An extensive scientific overview of methamphetamine addiction and treatment was presented by Dr. Alex Stalcup, medical director of the New Leaf Treatment Center in Lafayette, Calif., at Mental Health Systems Inc.’s Methamphetamine Update conference at the Bahia Resort Hotel on Feb 24.

San Diego Police Chief William Lansdowne led opening remarks and discussed the prevalence and potency of meth today as compared to 40 years ago when he began his law enforcement career.

Lansdowne stressed the importance of those who work in the drug treatment and prevention field.

“The solutions rest right here in the room today with the professionals who understand the issues and work collaboratively to be able to create a prevention system, a correction system, an enforcement system and a rehabilitative system that truly works,” he said.

Stalcup said meth abuse was initially viewed as an untreatable addiction, but that has changed. The New Leaf Treatment Center received funding as part of the federally funded Meth Treatment Project (MTP), and the center used research technology to determine that residential treatment is less effective in treating meth addiction, while outpatient treatment is more effective, he said.

“Given state-of-the-art outpatient treatment, spread over a sufficient length of time, with the superimposition of a drug court professional, about 65 to 70 percent [of addicts] were sober at a year,” Stalcup said. “That’s historic news for an otherwise fatal disease.”

Stalcup presented an overview of meth addiction from a physiological standpoint, detailing the neurochemical basis of the disease. After defining drugs as pleasure-producing chemicals that activate feelings of euphoria, Stalcup explained how drugs like meth damage the pleasure system of the brain.

“Once damage sets in, you don’t get pleasure out of things you used to do,” he said. “They [drugs] take away from us a lot of things that make it possible for us to live in society and community.”

Stalcup said understanding neuroadaptation, the process by which the reward and pleasure centers of the brain adapt to high concentrations of neurotransmitters, is essential to fully comprehending meth addiction. The damage caused by neurotransmitter insensitivity leads addicts to feel the opposite of being high when sober, thus the opposite of euphoria, he said.

This over-stimulation of the pleasure centers of the brain interferes with the normal experience of pleasure, Stalcup said, and thereby addiction is defined as a disease of the pleasure-producing chemistry of the brain.

“Once you’ve neuroadapted, your brain is not the same. There is a horrible interference with [an addict’s] ability to experience normal pleasure,” he said. “… Someone who is re-entering sobriety from a period of drug use, that’s the way they feel. It’s a joyless, flat and empty existence. Frankly, a lot of people can’t take it.”

Stalcup discussed what he called the “pleasure” or hedonic scale, and said most people have experiences within the normal range. Euphoria is at the top end of the spectrum, while dysphoria, a severe stage of displeasure, is at the bottom. He said meth addicts experience a prolonged feeling of euphoria when high and then experience anhedonia, or a loss of pleasure, when not.

Complete recovery from a meth addiction is a very complex process that can take a significant amount of time, he added.

“Current research says once the damage is done, it takes months to years to repair the damage, restore the dopamine receptor population to its normal level and regain the normal hedonic response,” Stalcup said. “We know from a number of studies that the craving and hedonic response to exposure to meth lasts at least seven years. Seven years where your pleasure is not normal. That’s a long time to deal with that.”

The subsequent loss of dopamine receptors in the brain creates a second disease process called low D2 hypofrontality, and is the basis of the disease of addiction, Stalcup explained. Hedonic disregulation, which is the state of dysphoria where addicts experience persistent boredom and drug hunger coupled with low D2 hypofrontality, are the two major pathophysiological components of the disease of addiction.

Stalcup said modern treatment plans are designed around craving, since it’s vulnerable to intervention and is the main symptom of meth addiction. He explained the Craving Identification and Management (CIM) treatment model where relapse prevention workshops, individual counseling, medical services and alcohol/drug testing are administered.

“When you recognize craving, it is possible to manage craving without using. That is the essence of treatment,” he said. “Addiction is a disease where you use under conditions of craving.”

Stalcup said that the circumstances in which a person becomes addicted to meth vary. At first, usage may be infrequent, but then can transform into a regular use pattern.

“These people are at the beginning of the pipeline that’s eventually going to lead to the late stages of the disease,” he said. “Early detection is something we don’t do enough.”

Stalcup said there is a brief period of time called a “moment of clarity” that addicts typically experience. Based on research, Stalcup said, this period, which typically lasts three days, is where an addict’s motivation for treatment is at its most ideal level.

Smoking meth is a lot more potent than snorting it, Stalcup said, citing a recent estimate from the National Institutes of Health that stated if a person smokes meth just three times, brain neuroadaptation sets in quickly and the person becomes addicted to the drug.

“If the standard unit of pleasure is the human orgasm, the first hit of meth generates dopamine equivalent to about 10 orgasms…. This can be horrendously damaging to the pleasure system of the brain,” he said. “It is equivalent to a horrible, loud thunder clap of the brain. There’s just no safe way to smoke this drug without hurting yourself. This is not a recreational drug.”