Chapter 4
Treatment for Stimulant Addiction

In the United States, experts estimate that stimulant abuse costs citizens about $43,000 a year for each addict who steals, receives welfare after losing a job, forfeits his or her children to custody of the state, or goes to jail. On the other hand, it costs about $16,000 to provide the best treatment available for that same addict. For most, treatment is the only way back to responsible living.

The Nicotine Trap

The number of people addicted to nicotine, one out of three Americans, is much greater than the total of both cocaine and amphetamine addicts. Surveys conducted by the American Lung Association found that 70 percent of nicotine users say they would like to quit. However, nicotine is a tough drug to walk away from. One regretful smoker put it this way: "In a London subway, I once saw a sign that said, 'Addiction to nicotine is worse than addiction to heroin.' At the time I first read this sign, I thought it was a complete exaggeration. But now, eight years later, I am convinced it's true."⁵⁵

Dinah, a smoker for twenty-two years, recalls the difficulty she had in quitting. She describes her experience:

I tried to quit "Gracefully," there was nothing graceful about it, besides the "miracle of Grace" in actually quitting. I fought tooth and nail against cravings, bad attitude, and anxiety. Every single morning I would have to decide whether or not to smoke that minute, that hour, that day. My mind would pop the question, "Time for a smoke?" It was horrible.⁵⁶

Even the rituals associated with smoking make the goal of quitting a very tough one to achieve. Studies show that the hand-to-mouth motion is comforting to smokers. In fact, 80 percent of ex-smokers surveyed said that they were always looking for something to pick up and put in their mouths. Similar conclusions were reached in a survey by the American Lung Association, which found that smokers who want to stop really miss "having something to hold in [their] fingers."⁵⁷

When Being a Quitter Is Good

Most smokers try to quit at least once a year. Many are not successful on their first try; on average, it takes more than five attempts to stop smoking for good. Seventeen-year-old Amanda tried several times before she quit. She says,

In the beginning of the year I had a smoking habit. It was very hard to stop and it took me three tries. (Even with the help of my mom, my teacher, and my friends.) Smoking may seem cool and fun but it's not. My 7-year-old brother wants to smoke because I did. It's hard for him to understand that it's a bad thing and that it hurts you.⁵⁸

Few people quit cold turkey, or stop abruptly, without help. Most need a tailor-made, step-by-step plan. The American Lung Association has created a "Quit Smoking Action Plan" that lets smokers pick a strategy that works for them. The plan suggests setting a target date on which to completely stop smoking. Writing the date on a calendar and telling one or two good friends about the plan also helps; friends can provide emotional support. On the night before the target date arrives, smokers should get rid of all tobacco and tobacco accessories, like lighters, matches, and ashtrays.

The American Lung Association also advises that it is easier to carry out the strategy at a time when life stressors are minimal; that way, the plan can receive top priority for three to four weeks. The best plans are those that include several actions, each designed to reinforce the other. Smokers are encouraged to make a list of all the reasons it is important to stop smoking, and to carry that list in a pocket or purse. It also helps to stay away from other smokers and from places where smoking seems natural. This may require a change in daily habits. For example, if smoking after dinner was a habit, then the usual routine could be changed so that the time after dinner is spent on a stroll outdoors instead.

Some research shows that if cessation is gradual, withdrawal symptoms are not as severe, and nicotine addicts are more likely to stick with their plan. To taper off nicotine gradually, some people benefit from pharmacological help such as nicotine gum and patches. Nicotine patches introduce a small amount of nicotine to

the body over a period of several hours. For those who need more help, counseling and support groups, hypnosis, acupuncture, or some antidepressant medications may be useful.

It is possible to quit smoking, and people do it every day. With time, effort, and a little help from friends, they conquer the habit and feel more in control of their lives and futures.

Opting for Treatment

During the 1970s most people believed there were few, if any, dangers associated with either legal or illegal stimulants. When cocaine use peaked in the 1980s and 1990s, addicts flooded the medical community with requests for help and treatment, presenting a new problem for practitioners. Very few members of the medical and counseling communities had seen or treated cocaine addiction before. Thus, few treatment plans or centers existed for cocaine addiction.

By the 1980s physicians and counselors knew a little about how cocaine and amphetamines affect the body. As a variety of strategies came and went, doctors learned what works and what does not work in the way of treatment. One of the oldest drug treatment centers is San Francisco's Haight Ashbury Free Medical Clinic. Started in 1967 by Dr. David Smith, the clinic originally opened its doors to treat drug users during a summer festival. Today the clinic has expanded its services to include both immediate medical care and a residential recovery program that treats cocaine and methamphetamine addicts.

At the Haight clinic, and in other stimulant abuse treatment centers around the United States, the goals are to help addicts give up drugs, learn to cope with their problems, and rebuild their lives. Clients are usually involved in months, or even years, of work. For the first six months, most undergo very intense treatment. After that, follow-up counseling can last for years.

The success of treatment depends on the willingness of the addict to overcome his or her problem. In other words, to be successful, an addict must be motivated to get better. K.R. is a young man who used stimulants heavily. He decided to quit after losing forty-five pounds in four months due to drug use. With the help of counselors, K.R. says, "I went through about 1 month of withdraws…. Now I want to get my life straight and there is ab solutely no room for speed in my life…. I consider doing speed the biggest mistake of my life."⁵⁹

Unlike K.R., many illegal stimulant addicts do not enter treatment voluntarily. According to research conducted by the Koch Crime Institute,

Methamphetamine causes a variety of mental, physical and social problems which may prompt entry into treatment…. The most commonly reported reason why methamphetamine users enter treatment is trouble with the law. These legal problems include aggressive or bizarre behaviors which prompt others to call police. Other reasons for entry include mental or emotional problems and problems at work or at school.⁶⁰

Counselors have found that the best time to talk to addicts about voluntary treatment is when they are coming down from the thrill and euphoria of their last stimulant rush. Says John DiDomenico, supervisor of the Haight Ashbury clinic, "Nobody wants to face the crash. It's real easy to grab them at that point."⁶¹ The crash can be such a difficult and scary experience that users who previously did not want to quit often see the value of help.

Starting with a Clean Slate

All treatment programs begin with detoxification, sometimes known as detox. Detox refers to the period of time during which the body eliminates all of the drugs in its system. It is an essential step in recovery, because all traces of the drug must be removed from tissues of the brain and body before they can completely heal.

When they enter treatment, coke and meth users may be physically run-down. During detox they need a safe place to sleep for several days so that their bodies can start recovering from exhaustion. Many users receive care for problems like rotting teeth, infected skin, or infectious diseases.

During detox, people undergo both physical and mental withdrawal symptoms. Withdrawal causes cravings and discomfort, so it can be tough to endure. Because of this, some recovering addicts prefer to detox as inpatients, remaining under the supervision of hospital personnel. If they need help with anxiety or pain, they can easily receive it in a hospital setting. Others, though, choose to detox at home. Outpatient detox works well for those who feel certain that they can stay off stimulants and promise to enroll themselves in a drug treatment program as soon as their detox is complete.

Avoiding Cues

Once the drugs are out of the body and the person's physical needs are met, the mental and emotional work can begin: learning to cope with problems without turning to drugs. One recovering addict says that counseling helped him understand that he used coke and meth to camouflage the real emotional issues in his life. Looking back, he now realizes that he felt "insecure [and not] worthy of anything in this world."⁶² By taking stimulants, he avoided facing, and dealing with, his problems. Now, by finding and expressing feelings instead of ignoring them, he has learned how to deal with his emotions in a safer way.

In counseling, addicts learn how to manage cravings and to avoid risky cues to prevent a relapse. Cues are stimuli, like friends, places, or drug paraphernalia, that a person associates with the stimulant's effects and that can trigger strong desires for the drugs. In both cocaine and meth addiction, relapse rates are highest when addicts do not avoid their old cues.

Some cues are much harder to avoid than others. Maryaka, a young mother, found that her strongest cues were the people who had been a part of her life when she was using drugs: her friends, her parents, and even her daughter, Krystal. To end her destructive relationship with stimulants, Maryaka had to get away from all of the reminders of her past drug life, including these family members. The hardest one for her to give up was her daughter. Eventually, she let Krystal move in with her father who lives in another state. For Maryaka, letting Krystal go was part of her own recovery. "If I see her, I know I'll relapse. I have to think of myself, and seeing her is one of my triggers to use."⁶³

The Matrix

Patients continue their counseling in either an inpatient or outpatient setting. Currently, many clinics are using the Matrix model, a method of outpatient therapy that is backed by research from the Center for Substance Abuse Treatment (CSAT). Over a four- to six-month period, clients take part in treatment for their minds as well as their bodies. They attend at least three group or individual therapy sessions per week where they receive coaching and support.

In addition, they go to family therapy, take part in relapse prevention treatment, and participate in frequent progress checkups with urine tests to confirm that drugs are no longer being used. The Matrix plan also encourages clients to attend a communitybased, self-help program, such as the twelve-step program. Twelve-step groups, found in almost every community, teach that recovery from addiction is an ongoing process that requires continual work. All of this work pays off: After one year, 60 percent of the clients who follow the Matrix plan are still no longer using stimulants.

Straight Talk

Diana is a nineteen-year-old recovered addict. She was addicted to both meth and cocaine in high school. Today, she talks to kids whenever she gets a chance to tell them about her addiction and recovery. The East Central Minnesota Post Review covered her story in "Teen Gives Straight Talk on Addiction."

Diana had tried other drugs, but on the night of the junior-senior prom, she says, "I tried meth for the first time. I liked it and I was addicted that first time." Diana says that she stayed high for one whole year. "I surrounded myself with other people who were getting high all the time." When she finally realized that drugs were not making her happy, Diana confessed to her parents that she was an addict. The next day, they enrolled her in a treatment program, but she lasted only two weeks. She went back to school and started using again. In no time, an accidental overdose landed her in the hospital.

Diana moved to an inpatient facility, where she finally made up her mind to stay sober, and she has succeeded. After returning to school, she graduated as valedictorian of her class. Now she is a college student, excited at the prospects of graduating and getting a job and apartment. "My friends have showed me that life is so much more fun without drugs. There are so many other things to do."

An anonymous addict who identifies himself as SFJ says that the Matrix-style treatment worked well for him:

I am a methamphetamine addict. It would be more precise to say, "I was an addict." I quit using September 14, 2001…. I am now in an intensive outpatient program. I go to therapy every day, individual counseling on a weekly basis, and medical psychiatric counseling every other week…. It has been a positive experience.

SFJ encourages others to be patient and give a treatment program time to work. "It takes as long to recover as it did to quit. For example, if you used two years, it takes two years to recover."⁶⁴

Extended Care

Addicts who need more structure and guidance can join inpatient programs. The standard inpatient plan is a twenty-eight-day stay in a hospital or residential treatment facility. Each day clients participate in self-help groups and group therapy and practice relaxation techniques. Inpatient programs are designed to be supportive yet confrontational enough to force clients to face their problems and get actively involved in their own treatment.

Long-term residential treatment is good for those who cannot, for social or psychological reasons, return to the community after inpatient treatment. Such programs can help clients make permanent changes in their attitudes about drugs and their lifestyles. Programs generally vary in length from ninety days to one year. In most cases, some of the support staff includes recovering stimulant addicts, people who are uniquely qualified to understand the problems facing their clients.

One type of long-term treatment is the therapeutic community (TC). The TC is a highly structured environment where addicts participate in regularly scheduled group activities that help them reevaluate their lifestyles, attitudes, and values. TCs strongly emphasize the addicts' own responsibility for their choices and behaviors, and they help addicts learn life skills and self-reliance. Many clients are referred to these facilities by the court system.

When clients graduate from TCs, they often move to halfway houses, where they still receive support but have more freedom to come and go as they please. Betty, who started taking cocaine at the age of twelve, says, "I never felt like I fit in. I had a lot of insecurities." After eighteen months in prison on drug charges, she was released to a halfway house. Once she was out of prison, she was terrified that she would revert to her old drug habits. But counselors in the halfway house helped her adjust. Betty found the halfway house to be a warm, secure place where she could recover. "I compare my experience at the House to that of a child who has hurt herself. She goes to her parent to get her boo-boo kissed. She still has the boo-boo, but she feels better."⁶⁵

A Brain on Meth

Even though cocaine and methamphetamine have similar dangers, many doctors believe that meth addiction is more difficult to treat than cocaine addiction. Mounting evidence strongly suggests that the early changes in brain tissue caused by meth may be permanent. If ongoing research proves this to be the case, a shortfall of neurotransmitters in the brains of meth users cannot be reversed, resulting in reduced mental function and loss of motor skills.

Cocaine users recover normal neurotransmitter production after a few weeks of their last use of the drug. Former meth users, however, still experience extremely low levels for months or years. A person with low levels of neurotransmitters feels tired and depressed and has trouble with higher-level reasoning skills like problem solving. As a result, it is hard for them to commit to and stick with a treatment program.

In Search of a Medical Treatment

Armed with this information and much more, the National Institute on Drug Abuse is involved in research on several fronts to find a medical treatment to lessen or reverse the damage caused by stimulant abuse. Some researchers are working on bringing medications to the market that can reverse damage to brain cells. Another group of scientists is working with a medicine that improves the body's ability to make neurotransmitters and help restore normal levels. Elsewhere, scientists are working with antidepressants, chemicals that seem to help addicts deal with the inevitable lows.

In other research, scientists are experimenting with a drug that prevents cocaine from stimulating the brain. In one lab, a cocaine vaccine with the code name TA-CD is under development. Cocaine is a very small molecule, so it can travel through the protective blood-brain barrier that is designed to keep foreign matter away from the brain. It is also too small to be recognized by the body's immune system. However, TA-CD stimulates the immune system to recognize cocaine and then make protective molecules, called antibodies, against it. When antibodies attach to them, cocaine molecules become too large to enter the brain. The hope is that the vaccination will keep cocaine out of a patient's brain and therefore prevent it from producing its characteristic high.

Alternatives to Jail Time

In the 1980s, judges were held to strict sentencing guidelines for drug offenses. But when the same offenders kept appearing in court over and over again, the legal system decided that time in jail was not solving the problem. As a result, a new program called Family Dependency Drug Court was implemented.

Twenty-one-year-old Zigmond Gryzbowski Jr. was arrested in August 2001 due to meth use. Ten years ago, a judge would have sent the young man straight to prison. But because of changes in the sentencing of drug addicts in Kitsap County, Washington, Gryzbowski was able to check into a treatment center and participate in Family Dependency Drug Court.

This program reflects a shift in philosophy to one that focuses more on treating the cause of stimulant addiction rather than punishing users. The family dependency court is being piloted in several Washington counties. The addicts and their families meet in court weekly. All have been through drug treatment programs and are involved in ongoing work with drug counselors to fight addiction. "[The family dependency court] creates a web of support so if they start to slip, we can catch them as quick as they fall," coordinator Cherie West tells Angela Smith with SunLink.com.

The program is young, but it seems to be working for Gryzbowski and many others. According to West, "There are some people who blow it, … but there are a lot of successes."

Scientists are also looking at a drug that may help reduce cravings. N-acetyl cysteine, or NAC, can eliminate the rewards associated with cocaine use. So far, NAC has only been tested on rats, but it is now ready for human trials. According to researchers at the Medical University of South Carolina, NAC works by boosting levels of glutamate, a neurotransmitter, in the brain. Glutamate levels rapidly increase when cocaine is ingested but decrease significantly in the brains of regular cocaine users. Dr. David Baker found that "treatment with n-acetyl cysteine not only restores glutamate to normal levels but also prevents glutamate levels from sharply increasing following subsequent injections."⁶⁶

There Is Good News

To date, the best treatment results are seen when an addict takes advantage of an array of techniques, such as medication, counseling, and behavioral therapy. Many medical professionals liken the healing of an addicted brain to the recovery of a broken leg: The injured body part needs medical support, safety, and enough time to successfully complete the healing process.

Mark Miller knows that recovery is a lifetime commitment. Mark, who started using meth in his late twenties, first entered treatment in 1999 at the age of thirty-five, suffered a relapse, and then returned in 2000. Journalist Jon Bonné reports that even though it has been a struggle, Mark is doing well and keeping busy. He is

working at Gold's Gym and exercising every day. He takes antidepressant medication, attends church on Sunday, and goes to recovery group meetings almost daily…. [Mark] acknowledges that he could easily feel sorry for himself, but he says part of the healing process has been learning to cope with how his life turned out. [He says,] "I don't have to be a cry-baby about it."⁶⁷

Since stimulant addicts are a diverse group, no two patients experience the same results or heal on the same schedule. Ultimately, the work of recovery is done by the addicts themselves. They are the ones who must make difficult decisions and stick with them. Their reward is an opportunity to return to life as they knew it before stimulant addiction.