In search of a silver bullet

As part of our focus on the drug ice this week, CHRISTOPHER HARRIS investigates treatment options for those impacted by the drug.

Little is known of clinically tested best practice models for helping those addicted to the drug with withdrawal.

Methamphetamine addicts can function for many years in society unnoticed. But for most, the problems of addiction eventually bubble to the surface.

While Australia, like other countries around the world, grapples with the challenges of the rise of ice, researchers have been rushing to find a silver bullet, akin the methadone for heroin addicts, to stop addiction in its tracks.

Associate Professor Nicole Lee is a practicing psychologist in Melbourne who has been working with amphetamine users for over 20 years.

Like many health educators who specialize in methamphetamine and its psychological effects, she likes to talk about it in terms of heroin.

“Methamphetamine withdrawal is physically relatively mild, but psychologically it is more difficult for people than heroin.”

She says the strangest thing is that withdrawal nearly mimics meth intoxication: dependent people get very agitated, have trouble sleeping, and feel depressed or anxious, or both. They may have some mild psychotic symptoms, they will have a lack of energy, teeth, and they might eat more or eat less.

“It creates over a long period, some pretty big brain changes that take a long time to resolve. The user experiences more chronic withdrawal symptoms during the next year. The biggest thing that leads to relapse is this strong psychological craving.”

The evidence indicates that more times than not, a person will relapse.

“More than 50 per cent relapse immediately after leaving rehab, and there is a high percentage who don’t even stay the course with rehab.”

Currently, all states around Australia have a best practice guide for presenting methamphetamine addicts, which was written in 2006 and usually, involves the prescription of benzodiazepine (valium) or antipsychotics.
When I ask professor Lee if this should be updated, she ponders and curiously answers the question.

“It is interesting that we do that, because there isn’t any actual evidence that it helps in the long term. What we tend to do in the absence of medication is offer symptomatic relief for anxious and irritated patients, and if they’re psychotic we give them an antipsychotic.”

While a lot of users who smoke the drug through a pipe can hold down jobs and go undetected for years, usage ultimately results in a psychotic breakdown.

On the frontline

Greg* who works in the mental health wing of the Prince of Wales hospital in Camperdown has seen hundreds of addicts with psychosis and believes the process as it stands is a stab at success, which sometimes works and often doesn’t.
Like most people I spoke to who are looking at better ways to treat methamphetamine addicts, he is neither convinced nor scathing of best practice as it currently stands.

“From a cynical point of view, a high proportion will go back to using. And a lot of patients, especially those who have been in the system a few times, know what to say to get out early. The psychiatric kind of recovery and compartment of health is so interesting because it is not black and white.”

He does say that ice is currently particularly prevalent, and like any other addiction, mental health is what both suffers and drives people to addiction in the first place.

“Most people have a popping point, and use of drugs has a definite stress on the mind and body.”

A possible solution?

How then do we deal with these people whose lives have become so entwined with the cycle of meth?

Perhaps the answer lies in understanding what long-term use, which results in psychosis in presenting patients, does to the brain.

Professor Linda Gowing says GPs must be educated in how to detect the use of methamphetamine in patients early on and treat early.

“A lot of the negative side effects of methamphetamine take a long time to develop, and they might not happen at all in a year of usage.”

She is still optimistic about the power of a drug to help addict and mention an amphetamine vaccine, which has been trialed in the last couple of years at Scripps Research Institute in California.

Interestingly, Nicole Lee’s systematic review of drug trials noted that the use of four sessions of cognitive behavior therapy paired with the use of trialed drugs might have played a significant role in the results.

That is something which resonates with one recovering addict City Hub spoke to, who said even though his recovery is “probably better than most” that “every single day is a struggle.”

He got clean after a combination of the loss of income from his job, seeing a psychiatrist and realising that he had reached rock bottom.

“Now I just decide every day not to do it, and I have been making that decision for two years now. Temptation is probably the best way to describe it now.”

If you or someone you know needs help regarding addiction contact Lifeline on 131114.