In the book From Chocolate to Morphine, researchers Andrew Weil, M.D., and Winifred Rosen commented on the fundamental nature of addiction, writing: "Addiction is a basic human problem whose roots go very deep. Most of us have at some point been wounded, no matter what kind of family we grew up in. We long for a sense of completeness and wholeness, and most often search for satisfaction outside of ourselves. Ironically, whatever satisfaction we gain from drugs, food, money and other 'sources' of pleasure really comes from inside of us. That is, we project our power onto external substances and activities, allowing them to make us feel better temporarily. This is a very strange sort of magic. We give away our power in exchange for a transient sense of wholeness, then suffer because the objects of our craving seem to control us. Addiction can be cured only when we consciously experience this process, reclaim our power, and recognize that our wounds must be healed from within."16
understanding the predictive factors of teen meth use, young children can be identified as "at risk" for use of drugs prior to using drugs. Informing these potential young users about the negative effects and risks of meth use (or any drug), as well as exploring drug alternatives, may be an effective prevention tool.
Current U.S. antidrug education and prevention campaigns increased in reach and frequency in the 1980s. Since then, adolescents have seen antidrug messages virtually every-where—on shopping bags, comic books, restaurant place mats, billboards, television, bumper stickers, and candy wrappers. Beginning in elementary school, the D.A.R.E. (Drug Abuse Resistance Education) program sends uniformed police officers into schools to teach about the dangers of drugs. Researchers tell us that today's teenagers have had more drug education than any group of young people in American history.16
There is little scientific evidence to support the effectiveness of antidrug messages or their impact on the drug-use decisions of adolescents.41 Media campaigns such as the Partnership for a Drug-Free America have strengthened antidrug attitudes and behaviors among young children and non-drug-using adults, but not in teenagers. Several recent studies report similar findings about the D.A.R.E. program.41
The concept of "zero tolerance" drives much of today's legal and educational policy. The zero tolerance policies teach that using a drug such as meth even once puts the user at risk for abuse and addiction. Most American drug education programs are built around this zero tolerance message. This policy stresses that the purpose of drug education is to prevent drug experimentation; therefore, the topic of drug use is practically forbidden.
This presents a dilemma. The zero tolerance approach contradicts the natural propensity of teens to want to learn about and possibly experiment with illegal drugs.
Additionally, most school-based drug education classes fail to provide information on the relative risks of different drugs, doses, routes of exposure, or patterns of use—the very basics of drug education.
As part of the zero tolerance policy, most schools impose harsh sanctions, including expulsion from school, for any use or possession of meth. Many students are reluctant to discuss their own drug use in drug education classrooms out of fear of these strict sanctions. Most drug education programs in American schools today do not seem to provide effective drug education for teenagers.16
In the 1970s, the National Institute on Drug Abuse endorsed an alternative approach to drug education. This approach, devised by researchers, psychologists, and drug-policy analysts, declared that the goal of drug education was to reduce drug abuse, not use. The proponents of this new policy argued that moralizing about drugs was ineffective, exaggerating the dangers from drugs was counterproductive (and might even lead more youth to try drugs), and expecting adolescents to be totally abstinent was unrealistic.7
Although this prevention approach was incorporated into some educational materials for a short time, it was abandoned in the early 1980s during President Ronald Reagan's campaign of "Just Say No" to drugs. Since then, zero tolerance has been the predominant educational antidrug approach in American classrooms.
Based on evidence that "Just Say No" does not seem to discourage teens from using drugs, many experts point out the success of "harm reduction" models of drug education. Proponents of harm reduction do not encourage or condone drug use, but
they assume that many adolescents will eventually experiment with illicit drugs. Since their goal is to lessen the harms associated with drug use, these programs actively educate adolescents about the relative risks of drugs and their responsible use. Most harm reduction education targets teenagers, since they are the age group most likely to experiment with drugs.16
Harm reduction is very controversial. Opponents believe it condones drug use, and may lull teens into thinking drugs are safe. Proponents think it can save lives. In an interesting comparison of zero tolerance versus harm reduction policies, statistics show that 34 percent of those over the age of 15 in the United States (with a zero tolerance policy) have used the illicit drug marijuana at least once, as compared to only 19 percent of 15-year-olds in the Netherlands (which has a harm reduction policy).42 While it is possible that other factors affect these use patterns, there appears to be evidence that harm reduction does not lead to increased drug use.
Two basic forms of meth addiction treatment are available: inpatient and outpatient. Inpatient (residential) treatment involves an extensive stay in a hospital or residential treatment center. Most common are 30- to 90-day programs, but meth addicts often need to stay at a center for a year or longer. This length of time gives the brain's damaged dopamine neurons a chance to repair themselves; the meth addict needs this time to deal with and heal the corresponding physical and psychological effects that result from this brain damage. Although recovery is possible, relapse to meth addiction is a possibility even after successful treatment. Intensive outpatient support is needed for a year or longer after this inpatient phase.27
Treatment for meth dependence begins with a user's own recognition that he or she is dependent and that this dependency is a problem in his or her life. Many successful recovery groups such as Narcotics Anonymous have the philosophy that effective drug treatment is entirely dependent on an individual's motivation to change.27
Individuals who seek treatment assistance under pressure, against their will, or who are not motivated to take responsibility for their drug-taking choices are not likely to have successful treatment outcomes. However, treatment does not need to be voluntary to be effective. Sometimes strong motivation can assist the treatment process. Interventions with family and friends, punishments or enticements by the family or school, or potential criminal penalties can significantly impact the decision of a meth user to seek and stay in treatment.16
The majority of drug treatment programs are designed to help manage the effects of psychological dependence.27 This is good for meth addicts because the psychological effects of meth withdrawal are very powerful and can be difficult to overcome. Traditional drug treatment programs may include individual, group, and/or family counseling in conjunction with 12-step programs (such as Narcotics Anonymous).
One form of outpatient treatment is known as the Matrix, created during the 1980s by the Matrix Institute on Addictions group in Southern California, with funding from NIDA. The multielement approach of the Matrix includes cognitive behavioral therapies (such as relapse prevention techniques), positive-reinforcing treatment, family involvement, psychoed-ucational information, 12-step efforts, and regular urine testing. Outpatients participate in group and individual sessions several times a week for four months, followed by eight months of continuing care support and 12-step program participation. To date, more than 15,000 meth and cocaine users have participated in the program.43
In 1999, UCLA coordinated a large-scale evaluation of the Matrix Model, with funding from the Center for Substance Abuse Treatment, for the treatment of meth users. Approximately 1,000 meth-dependent individuals were admitted into eight different treatment study sites. In each of the sites, 50 percent of the participants were randomly assigned to either the Matrix treatment or to a "treatment as usual" (TAU) condition (consisting of a variety of counseling techniques). The study results showed that individuals assigned to the Matrix approach treatment received substantially more treatment services, stayed in treatment longer, gave more meth-negative urine samples during treatment, and completed treatment at a higher rate than those in the TAU condition. When data at discharge and follow-up were examined, it appeared that both treatment conditions produced similar outcomes. Participants in both conditions showed very significant reductions in meth use, significant improvements in psychosocial functioning, and substantial reductions in psychological symptoms, including depression. Post-treatment data showed that over 60 percent of both treatment groups reported no meth use and gave urine samples that tested negative for meth (and cocaine) use. Use of alcohol, marijuana, and other drugs was also significantly reduced.43
An overall goal of treatment programs is to help dependent drug users identify and understand the motivators that drive their drug use. Together, the recovering drug abuser and the team at the treatment center can devise healthier, nondrug-taking ways to cope. Effective drug treatment programs for teens are geared exclusively to their age group. Being with adolescents who share the same problem is likely to be therapeutic for those who may feel isolated from their peers.
The National Association of State Alcohol and Drug Abuse Directors reported that "clinically appropriate treatment provided by qualified and trained staff is effective in stopping methamphetamine use," in its 2005 "Fact Sheet: Methamphet-amine." To further support this statement, they provided the following examples of treatment success in specific states:
* Colorado: 80 percent of meth users were abstinent at time of discharge from treatment
* Tennesee: 65 percent were abstinent six months after discharge
* Texas: 88 percent were abstinent 60 days after discharge
* Utah: 60.8 percent were abstinent at time of discharge44
In 2004, Iowa had reported similar success with its publicly funded substance abuse treatment programs, with 65.5 percent of Iowan methamphetamine clients still abstinent six months after being discharged from treatment.45
Meth addicts tend to suffer from depression, low energy, and anhedonia (no feelings of pleasure), as well as experience extreme paranoia and hallucinations.9 These feelings are extremely uncomfortable and can last for many months. Recovering meth addicts can feel suicidal because of these effects, and many meth abusers go back to the drug as a result. Many treatment programs now prescribe antidepressant and antipsychotic drugs to offset these effects, in addition to psychotherapy. In some recovering meth addicts, these withdrawal symptoms never totally go away. They may need to take these antidepressant and antipsychotic drugs for the rest of their lives.9, 11
A major goal in treating meth addiction is the reduction of cravings for meth. These cravings plague the meth abuser who is trying to clean the drug from his or her body and are a common reason for relapse. So far there is no prescription drug to alleviate meth cravings in the treatment process, but studies on the antidepressant drug bupropion show preliminary success in reducing meth cravings as well as the psychological hardship that defines meth withdrawal.46
Other drug rehabilitation programs assert that cravings result from a depletion of the meth abuser's bodily defenses. They use more alternative forms of treatment to stop cravings, giving heavy doses of vitamins, minerals, and neurotransmitters to meth abusers to help replenish what was lost during their time using the drug. These programs report a successful reduction in cravings that make it easier for a recovering meth addict to stick with the counseling part of the treatment program.47
The ancient practice of ear acupuncture is also used with success at alleviating the discomforting effects of drug withdrawal. Five sliver-thin needles are inserted into ear points thought to regulate the nervous system, cerebral cortex, respiratory system, liver, and kidneys. The U.S. government has granted millions of dollars to study this promising drug treatment method.47
Although drug dependency often masks other mental health problems, these core issues cannot be addressed until a methabuser becomes sober. Some meth-dependent teens go to treatment centers because they have grown desperate and asked their parents for help; sometimes parents force their addicted teen into a treatment center after seeing the unraveling of their child's life because of meth use.
Therapeutic boarding schools are facilities that rely on a wilderness-survival approach. Using nature, a skilled staff, vigorous exercise, and group therapy, these programs can run for two months or more and take place in wilderness areas mainly in the West. They nurture self-reliance and self-respect as teens come to terms with their behavior problems while backpacking, surviving, and thriving in nature. Counselors say adolescents in modern society do not go through the traditional rites of passage that came with growing up and crossing into adulthood. Instead of hunting for food, taking care of younger siblings, and learning to build shelter, for example, young people today often turn to drugs as a way to prove that they are "all grown up." These wilderness programs provide this rite of passage, and have been hailed as lifesavers by some, while others have criticized these programs as being overly strict as well as expensive.10
REQUIRED: A SET OF SUPPORTIVE FRIENDS
Once a teen meth abuser clears meth from his or her body and passes through any withdrawal symptoms, the journey to recovery begins. This is not an easy journey. It requires a complete reorganization and restructuring of thought processes, attitudes, and lifestyle. A meth-dependent teen may have organized nearly all daily thoughts and routines around obtaining or using meth. A new direction is needed toward school, work, hobbies, family, religion, and friends—and having fun! Recovery involves a conscious and deliberate effort to create different, more socially productive ways of spending time in order to focus on activities other than using meth.
In essence, recovering teens must entirely change their social structure. One of the hardest things for a teen to do is to stop associating with drug-taking friends. As we have seen, peer influence is one of the strongest predictive factors of teen meth use. Conversely, it is also the most effective deterrent to meth use. Simply put, teens that do not approve of drugs are less likely to use drugs, by themselves, or with their friends.16, 48
Treatment programs of varying intensity exist, but all programs have the same fundamental mission: A meth-dependent person must maintain complete abstinence while learning to cope with the emotional and behavioral motivators associated with its abuse. While most of the feelings or motivations for using meth may still exist, a great challenge for the recovering teen is to explore alternative ways of dealing with and expressing those intense feelings.1, 27
Sobriety High is a charter high school in Minnesota where recovering teens can stay away from drugs by removing themselves from their old social network. Students can choose to attend these schools or in some cases a court has ordered them to attend. Teens sometimes opt for Sobriety High after "graduating" from a drug treatment facility. In addition to typical required high school classes, students at Sobriety High meet in group therapy as a mandatory class and receive a grade for it. In these sessions, teens discuss their struggles and progress in staying clean. If a student relapses at Sobriety High and tells a staff member, chances are the teen will be allowed to stay. Repeated drug use will get a teen kicked out. For teens using drugs for years, it can be daunting to imagine a life without drugs, but Sobriety High has a wide diversity of classes, extracurricular activities, and students, all of which make sobriety anything but boring.10
Relapse is a frequent event in the treatment of addiction. Triggers for relapse include feeling Hungry, Angry, Lonely, and Tired. The acronym HALT is used to help addicted people recognize these common danger signs in their own feelings. Recovering addicts learn that these feelings can often trigger a relapse to meth abuse, and learn how to manage these and other high-risk feelings. Cognitive behavior therapy is another powerful tool that can prevent relapse. Therapists use techniques to help recovering meth abusers learn new ways of thinking and behaving so they are able to cope with high-risk situations that might arise in relationships or with certain feelings that might trigger a relapse.27
In many ways, the recovery process is similar to dealing with the loss of a loved one. Recovering teens may need to grieve for the loss of their past history as they move into a new, drug-free life. During such periods of bereavement, teens can experience feelings of depression and emptiness as families, friends, and familiar locations elicit memories of past drug use. Looking back, recovering teens can see how this bereavement period is a natural part of change and growth, and is considered by many to be a healthy sign of a teen maturing to adulthood.16
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