SPECIALICE EDITION

volume 11edition 5

Practical harmreduction measures: page 6

Footy star’sgreatest comeback: page 8

We can all relateto the effects of meth: page 4

Our appetitefor stimulants Forthcoming analysis by theAustralian Bureau of StatisticsMacro-Economic Research Sectionestimates the value of the 2010amphetamines market was around$1.7 billion. Of that, $1.3 billionwas profit. This dwarves theprofitability of heroin and cocainemarkets combined, and will be evenmore now that methamphetamineis making a resurgence inpopularity.

Human beings love stimulants. Tea and coffeeare essential pick-me-ups across manydifferent cultures. The boom in caffeine-basedenergy soft drinks is comparatively recent, butwas preceded by the massive popularity of thegranddaddy of them all, Coca-Cola, infamousfor also including coca leaves in the originalformulation.

The global consumption of caffeine iscurrently estimated to be 8,520,000 tonnesa year, and is growing steadily as more of theworld’s population move out of poverty andtoward middle-income status [7].

Unsurprisingly, illicit stimulants are also inhigh demand. The most recent estimates oftheir use indicate that more are used eachyear than heroin and cocaine combined.According to the United Nations Office onDrugs and Crime (UNODC), amphetamine-type stimulants are the second-most popularillicit drugs worldwide after cannabis [8].

Amphetamines are a more recent discoverythan tea or coffee, and they serve muchthe same purpose - to heighten energyand alertness. Amphetamine was firstsynthesised in 1887 in Germany, but itsinitial pharmacological use, in the 1930s,was in an inhaler sold as a decongestantunder the trade name Benzedrine [9].Some baby boomers have strong childhoodmemories of the exhilarating effects gained

from using the inhalers and of the yearningthey had for more.

A stronger variant on amphetamine ismethamphetamine, which was firstsynthesised in Japan in 1920 and wasmade available in pill form in 1938.Methamphetamine pills were handedout by military doctors on all sides duringWorld War II [10], with the Wehrmacht (theunified forces of Germany between 1935 and1945) alone consuming more than 200 million[11]. British troops used 72 millionamphetamine tablets during the war [11].

Underground markets for amphetamineshave existed in Australia for decades, withmotorcycle gangs favouring them forextended partying and truck drivers usingthem to stay awake while covering longdistances.

Wide cross sectionBurnet Institute PhD researcher BrendanQuinn has surveyed more than 250methamphetamine users and said one ofthe most significant points that emergesis that there is a wide cross-section ofpeople using it for functional, practicaland apparently rational purposes.

His study included “female office workerswho would use it one or two times a weekto lose weight. They didn’t use it to go out,or in another social context. It was primarilyto decrease their appetite and shed a fewkilos,” Mr Quinn said.

“I’d speak to people who’d use it for sexon the weekends, or to clean their house,for performing in their band, or for their latenight study.

“I think one of the reasons, a potential reason,is the decreasing stigma associated with it.I would hypothesise that some years agothere was probably a lot more stigmaassociated with it than there is now.

“The number of drugs that are available topeople are increasing every day, and I thinkthat contributes to people being a little bitmore comfortable about it,” he said.

Meth production techniques are rapidlychanging alongside social attitudestowards it. Before the 1990s, the mainillicit stimulants were amphetamine sulphateand amphetamine hydrochloride [3]. Thesewere sold as “speed”, “go-ey” or “louie”(“Lou Reed” is rhyming slang for speed), andcame as a powder, either white or off-white.The quality of street speed was frequently low,since the powder form made adulterating or“cutting” the drug easy. It was often snorted,mixed into drinks or injected.

Since the late 1990s, methamphetamine,the most potent of the amphetamine-typestimulants (ATS), began showing up onAustralian street drug markets. Its appearanceis often variable, sometimes having a glassyor crystalline nature, hence its common streetnames of “crystal”, “crystal meth” or “ice”.

Ice is less easily adulterated because ofits crystalline nature and its purity isusually much higher. Nevertheless,methylsulphonylmethane (or MSM), asupplement used for arthritic complaints,is increasingly employed as a cutting agentfor crystal methamphetamine as it allowsthe drug to keep its crystalline form.

Methamphetamine is also found as a high-purity base (an oily powder or paste that canbe injected) and as less potent powder ortablets, which are usually swallowed (thoughmay be snorted or injected) [12, 13].

Imports of crystal meth first started comingto the attention of Australian customs andfederal police in around 2001. In the late 1990s,Australian illicit drug markets were floodedwith heroin, but 2001 saw a sudden drought.At this time high-grade crystal meth firstappeared in street drug markets.

United Nations Office on Drugs and Crimereported last year that east and southeastAsia have the most developed ATS markets inthe world. UNODC chief Yuri Fedotov said ATSmanufacturing was now shifting to new marketsand trafficking routes were diversifying intonew areas that had previously been unaffected.

Clandestine labsThe shift is reflected in the Australianseizures of clandestine labs producingstimulants. In 2010-11, Australian policeuncovered 556 such labs producingstimulants, primarily methamphetamine,whereas a decade earlier, in 2001-2, thetotal was 252 [14].

The Global Drug Survey, which independentlymaps the drug use patterns of 45,000 usersaround the world, showed that crystal methwas an Australian and American phenomenon

among western nations. Survey founder DrAdam Winstock told the Bulletin that cocaineand ecstasy were the more commonstimulants in Europe.

“Meth still has not made the breakthroughin Europe and the UK. It is almost exclusivelywithin the gay dance and drug scene, alongwith GHB,” Dr Winstock said.

“We have coke and crack. A coke high doesn’tlast very long, crack doesn’t last very long -10 minutes and it’s all done. But with methit goes on for days.”

Continued on page two.

In February 2013 a whopping 585 kilogramsof quality imported methamphetamine was seizedin a joint customs and police operation in Sydney.

Then in April more than 365 kilos of liquidmethamphetamine was seized. It is clear that market for

methamphetamine appears to be in another growth phase.

2

Anex’s vision is for a society in which allindividuals and communities enjoy goodhealth and wellbeing, free from drug-related harm. A community-based, not-for-profit organisation, Anex promotesand supports Needle and SyringePrograms (NSPs) and the evidence-basedapproach of harm reduction. We strivefor a supported and effectively resourcedNSP sector that is perceived as beingpart of the solution to drug-relatedissues.

Chief EditorJohn Ryan

EditorDr Patrick Griffiths

WritersRoyal AbbottNicola CowlingKelly EngDr Patrick Griffiths

CorrespondenceAnex Bulletin95 Drummond Street,Carlton VIC 3053Australia

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The content of the Bulletin is intendedto stimulate discussion and informationsharing and does not necessarily representthe views of Anex. It does not encourageanyone to break the law or use illicit drugs.While not intending to censor or changetheir meaning, Anex reserves the right toedit articles for length, grammar and clarity.Anex takes no responsibility for any loss ordamage that may result from any actionstaken based on materials within the Bulletinand does not indemnify readers against anyloss or damage incurred. This publicationhas a targeted readership and is notintended for general distribution.

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Citations for the edition are availableonline athttp://www.anex.org.au/publications/anex-bulletin

ISSN: 1447 - 7483May 2013

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New breakthrough hepatitis drug on PBSTwo new treatments for chronic hepatitis C genotype 1 have beenavailable on the Pharmaceutical Benefits Scheme (PBS) since Aprilin a move that is expected to prevent liver cancer in thousands ofAustralians over the next five years.

Health Minister Tanya Plibersek said in announcing the listings thatabout 9000 cases of liver damage would be prevented over five yearsfollowing the PBS listing of boceprevir (Victrelis®) and telaprevir(Incivo®) for people with hepatitis C genotype 1.

“That in turn translates into 2400 fewer cases of liver cancer,”Minister Plibersek said.

“We hope to reduce the need for liver transplants by almost 870people over the next few years.”

Boceprevir is pronounced ‘bosep-revere’, while telaprevir ispronounced ‘tell-app-revere’.

Hepatitis NSW Chief Executive Officer Mr Stuart Loveday said:“NSP workers are ideally placed to engage with clients who havehep C, or might have hep C, and talk about treatment options thatare available.”

Chair of the Australian Liver Association and head of the livertransplant unit at Royal Prince Alfred Hospital in Sydney, ProfessorGeoff McCaughan, told the Bulletin that genotype 1 representsapproximately 55 per cent of people with hepatitis C in Australia.

For further information about the new drugs telephone the NationalHepatitis Information Line on 1300 437 222 (1300 HEPABC).

Drug treatment more effective forIndigenous offenders than prisonIndigenous adults are 14 times more likely to be incarcerated thannon-Indigenous people, and research findings indicate that up to$111,000 could be saved for every non-violent Indigenous offenderplaced into treatment rather than sent to prison [1]. In the long term,a further $92,000 could be saved per offender due to better healthoutcomes and improved quality of life from treating drugand alcohol issues. As well as financial savings, diversion is alsoassociated with improvements in health and mortality, the recentlyreleased research by the National Indigenous Drug and AlcoholCommittee (NIDAC) found.

“Bridges and Barriers: addressing Indigenous incarceration andhealth” compared the cost benefits of residential drug and alcoholtreatment with incarceration for Indigenous people convicted ofnon-violent crimes. It examined prison health risks, Indigenoussubstance use and incarceration trends, recidivism and interventionopportunities.

NIDAC Chair, Associate Professor Ted Wilkes said: “Diverting peopleaway from prisons leads to better health outcomes, but thatdiversion makes good economic sense as well.”

Deputy Co Chair of NIDAC Mr Scott Wilson said: “The long-termimpact of a criminal record on employment opportunities can alsooften have lifelong consequences.

“Of all Indigenous prison entrants, those aged 18-24 years old weremost likely to have used illicit drugs – some 76 per cent of that agerange. Do governments really believe that prison is the best answerto these problems?”

Sentinel tracking picks up iceincrease amongst injectors

Australia’s national drug reporting systemlast year showed increases in the use of ice

among injecting drug users in all statesexcept for the Northern Territory and

Queensland. According to 2012 data fromthe Illicit Drug Reporting System,68 per cent of injecting drug users

surveyed in NSW reported recent use(up from 53 per cent in 2011).

In the ACT, 66 per cent reported recent use;in Victoria, 59 per cent; in WA, 64 per cent

(up from 46 per cent in 2011);in South Australia, 56 per cent and

Tasmania 43 per cent.

Use of ice in Queensland however fellto 44 per cent of injecting drug users

from 50 per cent in 2011 [15].

Our appetite for stimulantsContinued from page one.

Dr Winstock said even crack use has lesspotential for severe harm than crystalmeth.

“With crystal meth, the physical andmental harms and amount of psychosisis much greater. In terms or rankings forstimulants, crystal is king in terms ofharms.”

Former ice user Tanya (not her real name)said she had moved across several statesduring her using period and foundcrystal methamphetamine wherevershe went.

“I recently did a talk at a local meetingand shared my story with over 200people. There are problems with methin every town - it’s everywhere, but ourcommunity is just starting to realiseit and wanting to get the support offamilies around these addictsand minimise harm.”

Meanwhile, there is agreement amongsenior clinicians that ATS use is here tostay.

“It’s obviously well and truly established- it’s not a flash in the pan,” saidBronwyn Crosby, Deputy Director of StVincent’s stimulant treatment programin Sydney.

“There’s been discussion around whetherwe’re having epidemics or we’re nothaving an epidemic or it’s just slow,steady use. I think we’re down to thebelief now that whatever majorexcitement there was about the numberof people using a lot ofmethamphetamine, we understand thereis a larger population who use less thanthose people, but fairly consistently, andthere is a market out there fortreatment.”

3

Treatment foramphetamine users

Methamphetamine or speed users whoseek help can be agitated, confused and burntout from prolonged lack of sleep. They willprobably also be desperate for a solution.

Initially the most useful intervention fora person at the end of a binge is to sleep -lack of sleep has a significant impact onthe physical and psychological wellbeing ofmethamphetamine users. Similarly, poornutrition and hydration have a significantimpact and people will need to get somedecent food into them when they can. Afterthe initial crash and extended sleep, mostof the physical symptoms of withdrawal(sweating, cramps, aches and pains) will passin a few days. Cravings, however, and someof the longer-term psychological symptomsoften become apparent after the individualhas completed their six- or seven-day detox.

This is perhaps why clinicians suggest thepath from detoxification to further treatmentis a difficult one.

Residential detoxLynda Bristow, the intake nurse at UnitingCare ReGen’s residential withdrawal unit inMelbourne, told the Bulletin that people withamphetamine-type stimulant (ATS) problemsoften left residential rehabilitationimmediately after a long sleep.

“We find that the person crashes [afterarriving], but they leave after resting andthey will still be agitated and leave eitherbecause they are experiencing cravingsand want to go and score drugs or becausewe are expecting them to join in a program.”

Bronwyn Crosby, the deputy director of StVincent’s stimulant treatment program inSydney, agreed that clients usually wantedto leave immediately after detoxification.

“They come in, they crash, they sleep, theyeat hugely and they go out after four or fivedays feeling much better, much calmer. Whilethey’re with us they often get invited to cometo our stimulant program.”

She told the Bulletin that while some didreturn for counselling, she and her colleagueswere fine about those who didn’t.

“Many aren’t at that stage of their life yet, butthey know they can come and do the detoxagain. People appreciate that we are patient.”

Researcher Brendan Quinn whose work witha cohort of more than 250 methamphetamineusers said in his experience, GeneralPractitioners were the most common formof professional health assistance accessed.

Brendan has reported that “GPs are alsolikely to be a common starting point whenmethamphetamine users are seeking referralto drug treatment services.” [20]. Accessingone-on-one counsellors was not uncommon,

but “only small numbers of participantsreported access of more intensive drugtreatment services.”

At ReGen in Melbourne, the difficulty inkeeping ATS patients in one place meantmethamphetamine treatment at theirresidential withdrawal unit was beingcontinually refined.

“We’ve changed the residential withdrawalprogram so that for the first two days theycan sleep. On the third day it is at thediscretion of the nurse as to whetherthey are required to participate in groups,”Ms Bristow said.

Outpatient care Ms Crosby said the agitation characteristicof stimulant use dictated that the St Vincent’sATS program had to allow clients to work theirway into any treatment gradually. She said theslowly-slowly approach had paid dividends inSydney.

“If people who were still using stimulants werecoming in, then we needed to be aware theirattention span was much shorter. They wereoften very agitated, often very paranoid andwe couldn’t deal with (ATS) patients in thesame way as opiate patients, who were oftenagitated but were, in essence, a lot calmer.

“We had to be flexible, and people reallyappreciated that we were patient, that wecould get their story down and then workout a program with them - a care plan basedon what they were looking to achieve.

“The treatment process is different becauseof the nature of the drug - the cyclical nature,the bingeing style that was very common.People have been quite pleasantly surprisedthat they could extend the period betweenbinges and then cut the length of the binge.So we developed program goals they werelooking for, and it’s been successful.”

Ms Crosby said they always had a smallwaiting list, and although client numbersvaried considerably, they would definitelybenefit from more staff.

Substitution therapySt Vincent’s offers a substitution program,Ms Crosby told the Bulletin.

“We do dexamphetamine substitution formeth use for a very small number [of patients].But the numbers are very small and peoplehave to work through with a stepped careapproach. Many people come because theywant substitution therapy, but find they don’tneed it. It’s explained very clearly that there’sa lot of work to be done in counselling termsbefore they’ll be considered for substitution,and most are very pleasantly surprised tohave achieved their goals without needingthe drug.”

Along with Professor Steve Allsop, AssociateProfessor Nicole Lee recently co-authored acomprehensive collection of papers onATS [21]. Dr Lee is also co-authoring aforthcoming review of the global literatureon pharmacotherapy and methamphetamines,commissioned by the Australian NationalCouncil on Drugs.

Pharmacotherapy prospectsThe Anex Bulletin spoke with Dr Leeand asked if there was any prospectof a pharmacotherapy response tomethamphetamine that could be regardedas potentially as effective as methadoneis with opiate dependency.

It is years before any such medicine wouldbe available, if at all.

“If we are looking at pharmacotherapy thatfills a similar role to methadone for opiates -a pharmacotherapy that is considered bestpractice treatment - my guess is that it is stillat least 5 to 10 years away,” Dr Lee said.

“Amphetamines have very complex actions onthe brain so treatment with pharmacotherapybecomes much more complicated than forother drugs like opiates or alcohol, so findinga medication that can address all of theactions on the brain has so far been elusive.

“It's a bit like a car, it has so many parts, if itneeds a service and you only change the spark

plugs, it may still run rough because the otherparts of the engine that have been affectedfrom driving it haven't been fixed.”

Dr Lee said there are some new drugs andvaccines under development, but they needto go through years of testing before theywill be ready for release, and none of themare yet up to the stage where theireffectiveness in treatment is beingexamined.

“There’s no pharmacotherapy that is suitablefor widespread prescription at this stage.The studies available have shown fairlyinconsistent results. There are four or fivepotential medications that seem to havesome benefit for some people and may beOK to prescribe in limited circumstances,but more research is needed,” she said.

“There are a few drugs that researchershave found to be potentially harmful andso should be avoided with meth users. Theantidepressant sertraline has shown worseoutcomes than a placebo, including increaseduse of meth, and one trial of the antipsychoticaripiprazole had to be abandoned because ofadverse side effects. There has also been someconcern over the anti-epileptic drug vigabatrinthat has been shown in other studies to causevisual field defects,” she said.

Overview of the rangeof treatment options

under the National Drug StrategyApproaches to methamphetamine users should be individually tailored and matcheach client’s goals for treatment.

Cognitive Behavioural Therapy (CBT) has been evaluated most extensively andis effective for a range of problems related to methamphetamine use, includingmental health problems such as depression and anxiety. Medicare pays for up to10 sessions of counselling by a registered psychologist if a general practitionerrefers clients. It is important to note however that, given that impaired motivationand impaired cognition is a common feature of methamphetamine withdrawal,such counselling may be difficult for some individuals to engage in. This is a goodargument for pharmacotherapy as it may increase the potential for engagementin treatment.

Other approaches include: brief interventions; counselling (eg narrative therapy,solution-focused therapy); residential rehabilitation; self-help groups; andbehavioural therapy.

Assessments should be offered in the context of a safe, reassuring, supportive,non-judgmental environment to enhance a client’s engagement with the service.In the early stages, this may be more important than the specific drug treatment.

No medications have yet proven to be more effective than others in treatment(eg for withdrawal or to prevent relapse). However, research is continuing intoseveral medications including dexamphetamine and Modafinil. Following aspecialist assessment, the appropriate prescription of medications to treatmental health and medical problems is strongly recommended.

Source: http://www.nationaldrugstrategy.gov.au/internet/drugstrategy/publishing

54

Crystal meth has the reputation of being a demon drug thatsweeps aside rationality in a frenzy of paranoid delusion.We spoke to people who had used meth and other stimulantsfor varying periods about their experiences.

GeorgeWhen I first injected crystal meth, it exploded inside me like that film of the space shuttleChallenger blowing up. It started an itch in my brain that had to be scratched over and over,searching for that first rush. That first binge drove me psychotic. I almost bashed to deatha mate for no better reason other than that he was irritating me.

Crystal took over my life. I stopped going to work because I was just too busy shooting upcrystal. Considering the consequences was totally irrelevant while crystal was available.Days and weeks blurred and I can remember hallucinations, ghost people walking besideme as I crisscrossed the city day and night. But my main impulse was: “Let’s have anothertaste of that crystal.”

The turning point came when I near killed my drug-buddy Len. Lenny had promised tocall with more crystal. Except when he arrived he had nothing while I was hanging outand coming down and counting on him.

He shared a house with an old-school Hells Angel, a founding member of the firstclub outside the US to be chartered by the Oakland Angels, so a legend. Anyway Lenfancied himself as a prospect for gang membership. He was a dreamer - he didn’teven have a bike.

We’d both been drinking heavily for a while and he’d been going on about the Angelsand how tough he was to be hanging out with them. I’d had enough with his tough-guyrubbish so I attacked him. I knocked him around the flat, chased him out to the back yardand kept battering him. He kept getting up but was not good at defending himself. Thehouse was perched over a cliff that fell down to a roadway below. I saw the cliff andforced him towards it, then pushed him off the edge and went back inside.

The next day Len came by and his face was a mess; both eyes blackened and swollen.In fact his whole face was lopsided and hardly recognisable. He said he forgave mebecause he’d found Jesus and I’d taught him a lesson about taking drugs and drinkingand he was going straight.

He was such a frightening sight, I swore never to take meth ever again. I never sawLen again either.

Tanya I used for nine years, from when I was 14 till I was 23. During that time I moved around a bit,ending up in Sydney. By then I’d become a dependent user, snorting it up my nose andbombing (mixing it with drinks). I’d go for periods of eight, nine days awake and you easilyslip into psychosis in those situations. I ended up living with a prostitute, not aware I wasthe prey for being pimped out. Using drugs determined my whole social circle. I maintainedno ties with regular community members and only hung out with dealers and bikies. Theonly reason I didn’t use intravenously was that when I was 17 I had a boyfriend and hisfather and partner both had hepatitis C. I told myself I couldn’t go there. I had to drawa line somewhere because I knew what sort of an addict I was.

What prompted me to stop was I was living in Townsville and my drug dealer was mybest friend. I needed the relationship to be like that because I couldn’t afford to pay formy habit. He had a psychotic outburst and guns were involved and the police were called.Because of the run-ins with the law, I think the police knew to a certain degree that I wascapable of better.

I was working at the time and the police actually sent me to stay with my bosses.My bosses knew I had a using problem and loved me as staff and treated me really kindly.They were so protective of me because they could see I was mixed up; it wasn’t who I was,I was just mixed up. Two weeks later, I ended up on a bus back to the Gold Coast to myparents. That was the end of my methamphetamine using.

Continued on page seven.

Users’ stories

Transmitters andreceptors jumbled

Methamphetamine can have a significantimpact on mental health, both in intoxicationand withdrawal. There are a number ofcontributing factors in regard to toxicity andmethamphetamine-induced psychosis, mostnotably sleep deprivation and the increasedavailability of the monoamineneurotransmitters, particularly dopamine,as well as noradrenalin and serotonin.

Methamphetamine increases the availabilityof these “feel-good” neurotransmitters.

Methamphetamine can increaseneurotransmitter availability by inhibitingthe enzymes that would normally break themdown, and by causing the neurotransmittertransporters in the brain to act in reversedirection. This brings the neurotransmittersto the receptors, rather than away from them,

further increasing the messages sent. It ispicking the dopamine up and taking it toreceptors, rather than away from receptorswhich is their normal function.

When dopamine is available in excess levels,its different functions are disturbed andgenerally amplified. Given that dopamineplays an important role in determiningmood, behaviour, cognition and motivation,the initial stages of methamphetamineintoxication can be linked with feelingsof great energy, enthusiasm and euphoria.

Similarly, serotonin is thought to help regulatemood, and so greater availability is associatedwith feelings of wellbeing, contentment andhappiness. It is also involved in how weinterpret our environment. Noradrenalin isthe neurotransmitter we most commonlyassociate with the “fight or flight” response.

So high noradrenalin levels are associatedwith symptoms seen in stress responseincluding increased breathing, increasedheart rate and high blood pressure. Whenthe methamphetamine use continues and/orincreases, the neurotransmitter levels rise toproblematic levels causing the individual tobecome hypersensitive to their surroundings.Feelings of euphoria and confidence can leadto feelings of omnipotence and grandiosity.Feelings of acute awareness and sensitivitycan escalate to suspicion or paranoia and

hallucinations or delusions. The risk of suchsymptoms is increased by sleep deprivation.

In withdrawal, the immediate effects arelargely caused by depletion in the availabilityof these dopamine, serotonin andnoradrenalin. The body’s immediate storeshave been used up during intoxication, andthe individual now experiences a deficiencyof these neurotransmitters.

It can take several hours or days for stores ofthese to replenish, and consequently, for theindividual to return to their normal baseline -in other words, to feel as they did before theywere intoxicated. This withdrawal period canextend to weeks or months however,especially after long term and/or heavy use.This is because the body will have madechanges to cope with the excess of theneurotransmitters, such as reducing accessto the receptors to which theneurotransmitters attach. This means thatalthough the stores of the neurotransmittersmay be replenished, they are only able tosend through a reduced number of messagesat a time. In the case of reduced dopaminemessages, this can result in symptoms suchas poor motivation, poor concentration anddepression. These are all symptoms that makeit difficult for people to engage in treatmentservices or address their problematic drug use.

- By Anex Methamphetamine Trainer,NICOLA COWLING.

Meth labs gettingmore portable

The illicit production of methamphetaminehas increased dramatically in the last15 years, according to the Australian CrimeCommission, with a five-fold increase inthe number of clandestine labs detectedsince 1996. In 2010-11, a record 556methamphetamine labs were discovered inAustralia, with most found in residential areas[2]. It is estimated that 90 per cent ofAustralia’s illicit amphetamine-typestimulants (ATS) are now manufacturedlocally, with just 10 per cent imported [3].

Cooks do not need advanced knowledgeof chemistry to be able to manufacturemethamphetamine.

Unlike cannabis, the production turnaroundis quick and only a limited space is required:the contents of a small lab can fit into a carboot and be reassembled quickly in placessuch as motel rooms, garages and storagesheds. Bigger operations have been run inplaces such as abandoned warehouses [4-6].

Additionally, the internet offers a wealthof recipes and instructions formethamphetamine production.

A simple method of production, known as“shake and bake” (or “one-pot” in the US),is gaining momentum in Australia. Thisrequires a piece of tubing and one or twoplastic bottles (such as those containing softdrinks) and household chemicals similar tothose used in larger-scale methamphetamineproduction. In the US, the process of ‘shakeand bake’ has been described by hospital

burns surgeons (who seek to understandwhy people are burnt in particular ways)as: Meth ‘cooks’’ are able to make multiplepurchases below the legal limit of precursorsupplies containing pseudoephedrine atdifferent stores, making detection by lawenforcement more difficult. Using containersas small as a two-litre soda bottle, the ‘cooks’will add each ingredient as they drive fromone store to another, obtaining different itemsat each stop. The actual meth productioncreates a ‘rolling’ process caused by thechemical reaction of combining lithiumwith water [5].

Despite restrictions on its availabilitythrough pharmacies, pseudoephedrinecontinues to be used. Other householdproducts such as drain cleaner, iodine,paint thinner and lithium batteries containmost of the necessary chemicals to completethe manufacturing process. The limitedequipment necessary makes for a veryportable lab, capable of producing a fewgrams of the drug at a time.

There are four main manufacturing methodsused in Australia. They are thehypophosphorus method (using hypophorousacid and iodine), the red phosphorous method,(using hydriodic acid and red phosphorous),the ‘Nazi’ method (using lithium or sodiumwith anhydrous ammonia) and the P2P orLeuckart method (using P2P, which is alsoknown as phenylacetone or benzyl methylketone, together with formic acid oraluminium amalgam) [6].

We can all relateto the effects

of methImagining what your own mentalstate would be like after goingdays without any sleep is oneway to conceptualise some ofthe psychological impacts thatmethamphetamine can haveon people.

There is no doubt methamphetamines arepopular because of ease of consumption,relatively low price when compared withalcohol, and an ability to deliver a rushthat includes feelings of enhanced well-being,heightened libido, increased energy, andappetite suppression” [16].

But there are negative side-effects, too.These include, among others, anxiety,aggression, paranoia, hyperactivity, reducedappetite, irregular heartbeat, increasedbreathing rate, dilated pupils, increasedblood pressure, headache, insomnia andpalpitations [17].

The anxiety and paranoia are not necessarilysolely because of the drug - although theymay be; they can also be influenced byrelated sleep deprivation.

According to a review of the literature,binge-related psychosis may be due toamphetamine use, or vulnerabilities in theuser or both. It could be that psychosis occursbecause of the sleep deprivation that followsamphetamine use, or it could be triggered

by other factors including use of other drugssuch as alcohol, benzodiazapines, opioids orcannabis.

It is interesting to read the results of sleepdeprivation studies. For example, one in theUnited States took 25 healthy males andkept them awake for 56 hours. It found thatthere was an increase in their self-reportedsymptoms of anxiety, depression and paranoia.

There was also an increase in “interpersonalmistrust and hostility toward others”, aswell as “increased feelings of persecutionand perception of unfair treatment by others,including greater resentment, sensitivity toperceived insults/slights, and projection ofblame onto others” [18].

Professor Jason White is Head of the Schoolof Pharmacotherapy and Medical Sciencesat the University of South Australia, and anexpert on the neurological dimensions ofAmphetamine Type Substances. His view isthat mood unpredictability and variabilityare the key features of meth use mostrelevant to NSP staff.

“With meth, a person is going to be very highlyvariable in terms of their mood. So when theyare under the influence of the drug they will beoutgoing, confident, full of energy, that sort ofthing,” Professor White said.

means it refers to a full-blown psychoticepisode [only]. And that’s not necessarilythe case. You can get that frommethamphetamine, but many more peoplehave low level paranoia where in factsometimes it might be hard to differentiate[a meth-related episode] from reality.

“So they might be telling a story that actuallyseems moderately plausible. When they saythe CIA is beaming things into their head, youknow that that is not true.

“But when they say certain people are outto get them and watching their house, it maybe true. So they [staff] need to understandthat there is a high level of paranoia amongstthese people that is caused by the drug, andit may lead to behaviours that are quiteirrational and the person might seemdelusional. But by the same take it maybe hard to differentiate from reality.”

“When they are off it, they can be quitedepressed, slow, unmotivated and will nothave the same degree of self-confidence,”Professor White said.

“So although we all vary from time to time,the amount of variability with a meth personwill be much greater than you would normallyget.”

For an NSP worker “seeing the same peoplecome through, as they often would, it can bequite variable as to what the presentation isgoing to be. And it can quite hard to deal withthat person, because you just don’t knowwhat they are going to be like on that day.So I would say that’s one of the biggest things,if not the biggest,” he said.

“The next issue is paranoia. The critical thinghere is that sometimes paranoia

Queensland Health has summarised thenexus between psychostimulants andpsychosis as follows [19]:

Intensive or prolonged psychostimulant usecan produce a psychosis similar to that whichoccurs in non-drug-induced psychosis. Itusually appears as a result of chronic high-dose use and usually disappears after druguse stops. Symptoms may include:

� hallucinations

� paranoid delusions

� uncontrolled violent behaviour.

The risk of drug-induced psychosis increasesas drug use risk increases (high doses, chronicuse and injecting as usual form of use)alongside psychosis vulnerability.

Psychosis vulnerability increases if the userhas:

� drug-related psychotic symptoms in thepast

� schizophrenia

� paranoid disorder

� brief reactive psychosis

� mood disorder with psychotic features

� family history of serious mental illness [19].

An experienced NSP worker in the outbacktold the Bulletin that some of his clientshad recently worked out how easy and cheapit was to buy Amphetamine-Type Substances(ATS) over the internet.

The worker, who has many years’experience working in drug andalcohol counselling, youth workand the NSP, said he generally hadno problems dealing with speed -or ice-using clients.

But, he told the Bulletin, his ease ofworking with complex clients came asa result of all those years of experience.He said that while dealing with meth-usingclients may be daunting for less experiencedstaff, it should not make them scared.

“Oh, they can be a bit more agitated thanopiate users; flighty, some can’t stand still,and it seems sort of like they’re on edge.If you were working with them and talkingto them about things, you may feel as if theyare not paying attention to you,” he said.

“It’s not the case though. They are listening,but their mind is racing.”

Main points forhealth workers

Methamphetamine can beswallowed, smoked, snorted,injected or inserted rectally,and, as with any drugs, thereare physical, psychologicaland social risks associated withtheir use. Good harm reductionpractice will help minimise thoserisks and potentially preventlong-term damage.

The positive side-effects ofmethamphetamine use also need to betaken into consideration. Increased energy,euphoria and feelings of invincibility canmean that people may be more likely touse the drugs more often.

If they are injecting, this can lead to veindamage and greater risk of blood borne virustransmission and other infections and injuries.

If injecting when intoxicated, it is possiblethat the associated feelings of invincibilityand impulsivity, in addition to an increasedpotential for tremor and blurred vision, canimpair injecting technique, increasing therisk of vein and tissue damage and infection.

In addition to this, the psychological sideeffects of methamphetamine can make peopleless likely to practice safe using techniques(eg using new injecting equipment, washinghands, swabbing, not rushing a shot, etc.).

Good vein careHarsh chemicals are used in the productionof methamphetamine and so they can bemore damaging to skin tissue compared toother injected drugs. A missed shot is morelikely to result in irritation, inflammationand infection in surrounding tissue(eg cellulitis or abscesses).

Tips:� To avoid blood borne viruses and other

infections, use new equipment every time -needles, syringes, swabs, spoons, filters,clean tourniquets, etc. Ensure that, if youare going out and likely to use, you haveaccess to clean injecting equipment.

� Using the thinnest needle possible(27 or 29 gauge) ensures that thesmallest hole is made in the vein,and the least damage done.

� Regularly change the injection site topreserve veins. This gives them the chanceto heal and reduces the risk of vein collapsecaused by injured and irritated veins fromrepeated or poor injection technique.

� Learn to inject with the right and lefthand to rotate injection sites.

Non-injecting routesof administrationBecause of the rapid onset of action, injectingor inhaling/smoking methamphetamineincreases the risk of tolerance, dependenceand methamphetamine-induced psychosismore than other routes of administration.

To reduce the multiple harms associatedwith methamphetamine use via injection,including blood borne virus transmissionand other injecting-related injury and

disease [22], it advisable to promote othersafer routes of administration.

Listed below are commonly used alternativesto injection. Each has its benefits and risks.

Snorting up noseSnorting methamphetamines is an easy andefficient way of using with a relatively fastonset of action. However, methamphetamine- particularly crystallized form - can be veryharsh on the lining of the nasal passage. Thiscan result in nosebleeds, sinus problems and,in some cases, permanent damage to the nasalstructure. People should crush the drug as finelyas possible, and consider mixing with somethingsuch as glucose powder. In addition to this,sharing straws or rolled paper for snorting linescan transmit infections from the common coldto hepatitis C.

Tips:� Don’t share rolled paper/straws etc; or if

you absolutely have to share them, cleanthem between use. Consider using Post-it®notes, so you can have easy access to anew paper each snort.

� Where possible, lengthen the timebetween use. Even alternating nostrilscan help reduce damage [23].

Rectal administrationThe thin membrane in the anus allows drugsto be absorbed into the bloodstream relativelyrapidly. Some users prefer this method as itprovides a relatively quick onset of action andless stomach upset. It can also increase sexualpleasure. Again, methamphetamine are irritantdrugs so there is a risk of ulcers, rectalmembrane damage, diarrhoea and boweldysfunction.

Tips:� Use the minimum amount of water

necessary to dilute the drug. If not enoughwater is used it may increase irritation, andif too much is used it may increase the riskof a bowel movement before the drug isabsorbed.

� Ensure that you have emptied your bowels.� Find a calm environment where you can

comfortably sit or lie down after the insertion. � If there is pain or resistance at any time,

wait a bit before you try again later.� Swab the end of the syringe and take the

needle off!� Lubricant can be used if needed.� Some users mix with milk instead of

water to reduce irritation [23].

SmokingMethamphetamine can be smoked in pipesor on foil heated by a flame underneath.Given the heat of the vapours and theirritant nature of the drug, smokingmethamphetamine can increase the riskof damage to the mouth, teeth and upperrespiratory system.

Tips:� To reduce risk to dental health, hold the

pipe behind the teeth and frequently rinsethe mouth out.

� As the vapours are toxic to the lungs,don’t hold the smoke in your lungs(don’t hold your breath).

� Avoid burns: don’t hold the flame directlyon the glass - keep it below and move itaround. Remember that glass pipes canbecome very hot [23].

Polydrug usePolydrug use (using more than one type ofdrug at the same time instead of a singledrug of choice or to come down from anotherdrug) is common among people who usedrugs, and methamphetamine are oftenused alongside others. Mixing more than onesubstance with another increases the toxicityof both drugs and slows the metabolising ofboth. In addition to this, polydrug use (witheither licit or illicit drugs) can increase therisk of overdose [24].

Alcohol and cannabis are the drugs mostcommonly used with methamphetamine,but other combinations are increasinglycommon. Stimulant drugs such as cocaine,MDMA and prescribed stimulants (egdexamphetamine and methylphenidate)may be used to further enhance the stimulanteffects of methamphetamine. Depressantdrugs (eg benzodiazepines, cannabis andopioids) may be used to come down frommethamphetamine or simultaneously toenhance the desired effect of each drug(eg opioids and GHB).

Drug interactionsMethamphetamine’s interactions with otherdrugs:

Alcohol: Reduces the subjective effects ofalcohol. Causes greater increases in bloodpressure and heart rates compared to wheneither is taken alone. Slows metabolism ofmethamphetamine.

Antidepressants: Increases the risk ofserotonin toxicity (especially SSRIantidepressants). May impair the metabolismof methamphetamine through inhibition ofliver enzymes.

Anti-psychosis: Antipsychotics antagonisethe effects of dopamine at the d2 receptor.Concurrent use may reduce the efficacy ofeither agent and increase seizure risk.

Benzodiazepines: Often used during comedown. There is a risk of stimulant depressantcycles. Also, if you are using them regularlyyou may develop a benzo dependence orrisk overdose.

Cannabis: Some people use cannabis tosoften the comedown. However, cannabis useincreases the risk of psychological symptomssuch as paranoia.

Nicotine: Has a synergistic, reinforcing effectwith methamphetamine so may increasesmoking behaviours.

Opioids: As methamphetamine can maskthe depressant effects of heroin, peopleare at risk of using more and thereforeat greater risk of overdose.

Stimulants such as ecstasy and cocaine:Increases stimulant effects, therefore greaterrisk of adverse outcomes including heartattack, stroke and psychosis or overdose.

Good nutrition and hydrationMethamphetamine use suppresses theappetite and users are likely to have pooror irregular eating habits [25]. In the longterm this can lead to malnutrition and loss ofmuscle and bone density. Poor nutrition alsocontributes to other adverse outcomes suchas increased risk of infections. Where appetiteis poor, smoothies, milkshakes or Sustagen®can be a useful way of replacing nutrients.

As methamphetamine use increases heartrate, breathing, body temperature and

overall physical activity, good hydrationis also important. Sip water on a regularbasis to reduce the risk of dehydrationand overheating. Avoid high-sugar drinksthat will do more damage to dental health.

Prioritise dental careMethamphetamine use can cause teeth andgums to deteriorate significantly as it shrinksblood vessels, which reduces their bloodsupply and also stops bacteria-fighting salivafrom being produced [22]. In addition,increased serotonin levels can cause users togrind their teeth and clench their jaws,damaging tooth enamel and causing mouthsores. These effects, coupled with poornutrition and impaired immune function,contribute to the risk of missing andblackened teeth, which is commonly termed“meth mouth” [25, 26].

Tips:� Drink water.� Brush your teeth after a big night out.� Try to maintain a nutritious diet that’s

high in calcium and anti-oxidants.� Avoid rubbing methamphetamine into

the gums as the irritant nature of the drugcan damage the mucous membranes.

� Chew sugarless gum to help salivaproduction.

Overdose

Methamphetamine overdose, ormethamphetamine toxicity, can potentiallyoccur even with small doses, especiallywhen mixed with other drugs [27]. Whilephysical overdose is a less commonemergency presentation than psychosis,the risks to the cardiovascular system arestill significant, especially where there is apre-existing health problem.

The greatest concern regarding physicaloverdose is the risk of seizures, stroke andheart attack. Symptoms of methamphetaminetoxicity may include:

� nausea and vomiting

� headache

� chest pain

� tremors

� increased body temperature and heart rate.

Symptoms suggesting methamphetamine-induced psychosis resulting frompsychological toxicity include:

� anxiety

� panic

� agitation and aggression

� suspicion and paranoia

� delusions

� hallucinations [19].

Tips:

� Call 000.

� Move the person to a quiet, calm place andreassure them that things will be ok.

� If they are overheating, loosen clothing andput icepacks or a wet towel on the person’sneck, underarms and groin to reduce bodytemperature.

� If the person is unconscious, put them ontheir side to ensure breathing isn’tobstructed. If they are having spasms,remove anything that could cause injury[28]. Wait with them until help arrives. 6

Practical harmreduction measures- methamphetamine

7

Psychiatric nursestresses calm

listeningA psychiatric nurse with more than 20 years’experience working with drug affected peoplein acute care settings, Kirsten Ross said theadvice she would give frontline NSP workersunfamiliar with meth-using clients is prettystraight forward.

“If they only want syringes, to me that’s afairly easy thing. You deal with them directly,making them feel as you are listening to them.

“The first thing to do is, when they are alreadyat the agitated level, is to remember thatthings are a bit heightened already. So theyare already going to be a bit unreasonable.So you go through the manner of askingwhat they are wanting, and dealing withthem directly.

“They are not having a fabulous time[anyway], so it’s about making them feelat ease. You need to have good eye contact,and listen to them.

“I would make it very short, very simplebecause they are only wanting a simplething from you guys. I wouldn’t drag on thedialogue. Make it very pleasant, open-endedso you are not being attacking.

“If they are agitated, they probably don’t wanta lot of dialogue, maybe not wanting to havea full on conversation. But they are still goingto want that pleasantness. Smile, ask thema couple of things, ‘Is that all you are wanting,is there anything else you need?’

“Sometimes we can still get it wrong. I stillget it wrong. Best thing I would advise is tobe calm, not talk over them. Allow them totalk and you reiterate that you are listening.That’s the main thing. You want people to becalm. To be defensive, to kind of attack them,to be judgemental is only going to escalatethings.”

Kirsten said additional points of considerationto workers are:

� “Confidence is important to demonstratethat you are able to assist the individual. Ifyou appear nervous, anxious or intimidatedthe individual’s own anxiety can escalateand they may doubt your capacity to assistthem

� “Offer reassurance. The individual maygenuinely believe that their life is genuinelyat risk. They may feel that they are “goingcrazy” and need reassurance that thepsychotic effects of the drugs willdiminish with time.

� “Keep the individual informed, let themknow what you are doing. This gives thema greater sense of involvement and controlwhilst limiting them from becoming moreparanoid. For instance if you suddenlyremember to call a colleague, the individualmay assume the call is related to themand that may worry them more.

� “If you have time and are engaging theclient, consider giving them an innocuousactivity to distract their attention awayfrom suspicion, fear and paranoia.”

‘Don’t write people off’

An NSP manager in a busy primary healthservice stressed that people affected byamphetamines may be challenging at times,but it was all the more reason to be engagingand to not jump to conclusions.

He said: “If a person is experiencing evenmild paranoia it can be little clues taken toan extreme. It’s also a self-esteem thing.A person may think ‘I’m not good enough,I can’t cope. I may as well not try becauseI’m never going to succeed anyway.’

“Or they may think ‘I’m not going to paythe rent because I’ll get evicted anyway.’All those sorts of fatalistic things.”

But there’s a role there for the worker,especially those with time for engagementand/or case management.

“It’s to try and prevent the wheels falling off.It is important to stay engaged...don’tdiscount something a person has said justbecause it may seem unreal. There shouldn’tbe automatic suspicion that it’s paranoia,because there is often a lot of stuff there.

“Don’t write it off. Don’t be dismissive, andtry and keep things really simple. Keeping itsimple and breaking things down is important.Maybe there is not a lot that can be solved,but there are some things that can be done.”

Stress on workforce

Clinical supervision, staff support and solidself-care routines are essential for staff,according to Lisa Derham who is a socialworker with 18 years’ experience in thefields of homelessness, alcohol and otherdrugs and counselling.

“With its [methamphetamine] complicationsof increased client agitation and aggression,it is even more likely that some of thenegative impacts will spill over from worklife to home life. This can make it hard forworkers to relax and feel safe and harderto recharge and to continue looking forwardto being at work,” Ms Derham said.

The benefits of acknowledging the emotionalimpact on staff and providing them withsupervision and support can pay dividendsin terms of staff morale, reducing workerburnout and renewed energy to be genuinelysupportive of clients, Ms Derham told theBulletin.

When my heroin dealer boyfriend went to prison for the third time, I moved in with hismother. But he would come home and beat me up regularly. After landing in hospital onetoo many times, I called a community health worker and said “I can’t live like this anymoreand I need some help”. They got me into some crisis care places and I was raped three timesover a four-week period. I ended up in a women’s refuge where I was raped again by a verystrong butch woman.

I basically went to a support worker and said “I can’t live like this, I’m going to kill myself ”.I’d already tried to kill myself a few times and hadn’t managed it. I said “I need to stop usingdrugs and start getting back a little bit of some control and some strength; I feel like I’mjust everybody’s rag doll”.

At first she referred me to a detox house but they refused to take me because of theamount I was using. They said if they tried to even medically reduce me I’d seize and dieand they referred me to a naturopath who worked with me for about eight weeks to getme down to a manageable level to get into detox for 30 days.

Then they decided I had mental health issues that were being masked by the drugs and saidthey couldn’t treat me anymore because I was considered dual diagnosis and they didn’thave any dual diagnosis workers. Three months later they rang me back to say they had oneand could take me. I’d gone straight back to using smack and meth again on the street. I’dbeen in and out of homeless shelters and jumped at the chance. I said “Yes, I really do wanthelp but I’m back at square one” so they put me back through detox and then sent me offto rehab at a therapeutic community. I did four-and-a-half months there and then went toanother community rehab where I spent three months and from there moved intosupported accommodation, did two years there and from there into a government house.I’ve been here two years now.

I’m still in peer treatment with Narcotics Anonymous and AA meetings and classes justto keep my head in the game. I do 12-step work with other addicts as well and I’ve donepeer support training and I’ve done a Certificate IV in dual diagnosis to understand a littlebit more about myself. I’ve been off all psych medication three years as well so I’mmanaging my mental health as well as my addiction very effectively. I’m also marriedand trying to have a baby and have a 14-year-old stepson and own my own businessand run my husband’s business as well.

But it isn’t easy. For even the first six months of being clean I either wanted to use orkill myself. I had to put myself in contact with people who could help every day. It isa never-ending process.

Continued from page five.

AngelThe first time I used was because I was trying to discourage a friend I was sharinga house with. She said: “You’ve never done it, you don’t know what it’s like.” So Itried it with her and let her inject me. She later went on to overdose on heroinand die.

It was a couple of years after that I started using earnestly myself. I drank andtook LSD and smoked pot before then but not amphetamines. Someone said:“Have you ever done this before?” and I said yes, sure. I was drunk and letsomebody inject me again and that kicked off a spiral of using which ended mymarriage and my business and ended up with me living on the streets as a prostituteand bouncing between meth and ice and heroin.

My husband left in 2003. He never drank or used at all, he was a St John Ambulance officer- as straight as they come. During the later part of my marriage I was using morphineintravenously and I overdosed on that a few times and he’d just let the ambulance takeme away. I’d end up in hospital and he wouldn’t even visit.

I eventually hooked up with a girl who moved in with us and I dated her for about sixmonths. We finally kicked him out of the house, but I hadn’t paid the rent for four weeksand couldn’t catch up so we were evicted very quickly and ended up living in our car, thegirl and I. We tried a few different share houses but our relationship became very volatilewith the meth use and she ended up in juvie [ juvenile detention] and I ended up in hospital.There were stabbings and kidnappings and all sorts of stuff going on then; it was justcompletely crazy. I ended up living on the streets and getting involved with a Russiancrime syndicate and dealing drugs for them and prostituting myself - just crazy.

I would get to where speed would scatter me out and I needed to switch drugs if I wantedto stay awake and not be scattered, so I would switch to ice for a couple of days. When I gotsick of the awake/scatter combination, I would drown myself in Mogadon or heroin orwhatever I needed to put me down for a couple of days, and then I would start all overagain.

For a few years I went to doctors for help and they’d prescribe things like Xanax® to tryand stop me using, but I’d get addicted to them.

Users’ story

Footy star’sgreatest comeback

Tell us a bit about your footy careerfor our readers who may not be AFLfollowers.

My AFL career started with CollingwoodFootball Club in 1986, and over the next15 years I was able to play in the historicdrought-breaking 1990 premiership, play formy state and receive several top-three finishesin the Collingwood Best and Fairest. I played246 games for the black-and-white whiletrying to manage a daily cannabis addiction.I kept this part of my life completely awayfrom everyone, even the players I was involvedwith. For me, my cannabis use was for me andonly me.

You’re on record as sayingamphetamines were also a partof the problem.Cannabis was my daily drug of choice,alongside binge drinking. However,immediately on retiring, my true drugof choice, speed, became my daily drug.Amphetamines were always my preferreddrug as I believed that this drug gave memore confidence, allowed me to communicatewith others and be the person I wanted to be.How wrong I was.

Was there a background of alcohol usein your family?Yes, the Crosisca family has a long lineof alcoholics. I believe in the genetics ofalcoholism and addiction and have nowlearnt that the disease of addiction has a60 per cent chance of being passed onfrom generation to generation. My fatherpassed away in 2010 from organ failure fromuntreated alcoholism. His father was a violentdrunk - my grandfather and also my greatgrandfather. I now realise I was predisposedto addiction from early childhood.

Do you think the footy cultureencourages excessive drinking?I don’t think it’s just an issue in sports. For me,I believe it is a community issue as a result ofthe binge-drinking culture in Australia. Lookingback, I can now see that I never wanted nightsto end and so for me it was always excessive,not just during my football career.

When did you start to feel that youramphetamine use was an issue?Looking back, my amphetamine use wasan issue straight away. I was using everysingle day from the very beginning. Thenmy tolerance level increased and so I usedmore. For many years I would go to bedeach night thinking: “What are you doing?You’ve got a wife, family, a good job you’rerisking. Why am I doing this? I need to stop.”And then the next morning all I could thinkabout was scoring again. Addiction is a braindisease that takes away all ability of choice.I was using against my will.

How were things more generally withthe family at this time?I became completely withdrawn from mywife and children. I was not presentemotionally for my family, I hadminimal contact with friends and I washappiest when I was isolated, on my ownwith my drink and drugs. I lacked motivationto do the simplest of things unless it revolvedaround getting or taking drugs. My addictionhad completely consumed me and sadly atthat time I didn’t care. My life was full ofdishonesty, selfishness, manipulation,isolation, guilt and shameful behaviours.

What happened to change thatsituation?Nicole had enough of my behaviours andasked me to leave the family home. I didn’twant to leave, I didn’t want to stay. Myreality had become so delusional that I didn’tknow what I was doing. I’d been out of thefamily home for six weeks and had shownno change, and Nicole thought: “It’s not right.He can’t just throw his family away so easily.There must be something else going on”.Investigating further, she spoke with apsychologist and psychiatrist, who consideredthat perhaps there was heavy drinking and

gambling occurring and suggested to Nicolethat I be admitted to a dedicated 36-bedaddiction rehabilitation facility.

How long did you spend there?I spent 28 days at a clinic and then it wasrecommended that I transfer to a residentialrehabilitation facility for a further threemonths. This is where I had group therapyevery day, individual counselling and extensivecouples counselling, to start learning aboutmyself, the disease of addiction and re-building the relationships with my familythat I had damaged throughout my activeaddiction.

What did you feel was most effectivefor you?Everyone’s journey in addiction and journeyinto recovery is different. I was extremelyfortunate to have the opportunity toexperience four months of treatment, havingregular counselling with alcohol and drugspecialists, daily group therapy workingalongside the other 11 people who I livedwith for three months, regular 12-stepmeetings that allowed me to connect with

and relate to other recovering addicts andworking with my sponsor. I have openedmyself up to a new way of life through thespiritual principles I am living by - honesty,openness and willingness.

I know one thing for sure: if it wasn’t for theunconditional love, support and acceptancefrom my wife Nicole and my three children,I don’t believe that I would be in the positionI am today - clean and sober for nearly twoyears now.

Could anyone have steered you awayfrom amphetamines earlier?I don’t know. My drug use was completelyhidden. That was a big part of it, the secrecy,just not letting anyone know about it. Duringmy active addiction I was in denial of theproblem. I was just doing what I thought I hadto do to survive life. So when Nicole soughtout help for me, it was for drinking andgambling.

What would you say to people out therewho still have unresolved issues?Everybody is different but I’d say: “You can gethelp. You don’t have to lose everything beforeyou do, like I did.”

As a successful AFL Premiership player with arguably the most popular club, Collingwood, Gavin Crosisca appeared to haveeverything going for him. Tipped to be one of the next generation of AFL coaches after retirement, he had a beautiful wife,

Nicole, three healthy children and opportunities galore. Everything looked rosy - but Gavin was battling with addiction.He recently spoke to the Bulletin about life after footy and about drugs.

Collingwood Football ClubPresident and media personality,Eddie McGuire, with Collingwoodpremiership great Gavin Crosisca.