorSemel Institute for Neuroscience and Human BehaviorDavid Geffen School of MedicineDavid Geffen School of Medicine
University of California at Los AngelesUniversity of California at Los Angeleswww.uclaisap.orgwww.uclaisap.org
[email protected]@mednet.ucla.edu
Supported by:Supported by: National Institute on Drug Abuse (NIDA)National Institute on Drug Abuse (NIDA)
Pacific Southwest Technology Transfer CenterPacific Southwest Technology Transfer Center (SAMHSA) (SAMHSA)
MethamphetamineMethamphetamine
Methamphetamine is a powerful central nervous Methamphetamine is a powerful central nervous system stimulant that strongly activates multiple system stimulant that strongly activates multiple systems in the brain. Methamphetamine is systems in the brain. Methamphetamine is closely related chemically to amphetamine, but closely related chemically to amphetamine, but the central nervous system effects of the central nervous system effects of methamphetamine are greatermethamphetamine are greater..
Forms of MethamphetamineForms of Methamphetamine
Methamphetamine Powder
IDU Description: Beige/yellowy/off-white powder
Base / Paste Methamphetamine
IDU Description: ‘Oily’, ‘gunky’, ‘gluggy’ gel, moist, waxy
Crystalline Methamphetamine
IDU Description: White/clear crystals/rocks; ‘crushed glass’ / ‘rock salt’
EPHEDRINE
OH
CC
HHH
3CH 3CH
N
M ETH AM PH ETAM IN E
H
CC
HHH
3CH 3CH
N
MethamphetamineMethamphetamine
The US EpidemicThe US Epidemic
According to surveys and estimates by WHO According to surveys and estimates by WHO and UNODC, methamphetamine is the most and UNODC, methamphetamine is the most widely used illicit drug in the world except for widely used illicit drug in the world except for cannabis.cannabis.
World wide it is estimated there are over 26 World wide it is estimated there are over 26 million regular users of million regular users of amphetamine/methamphetamine, as compared amphetamine/methamphetamine, as compared to approximately 16 million heroin users and 14 to approximately 16 million heroin users and 14 million cocaine usersmillion cocaine users
Scope of the Methamphetamine Scope of the Methamphetamine Problem WorldwideProblem Worldwide
Meth Epidemic; less drama, Meth Epidemic; less drama, more long term risk/dangermore long term risk/danger
Cocaine/Crack epidemic hit fast (in NYC 1986-87, as Cocaine/Crack epidemic hit fast (in NYC 1986-87, as well as other major east coast cities); overnight well as other major east coast cities); overnight emergency, tremendous media attention.emergency, tremendous media attention.
Big federal response (Reagan and Bush I). High visibility Big federal response (Reagan and Bush I). High visibility deaths, stigmatization as a ghetto drug.deaths, stigmatization as a ghetto drug.
Dramatic decreases in indicators by early 1990s, except Dramatic decreases in indicators by early 1990s, except in inner cites of east coast.in inner cites of east coast.
Crack epidemic: Rapid onset; Rapid decreaseCrack epidemic: Rapid onset; Rapid decrease
Meth epidemic: Slow west to east spread. No decrease Meth epidemic: Slow west to east spread. No decrease in western cities. Use becomes endemic?in western cities. Use becomes endemic?
The Methamphetamine Epidemic:The Methamphetamine Epidemic:Admissions/100,000: 1992-2003Admissions/100,000: 1992-2003
0
50
100
150
200
250
300
350
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
California
Hawaii
I owa
Oregon
Washington
It keeps going up
Figure 1. Methamphetamine/Amphetamine Treatment Admission Rate per 100,000 Population Aged 12 or Older:
1992-2002
Source: 2002 SAMHSA Treatment Episode Data Set (TEDS).
Figure 2. Methamphetamine/Amphetamine Treatment Admissions, by Route of Administration: 1992-2002
Source: 2002 SAMHSA Treatment Episode Data Set (TEDS).
The Eastward Spread of The Eastward Spread of MethamphetamineMethamphetamine
Primary Amphetamine/Methamphetamine Primary Amphetamine/Methamphetamine TEDS Admission Rates: 1992TEDS Admission Rates: 1992
(per 100,000 aged 12 and over)(per 100,000 aged 12 and over)
35 - 5812 - 35
< 12No data
> 58
< 12
Primary Amphetamine/Methamphetamine Primary Amphetamine/Methamphetamine TEDS Admission Rates: 1997TEDS Admission Rates: 1997
(per 100,000 aged 12 and over)(per 100,000 aged 12 and over)
35 - 5812 - 35
< 12No
data
> 58
Primary Amphetamine/Methamphetamine Primary Amphetamine/Methamphetamine TEDS Admission Rates: 2003TEDS Admission Rates: 2003
(per 100,000 aged 12 and over)(per 100,000 aged 12 and over)
127+< 5
5 - 5960-126
Incomplete Data
Inter-generational Use & CookingInter-generational Use & Cooking
Anhydrous Ammonia Tank Tips Anhydrous Ammonia Tank Tips Officers to Possible Meth LabOfficers to Possible Meth Lab
5/4/04 Omaha, Neb. – A large
anhydrous ammonia tank
helped Sarpy County
Sheriff’s deputies bust
a suspected
methamphetamine
lab Tuesday.
SOURCE: TheOmahaChannel.com
Methamphetamine: A Growing Menace Methamphetamine: A Growing Menace in Rural Americain Rural America
In 1998, rural areas In 1998, rural areas nationwide reported 949 nationwide reported 949 methamphetamine labs. methamphetamine labs.
Last year, 9,385 were Last year, 9,385 were reported. reported.
This year, 4,589 rural labs This year, 4,589 rural labs had been reported as of had been reported as of July 26.July 26.
Source: El Paso Intelligence Center (EPIC), Source: El Paso Intelligence Center (EPIC), U.S. DEAU.S. DEA
MethamphetamineMethamphetamineAcute Physical EffectsAcute Physical Effects
- - IncreasesIncreases --DecreasesDecreases
Heart rate Heart rate AppetiteAppetite
Blood pressure Blood pressure Sleep Sleep
Pupil size Pupil size Reaction Reaction timetime
RespirationRespiration
Sensory acuitySensory acuity
EnergyEnergy
MethamphetamineMethamphetamineAcute Psychological EffectsAcute Psychological Effects
IncreasesIncreases
– Confidence Confidence – Alertness Alertness – MoodMood– Sex driveSex drive– EnergyEnergy– TalkativenesTalkativenes
ss
DecreasesDecreases – BoredomBoredom– LonelinessLoneliness– TimidityTimidity
MethamphetamineMethamphetamineChronic Physical EffectsChronic Physical Effects
-- Tremor Tremor - Sweating- Sweating- Weakness - Weakness - Burned lips; - Burned lips;
sore nosesore nose- Dry mouth - Dry mouth - Oily - Oily
skin/complexionskin/complexion- Weight loss - Weight loss - Headaches- Headaches- Cough - Cough - Dental Problems- Dental Problems- Sinus infection - Sinus infection - Anorexia- Anorexia
Prenatal Meth ExposurePrenatal Meth Exposure
Preliminary findings on infants exposed Preliminary findings on infants exposed prenatally to methamphetamine (MA) and prenatally to methamphetamine (MA) and nonexposed infants suggest…nonexposed infants suggest…– Prenatal exposure to MA is associated with an Prenatal exposure to MA is associated with an
increase in SGA (small for gestational size).increase in SGA (small for gestational size).– Neurobehavioral deficits at birth were identified in Neurobehavioral deficits at birth were identified in
NNNS (Neonatal Intensive Care Unit Network NNNS (Neonatal Intensive Care Unit Network Neurobehavioral Scale) neurobehavior, including Neurobehavioral Scale) neurobehavior, including dose response relationships and acoustical analysis dose response relationships and acoustical analysis of the infant’s cry. Lester et al 2005of the infant’s cry. Lester et al 2005
Source: The New York Times, June 11, 2005.Source: The New York Times, June 11, 2005.
“METH Mouth”“METH Mouth”
METH Use Leads to Severe Tooth Decay
Meth Use in HawaiiMeth Use in HawaiiAs of the middle of May, not even halfway through the As of the middle of May, not even halfway through the year, the city medical examiner's office already recorded year, the city medical examiner's office already recorded 38 deaths connected to crystal methamphetamine. So, 38 deaths connected to crystal methamphetamine. So, we're well on the way to exceeding last year's total of 68.we're well on the way to exceeding last year's total of 68.
Deaths:Deaths: 2005 (mid-May) - 38 deaths 2005 (mid-May) - 38 deaths 2004 - 68 deaths 2004 - 68 deaths 2003 - 56 deaths 2003 - 56 deaths 2002 - 62 deaths 2002 - 62 deaths 2001 - 54 deaths 2001 - 54 deaths 2000 - 34 deaths2000 - 34 deaths
Trauma in MA UsersTrauma in MA Users
MA + n (%)MA + n (%) Non-MA n (%)Non-MA n (%) pp
IntentionalIntentional 21 (37%)21 (37%) 34 (22%)34 (22%) <.04<.04
AdmittedAdmitted 52 (91%)52 (91%) 108 (70%)108 (70%) .001.001
Mean (SEM)Mean (SEM) Mean (SEM)Mean (SEM)
LOS (days)LOS (days) 2.7 (0.4)2.7 (0.4) 1.7 (0.1)1.7 (0.1) .003.003
ChargesCharges 15,617 (1866)15,617 (1866) 11,600 (648)11,600 (648) .01.01
Tominanga et al., 2004Tominanga et al., 2004
Adolescent Meth Abuse Treatment Adolescent Meth Abuse Treatment AdmissionsAdmissions
Matrix Matrix (Boys)(Boys) (Girls) (Girls)– 2002 2002 16%16% 63%63%– 2003 2003 25%25% 67%67%– 2004 2004 22%22% 69%69%
Phoenix Phoenix (Boys)(Boys)– 2002 2002 25%25% 43%43%– 2003 2003 23%23% 51%51%– 2004 2004 27%27% 53%53%
MethamphetamineMethamphetamineChronic Psychological EffectsChronic Psychological Effects
- - Confusion - IrritabilityConfusion - Irritability
- Concentration - Paranoia- Concentration - Paranoia
- Hallucinations - Panic - Hallucinations - Panic reactionsreactions
- Fatigue - Depression- Fatigue - Depression
- Memory loss - Anger- Memory loss - Anger
- Insomnia - Psychosis- Insomnia - Psychosis
MethamphetamineMethamphetaminePsychiatric ConsequencesPsychiatric Consequences
Paranoid reactionsParanoid reactions
Protracted memory lossProtracted memory loss
Depressive reactionsDepressive reactions
HallucinationsHallucinations
Psychotic reactionsPsychotic reactions
Panic disordersPanic disorders
Rapid addictionRapid addiction
MA Psychosis Inpatients from 4 CountriesMA Psychosis Inpatients from 4 Countries
Psychotic symptomPsychotic symptom LifetimeLifetime CurrentCurrent
Persecutory delusionPersecutory delusion
Auditory hallucinationsAuditory hallucinations
Strange or unusual beliefsStrange or unusual beliefs
Thought readingThought reading
Visual hallucinationsVisual hallucinations
Delusion of referenceDelusion of reference
Thought insertion or made actThought insertion or made act
Negative psychotic symptomsNegative psychotic symptoms
Disorganized speechDisorganized speech
Disorganized or catatonic behaviorDisorganized or catatonic behavior
130 (77.4)130 (77.4)
122 (72.6)122 (72.6)
98 (58.3)98 (58.3)
89 (53.0)89 (53.0)
64 (38.1)64 (38.1)
64 (38.1)64 (38.1)
56 (33.3)56 (33.3)
35 (20.8)35 (20.8)
75 (44.6)75 (44.6)
39 (23.2)39 (23.2)
27 (16.1)27 (16.1)
38 (22.6)38 (22.6)
20 (11.9)20 (11.9)
18 (10.7)18 (10.7)
36 (21.4)36 (21.4)
19 (11.3)19 (11.3)
14 (8.3)14 (8.3)
No. of patients having No. of patients having symptoms (%)symptoms (%)
Srisurapanont et al., 2003Srisurapanont et al., 2003
MA PsychosisMA Psychosis
69 physically healthy, incarcerated Japanese 69 physically healthy, incarcerated Japanese females with hx MA usefemales with hx MA use– 22 (31.8%) no psychosis22 (31.8%) no psychosis– 47 (68.2%) psychosis47 (68.2%) psychosis
19 resolved (mean=276.219 resolved (mean=276.2±222.8 days)±222.8 days)8 persistent (mean=17.6±10.5 months)8 persistent (mean=17.6±10.5 months)20 flashbackers (mean=215.4±208.2 days to initial 20 flashbackers (mean=215.4±208.2 days to initial resolution)resolution)
– 11 single flashback11 single flashback– 9 Recurrent flashbacks9 Recurrent flashbacks Yui et al., 2001Yui et al., 2001
Polymorphism in DAT Gene associated with MA Polymorphism in DAT Gene associated with MA psychosis in Japanesepsychosis in Japanese
Ujike et al., Ujike et al., 20032003
A Major Reason People Take a Drug is they Like
What It Does to Their Brains
A Major Reason People Take a Drug is they Like
What It Does to Their Brains
00
5050
100100
150150
200200
00 6060 120120 180180
Time (min)Time (min)
% o
f B
asal
DA
Ou
tpu
t%
of
Bas
al D
A O
utp
ut
NAc shellNAc shell
EmptyEmpty
BoxBox FeedingFeeding
Source: Di Chiara et al.Source: Di Chiara et al.
FOODFOOD
100100
150150
200200
DA
Co
nce
ntr
ati
on
(%
Bas
elin
e)D
A C
on
cen
tra
tio
n (
% B
asel
ine)
MountsMountsIntromissionsIntromissionsEjaculationsEjaculations
1515
00
55
1010
Co
pu
latio
n F
req
ue
nc
yC
op
ula
tion
Fre
qu
en
cy
SampleNumberSampleNumber
11 22 33 44 55 66 77 88 99 1010 1111 1212 1313 1414 1515 1616 1717
ScrScrScrScrBasBasFemale 1 PresentFemale 1 Present
ScrScrFemale 2 PresentFemale 2 Present
ScrScr
Source: Fiorino and PhillipsSource: Fiorino and Phillips
SEXSEX
Natural Rewards Elevate Dopamine Natural Rewards Elevate Dopamine LevelsLevels
Natural Rewards Elevate Dopamine Natural Rewards Elevate Dopamine LevelsLevels
00
100100
200200
300300
400400
Time After CocaineTime After Cocaine
% o
f B
as
al
Re
lea
se
% o
f B
as
al
Re
lea
se
DADADOPACDOPACHVAHVA
AccumbensAccumbensCOCAINECOCAINE
00
100100
150150
200200
250250
00 11 22 3 hr3 hr
Time After NicotineTime After Nicotine
% o
f B
as
al
Re
lea
se
% o
f B
as
al
Re
lea
se
AccumbensAccumbensCaudateCaudate
NICOTINENICOTINE
Source: Shoblock and Sullivan; Di Chiara and Imperato
Effects of Drugs on Dopamine ReleaseEffects of Drugs on Dopamine Release
100
150
200
250
0 1 2 3 4hrTime After Ethanol
% o
f B
as
al
Re
lea
se
0.250.512.5
Accumbens
0
Dose (g/kg ip)
ETHANOLETHANOL
Time After Methamphetamine
% B
as
al
Re
lea
se
METHAMPHETAMINE
0 1 2 3hr
1500
1000
500
0
Accumbens
Prolonged Drug Use ChangesProlonged Drug Use Changesthe Brain In Fundamentalthe Brain In Fundamentaland Long-Lasting Waysand Long-Lasting Ways
Source: McCann U.D.. et al.,Journal of Neuroscience, 18, pp. 8417-8422, October 15, 1998.
Decreased dopamine transporter Decreased dopamine transporter binding in METH users resembles binding in METH users resembles
that inthat in Parkinson’s Disease patients Parkinson’s Disease patients
%ID/cc
Control Methamphetamine PD
Partial Recovery of Brain Dopamine Transporters in Methamphetamine
(METH)Abuser After Protracted Abstinence
Normal Control METH Abuser(1 month detox)
METH Abuser(24 months detox)
0
3
ml/gm
Source: Volkow, ND et al., Journal of Neuroscience 21, 9414-9418, 2001.
Methamphetamine: Methamphetamine: Neurochemical MechanismsNeurochemical Mechanisms
Methamphetamine enters the brain and is Methamphetamine enters the brain and is removed from the synapse by dopamine removed from the synapse by dopamine transporterstransporters
Methamphetamine: Methamphetamine: Neurochemical MechanismsNeurochemical Mechanisms
Enters dopamine vesiclesEnters dopamine vesicles
Vesicles deplete themselves of dopamineVesicles deplete themselves of dopamine
Methamphetamine: Methamphetamine: Neurochemical MechanismsNeurochemical Mechanisms
Free-floating DA produces “free radicals” Free-floating DA produces “free radicals” (neurotoxins), so it is forced out of the (neurotoxins), so it is forced out of the neuron.neuron.
The synapse is flooded with dopamine, The synapse is flooded with dopamine, producing a profound sense of pleasure.producing a profound sense of pleasure.
Their Brains
have been
Re-Wired by Drug Use
Their Brains
have been
Re-Wired by Drug Use
Because…Because…
Control > MA
4
3
2
0
1
MA > Control
5
4
2
0
1
3
Brain Serotonin Transporter Density and Brain Serotonin Transporter Density and Aggression in Abstinent Aggression in Abstinent
Methamphetamine AbusersMethamphetamine Abusers**
**
Sekine, Y, Ouchi, Y, Takei, N, et al. Brain Serotonin Transporter Sekine, Y, Ouchi, Y, Takei, N, et al. Brain Serotonin Transporter Density and Aggression in Abstinent Methamphetamine Abusers. Density and Aggression in Abstinent Methamphetamine Abusers.
Arch Gen Psychiatry.Arch Gen Psychiatry. 2006;63:90-100. 2006;63:90-100.
Objective of StudyObjective of Study
Investigate the status of brain serotonin Investigate the status of brain serotonin neurons and their possible relationship neurons and their possible relationship with clinical characteristics in currently with clinical characteristics in currently abstinent methamphetamine abusers.abstinent methamphetamine abusers.
Results Results 1.1. Serotonin transporter density in global brain Serotonin transporter density in global brain
regions was significantly lower in regions was significantly lower in methamphetamine abusersmethamphetamine abusers
• Suggests that abuse of methamphetamine leads Suggests that abuse of methamphetamine leads to a global and severe reduction in the density of to a global and severe reduction in the density of human brain serotonin transportershuman brain serotonin transporters
2.2. Values of serotonin transporter density in Values of serotonin transporter density in widely distributed brain regions were found widely distributed brain regions were found to negatively correlate with the duration of to negatively correlate with the duration of methamphetamine use.methamphetamine use.
• Suggests that the longer methamphetamine is Suggests that the longer methamphetamine is used, the more severe the decrease in serotonin used, the more severe the decrease in serotonin transporter density.transporter density.
Results (Continued)Results (Continued)
3.3. Magnitude of aggression in methamphetamine abusers Magnitude of aggression in methamphetamine abusers increased significantly with decreasing serotonin increased significantly with decreasing serotonin transporter densities in some brain regions.transporter densities in some brain regions.
• Bitofrontal cortex, anterior cingulate, temporal cortexBitofrontal cortex, anterior cingulate, temporal cortex
4.4. No correlation between a representative measure of No correlation between a representative measure of serotonin transporter density and the duration of serotonin transporter density and the duration of methamphetamine abstinence. Individuals abstinent methamphetamine abstinence. Individuals abstinent for > 1 year still had a substantial decrease in for > 1 year still had a substantial decrease in serotonin transporter density.serotonin transporter density.
• Suggests reductions in the density of the serotonin transporter Suggests reductions in the density of the serotonin transporter in the brain could persist long after methamphetamine use in the brain could persist long after methamphetamine use ceases.ceases.
Treatment OptionsTreatment Options
MA Treatment IssuesMA Treatment Issues
Acute MA OverdoseAcute MA Overdose
Acute MA PsychosisAcute MA Psychosis
MA “Withdrawal”MA “Withdrawal”
Initiating MA AbstinenceInitiating MA Abstinence
MA Relapse PreventionMA Relapse Prevention
Protracted Cognitive Impairment Protracted Cognitive Impairment and Symptoms of Paranoiaand Symptoms of Paranoia
MA “Withdrawal”MA “Withdrawal”
- - DepressionDepression - Paranoia- Paranoia
- Fatigue- Fatigue - Cognitive - Cognitive ImpairmentImpairment
- Anxiety- Anxiety - Agitation- Agitation
- Anergia- Anergia - Confusion- Confusion
Duration: 2 Days - 2 WeeksDuration: 2 Days - 2 Weeks
Meth Treatment Effectiveness?Meth Treatment Effectiveness?
A pervasive rumor has surfaced in many A pervasive rumor has surfaced in many geographic areas with elevated MA geographic areas with elevated MA problems:problems:
MA users are virtually untreatable with negligible MA users are virtually untreatable with negligible recovery rates.recovery rates.
Rates from 5% to less than 1% have been quoted in Rates from 5% to less than 1% have been quoted in newspaper articles and reported in conferences.newspaper articles and reported in conferences.
Meth Treatment StatisticsMeth Treatment Statistics
During the 2002-2003 fiscal year:During the 2002-2003 fiscal year:
35,947 individuals were admitted to 35,947 individuals were admitted to treatment in California under the Substance treatment in California under the Substance Abuse and Crime Prevention Act funding.Abuse and Crime Prevention Act funding.
Of this group, 53% reported MA as their Of this group, 53% reported MA as their primary drug problemprimary drug problem
StatisticsStatisticsA A comparison of treatment outcomes between comparison of treatment outcomes between
individuals diagnosed with methamphetamine individuals diagnosed with methamphetamine dependence and all other diagnostic groups indicated dependence and all other diagnostic groups indicated no between group significant differences in any no between group significant differences in any treatment outcome measures including:treatment outcome measures including:Retention in treatment ratesRetention in treatment ratesUrinalysis data during treatmentUrinalysis data during treatmentRates of treatment program completion.Rates of treatment program completion.
All these measures indicate that MA users respond in an All these measures indicate that MA users respond in an equivalentequivalent manner as individuals admitted for other manner as individuals admitted for other drug abuse problems.drug abuse problems.
Comparability of Treatment Outcome: Cocaine vs Comparability of Treatment Outcome: Cocaine vs MethamphetamineMethamphetamine
Huber, Ling and Rawson (Jnl of Addictive Huber, Ling and Rawson (Jnl of Addictive Diseases, 1997).Diseases, 1997).
Cohorts of methamphetamine dependent Cohorts of methamphetamine dependent patients (N=500) and cocaine dependent patients (N=500) and cocaine dependent patients (N=224) treated with a standardized, patients (N=224) treated with a standardized, outpatient treatment protocol (Matrix Model) at outpatient treatment protocol (Matrix Model) at the same clinic site, by the same staff over the the same clinic site, by the same staff over the same time period, demonstrated very similar same time period, demonstrated very similar treatment response on virtually all treatment treatment response on virtually all treatment participation and outcome measures participation and outcome measures
MA Users(n = 500)
Cocaine Users(n = 224)
Early Recovery Group+ 3.4(4.4) 3.7(3.3)
Relapse Prevention Group+ 23.7(29.0) 21.0(26.8)
Family Education Group+ 11.6(14.0) 12.2(12.8)
Social Support Group+ 4.4(14.9) 4.3(18.2)
Total of Treatment Hours Received+
52.9(51.4)
54.5(49.3)
Weeks in Treatment+ 17.1(22.3) 18.0(21.3)
Urine Sample Collected+ 8.3(8.0) 8.1(7.6)
Percentage of Samples Positive for Primary Drug++
19.3%
13.3%
Table 3. Treatment Experience to Methamphetamine and Cocaine Users
{Treatment Received in Number of Hours}
+ Numbers presented are means and (standard deviations)++ Numbers presented are percentages
Treatments for Stimulant-use Disorders with Treatments for Stimulant-use Disorders with Empirical SupportEmpirical Support
Cognitive-Behavioral Therapy (CBT)Cognitive-Behavioral Therapy (CBT)Community Reinforcement Approach Community Reinforcement Approach Contingency ManagementContingency Management12 Step Facilitation12 Step Facilitation
All have demonstrated efficacy for the All have demonstrated efficacy for the treatment of cocaine dependencetreatment of cocaine dependence
Methamphetamine Treatment: Controlled Methamphetamine Treatment: Controlled Clinical TrialsClinical Trials
– Brief Cognitive Behavioral Therapy Brief Cognitive Behavioral Therapy – Extended Cognitive Behavioral TherapyExtended Cognitive Behavioral Therapy– Contingency ManagementContingency Management– Matrix ModelMatrix Model
SummarySummary
Methamphetamine is a significant public Methamphetamine is a significant public health problem in the US and in the worldhealth problem in the US and in the worldIt produces significant damage to the body It produces significant damage to the body and the brainand the brainRecovery from methamphetamine Recovery from methamphetamine dependence is possible and most brain dependence is possible and most brain changes are reversible.changes are reversible.There are effective treatments for There are effective treatments for methamphetamine dependence.methamphetamine dependence.