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Chapter 12. Clinical Management: Methamphetamine

Richard A. Rawson; Walter Ling
DOI: 10.1176/appi.books.9781585623440.349963

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One of the fastest growing illicit drug problems in the world between 1995 and 2005 has been the use and abuse of methamphetamine (MA). According to estimates by the United Nations Office on Drugs and Crime (2005), approximately 26 million people around the world used amphetamines in a 12-month period during 2003–2004. In contrast, approximately 11 million people used heroin and 14 million used cocaine. Statistics on the extent of the MA problem within the United States create a somewhat mixed picture. According to the National Survey of Drug Use and Health, in 2004 an estimated 12 million people had used MA at least once in their lifetime, 1.4 million had used it in the previous year, and 600,000 had used it in the previous 30 days (SAMHSA Office of Applied Studies 2005). Although these estimates have been stable since 2002, the number of previous-month users who met criteria for stimulant abuse or dependence increased from 63,000 in 2002 to 130,000 in 2004. Therefore, according to National Survey of Drug Use and Health data, although the number of new users remains relatively stable, a higher percentage of people who use MA are developing significant clinical disorders as a result of their use.

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Table Reference Number
TABLE 12–1. Adverse effects of methamphetamine abuse
Table Reference Number
TABLE 12–2. Early abstinence/withdrawal from methamphetamine: symptoms and clinical challenges (duration 2–10 days)
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TABLE 12–3. Methamphetamine psychosis symptoms
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Methamphetamine use, abuse, and dependence in the United States has increased from 1995–2005.

Chronic methamphetamine use produces significant medical and psychiatric symptoms, including cardiovascular and respiratory system irregularities, neurological abnormalities, skin and dental problems, as well as psychosis, dysphoria, and anhedonia.

Symptomatic treatment for methamphetamine-related psychosis, intoxication, and withdrawal using antipsychotics and benzodiazepines is the current accepted practice.

Numerous groups require special attention regarding methamphetamine-related consequences. They are methamphetamine injectors, adolescents, women, and men who have sex with men.

Current psychosocial treatments with demonstrated efficacy for the treatment of cocaine disorders appear appropriate for treatment of methamphetamine users. These include: cognitive-behavioral therapy, community reinforcement approach, contingency management, 12-step facilitation, and the National Institute on Drug Abuse drug counseling approach.

Contingency management and the Matrix Model are the only two psychosocial approaches with data to support their efficacy for the treatment of methamphetamine dependence.

Many medications currently show promise as pharmacotherapies for the treatment of methamphetamine dependence, but currently none have clearly demonstrated efficacy.

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Sample questions:
1.
Methamphetamine and cocaine have similar effects but there are important differences in their mechanisms of action. Which of the following describes how cocaine acts in the nervous system?
2.
Which of the following is a common, acute physiological effect of methamphetamine?
3.
Methamphetamine-induced psychotic symptoms can be difficult to distinguish from preexisting disorders. Which of the following symptoms usually does not occur in methamphetamine-induced psychotic symptoms?
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