Episode 41

What is meth and why would people use it?

Have you ever thought “Why would someone ever use meth?” Even those who know how bad it can be still can end up using it and falling into a full blown meth addiction. This episode sheds light on the attraction of meth and why it’s so hard to quit.   

Helpful Links

History of the methamphetamine problem – PubMed

History of Methamphetamine | Methamphetamine: Implications for the Dental Team | Continuing Education Course | dentalcare.com

The History of Crystal Methamphetamine – Drug-Free World

History of Meth – HISTORY

How is methamphetamine manufactured? | National Institute on Drug Abuse (NIDA)

Methamphetamine Production | Methamphetamine: Implications for the Dental Team | Continuing Education Course | dentalcare.com

How to Recognize a Meth Lab

5 Ways to Know There’s Methamphetamine in Your Home

Recognizing a Meth House or Structure

Know the Risks of Meth | SAMHSA

Household Contamination with Methamphetamine: Knowledge and Uncertainties

What are the long-term effects of methamphetamine misuse? | National Institute on Drug Abuse (NIDA)

How Meth Destroys The Body | The Meth Epidemic | FRONTLINE | PBS

Breaking Bad and crystal meth – a chemical reaction

Are You Living in a Former Meth Lab? – Scientific American

The Many (Surprising) Health Benefits of Meth – Pacific Standard

Understanding the Feelings of a Meth High

Methamphetamine (Desoxyn): ADHD Drug Side Effects, Addiction & Withdrawal

Methamphetamine Toxicity – StatPearls – NCBI Bookshelf

Meth Has Health Benefits? In Low Doses, It Might Just Cure A Number Of Ailments – GQ

Crystal Meth

Methamphetamine | Effects of Methamphetamine | FRANK

Is There a Safer Way to Use Meth? Some Portlanders Are Trying to Provide One. – Willamette Week

An ex-meth addict describes in detail what it feels like to take meth – it’s a long video but I found it incredibly interesting (and scary) : videos

How is Methamphetamine (Meth) Consumed? | The Recovery Village

Symptoms and course of psychosis after methamphetamine abuse: one-year follow-up of a case. – Abstract – Europe PMC

A Comparison of Methamphetamine-Induced Psychosis and Schizophrenia: A Review of Positive, Negative, and Cognitive Symptomatology

Methamphetamine Psychosis: Why It Happens and How You Can Get Help

Frontiers | A Comparison of Methamphetamine-Induced Psychosis and Schizophrenia: A Review of Positive, Negative, and Cognitive Symptomatology | Psychiatry

How Is Meth Made? Ingredients and Cutting Processes – Oxford Treatment

Timeline of Meth Withdrawal | Banyan Texas

What are the immediate (short-term) effects of methamphetamine misuse? | National Institute on Drug Abuse (NIDA)

How long does meth stay in the system? | Drug Policy Alliance

Why do people use meth? | Drug Policy Alliance

What Does Using Crystal Meth Make You Feel Like? – Drug-Free World

Methamphetamine Withdrawal Symptoms, and How You Can Get Help

Methamphetamine: What To Expect When Someone Quits

Withdrawal symptoms in abstinent methamphetamine-dependent subjects

Drug Index – Meth – 10 ways to keep well – DrugHelp

IAmA Former meth addict · GitHub

I was a high-functioning meth addict for a decade | SBS Voices

Methamphetamine Psychosis: Epidemiology and Management

Long-Term Effects Of Meth Use

What are the Long-Term Effects of Meth? – San Diego | API

Partial Recovery of Brain Metabolism in Methamphetamine Abusers After Protracted Abstinence | American Journal of Psychiatry

Decreased dopamine activity predicts relapse in methamphetamine abusers | Molecular Psychiatry

Researchers Find A Way To Help People With Meth Addiction Avoid Relapse : NPR

Methamphetamine (Meth) Addiction | Crystal Meth | Hazelden Betty Ford

Desoxyn (Methamphetamine Hydrochloride): Uses, Dosage, Side Effects, Interactions, Warning

Methamphetamine Induces Dopamine Release in the Nucleus Accumbens Through a Sigma Receptor-Mediated Pathway | Neuropsychopharmacology

Explainer: What is dopamine? | Science News for Students

Methamphetamine Regulation of Firing Activity of Dopamine Neurons

Meth In The Body – Meth And The Brain | The Meth Epidemic | FRONTLINE | PBS

What treatments are effective for people who misuse methamphetamine? | National Institute on Drug Abuse (NIDA)

Free Treatment Tool https://betsybyler.com/treatment-tool/


You’re listening to the All Things Substance podcast, the place for therapists to hear about substance abuse from a mental health perspective.  I’m your host, Betsy Byler and I’m a licensed therapist, clinical supervisor, and a substance abuse counselor.  It is my mission to help my fellow therapists gain the skills and competence needed to add substance use to their scope of practice.   So join me each week as we talk about All Things Substance.

Welcome back to the All Things Substance podcast. This is episode 41. Today we’re going to continue talking about methamphetamine. The last episode is dedicated to basically all the facts about meth. Talk about the history, the rise in popularity, the manufacture and distribution of meth, the short-term effects, the long-term effects and the specific risks associated with people using meth in a long-term way.

Today we’re going to be focusing  on something, a little different. We’re going to seek to answer the question. Why would someone ever use meth?

I imagine that lots of people and plenty of you listening have had that thought as you look at pictures of somebody who’s been on meth, as you hear stories of somebody’s life who was destroyed by meth, the natural question is why would someone do that knowing what it does? 

It’s sort of like a pool filled with piranhas. Why would you even stick your toe in the pool? Well, meth is so powerful, it can make somebody make choices that they would never have made in a sober life.

So meth feels good, but what else?

The basic answer is that it feels good, but that’s not a good enough answer. A lot of things feel good.  Pleasure is something that we look for all the time. The pleasure in eating something that tastes amazing or accomplishing something that we’ve wanted to for a long time or spending time with somebody that we love or going to an amusement park and getting a rush from the roller coasters.

The pleasure system in our body is built to make us survive and procreate.  The way our brains are built is to seek pleasure. The basic system at play here is dopamine. Dopamine is the neurotransmitter responsible for the feeling of pleasure. Every time we do something pleasurable, our dopamine level rises in our brain. Our body produces it. We feel it and it’s a message to tell us that we should do that thing again.

So our body was created to take pleasure and want to do it again and again. And so we eat and we have sex. Those are the things that we are designed to do as the base instinct of life.

Dopamine is actually pretty amazing and versatile. While it is responsible for pleasure. It also does other things in our brain. This chemical acts as a messenger between brain cells. It plays a role in how we move as well as what we eat and how we learn. When the brain cells that make dopamine begin to die off  a person can start having trouble initiating movement. It’s one of the symptoms that occurs with Parkinson’s. 

Remember that when someone’s using meth, they’re probably not going to be using meth and nothing else. Most people don’t use meth as their first drug. Remember “drug” in this case also includes alcohol because we’re talking about a mood altering substance.  When someone gets to meth, they’ve usually used other things. They’ve already been working those muscles in their brain to seek more and more pleasure. 

Maybe it’s weed, maybe it’s alcohol, maybe it’s some other kind of drug like cocaine or ecstasy or acid. Any of those things could be precursors for meth. Not because they’re necessarily inherently evil, but just because meth seems really dangerous to most people.

I really don’t know of anyone that’s going to tell you that meth is good for you and not harmful. I have had people tell me that using meth recreationally isn’t a big deal and that they can control it. And in that moment, maybe that’s the case. That isn’t what happens long-term though, because of these changes in the brain.

So to set the stage for why someone would use meth, we have to look at what their behaviors have been like beforehand. By the time they get to meth it’s because the one that they’re using doesn’t seem that big of a deal anymore and probably isn’t as enjoyable as it used to be. The tolerance piece is the problem here

With any drug, the longer you use it, the less your body is going to respond because it’s used to the feeling now.  You have to use more in order to get the same effect. We adapt. That’s a basic function for us.

So meth might be something that they have sworn they would never use. When you’re smoking weed, it seems like it’s really far away. As you get further into the drug culture, though, it seems less scary. And let me clarify. I’m not talking about people who are smoking weed every now and again, using it socially recreationally the way one might use alcohol. We’re talking about people who are smoking all day, every day, where meth doesn’t seem quite as far away as it used to.

Think of it getting in the lake or an ocean or a pool where at first, the water’s really shockingly cold. As you stand there, you get used to it and you can go in a little farther and a little farther. You slowly warm up to the idea and then it doesn’t seem like a big deal.

The mechanism at work here is dopamine. So let’s put some numbers on this so that it makes a little more sense.  Each thing that we do that’s pleasurable is going to raise dopamine levels. I think of it sort of like a faucet where dopamine comes out of the faucet like water would, but there’s always a drain. That’s  gonna take the dopamine back into the system. So here we’re talking about the reuptake of dopamine.

In our normal system when we do something pleasurable, the water turns on, we get a rush of dopamine, we feel good for a period of time depending and then it slowly fades. Each thing we do, we’ll raise the dopamine level to a specific place and it lasts for a certain period of time. 

What makes meth so different from other drugs?

So as we think about dopamine levels, we’ll set the base level at zero.  Because I can’t show you a graph while you’re listening to a podcast you’ll have to imagine it.  If a dopamine level is at zero, then the person does something pleasurable and it rises. 

So let’s take food for instance. Food takes dopamine to about 100 to 150 units. Sex  takes the dopamine level to about 250. As humans without drugs there’s really nothing we can do to get higher than that. It is at the point of orgasm that you get to 250 dopamine. 

That’s your body responding to the orgasm, making you feel the pleasure from it. It’s also designed, of course, to make us want to do that again. If having sex and even having the best sex of your life is at 250, then drugs are going to raise that.  Then we can understand how drugs work.

Nicotine pops it up to over 100, close to 150. It lasts for about 45 minutes and then it drops. This is why people who smoke regularly  tend to smoke approximately every 45 minutes to an hour. If anyone’s wondered how you can smoke 20 cigarettes, that’s a pack of cigarettes by the way, in a day that’s how it works. Your body starts wanting it because the dopamine level is heading back to its regular level.

Alcohol is about between 100 to 200 units. Marijuana is about 150 to 200 units. Cocaine is approximately 350 to 400 units depending. Morphine or opiates are around 200 to 250. In looking at drugs, nothing is higher than cocaine until we get to meth. 

So I want us to remember that when we’re talking about these numbers, these aren’t arbitrary numbers. These are spikes of pleasure. Remember when we talked about crack and cocaine, that crack gets into your system immediately within seconds and has a huge spike. So imagine smoking something and within seconds, you’re at 350. 100 to 150 units higher than the best sex of your life and it costs you five bucks. 

So here’s why meth is so addictive. When you use meth, the dopamine units go up to 1000 to 1500. 1000 to 1500. That can happen in seconds and it doesn’t just last for a couple minutes. It lasts for hours for 4,  6, 12, and depending on the kind that you get, it could last even longer. We’re talking about a rush of pleasure that isn’t fleeting, that you don’t come down from for a really long time. A person feels that, and it feels amazing. 

Now, imagine doing other pleasurable things while on meth. Specifically sex. Sex and meth are really closely linked because sex on meth is like nothing we could ever experience on our own. If a partner isn’t available, then there’s porn. There are people who have been using meth, who would watch porn for hours and hours continuously for days on end.

What we know from the research is that viewing porn is similar in our brains to having sex. It’s not exactly the same because there is some difference between what spikes when a partner touches your skin and when you’re just watching something that’s sexual but it is very similar.

While you’re up having this pleasurable experience, that is  more than anything natural could give you. You got a lot of time. If you’ve got 12 or 14 hours to kill. Let’s imagine that someone’s had this meth experience one time. They go on with their regular life because that’s how people typically do.

They don’t typically start using meth and then use it every day. I would say almost everyone who uses meth even the first time knows it’s dangerous. That people will have their lives ruined. They know that it can make somebody into a walking skeleton where all they care about is getting high.

They believe in their very soul that they’re going to control it, that they are not going to fall victim the way that other people do. We all believe that things aren’t going to happen to us. Self-deception is the hallmark of humans. We believe that we’re going to be unique. We’re not the ones that are going to get COVID. We’re not the ones  getting pulled over for speeding. We’re not going to be the ones that have those negative consequences because we’re either luckier than that or we’re smarter than that.  Even as adults, we still fall victim to that. It’s just part of the bias we have. 

What makes meth hard to give up

So someone’s used meth the first time and they felt like it was the most beautiful experience they ever could have had and they feel like they’re going to get it under control.  Doing it every now and then doesn’t seem like a big deal.  Like I said, in the last episode, when you’re using it in the beginning you can still do normal things.

You could do it on a weekend and go to work on Monday and still be okay. Because the comedown isn’t going to be as hard because you weren’t up for that long and you’re not going to have mad cravings. You’re probably going to miss it a little bit because our brain is wired to remember good experiences.

Any negative that went with it, if there was any is going to fade, because that’s just how we are. We like to forget about the negative parts of an experience.  Maybe somebody starts using meth recreationally once in a while. The problem though, is that rush, that feeling of getting to 1000 to 1500 units of dopamine for hours, that feels better than anything.

We are designed to keep seeking that out no matter what our logic says. This is why we do things that we shouldn’t do, even though we know we’re going to be upset about it later. Our good intentions get overwritten by our need for pleasure.  This is a biological direction. 

What happens with meth is that the rest of life starts to be really pale in comparison. Nothing seems quite as good as it did when you were on meth. Simple pleasures of life don’t compare in the slightest.

Here’s a description that I read that I felt like really helped explain it.  This was from a Redditor on the website, Reddit, in a section entitled, Explain It Like I’m Five. The question was asked: “What exactly does crystal meth do to someone? What’s so addicting about it?”

One of the Redditers said this: “Think of happiness like light. Everyday things are like candles and camera flashes. And that’s good. Now meth, meth is like looking into the sun. If you look at the sun too long, you have trouble seeing other light. Even things you could see clearly before, like camera flashes you can’t anymore, but that’s okay because you’re looking into the sun, right? Wrong. The sun is the brightest thing you can see. Too bright. Your eyes can’t handle it. Eventually you start to go blind. You can’t see the sun’s light as much anymore. So you keep looking and looking. Nothing else matters because that brightness was so intense nothing else can even come close. Why would you want to go back to a world of camera flashes and candles when you’ve known the sun?”

There’s another statement that I wanted to read. It’s a little long, but I feel like the description from someone who’s actually used meth is better than something I could come up with.  He titled the post “How I describe a tweakend.” 

The question was: What does a meth high feel like? 

“Honestly, euphoria. It’s like a flash of good tingly feeling throughout your whole body. You do not feel tired or hungry or in pain. Warm comfort. This lasts for a few hours. As time goes on, it starts to lose that beautiful feeling. Your tongue gets caked and residue. The tip of your tongue starts to hurt because you keep running it over your teeth. 

Every moment tastes awful and it starts to get unpleasant, but you’ve already been up for 22 hours and you’re not tired. So you might as well smoke some more just to get a little burst of that good feeling. The euphoria is gone in a flash, but you’re full of energy and can focus on anything. 

Housework isn’t a chore. You can draw for hours. You can make a rubber band ball or build a skate park. Nothing is boring. And now it’s been 36 hours. You start to lose that focus and there are occasional dots that swarm your vision. You’re sticky. You realize that yesterday was the last time you ate something. You smoke, but the euphoria is gone.

The tip of your tongue is red and very tender. Your mouth is a pasty white, gray due to the residue, which you keep trying to wash away with soda. You think about brushing your teeth, but your body is exhausted. Even if your mind is up, jittery. You want to feel better. So you keep smoking.

Fifty hours in your body is exhausted. You don’t have the control you’re used to, and you keep making clumsy mistakes. You try to occupy yourself with something, but you just end up frustrated and angry. You start to talk about the things that piss you off or the things that go wrong as if there’s some actual plot out to get you.

You start to think that it might be time to sleep. At this point, you either sleep or you press on the world takes on a surreal feeling. You hallucinate, you see people and try to figure out if they’re tweaking too. You don’t smile. Your mouth is fucking disgusting. You stink unless you had the presence of mind to shower.

At some point, that’s unlikely. If you’re tweaking with a group of people though. You can’t all shower. You find that you’ve developed a tick. You pick at your skin or tweeze your eyebrows until you draw blood. You rub the hem of your shirt  between your thumb and finger, without being aware of it. Everything feels hollow and heavy, but your mind is still jittery. Still working. You eat not because you’re hungry, but because the last time you ate, the sun was coming up. 

When meth takes over

Once a person gets into meth, it starts to become their whole life. Slowly for sure, but the walls do close in. You don’t want to hang around with people who aren’t using meth because they would have thoughts and feelings about your use. And so your circle becomes smaller. 

A person starts hiding things. They start spending money  that they have and then money they don’t have on it. Might need to start pawning some things and then they come to a point where they have to decide, are they going to sell it, be a mule maybe for the dealer, or are they going to do other things?

What I have found in my experience is that people who are using meth tend to steal things and people who are using opiates tend to do more identity theft crimes. I’m guessing it’s the impulsivity that comes with meth that makes it seem faster and better to steal things.

Whether it’s from people you know, people you don’t know, stores, all those sorts of crimes. By the time people are at this point they’ve already compromised a number of different morals in their life. Could be faithfulness to a partner, could be that they don’t lie or they don’t steal.

In order to keep using, a person has to cover it up. They also have to convince themselves while they’re convincing others that they don’t have a problem and that they can handle this. By the time it’s too late it is already very deep in the quicksand. It is extremely hard to get out because their life has revolved around getting high, recovering from its effects and figuring out how to get more. All the while trying to hide it from loved ones and friends.  Eventually that’s all too much stress and something has to give.

It’s not going to be the drugs though. It’s not going to be finding it and it’s not going to be recovering from it. So then somebody starts pushing away all of the people who aren’t involved in that. They isolate, they move out, they go couch hopping instead of coming home or stop showing up to work. Their life becomes insulated from the outside world by others who are using meth.

This could be in a trap house. Which is what used to be called a flop house when I was in high school. It’s a house, an apartment where people just show up and they use it and they’re crashing there and they’re usually extremely dirty. There may or may not be utilities turned on to the place, but it is a place that they can use and be out of the main public eye because of course the paranoia.

There are accounts  of people talking about how they sort of had an epiphany when they were in a room with a bunch of other really dirty filthy people. And I mean, legitimately filthy, not a comment on their morality. No one was showering and everybody was doing some sort of compulsion.

A common one is to look for shards of meth on the floor. The person could do that for six hours straight and be picking up things that were a fuzz from the carpet that they thought was a shard of meth and try smoking it. Anything can become this obsessive. They’re in a room with each other, and they’re all doing these various things they’re strange by other standards, but nobody thinks it’s odd and nobody knows the passage of time. 

Eventually when you start coming down, it’s a matter of, are you going to sleep and crash or are you going to find more to smoke.

If you’ve ever had an experience where you had a deadline or a project or something that you were working on. And it was completely all out; you had to give everything you had to it. Barely sleeping, knowing that at the end, you can relax. This is what it’s kind of like for a meth addict, who’s facing the crash that’s coming.

They want to keep getting stuff done or doing things or staying up because they know how bad it’s going to be. It’s not just the physical feeling. If we take that example earlier, imagine that you’ve been basking in the sun and now you’re going to voluntarily drop into darkness that nothing will touch.

Everything feels hopeless and dark and ugly and cold and alone.  The person knows that just a needle prick, just a hit is going to bring them back to where they want to be. Remember that there are these moments of fun, even in the middle of looking like a skeleton and your teeth are falling out and you smell like chemicals because it definitely sweats out their pores.  The person doesn’t know that. They feel like the most confident, most bad-ass person on the street.

It’s a little like being in a weird dream that is extremely long and feels like time doesn’t move in the right way. Where it’s sex and drugs and compulsions and paranoia. In order to wake up from it, a person has to voluntarily embrace the pain, the sickness and the loneliness and depression that comes after. Feeling down and depressed and not being able to feel joy, like happens when someone’s in a depressive episode is bad enough. If we put it in contrast to using meth and the high that is experiencing the low is even worse.

Here’s the reason that meth is such an awful drug. When someone’s been flooding their system with dopamine this much over a period of time, of course, the body adapts. Well while their tolerance is increasing, they have to use more and more meth. Right. We know that. That’s not the only problem though.

Eventually the dopamine receptors stop working  and the body no longer produces dopamine. Why would the body need to produce dopamine? If it’s getting hits of a thousand units or more, as often as is happening. It doesn’t happen right away. But eventually these dopamine receptors, they’re not there anymore. They’re destroyed. When somebody gets sober, yeah, it will mostly come back. There are reports that people have that they say that even years after using they feel a shadow of happiness or an echo of it. But not necessarily like it was before they started using. 

You can find brain imaging scans online if you just put in meth, dopamine brain scan into Google and look at the images. You can see brain scans of people who were using meth. You can see a normal brain, someone who is one month clean from meth, and then someone who is 18 months to two years clean from meth. What you’ll see is that it can take up to two years for the dopamine receptors to begin functioning again.

So a person’s just been using. They’ve been feeling on top of the world, even though their world is crumbling. Even though from the outside, others can see that everything is a disaster and the disease of addiction has ravaged everything. That’s  not how the person necessarily felt until after. 

And now they have to endure that feeling. They have to deal with all of the consequences from using, from relationships to legal consequences, to physical consequences. Whether it’s teeth or psychosis or sexually transmitted infections, any number of things. They have to tolerate all of that. Their body has mad cravings and wants them to use .

Every day feels like two weeks has passed and it’s interminable and they have to do it without having anything that feels good. It’s like living in gray. Everything’s gray. Clothes. Sky. Ground. Body. Everything is gray, nothing is bright. The only thing that happens is you can see darker than gray.

You have sad, angry, and nothing. Those are the feelings. And this could last for months and months, up to even two years to get that back. Recovery from meth is terrible and hard. Because all of that time that a person is working on recovery they have real life to deal with. Everything that they were running from everything that happened while they were using has all come crashing back and is presenting its bill.

They have very few emotional resources and they’re really confused for kind of a while. It’s like they’re waking up from being in a coma and they just aren’t sure what’s happening around them. Even the most supported people ever struggle with those feelings of loneliness and our brains like to romanticize other experiences. Ask anybody who’s given birth to more than one child. A lot of the bad stuff we tend to overlook. That’s why there’s second and third and fourth siblings.

The person who is working on recovery and in this terrible place remembers meth fondly. Yes they know that it destroyed their lives and it was their best friend. It was their lover. It was part of them. It made them feel good. 

Once people who are in recovery, long-term, they’ll tell you that it wasn’t worth it. They’ll tell you that they wished they had never found meth, that they had never heard of it before. A lot of people never get to that place in recovery. It is hard to stay away from, and the people that they used to use with are more than happy to bring them right back in. 

When we think about why someone would use meth we have to remember that we don’t believe it’s going to be us. We believe as humans, that we are smarter and more capable than others. Left to our own devices, we think we’re going to be able to handle it. It’s just going to happen once in a while, even people who got free from meth and had years of sobriety, they sometimes relapse because they feel like they understand it now and they won’t let it go that far again. 

They’ll pull back. It’s going to be okay this time. And it never is. Once the addiction switch is flipped, that’s it. It is flipped. I do want to take this moment to support harm reduction efforts.

I do believe that someone who has been addicted to meth will not be able to use meth safely and without consequence at any point in the future. That said, harm reduction is important. There are safer ways for someone to use meth or heroin or cocaine or whatever the drug is we’re talking about. I do not want to discourage harm reduction. 

Sometimes harm reduction efforts are what it takes for someone to get their brain clear enough, to be able to make different choices. Some of those harm reduction strategies include needle exchange or safe injection sites. These are both somewhat controversial. A needle exchange is just what it sounds like. You can take needles and bring them in and get free, clean needles. You can also get needles without bringing them back in.

A lot of people do bring their used needles in because you have to put them somewhere. In those places, they often have other kinds of resources like testing for HIV and Hep C, resources for food ,shelves or shelter or treatments. The person there is trained to work with that person without judgment. Needle exchanges are really important and I wholeheartedly support them.

I know people feel like it’s enabling, I understand that point of view and I disagree. People are going to use, regardless of whether there are needle exchanges or not. Our goal is to keep the person alive and try to protect them and the rest of the public from infections due to IV drug use, or from dirty needles being left all over the place.

Remembering that drug use, getting high is a reality of human nature. People are going to do it. It isn’t about being deviant or saying, fuck you to the world or any of those things. Most people are using to manage themselves, to deal with pain, to try to feel better. When they are using at the point of needing needles, their life is typically a total disaster by then. Needle exchanges give them a point of contact in a prosocial way.

Safe injection sites are even further on the spectrum of harm reduction and definitely controversial.  A safe injection site would be a place where somebody could go to bring their drugs and shoot up while they’re there. There are supplies there for cleaning the injection site, fresh needles, being able to dispose of them. As well as connection to resources and professionals there that can help when somebody decides that they’ve had enough and want to get help.

I think the issue that people have is that others are just watching someone shoot up illegal drugs. That to them feels like enabling. What we’re looking for here is reduction of harm and preservation so that they can have a life in recovery. 

There needs to be a different way to intervene. Remembering that addiction is not a choice. The person chose to use. They did not choose to become addicted. They truly didn’t mean for this to happen and never believed it would get as bad as it has. They just don’t see it coming. 

Until someone is able to choose to get help for recovery. These harm reduction strategies are really important. Needle exchanges, safe injection sites, test strips, being available to check for the presence of fentanyl in meth. Suggestions, like using post-it notes for snorting rather than sharing a straw with somebody or using a dollar bill, which definitely has bacteria on it. Encouraging people to not share pipes, using lip balm to help with some of the dry mouth, encouraging them to get showers and eat even if they’re not hungry, encouraging hygiene, providing ways for them to do those things. 

Those are things that are part of the harm reduction world as the goal is to help people do less damage. I firmly believe that as long as there is breath in someone’s body, there is a chance for them to get sober. Recovery from meth is hard and people do recover. It is just long and there needs to be a lot of support.

One of the hard things about recovery for meth is that we don’t really have medications to help. Antidepressants are not going to help someone’s lack of joy. They can’t feel joy because the chemicals literally aren’t there. 

Using medications  that increase dopamine production have some very serious side effects  and aren’t an option here. The receptors have to grow back on their own, and that takes as long as it takes depending on the person’s biological makeup. As far as we know, we don’t have anything that will speed it up.

There has been a little research that has come out recently of combining the drug naltrexone with bupropion or Wellbutrin. Remember that naltrexone is an opiate blocker. It literally plugs the opiate receptor and is used for a number of different things. It can be used for alcohol and opiate addiction. There have been cases of it being used along with Wellbutrin, for weight loss, dealing with food addiction. There’s some research that it might be helpful with meth addicts, combining those two medications. 

One of the research trials that came out found that it was able to help some meth addicts avoid relapse. The numbers were kind of small though, in terms of those who felt like it was helpful, but it is one of the first positive signs that we’ve seen in this area of research.

When it comes to opiate addicts, we have a couple of different options. We have Suboxone, we have methadone and we have naltrexone. We can help opiate addicts slowly deal with the aftermath of opiate addiction. When it comes to meth, we know that it takes a really long time and  we don’t have a lot of resources to treat it. That is a big problem. I am hopeful that they will continue doing this research to see if there’s a way we can help people. 

So let’s talk about treatment. Treating methamphetamine addiction is complicated. Right now the best we have are behavioral treatments. There’s a specific treatment protocol called the Matrix Model that is from the Hazelden Betty Ford Center in Minnesota. It is a 16 week intensive course that is as close to intensive outpatient, about 12 hours a week. Where clients attend and they learn all sorts of stuff about addiction and they have support there. 

I’ve worked with the matrix model for years, and I do think it’s helpful. There are times when it can seem a little simplistic, but the issue is that in the beginning of treatment, people are often really foggy and they don’t really grasp certain concepts very easily.

Repetition is kind of the name of the game when it comes to working with someone who’s in recovery, from meth. They struggle with following through with basic tasks. And so a lot of it is managing day to day. One of the things the program does is work on them with scheduling of each day, so that they have an idea of what they’re going to be doing.

Living life on a basic adult basis is not something that they’ve really been doing.  The other thing that is important is getting them involved in other types of activities that are good for them and healthy. Whether it’s finding a new hobby, exercising, having a spiritual practice or going to outside support meetings. 

Additionally, at least in our program, we were making sure to connect people with medical services, getting STI and infectious disease testing done as well as getting them into mental health therapy to start managing some of those things that start arising.

The matrix model  is the only thing that’s been tested and shown to have some effect to help with meth recovery. I’m certain that there are other types of programs that are being used that are evidence-based. It’s just, they haven’t been tested on meth specifically

There are some pharmacological treatments that are under review. There are currently medications that are being tested to help with the neuro immune system. Chronic methamphetamine use is associated with the activation of  microglia  cells that mediate inflammation in the central nervous system. Drugs like minocycline are being studied for their capacity to inhibit activation of that system.

There are also a number of drugs being researched to improve cognition and people who have used meth chronically. In terms of dealing with dopamine, there are some studies looking at ADHD medications and their impact on dopamine activation. The issue here is that a lot of meth addicts have also abused stimulants when they weren’t able to find meth or for some of them that’s actually how they started using meth was that it was easier to obtain then the growing amount of pills that they would need.

There are medications being researched for their work on GABA and the glutamate system. There is also some work being done on dealing with specific hormones. That may reduce the enjoyment of methamphetamine.

The kinds of non-pharmacological interventions are things like neurofeedback and transcranial magnetic stimulation or TMS. This is a non-invasive procedure using magnetic pulses for therapeutic purposes.

Lastly, there’s some research being done in the form of a type of methamphetamine vaccine that would  stop the drug from entering the brain. The idea  would have the vaccine bind to the methamphetamine drug before it gets a chance to go active in the brain. That would be pretty amazing.

In my experience, not a lot of people show up in the middle of using a ton of meth. When they’re at that point, they typically end up coming in through a chemical dependency access point, like outpatient treatment or into detox. The reason that they don’t show up in the midst of all of that typically is because they’re not thinking about getting help necessarily. There’s something about meth that keeps them so insulated that they don’t think about the outside world very much at all.

You may get some people coming in who’ve tried to get some sobriety or who have had a little success and keep relapsing or who have some form of history with meth. So I want to talk about what to do when that happens.

Working with someone who’s using meth can feel like pushing a boulder uphill. There are so many things stacked against them in the recovery process that it can feel overwhelming, even for us.

I want to encourage you just to keep doing the things that you do. The relationship with a helping professional is still the thing that helps a person the most, not our technique, not other things that we can offer them. We’re offering them a space where they can be themselves and where they can be honest.

Addiction is all about keeping secrets  and not admitting the truth of what’s happening, not even to themselves. So having a place where they’re able to do that and where we’re not going to run away or be shocked or think they’re a terrible person is a very healing thing.

Assessing meth use

The first step of course, is that you’re taking the substance use history so that you can find out what kinds of substances they’ve tried, even if it was just a few times.

Now would be a good time to download the treatment planning tool that I created. If you go to my website, betsybyler.com/treatment tool,  you can download the planning tool to help walk you through the process of thinking about the person and their substance use. Yes, it’s totally free. You just put your email in and it’ll come to your email. If for some reason you have any problems opening it or getting to it, please send me an email. I’d be happy to help.

If you have someone who’s used meth, just a couple of times, it isn’t something that you want to ignore. Remember what we talked about just a little while ago about the incredible rush and that overwhelming feeling of euphoria.

If they’ve tried meth, it means they have friends who use it and they have some connection to the drug world. I would ask them how they feel about meth, whether they feel like they would ever do it again and what it was like for them. This way you know their attitudes about it. 

Someone who is using meth on a regular basis, the important thing is to find out what it is that they want to do. Do they believe that their meth use is under control? Do they believe that they can use recreationally? What’s the longest period of time that they’ve had sobriety?

I worked with a guy who would pull about four or five days together and then go on a binge. And then after the crash then he pulled together another four or five days of clean time.  We had to look at what caused him to go back to using, after he had gotten a few days clean. 

Everybody who’s using, is using for a reason. It might be multiple reasons. In this instance he was using because it brought him to other people and gave him some kind of connection. He was desperately lonely and struggling because he didn’t have friends who wanted to be around him if he wasn’t using. 

The first thing I do when someone is actively using a substance is set some boundaries around when they come to see me. I let them know  that I don’t want to work with them while they’re high. For someone using meth, this is going to be a little trickier. It means that I need to see them as they’re on the way down, but before they crash. 

Preferably,  I want to see them after the crash, before they start using again. But I want to set some limits to let them know that I really don’t want them in my office if they’re high, I let them know that it is not because I don’t care about them, but because with therapy, they need to be emotionally present. And that if they’re high, when they’re in my office, that’s not going to work and they’re not going to get anything done or remember what we did. 

You have someone in your office who’s using meth. Your goals are to find out how much, how often and how the person’s using. Are they smoking, snorting or using a needle?  The answer to that question is going to give you a lot of information. Then you want to find out what they want to do about their use? 

How do they feel about it? Next, do you want to find out if they feel like they’re able to get some clean time, if that’s going to be the goal and what they feel like they want to do for the next week. When they come back in, you can check in with them on how they did.  

If they relapsed, you’ll probably know because they’ll probably cancel the next appointment, but maybe not. Once you find out how the week went, you can plan a little further. If they feel like they need more support, there’s plenty of ways to do that.  Certainly the most easy and free option are the communities of Alcoholics Anonymous and Narcotics Anonymous.

If the person is really anti going to AA or N A, then you have to do something a little different. I would check with them about why they don’t want to go and if they’ve ever been before. If it’s because they’re an atheist. Okay. I’m not saying atheists never go to AA or NA, but it can be really hard and that’s something that an early recovery could be difficult.

There are other types of support groups. In bigger cities typically there’s going to be health realization groups. That is a support group to work on health-related issues. It doesn’t have any religious underpinnings.

If your client happens to be a female, there is an amazing group of women of which I’m a part called. She Recovers. She Recovers is on Facebook and has a huge community of women who are all recovering from something. It does not have any religious underpinning and welcomes all people who identify as women, including trans women and non-binary individuals who identify with women’s communities.  She Recovers holds meetings every day of the week via zoom. It’s an excellent choice.

Additionally, there is Smart Recovery that you can find online for information about recovery.

Depending on where you are, there may be meetings of Life Ring, which is secular, meaning not religious, recovery from drugs and alcohol. These are typically peer led groups. If your person is not having success, getting any clean time on their own, they may need to go to detox. 

Finding a detox center can sometimes be difficult. You may have to do some legwork and call to see if someone can detox for meth in that facility. Sometimes detox centers have some kind of weird standards.  A behavioral health and chemical dependency unit at a hospital may be able to help them detox from meth.

Getting specific help detoxing from meth  isn’t totally necessary,  but it really depends on your person and whether or not they feel like they can get through the crash without help. They may have to try a couple times till you can figure out if they need detox or not.

After that point the best thing I think that they can do is go into some form of treatment program. We don’t necessarily jump straight to inpatient treatment. A lot of times people can’t afford it. Or the state that you live in  doesn’t have funding, or they don’t have insurance and quite possibly it’s not available. 

Like where I live we don’t have treatment centers available this far north in our state. The closest one is a couple hours away. Again, you may have to do a little legwork to talk to someone at a treatment center to find out what the process is. It’s really good information to have. One of the counselors at a treatment center can help you or an intake coordinator at one of the facilities.  

I think that inpatient has its place. I think that for some people getting away for 21 to 28 days is something that’s helpful. The problem is when they come home and no one at home has changed. They’re the only ones who went away. They’re the only ones who did anything different. And so it can be really hard to get home and make those changes. 

For someone who’s still trying to hold their life together. They can’t go away for that long because they would lose a job or housing or something of that nature. So an outpatient program can work. There will typically be some outpatient groups around you. 

There are outpatient programs that have groups during the day and during the evening. Insurances will typically fund those things and there might even be some funding from the county or the state.

You don’t have to be the one to determine how much treatment they need. That’s going to be the treatment center’s assessment. I talked about this in early podcasts where someone does a chemical dependency assessment and they look at standards of care. Those standards of care are typically the ones put out by ASAM, which is the American Society of Addiction Medicine.

It’s a level system to see whether they need outpatient, day treatment,  residential, or inpatient. Inpatient being a medically monitored place. There is a wide spectrum of services for someone who needs them. The reason I like outpatient treatment for someone using meth is because the day-to-day is really hard. They need contact and they need some basic information. 

One of the hard things about getting clean from meth is coming to grips with the things that happened while the person was using meth. A lot of times  there are family members and friends that have been hurt or exploited. There’s also shame around sexual behavior and any number of things that the person might be feeling regret over. 

Managing that day to day when they’re not in your office can get hard. They’re only seeing you once, maybe twice a week. Having other people who are able to see them on a more consistent or daily basis is going to be really helpful.

Once you figured out what they want to do about their meth use and figured out the course of action then you want to look at trying to manage the different parts of their life that might have gotten screwed up or that they have issues that need to be resolved. 

The name of the game for this work is about creating stability and getting them into day-to-day life. We are not looking at addressing trauma. We are not looking at dealing with deep seated family issues and dynamics. Once someone feels like they are stable enough and have enough emotional resources to do that then we can move into that work. 

Walking through this with your person is going to be huge for them. As they move forward and get more clean time. They are going to want to talk about things that are more mental health related. 

Over my career I’ve worked with a lot of people who were using, and I got to tell you the majority of them had trauma histories. Some of it was childhood trauma.  Some of it was trauma that happened in adulthood. Almost all of them had co-occurring mental health disorders though and the majority of them, again, predate their substance use. Once they pull the substance away,  those issues are going to be there and they need us.

I think it is great to have a mental health therapist on board even while somebody is in outpatient chemical dependency treatment. Because catching us up later or separating their life so that chemical dependency is separate from mental health. I don’t think that’s wise. 

We aren’t separate sides of ourself. We are a whole person. Why chemical dependency tends to be separated from mental health? I really don’t know and I don’t really think there’s any reason for. Our masters and PhD programs just don’t teach about it unless we’re specifically going to school to learn that thing.

To find out what areas of the person’s life got messed up from the substance use. It can be overwhelming to go through this with the person, because it feels like a giant disaster. The way I phrase it is that I want to get a feel for the whole picture and then we’re going to focus on each step and what’s most important.

Generally the biggest step is getting some clean time and doing that in a safe place. We can’t do much forward work with someone who’s actively using. If your client isn’t ready to address their substance use, then you have some decisions to make. If they are willing to come to therapy mostly sober, you can keep seeing them. There will come a point at which they have to make a choice either one way or the other. 

I think at times some therapists hear that someone is actively using and feel like, Nope, can’t touch it. They have to get sober first. I don’t know if that’s true.  I think that chemical dependency treatment and mental health treatment can happen at the same time.

I would check in often with your person to make sure that you know if they’ve been using or not. It is hard for them to tell us when they relapsed.  Asking questions directly is the best way I know to make sure that we know the information. Assuming that they would tell us if they used, isn’t accurate.

Those of you who have worked with people who engage in self-harming behavior, know this to be true. You have to ask. They don’t want to tell us if they “failed” and ended up doing whatever behavior they were trying to avoid. We just make it part of our regular check-in and then we talk about what happened if they did have a relapse, or if they weren’t able to accomplish whatever step they were working on.

You don’t have to be an expert on meth treatment. You don’t have to know everything about it. You just have to know your client. Each person that you work with is going to have a unique set of circumstances. You are the best person to work with them. You already know what’s happening in their life and how they feel.

Even if they’re new to you, you have those skills. They need to be able to hand someone this giant mess  and have that person guide them towards the exit. We often can see options that they can’t.

Meth is incredibly destructive and people do recover. Next week we’re going to be hearing from one of those people. I am excited to bring you an interview with Mary Beth O’Connor. Mary Beth has over two decades of recovery. She went from being a meth addict to a lawyer, to a federal judge. 

Thank you for listening to the All Things Substance podcast. For show notes, links and downloads, please visit betsybyler.com/podcast. If you loved what you heard today, it’d be great if you would share those with your therapist friends and colleagues. If there are topics that you think would be useful and you’d like to hear me cover them, please let me know.  Just send a message to podcast@betsybyler.com. I’ll see you on next week’s podcast. And until then have a great week.

This podcast is designed to provide accurate and authoritative information in regards to the subject matter covered. It is given with the understanding that neither the host, the publisher or the guests are rendering legal, clinical or any other professional information.