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ALICE MILLERBreaking Down the Wall of Silence
What is addiction, really?
It is a sign, a signal, a symptom of distress. It is a language that tells us about a plight that must be understood.
Proposed Ground Rules
• Bring open minds and hearts to this workshop• Refrain from bringing judgments to what
others say• This is an interactive workshop; bring up
issues as you have them• We will all value diversity of perspective
Stimulants
• Class of drug that has historically been used to treat asthma and other respiratory problems, obesity, neurological disorders, and a variety of other ailments.
• Prescribed for the treatment narcolepsy, ADHD, and depression that has not responded to other treatments.
• Stimulants increase alertness, attention, and energy, as well as elevate blood pressure, increase heart rate and respiration, constrict blood vessels, increase blood glucose, and open up the pathways of the respiratory system.
Crystal Meth/Speed
Benefits:• Increased alertness and
energy• Feelings of intense pleasure,
well-being and euphoria• Feelings of competence and
superiority• Self-confidence• Sociability• Heightened sexual arousal• Intense focus
Risks: Insomnia, restlessness Paranoid psychosis Hallucinations Violent & aggressive behavior Weight loss, reduced appetite Increased heart rate Increased blood pressure Fatal overdose is possible, but not
common
Ritalin (Methylphenidate) and Adderall (Amphetamine)
• Ritalin and Adderall are central nervous system (CNS) stimulants.
• Researches speculate that Ritalin and Adderall amplify the release of dopamine thereby improving attention and focus in individuals who have dopamine signals that are weak such as people with ADHD.
• Ritalin 10 mg
• Adderall 10 mg
Ritalin/AdderallBenefits:• Wakefulness• Increased focus/attentiveness• Euphoria • Appetite suppression
Risks:• Increased blood pressure, heart rate• Crashing: extreme fatigue, insomnia,
irritability, and depression• Psychosis• Heart attack, seizure, stroke
Experimentation Acute Addiction
Abstinence
ACUTEPhysical and Psychological
Effects
CHRONICPhysical and Psychological
Effects
What is a “stimulant” overdose?
• Some users call it “overamping” when the effects of a stimulant like cocaine (powder), crack or speed become distressing or dangerous.
• Can be a problem with the body, or it can be psychological, or both.
• Sometimes overamping is considered part of the high for some users, not always negative.
Can it be fatal or harmful?• Yes but more likely for cocaine to cause a
fatality because of heart attack risk.
• Serious medical complications include seizure, stroke, and overheating (hyperthermia).
• Drug-induced psychosis can result in dangerous situations, or feeling suicidal.
Speed Psychosis
• Psychosis symptoms can include paranoia, delusions, hallucinations and obsessions.
• Psychosis can lead to someone becoming a danger to themselves or others.
• Some enter the psych ER voluntarily or involuntarily
0
50
100
150
200
0 60 120 180
Time (min)
% o
f B
asal
DA
Ou
tpu
t
NAc shell
Empty
Box Feeding
Source: Di Chiara et al.
FOOD
100
150
200
DA
Co
nce
ntr
ati
on
(%
Bas
elin
e)
MountsIntromissionsEjaculations
15
0
5
10
Co
pu
latio
n F
req
ue
nc
y
SampleNumber
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17
ScrScrBasFemale 1 Present
ScrFemale 2 Present
Scr
Source: Fiorino and Phillips
SEX
Natural Rewards Elevate Dopamine Levels
Source: Shoblock and Sullivan; Di Chiara and Imperato
Effects of Drugs on Dopamine Release
0
100
200
300
400
Time After Cocaine
% o
f B
as
al
Re
lea
se
DADOPACHVA
AccumbensCOCAINE
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)
ETHANOL
0
100
150
200
250
0 1 2 3 hr
Time After Nicotine
% o
f B
as
al
Re
lea
se
AccumbensCaudate
NICOTINE
Time After Methamphetamine
% B
as
al
Re
lea
se
METHAMPHETAMINE
0 1 2 3hr
1500
1000
500
0
Accumbens
Partial Recovery of Brain Dopamine Transporters in 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.
Effective Approaches• Real harm reduction techniques can work for
some at key stages of use – thought maybe not addiction
• Can be most effective with early users
• Harm reduction = honesty
• Works when the messenger is on the user’s team
Examples of Harm ReductionSome tips from fellow users:
• Breathing or meditation exercises• Physical contact, like massage• Walking, walking, walking—walk it off!• Take a warm shower• Get some fresh air
Some tips from fellow users:
• Drink water/sports drink, eat some food• Try to sleep• Switch how you’re doing your speed or
coke (From shooting -> smoking)• Change your environment or peers• Take a benzo (a small, safe dose of Ativan
or similar sedative)
• First 12 months can be the most difficult
• Relapse potential very high in the first six months
• Different from alcohol, opiates and other drugs – there’s an earlier payoff
Effective Approaches
• Crystal meth users in recovery find great value in relating to other users in recovery – not just anyone with an alcohol or addiction problem;
• Language is distinct
• Unique experiences
• *Are You A Tweeker? (CMA)
Effective Approaches
Experimentation
Acute Addiction 24 months< 12 Months
Abstinence
Harm Reduction
User Experiences
an Event
Experimentation
Acute Addiction 24 months< 12 Months
Abstinence
Harm Reduction
User Experiences
an Event HighRelapse
Potential
Experimentation
Acute Addiction 24 months< 12 Months
Abstinence
Harm Reduction
Support of Like Peers
Critical
User Experiences
an Event HighRelapse
Potential
CRYSTAL METH ANONYMOUSwww.crystalmeth.org
HARM REDUCTION COALITIONwww.harmreductioncoalition.com
GABOR MATÉIn the Realm of the Hungry Ghost
THE MATRIX MODEL OF TREATMENTSteve Shoptaw, Ph.D., Rawson, Ph.D.
TWEAKERwww.tweaker.org
• "ARE YOU A TWEAKER?"
• It doesn't matter what you call it. It doesn't matter how you did it.? It brought us to our knees, because, without exception, that's what it does.
• Is speed a problem in your life? Are you an addict? Only you can answer those questions. For most of us who have admitted defeat, the answer is very clear. Yes, we had a problem with speed, and no, we couldn't fix the problem by ourselves. We had to admit defeat to win. Speed was our master.
• We couldn't control our drug use. What started out as weekend or occasional use became daily use, and we soon found ourselves beyond human aid. We truly suffered from a lack of power to fix our problem.
• Some of used speed as tool to work harder and longer, but we couldn't keep a job. Others picked at their faces and arms for hours and hours or pulled out their hair. Some of us had uncontrollable sexual desire. Others endlessly tinkered with projects, accomplishing nothing, but found ourselves so busy we couldn't get to work on time.
• We deluded ourselves into thinking that staying up for nights on end was OK, that our tweaking was under control, and that we could quit if we wanted to, or that we couldn't afford to quit, or that our using didn't affect our lives.
Maybe we saw a friend go to jail, or lose their apartment, or lose their job, or lose the trust of their family, or die, but our clouded minds wouldn't admit we were next.
Most of us saw no way out, believing that we would use until the day we died.
Almost universally, if we had an honest moment, we found that our drug use made seemingly insurmountable problems in our lives.
The only way out was if we had the courage to admit that speed, our one time friend, was killing us.
It doesn't matter how you got here. The courts sent some of us; others came for family or friends, and some of us came to CMA on our own. The question is if you want help and are willing to go to any lengths to change your life.
Bath Salts • MDPV is a powerful stimulant that
effects the central nervous system and cardiovascular system.
1. physical: rapid heartbeat, increase in blood pressure, vasoconstriction, sweating.
2. mental: euphoria, increases in alertness & awareness, increased wakefulness and arousal, anxiety, agitation, perception of a diminished requirement for food and sleep.
• MDPV is sometimes labeled online as legal cocaine or legal amphetamines.
• Last about 3 to 4 hours, after effects such as rapid heart beat, hypertension, and mild stimulation lasting from 6 to 8 hours.
• High doses can cause intense, prolonged panic attacks in stimulant-intolerant users
• There are anecdotal reports of psychosis from sleep withdrawal
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