Meth addiction and treatment

From Scientific American, by Claudia Wallis, April, 2021. p.21

Poor results remain all too typical for what is more formally

known as methamphetamine use disorder. About one million

people in the U.S. are addicted to meth, a powerful stimulant

that—smoked, snorted, injected or swallowed—ruins lives and

contributed to more than 12,000 overdose deaths in 2018. Fatal

overdoses appear to have spiked by nearly 35 percent during the

COVID pandemic. Unlike people battling alcoholism or opioid

misuse, meth users have no approved medications to help them

shake their habit. And most behavioral therapies fail.

But this tragic picture at last may be changing. A recent study

found that a regimen of two medications helped some users stay

off the drug. In addition, a psychosocial intervention called contingency

management (CM) has been shown to be especially effective...

.....

All addictions are tough to beat, but methamphetamine poses

a particular challenge. A key way that researchers measure the

addictive grip of a substance is to look at how much dopamine (a

neurotransmitter associated with pleasure) floods into the brain’s

major reward center during use, based on animal studies. “Methamphetamine

is the drug that produces the largest release,” says

Nora Volkow, director of the National Institute on Drug Abuse.

“An animal will go crazy pressing a lever in order to get the drug,”

she adds. Another metric involves real-world human experience:

When you try a new substance, what is the likelihood of becoming

addicted? “In this respect, methamphetamine ranks along

with heroin among the top addictive drugs,” Volkow says.

...

The medication study used two substances that target withdrawal.

Bupropion, an antidepressant also prescribed for smoking cessation,

raises dopamine levels in the brain and thus may buffer the

misery of steep drops that occur when people stop using meth. Naltrexone,

the second medication, is an opioid blocker that “has an

effect on the reward circuit, potentially relieving cravings,” explains

the study’s lead author, Madhukar H. Trivedi, a psychiatrist at the

University of Texas Southwestern Medical Center. In a trial with

403 heavy users of meth, a regimen of the two medications helped

13.6 percent stay off the drug, testing meth-free at least three quarters

of the time over a six-week period. Only 2.5 percent of those

given placebos achieved that level of abstinence.

Contingency management works on behavior by reinforcing

abstinence with prizes. At VA clinics, addicted veterans submit a

urine sample twice a week. If the sample is meth-free, they get to

pull a slip of paper from a fishbowl. Half the slips show various dollar

amounts that can be spent at VA shops, and the rest feature

words of encouragement. Two clean samples in a row earn two

draws from the fishbowl, three in a row earn three draws, and so

on, up to a maximum of eight. But drug-positive urine means no

prize. The key “is the immediacy of the reinforcement,” says Dominick

DePhilippis, a clinical psychologist at the Corporal Michael J.

Crescenz VA Medical Center in Philadelphia. That is important, he

notes, because the rush of meth is also immediately reinforcing,

whether it is the “euphoric feeling that substance use brings or the

escape from fatigue or unpleasant mood states” of withdrawal.

Some interesting facts and trends:

Meth addiction rates tend to be worse west of the Mississippi and opioid addiction rates tend to worse east of the Mississippi.

The hit TV series, "Breaking Bad" depicted the manufacturing, distribution, and deadly consequences of the meth industry.