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Meth’s Resurgence Spotlights Lack of Meds to Combat the Addiction

crystal meth

[By Carmen Heredia Rodriguez of Kaiser Health News, republished by permission.]

In 2016, news reports warned the public of an opioid epidemic gripping the nation.

But Madeline Vaughn, then a lead clinical intake coordinator at the Houston-based addiction treatment organization Council on Recovery, sensed something different was going on with the patients she checked in from the street.

Their behavior, marked by twitchy suspicion, a poor memory and the feeling that someone was following them, signaled that the people coming through the center’s doors were increasingly hooked on a different drug: methamphetamine.

“When you’re in the boots on the ground,” Vaughn said, “what you see may surprise you, because it’s not in the headlines.”

In the time since, it’s become increasingly clear that, even as the opioid epidemic continues, the toll of methamphetamine use, also known as meth or crystal meth, is on the rise, too.

The rate of overdose deaths involving the stimulant more than tripled from 2011 to 2016, the Centers for Disease Control and Prevention reported.

But unlike the opioid epidemic — for which medications exist to help combat addiction — medical providers have few such tools to help methamphetamine users survive and recover. A drug such as naloxone, which can reverse an opioid overdose, does not exist for meth. And there are no drugs approved by the Food and Drug Administration that can treat a meth addiction.

“We’re realizing that we don’t have everything we might wish we had to address these different kinds of drugs,” said Dr. Margaret Jarvis, a psychiatrist and distinguished fellow for the American Society of Addiction Medicine.

Meth revs up the human body, causing euphoria, elevated blood pressure and energy that enables users to go for days without sleeping or eating. In some cases, long-term use alters the user’s brain and causes psychotic symptoms that can take up to one year after the person has stopped using it to dissipate.

Overdosing can trigger heart attacks, strokes and seizures, which can make pinpointing the drug’s involvement difficult.

Meth users also tend to abuse other substances, which complicates first responders’ efforts to treat a patient in the event of an overdose, said Dr. David Persse, EMS physician director for Houston. With multiple drugs in a patient’s system, overdose symptoms may not neatly fit under the description for one substance.

“If we had five or six miracle drugs,” Persse said, to use immediately on the scene of the overdose, “it’s still gonna be difficult to know which one that patient needs.”

Research is underway to develop a medication that helps those with methamphetamine addiction overcome their condition. The National Institute on Drug Abuse Clinical Trials Network is testing a combination of naltrexone, a medication typically used to treat opioid and alcohol use disorders, and an antidepressant called bupropion.

And a team from the Universities of Kentucky and Arkansas created a molecule called lobeline that shows promise in blocking meth’s effects in the brain.

For now, though, existing treatments, such as the Matrix Model, a drug counseling technique, and contingency management, which offers patients incentives to stay away from drugs, are key options for what appears to be a meth resurgence, said Jarvis.

Illegal drugs never disappear from the street, she said. Their popularity waxes and wanes with demand. And as the demand for methamphetamine use increases, the gaps in treatment become more apparent.

Persse said he hasn’t seen a rise in the number of calls related to methamphetamine overdoses in his area. However, the death toll in Texas from meth now exceeds that of heroin.

Provisional death counts for 2017 showed methamphetamine claimed 813 lives in the Lone Star State. By comparison, 591 people died due to heroin.

The Drug Enforcement Administration reported that the price of meth is the lowest the agency has seen in years. It is increasingly available in the eastern region of the United States. Primary suppliers are Mexican drug cartels. And the meth on the streets is now more than 90 percent pure.

“The new methods [of making methamphetamine] have really altered the potency,” said Jane Maxwell, research professor at the University of Texas at Austin’s social work school. “So, the meth we’re looking at today is much more potent than it was 10 years ago.”

For Vaughn, who works as an outpatient therapist and treatment coordinator, these variables are a regular part of her daily challenge. So until the research arms her with something new, her go-to strategy is to use the available tools to tackle her patients’ methamphetamine addiction in layers.

She starts with writing assignments, then coping skills until they are capable of unpacking their trauma. Addiction is rarely the sole demon patients wrestle with, Vaughn said.

“Substance use is often a symptom for what’s really going on with someone,” she said.

Drug-Impaired Driving

Feel Different – Drive Different: The NHTSA’s National Campaign Shines Light on Drug-Impaired Driving

Overview

You can’t drive safely if you’re impaired. That’s why it’s illegal everywhere in America to drive under the influence of alcohol, marijuana, opioids, methamphetamines, or any potentially impairing drug–prescribed or over the counter. Driving while impaired by any substance—legal or illegal—puts you and others in harm’s way. Learn the latest research on drug-impaired driving, misconceptions about marijuana use, and what you can do to make smarter choices to drive safely.

The Issues

Many Substances Can Impair Driving

Many substances can impair driving, including alcohol, some over-the-counter and prescription drugs, and illegal drugs.

  • Alcohol, marijuana, and other drugs impair the ability to drive because they slow coordination, judgment, and reaction times.
  • Cocaine and methamphetamine can make drivers more aggressive and reckless.
  • Using two or more drugs at the same time, including alcohol, can amplify the impairing effects of each drug a person has consumed.
  • Some prescription and over-the-counter medicines can cause extreme drowsiness, dizziness, and other side effects. Read and follow all warning labels before driving, and note that warnings against “operating heavy machinery” include driving a vehicle.

Impaired drivers can’t accurately assess their own impairment – which is why no one should drive after using any impairing substances. Remember: If you feel different, you drive different.

Marijuana Impairs

There are many misconceptions about marijuana use, including rumors that marijuana can’t impair you or that marijuana use can actually make you a safer driver.

Several scientific studies indicate that this is false. Research shows that marijuana impairs motor skills, lane tracking and cognitive functions (Robbe et al., 1993; Moskowitz, 1995; Hartman & Huestis, 2013). A 2015 study on driving after smoking cannabis stated that THC in marijuana also hurts a driver’s ability to multitask, a critical skill needed behind the wheel. 

NHTSA continues to conduct research to better understand the relationship between marijuana impairment and increased crash risk. NHTSA’s Drug and Alcohol Crash Risk Study found that marijuana users are more likely to be involved in crashes. However, the increased risk may be due in part because marijuana users are more likely to be young men, who are generally at a higher risk of crashes. 

While evidence shows that drug-impaired driving is dangerous, we still have more to learn about the extent of the problem and how best to address it. In January 2018, NHTSA launched a new initiative to address drug-impaired driving. NHTSA’s National Drug-Impaired Driving Initiative brings together experts, including law enforcement officials, prosecutors, substance abuse experts and others, to discuss strategies that can reduce drug-impaired driving.

Responsible Behavior

We can all save lives by making smarter choices.

  • If you use an impairing drug, designate a sober driver, call a cab, or use a ride-hailing service.
  • Don’t let friends get behind the wheel if they’re under the influence of drugs or alcohol.
  • Download NHTSA’s SaferRide app from Google Play or the iTunes Store to help you call a friend or taxi, pinpoint your location, and arrange to be picked up.
  • If you’re hosting a party where alcohol or other substances will be used, it’s your job to make sure all guests leave with a sober driver.
  • Always wear your seat belt—it’s your best defense against impaired drivers.

[Article source: National Highway Traffic Safety Administration]

If you or a loved one has a drug or alcohol problem, and need help, call The Council on Recovery at 713-942-4100 or contact us online.

The Lifelong Quest For Sobriety…The Ultimate Hero’s Journey—Part 50

Guest Blogger and long-time Council friend, Bob W. presents Part 50 of a series dealing with Alcoholism and Addiction from a Mystical, Mythological Perspective, reflecting Bob’s scholarly work as a Ph.D. in mythological studies.

The 2018 film, A Star is Born, is the fourth remake of an original 1937 film about an aging star and a young new prodigy.  This one stars Bradley Cooper as Jackson Maine, a famous C& W singer, and Lady Gaga, as Ally, a struggling lounge singer whom Jackson takes to stardom.  The story is impeccably done by Cooper and Gaga; its power is in the truly profound impact it seems to have on many of us in recovery.  This recent version also tracks almost precisely with two prior ones, a 1954 version with Judy Garland and James Mason, and a 1976 version with Barbra Streisand and Kris Kristofferson.

In this version, Jackson is a serious alcoholic and addict who stumbles into a back-street drag bar, desperately needing a drink between gigs;  he  finds Ally as a waitress who also sings in the small club venue.  The connection, both in the acting and in the energy Cooper and Gaga bring to the roles, is mesmerizing.  Predictably, and in line with its predecessors, they form a bond and perform together.  The bond leads to an affair of the heart.  Soon Ally’s career begins to take off while Jackson’s is continuing a drunken downward spiral.   

While Ally remains fully committed to Jackson, he becomes a major liability to her career.  He vacillates between loving attention to her and mean-spirited comments and abuse. Her manager does everything he can to try to keep Jackson away from Ally in various phases of her development and touring.  But Jackson’s drinking and drugging just keeps getting worse.  At the Grammy’s, when Ally goes up to accept the Award of Best New Artist, a falling down drunk Jackson goes up with her and, on stage, he wets himself and passes out.

Jackson does rehab and seems to be recovering, but the damage he believes he has done to Ally’s career and the constant pull of the disease lead him to a deep state of remorse and regret.  While Ally is singing at a major concert at which Jackson was to be present, he hangs himself in their garage.

It is interesting that this story seems to have a basic fundamental power…it has been told and retold in the span of generations over the last 80 years…with the players having the same general presence in their generations as Gaga and Cooper do here.  While, to this alcoholic, the option of suicide is never a valid one, there are untold examples where the bottom reached in a drinking life seems to present no other recourse to the sufferer.  It is a sad, sad, tragic reality.

How wonderful it is that many of us have been able to move beyond that point of “pitiful and incomprehensible demoralization” and put the probability of such a tragedy well behind us.  

Guide: 11 Indicators of Quality Addiction Treatment

How to identify high-quality addiction treatment programs.

The Council on Recovery recommends the following guide published by the Recovery Research Institute, an affiliate of Harvard Medical School. We suggest using it to evaluate addiction treatment options for you or your loved ones. [The Council meets/exceeds all 11 quality indicators.]

Intro

With thousands of programs and rehabs to choose from, it can be challenging to assess which addiction treatment programs offer the highest quality of care.

Finding the right treatment facility is all too important, given the time, money, and energy that substance use disorder treatment and recovery requires of not only the individual, but the entire family.

The 11 Indicators of Quality Addiction Treatment:

Research has identified elements that quality substance use disorder treatment facilities should possess. These range from personalized treatments, to national accreditation, to assertive linkages to continuing care.

The experts at the Recovery Research Institute have compiled a comprehensive list of 11 indicators of effective treatment, as a blueprint to help guide you or your loved one to high-quality addiction treatment, maximizing your recovery success.

1. Assessment and Treatment Matching (Identify)

Finding effective help for an alcohol or other drug use disorder begins with reliable and valid screening for a range of substance use disorders and related conditions, as well as any physical or mental health conditions. This is followed by more comprehensive assessment of substance use history and related disorders, medical history, psychiatric history, individual’s family and social networks, and assessment of available recovery resources (“recovery capital”). These endeavors help uncover the many interrelated factors affecting the patient’s functioning and life and assess a patient’s readiness to change. This careful and comprehensive assessment can help prevent missing aspects or minimizing important aspects of a person’s life, such as trauma or chronic pain, inattention to which could compromise recovery success.

2. Comprehensive, Integrated Treatment Approach (Treat)

As discussed above, patients in treatment may have co-occurring psychiatric disorders, like depression and anxiety, as well as other medical problems like hepatitis C, alcoholic liver disease, or sexually transmitted diseases. Programs should incorporate comprehensive approaches that directly address these additional concerns, or otherwise assertively link patients to needed services. Treating the whole patient, will improve the likelihood of substance use disorder recovery and remission.

3. Emphasis and Assertive Linkage to Subsequent Phases of Treatment and Recovery Support          

Continuing care is defined as the ‘ongoing care of patients suffering from chronic incapacitating illness or disease.’ Ongoing care provides essential recovery-specific social support and necessary recovery support services after the patient leaves or transitions away from the initial phase of treatment. Programs that strongly emphasize this continuing care aspect will provide more than just phone numbers or a list of people to call, but instead, will provide assertive linkages to community resources, on-going health care providers, peer-support groups, and recovery residences. This ‘warm hand-off’ or personalized introduction to potential peers and resources in the recovery community, produces substantially better outcomes.

4. A Dignified and Respectful Environment

The treatment program should possess at least the same type of quality environment as one might see in other medical environments (e.g., oncology or diabetes care). You don’t need palm trees and luxury mattresses, but you should expect a clean, bright, cheerful, and comfortable facility. It is important that the program treats substance use disorders with the same professionalism and allocates similar resources for patient care as other chronic conditions. Creating a respectful and dignified environment may be particularly important for addiction patients, because those suffering from substance use disorders often feel as if they’ve lost their self-respect and dignity. A respectful environment helps them regain it.

5. Significant Other and/or Family Involvement in Treatment

Engaging significant others and loved ones in treatment increases the likelihood that the patient will stay in treatment and that treatment gains will be sustained after treatment has ended. Techniques to clarify family roles, reframe behavior, teach management skills, encourage monitoring and boundary setting, re-intervention plans, and help them access community services all help strengthen the entire family system and help family members cope with, and adapt to, the family system changes that occur in recovery.

6. Employ Strategies to Help Engage and Retain Patients in Treatment

Dropout from addiction within the first month of care is around 50% nationally. Dropout leads to worse outcomes, so it is vital to employ strategies to enhance engagement and retention. These include creating an atmosphere of mutual trust through clear communication and transparency of program rules, regulations, and expectations. Treatment programs can also work to retain patients by providing client-centered, empathic, counseling that works to build strong patient-provider relationships. They also can use motivational incentives to reward patients for continued attendance and abstinence.

7. Use of Evidence-based and Evidence-informed Practices

Programs that deliver services founded on scientific research and principles and that are delivering the available “best practices” tend to have better outcomes. In addition to psychological interventions, these should include accessibility to FDA approved medications for addiction (e.g., buprenorphine/naloxone, methadone, naltrexone/depot naltrexone, acomprosate) as well as psychotropic medication for other types of psychiatric conditions (e.g., SSRIs etc.). This is typically combined with qualified staff (see below).

8. Qualified Staff, Ongoing Training, and Adequate Staff Supervision

Having multi-disciplinary staff (e.g., addiction, medicine, psychiatry, spirituality) can help patients uncover and address a broad array of needs that can aid addiction recovery and improve functioning and psychological wellbeing. Staff with graduate degrees, and adequate licensing or board certification in these specialty areas are indicators of higher quality programs. In addition, clinical supervision and team meetings should take place at least once or twice a week for outpatient programs and three to five times a week for residential and inpatient programs.

9. Personalized Approaches that Include Specialized Populations, Gender, and Cultural Competence

Stemming from individualized comprehensive screening and assessment, programs should treat all patients as individuals attending to their needs accordingly. One size does not fit all, and neither does one treatment approach work for every individual. High-quality treatment programs identify the potentially different needs of men and women, adolescents versus adults, and those from different minority communities (e.g. LGBT) or cultural backgrounds, creating in turn, treatment and recovery plans that address their specific needs and acknowledge their available strengths and recovery resources.

10. Measurement of Program Performance Including During-treatment “Outcomes”

A further indicator of quality treatment is having reliable, valid measurement systems in place to track patients’ response to treatment. Similar to regular assessment of blood pressure at each check-up in treating hypertension, addiction treatment programs should collect “addiction and mental health vital signs” in order to monitor the effectiveness or ineffectiveness of the individualized treatment plan and adjust it accordingly when needed. Without any kind of standardized metrics, it is difficult to document and demonstrate patients’ progress.

11. External Accreditation from Nationally Recognized Quality Monitoring Agencies                            

Accreditation from external regulatory organizations such as the Joint Commission on Accreditation of Healthcare organizations (JCAHO; aka “the Joint Commission”), the Commission on Accreditation of Rehabilitation Facilities (CARF), and the Council on Accreditation (COA); and other programs licensed by the state are required to offer minimum levels of evidence-based care. These licensing and accreditation requirements serve as quality assurance that the treatment program is incorporating a certain level of evidence-based care in its model and is open to random audit of its clinical care.

New Study Finds Distressing Increase in E-cigarette Use by Middle and High School Youth

Electronic cigarettes (e-cigarettes), battery-powered devices that provide nicotine and other additives to the user in the form of an aerosol, have become the most popular form of tobacco use among middle and high school youth. The recent National Youth Tobacco Survey, 2011-2018 found a distressing increase in the use of e-cigarettes, also known as “vaping“, that far surpassed the rate of use of conventional cigarettes during survey period.

What’s more, concurrent studies by both the Center for Tobacco Products at the Food & Drug Administration and the Centers for Disease Control point to a rapidly escalating problem. High school students currently using e-cigarettes increased from 1.5% in 2011 to 20.8% 2018. During 2017–2018 alone, e-cigarette use increased by 78% (from 11.7% to 20.8%).

At the same time, among middle school students, e-cigarette use increased from 0.6% in 2011 to 4.9% in 2018. During 2017–2018, current e-cigarette use increased by 48% (from 3.3% to 4.9%).

Percentage of middle and high school students who currently use e-cigarettes and any tobacco product

The studies also showed that, while current use of any tobacco product among high school students grew from 24.2% in 2011 to 27.1% in 2018, the use of e-cigarettes continued to increase at rates not seen in previous surveys.

This sharp rise in e-cigarette use among U.S. middle and high school students during 2017–2018 is likely because of the recent popularity of e-cigarettes shaped like a USB flash drive, such as JUUL. These products can be used discreetly, have a high nicotine content, and come in flavors that appeal to youth.

Although e-cigarettes can be of potential benefit to adult smokers as a complete substitute for smoking tobacco, adolescent use of any tobacco product, including e-cigarettes, is considered unsafe. The Surgeon General has concluded that “e-cigarette use among youths and young adults is of public health concern; exposure to nicotine during adolescence can cause addiction and can harm the developing adolescent brain”.

The Council on Recovery provides a wide range prevention and education programs aimed reducing tobacco use, especially among adolescents and young adults. These programs are provided at area schools, churches, community centers, employers, and health fairs. For more information about The Council’s Prevention & Education Programs , please call 713-942-4100, email education@councilonrecovery.org  or contact us online.

Baby Boomers and the Alarming Increase in Alcohol Use Disorders

Baby Boomers are the fastest growing segment of the population. They’re also the group with the most dramatic increase in harmful alcohol use. According to a research published in the journal JAMA Psychiatry, increases in alcohol use, high risk drinking, and alcohol use disorders (AUD) among adults 65 years and older were substantially higher relative to earlier surveys.

The most alarming findings indicated that the number of adults 65 years and older who drank has risen higher than the national average by about 23 percent. And the average number of adults 65 and older suffering from alcohol abuse had risen by nearly 107 percent.

The study also reconfirmed the well-known correlation between alcohol use and the higher risk for disability, morbidity, and death from many alcohol-related chronic diseases. According to the National Institute on Aging, drinking too much alcohol over a long time can:

In addition to the medical risks are the many safety risks that alcohol creates for older adults. Drinking can impair a person’s judgment, coordination, and reaction time. This increases the risk of falls, household accidents, and car crashes.

In the midst of the medical and safety risks, the increase in both binge drinking and AUD among older adults has created a new urgency for doctors to screen for and identify unhealthy alcohol use by their older patients. Physicians are ideally positioned to discuss the risks of continued use and the options available to stop drinking for those with the problem. To support this effort, the National Institute on Alcohol Abuse and Alcoholism (NIAAA), offers multiple online resources for providers, such as brochures, fact sheets, alert bulletins, classroom resources, and videocasts. NIAAA’s website also provides the general public with information related to alcohol abuse among older adults.

In Houston, The Council on Recovery’s Wellderly program provides information and resources to help older adults, their family members, caregivers, and service providers identify and address alcohol and substance use and/or misuse. The Wellderly program’s unique suite of services include:

  • Community education and outreach to older adults and service providers
  • Screening, Brief Intervention, Referral to Treatment (SBIRT)
  • Case management
  • Specific help and guidance in talking with an older adult who has questions about their own substance use or a friend’s use of substances
  • Education and support for family members
  • Educational materials that aid older adults in taking better care of themselves

The Wellderly Program is supported by funding from The United Way of Greater Houston. For more information about the Wellderly Program please call 281.200.9109, email wellderly@councilonrecovery.org, or contact us online.