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At the outset, a discussion about meth requires some brief clarification on the different drugs in this category. Methamphetamines belong to the stimulant drug class. Within the methamphetamine group, there are licit and illicit drugs. Licit methamphetamine is used in a prescription drugs, such as Desoxyn (methamphetamine and hydrochloride), a prescription medication that is indicated for uses in those with ADHD or as a weight loss therapy for obese individuals.1
To further clarify, prescription stimulant drugs such as Adderall contain amphetamine (methylated phenylethylamine), not methamphetamine (double methylated phenylethylamine). In the body methamphetamine breaks down into amphetamine. Desoxyn abuse can occur but individuals who are seeking a meth high are more likely to abuse more potent variants, such as foreign meth pills or crystal meth.
Since pharmaceutically manufactured methamphetamine has therapeutic value in the medical community but also a high potential for abuse, this stimulant has a Schedule II classification under the federal Controlled Substances Act.2
It may not be well known to the general public, but there are meth pills that are manufactured abroad, in countries such as Burma. These pills typically contain both methamphetamine and caffeine.3 These meth pills come in an assortment of colors, stamped with figures or letters such as WY, and they are internationally smuggled to US streets where they are known by nicknames such as Yaba.
Texas has an estimated population of 25,145,561 people, second only to California (37,253,956) and right ahead of New York (19,378,102). The top three largest cities by population are Houston (2,099,451), San Antonio (1,327,407), and Dallas (1,197,816).
Sources: IPL, 2010 Census
Writer David Sheff authored the New York Times bestseller Beautiful Boy, a harrowing but insightful memoir about his experience of his son Nic Sheff’s addiction to meth. Nic Sheff later authored the New York Times bestseller Tweak: Growing Up on Methamphetamines(and a second memoir, We All Fall Down) in which he details the repeated trauma he faced in a cycle of getting clean and then relapsing on meth. Nic often admits that he knew crystal meth had commandeered the driver’s wheel in his life, leaving him to ride as a passenger and commit a host of crimes, such as theft and prostitution, to keep his addiction fueled.
The presentation of the father’s story and the son’s story, in separate books (which was unplanned – when David Sheff wrote his book, Nic was still very much plunged in addiction) tells two sides of addiction that are helpful for anyone affected by this drug.
Sources: David Sheff, Tweak
ccording to the National Drug Intelligence Center, the true volume of Yaba that enters and is consumed in the US is difficult to discern. It appears to be in circulation in Los Angeles and Northern California, which are gateways into the rest of the country.4
Meth is a crystalline powder, generally white or yellowish. This drug has several street nicknames such as crystal, ice, glass, crank, and speed. This drug is not methamphetamine, but it is close in chemical structure. The chemical formula of street meth is usually d-methamphetamine HCI. This street drug has no legitimate therapeutic value and is abused recreationally for its euphoric effects.
This drug can be crushed or used in its crystal form, depending on the method of administration. According to street use accounts, there are different ways to take meth. This drug can be swallowed (such as in gel caps or wrapped in a bit of toilet paper, called parachuting), snorted, smoked, injected (also called slamming), hot railed (involves use of a hot pipe over a line of the drug and inhalation of the resulting vapors), or booty bumped (involves administering the drug through the anal cavity).5
Aside from the danger of addiction, and a host of negative physical and psychological effects, meth is exceptionally dangerous because its illegal makers may mix in amphetamines or potentially poisonous chemicals, such as lantern fuel, battery acid, drain cleaner, and antifreeze.6 When meth results in an emergency room visit, the patients either present with complications related to the drug itself, poisoning from the additives, or accidents (e.g., burns from making this drug in an illegal lab).
The Gulf Coast Addiction Technology Transfer Center provides statistical data from different sources on the prevalence of meth use in Texas along with additional helpful information. Highlights of the center’s most recent report include:
Meth abuse is considered to have reached the level of an epidemic in Texas. Authorities site the relatively easy availability of meth as a main contributing factor. As the Dallas Morning News reports, drug gangs in Mexico have released a flood of methamphetamine onto the Texas street drug market.8
The DEA estimates that greater than 90 percent of the meth in Texas has come from sources in Mexico. According to statistical research, the surge in meth abuse has caused Mexican drug gangs to decrease their volume of cocaine sales. For instance, in 2011, there were 16,908 kilos of cocaine seized at the Mexico/Texas border compared to 7,143 kilos in 2012 (which amounts to a 58 percent decrease).
The meth operation reportedly runs from secret Mexican laboratories to drug houses in Texas. The drug comes over the border in the form of a liquid. The liquid is then taken to designated drug houses in both large and small cities, and converted to meth.
The meth cookers in Texas include families who most would not suspect by looking at their lives from the outside. Meth is a powerful equalizer and does not discriminate based on socioeconomic status; those who use meth in Texas include individuals with criminal histories as well as teachers and lawyers. According to a district attorney in Marshall, nine out of every 10 drug cases deemed low-level in his East Texas county involves the sale or possession of meth.9
As The Texas Tribune reports, an increasing number of Texans are seeking treatment for stimulant abuse.10 Per the Treatment Episode Survey (sponsored by the U.S. Substance Abuse and Mental Health Services Administration), in 2014, 6,219 Texas residents received treatment for methamphetamine and amphetamine abuse at rehab centers. The number seeking treatment rose considerably from 2013, when only 590 did so.
In 2014, among drug rehab treatment facilities, 15.8 percent of the Texans who sought help stated that amphetamines were their primary drug of abuse. The number of people in treatment and the number seeking treatment for stimulant abuse were higher than the rates for 2006. Texas is not alone in this respect. In 2014, 4,000 Georgia residents sought treatment for meth abuse, an increase of 1,143 from 2012.11
There appears to be a consensus among Texas officials and addiction specialists that more people may be seeking treatment because of the increased potency of Mexican-made meth. In addition, more people may be using meth because of the high volume of this drug crossing over from Mexico. The Combat Methamphetamine Epidemic Act of 2005 (CMEA) (which became law on March 9, 2006) helped to shut down illegal US meth labs by limiting sales of over-the-counter medications that contain drugs used in meth manufacturing (e.g., phenylpropanolamine, ephedrine, and pseudoephedrine).12 However, an unintended outcome is that meth made and distributed by Mexican gangs is filling the hole in the market that the CMEA created by shutting down US labs.13 The uptick in treatment admissions for meth may owe in part to people quitting this drug when demand initially waned post-CMEA, and then returning to it once Mexican meth flooded the market.
Texas can be thought of as having experienced at least three meth-related phases: pre-CMEA, post-CMEA, and post the advance of Mexican-made meth. The Gulf Coast Addiction Technology Transfer Center at the University of Texas, Austin provides information on pre-CMEA trends regarding treatment for meth abuse as well as some insights into those who used this drug during that time. Based on different surveys covering the years 1985-2005, the following was found:
According to an addiction treatment specialist in Austin, meth is inexpensive, which makes it attractive among other more expensive street market options. The low cost and relative ease of access contributes to the observation of an addiction specialist, affiliated with centers in Dallas, Austin, and Houston, who reported that more teenagers have been admitted to his rehab centers than ever before.14 Overall, while national research sponsored by the U.S. Substance Abuse and Mental Health Services Administration has found that abuse rates for meth have not changed much, states like Texas have had periods of fluctuations in supply that have led rates to dip only to rise again.15
Despite the current reality of epidemic levels of meth abuse in Texas, the increase in the number of Texans seeking treatment at a minimum signals that many individuals who use this drug have a desire to stop using it. If recovering meth abuser Nic Sheff’s personal account is taken into consideration, many who are addicted to this drug have a desire to quit but often lapse back into use because the withdrawal symptoms are comfortable, if not painful, and there are strong cravings for the drug during this time. Over time, ongoing meth abuse can be more about wanting to stave off withdrawal symptoms than wanting to experience a meth high.
The Public Broadcast System (PBS) Frontline series covered meth abuse in documentary fashion in the episode “The Meth Epidemic” (2011). The show begins with meth’s first appearance as a drug of abuse in the 1970s when it was a fad drug among West Coast motorcycle gangs. It continues along meth’s timeline to show how this dangerous stimulant gained popularity and reach epidemic heights.
Attention is paid to international criminal stakeholders, including Mexican drug gangs and how they have worked around US laws limiting the sales of over-the-counter medications that contain legal drugs that can be distilled into meth. This investigative documentary succeeds in revealing the life of meth in the separate but related spheres of American streets, US governmental bureaucracy, and international drug smuggling rings.
Source: PBS Frontline
The geographical component of treatment services revolves around convenience, which is a factor in keeping people in treatment. An individual may seek treatment in Texas for several reasons other than residency, such as the strength of the programs in the area of meth abuse treatment.
As a general matter of clinical practice, meth abuse treatment typically begins with medical detox, which is immediately followed by intensive therapy. Addiction treatment literature may reference medication-assisted therapy (MAT), which consists of targeted addiction treatment medications. It is important to understand that while there is ongoing research in the area of pharmacology and addiction treatment, at present, the U.S. Food and Drug Administration has only approved medications to treat recovery from alcohol and opioids. There are presently no medications officially approved for use during meth withdrawal.
One of the greatest benefits of a detox at an outpatient or inpatient program is the supervision and monitoring involved. Meth withdrawal is associated with a host of symptoms, including depression, fatigue, a lack of emotion (anhedonia), general malaise, pain, suicidal thoughts, and/or cravings for the drug.16
Relapse is often cited as part of the recovery process. There is a considerable risk of relapse due in large part to how meth operates in the brain. A supervised detox can provide a strong safeguard against relapse and keep a recovering person in a program so the benefits of recovery can continue to take hold and supplant drug-related thinking and behaviors.
A discussion on meth in Psychology Today insightfully explains the psychological aspects of meth withdrawal and its effect on relapse.17 In the case of meth abuse, levels of dopamine decrease in the brain, in addition to some of the dopamine receptors being damaged and impaired. This explains why, in part, much of the literature around meth recovery states that it takes at least two years for the brain to return to its pre-meth state of functioning (i.e., it can take dopamine receptors that long to rebuild and repair themselves). Due to the decrease in dopamine in the brain, as stated above, recovering individuals are likely to experience anhedonia, the clinical name for the state of being unable to experience pleasure. The ensuing depression is one reason why recovering people may resume meth use in order to feel normal again.18 Staying abstinent is paramount so the brain can begin its journey to repair itself.
After detox, the main component of recovery treatment is therapy. As the National Institute on Drug Abuse discusses, certain forms of behavioral have been tested and proven to be effective in the meth abuse treatment context (i.e., these are research-based approaches).19
Examples of behavioral therapy include the Matrix Model, Contingency Management (CM), and Cognitive Behavioral Therapy (CBT). Different therapy approaches may be used at different times or alongside one another. The therapy approaches taken at a particular rehab center mainly depend on which ones are considered to be most compatible with the center’s overall treatment philosophy. As the examples provided here are research-based, they are likely to figure into many meth treatment programs.
According to the Substance Abuse and Mental Health Services Administration, the Matrix Model is built off 20 years of clinical experience in addiction treatment.20 Over a 16-week period, participants in this program engage in individual counseling, education groups, relapse prevention groups, and social support groups. They are also given urine and breath tests for alcohol or other drug detection. Family members may also be brought into educational and counseling programs. The therapists involved serve as teachers, coaches, and positive role models, as they guide and encourage positive change in participants without taking on an authoritative or parental role. This bundling of services essentially targets the psychological, familial, and social factors involved in drug abuse.
Contingency Management interventions have been shown to be effective during the early stages of recovery. Aimed at keeping a person in treatment, CM provides rewards to participants to stimulate and reinforce behaviors that are supportive of abstinence.21 Rewards can include vouchers, points, or prizes for healthy activities, such as going to a movie, having dinner out, or fitness classes. This system is intended to address the rewards-based system in the brain that is involved in meth abuse. The rewards stimulate pleasure, but it is a healthy form of pleasure. As recovery time increases and those benefits take hold, typically, the need for CM should decrease and more emphasis is placed on therapies, such as CBT, which is aimed at teaching recovering individuals how to strategically think about recovery.
CBT has been proven to be effective as a relapse prevention measure in meth treatment services.22 The cornerstone of CBT is the assumption that the way people think plays a critical role in the development of drug abuse. In short, the learning process gets maladapted by virtue of the thought that using drugs is a way to cope with stress. CBT sessions take clients through an awakening type of process where they are guided to identify the thoughts underlying their drug use patterns. Once identified, these thoughts can be interrupted when they occur. For instance, a person may experience a drug cue (which can include people, places, things, and even odors), be able to intercept the impulsive thought to use drugs, and choose to do something else, such as go for a run or a call a sober sponsor.
After graduation from an intensive rehab program (inpatient or outpatient), a recovering person is always advised to engage a combination of aftercare services. Group recovery meetings are one of the most common and beneficial types of aftercare. Group recovery meetings are led by members, and may follow the 12-Step format.
In addition to the nationwide Narcotics Anonymous group, a 12-Step fellowship, Crystal Meth Anonymous (CMA) meetings are designed for those recovery from meth abuse. The group’s official site explains that there are never any membership dues, and the only requirement for participation is a desire to quit this drug/abstain from this drug. Although the group has a spiritual 12-Step basis, it is non-religious and a member’s religious background, if any, is irrelevant.
Recovery from meth abuse, however advanced, is possible. Bestselling author Nic Sheff has become the informal poster boy for meth recovery. After more than three rehab stays and relapses, Nic ultimately attained sobriety (currently in his 8th year and counting), began a career as a writer, got married, and started a family. In an article for The Fix, Sheff reflects on his recovery process and shares that as the years pass, his addiction remains with him as a disease, but it has ceased to be his defining quality (even though it is the source of his national fame).24
Sheff is not certain at which point anyone can state they are recovered, and some think it is more accurate to permanently state recovering. Sheff feels that he has recovered from meth addiction, though he acknowledges that relapse, however unlikely, may always be a lingering concern. He notes, however, that if he were ever to face this possibility, he knows how and where to get help.