Internal Change
According to Nakken, addiction begins with a high that produces a mood change in the person. This high can be connected with a pattern of behavior with either an object (as in substance abuse) or from an event (as in gambling). Usually, these initial experiences are perceived to be positive, so that the mood change is desirable. Though all people use objects and events to some degree in this way, addiction refers to the internal change or decision on the part of a person to turn away from a "natural relationship" (both intra- and interpersonal) in order to find relief in the object/event.
"Natural relationships are based on emotionally connecting with others; addiction is based on emotional isolation." (n2)This pattern is well-established in methamphetamine abuse. To begin with, the neurological and biological processes initiated by methamphetamine abuse and addiction provide intense 'rushes' or 'highs.' Methamphetamines in fact differ from amphetamines "by the presence of a methyl group on the amine portion of the molecule, which affords improved central nervous system penetration." This, in turn, enhances the basic effect of the drug, which is the "releasing the catecholamines dopamine and norepinephrine from presynaptic nerve terminals." (n3) Since "Dopamine plays an important role in the regulation of pleasure," methamphetamine abuse gives the illusion of intense pleasure in the user. (n4)
Further, methamphetamines are often introduced in the context of enhancing social enjoyment. For example, one of the many drugs belonging to the methamphetamine family is MDMA, or 'ecstasy.' Today, it "has become the most common stimulant found in dance clubs and is available at 70 percent of raves." (n5) Methamphetamine abuse has also been linked to increased sexual stimulation and a loss of sexual inhibitions. (n6) Perceived social motivations such as these form both a tempting beginning and provide the foundations for euphoric recall while masking the true descent into emotional isolation. (n7)
What happens next is crucial. Turning away from true emotional connectedness, the person begins on a downward spiral. First, an addictive cycle is developed: pain signals the need for acting out, acting out provides some momentary relief, the pain returns and is often enhanced from consequences of acting out, which signals the need to act out again, etc. Second, the addictive personality emerges and increases in power: with each instance of acting out, the 'addict' has won some emotional battle over the 'self.' Third, the 'addictive delusion system' establishes itself to protect the ascending addictive personality. All the lies and denial used to excuse acting out and justify the addictive personality become "more complex and rigid." (n8) With its establishment the internal change of emotional isolation is complete.
Again, methamphetamine abuse facilitates this step. As noted previously, the exhilarating nature of the mood change is matched only by the painful consequences that follow methamphetamine abuse. Further, the psychological and psychophysiological impact of methamphetamine abuse can lead to paranoia, depression, suicidal tendencies, and numerous psychiatric disorders, (n9) which in turn encourage the emotional isolation needed to keep the addictive delusion system intact. In fact, the very biological process that provides the intense pleasure is also responsible for great pain:
"The large release of dopamine produced by methamphetamine is thought to contribute to the drug’s toxic effects on nerve terminals in the brain." (n10)Unfortunately, the tables are set for stage two.
Lifestyle Change
The second stage in addiction is simply the fruit of the first. What has been established internally - the control of the addict over the self - is now increasingly manifested externally in addictive behavior. In the first stage, the internal nature may keep the problem from being noticed by many others; by stage two, the addict's preoccupation with the mood change overtakes the person's life and routines:
It is in this stage that addicts start to arrange their lives and relationships using addictive logic to guide them. ... the behavioral commitment to the addictive process has become all-encompassing. (n11)This translates in the development of destructive attitudes and behaviors, namely coping mechanisms and rituals. These coping mechanisms function to protect the addiction from being exposed as what it is and often includes: lies, blame-shifting, withdrawal, and the creation of a 'secret world' (e.g., a second job to pay for the addiction). This outwardly confirms the emotional isolation, which in turn "internally becomes another signal to act out." (n12) At each step, life is more and more dedicated and consumed by the addiction:
Addiction is a progressive process. It does not stabilize. It does not plateau. It does not settle down to a moderate, predictable level. The chemicals necessary to feel all right increase in amount and frequency. The cycle of chemical use and nervous system disturbance reinforce each other. (n13)This, too, has been noted in methamphetamine addiction. In addition to normal shame and preoccupation, the user is motivated by the illegal nature of the drug to create the secret world. (n14) Studies have connected methamphetamine addiction to "reduced work effort, disruptions in family relations, and poorer mental health" (n15), which would tend to indicate the type of lifestyle change expected at this stage of the addictive process.
By way of personal observation among those with methamphetamine use, it is easy to note both coping mechanisms and rituals. For example, in one case, the early association of methamphetamine abuse with dance/rave music (and one particular rap artist) led to the necessity of listening to this specific music while acting out. Moreover, she had developed a new circle of 'friends' that would reinforce the rituals of addiction. (n16)
Life Breakdown
There comes a point in the addiction where the addict finds it impossible to sustain and control his behavior or the consequences. This is what Nakken refers to as 'life breakdown.' This stage is recognized by the decreasing returns of acting out, replacement of addictive logic with bare ritual, uncontrollable emotional responses and outbreaks, withdrawal and childlike attachment, legal consequences, and physical illness. Suicidal thoughts are not uncommon, especially since the addict is stuck at this stage of the addiction and cannot free himself from the life he has created. (n17) Unfortunately, it is often not until this point that the person recognizes there is a problem.
Methamphetamine abuse is also characterized by decreasing payoffs: With chronic use, tolerance for methamphetamine can develop. In an effort to intensify the desired effects, users may take higher doses of the drug, take it more frequently, or change their method of drug intake. (n18) Often, the user tries to compensate for this tolerance (where the drug remains present in the bloodstream despite the disappearance of the euphoric effect) by a method known as 'binge and crash.' The user 'binges' to created the high, and then 'tweaks' to try to maintain it. The 'tweaking', or the repetitive consumption of the methamphetamine after each initial high has faded but while the drug remains at high levels in the bloodstream, leads to the 'crash.' When a methamphetamine abuser crashes, they are often unable to be aroused for long periods of time. (n19) The 'binge and crash' pattern is especially destructive. Users' behaviors are most uncontrolled and abusive during 'tweaking' (n20) and become most susceptible to 'methamphetamine psychosis' after employing this method. (n21)
Unfortunately, there is no doubt of the consuming, destructive nature of this addiction, as this testimony of a mother of a former addict demonstrates:
I buried my beautiful 25 year old daughter on April 8, 2005. ... Some wonderful person got her to try methamphetamine shortly after the birth of her son ... She took meth for aprox. 6 months, every day. ... she tried the meth because they told her it would make her smart, and give her energy. Gullible girl - she went from 130 to 85 lbs. She had her child taken from her. She slowly seemed to recover, but never quite made it. She convinced a doctor that she had adult attention deficit disorder and he gave her Addarol - which was the beginning of the end. after taking for a month and not liking how it made her feel, she quit taking it - then she took too much, and then the depression really got ahold of her. She was bouncing off the walls, she was psychotic, delusional, paranoid, afraid of water, the devil, etc. ... This stuff kills, sometimes fast, sometimes it takes awhile - but it steals your family, your soul, your body, your mind. and eventually, your very life. (n22)
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1 For perspectives on the relative successes and
the challenges of regulation, see, for instance:
James K. Cunningham & Lon-Mu Liu,
"Impacts of federal ephedrine and pseudoephedrine regulations on
methamphetamine-related hospital admissions," Addictions.
2003: 98, 1229–1237.
Denise Herz & Rebecca Murray,
"Exploring Arrestee Drug Use in Rural Nebraska," Journal
of Drug Issues. Winter 2003: 99-118.
Rodger McDaniel, "Solving the Meth
Problem: The Wyoming Plan," SPECTRUM: The Journal of State
Government. Fall 2004: 33-34.
Peter Reuter & Jonathan Caulkins,
"Does precursor regulation make a difference?," Addictions.
2003: 98, 1177-1179.
2 Nakken, 23. This summary is drawn from pages 19-36.
3 Aaron Schneir & Anthony Manoguerra,
"Medical Consequences of the Use of Cocaine and Other
Stimulants," 269. In John Brick, ed. Handbook of the Medical
Consequences of Alcohol and Drug Abuse. New York: Haworth,
2004.
4 NIDA, "Methamphetamine Abuse and Addiction," 3.
5 Paul Gahlinger, Club Drugs: MDMA, Gamma-Hydroxybutyrate (GHB), Rohypnol, and Ketamine," American Family Physician. June 1, 2004: 69/11. Available on the World Wide Web at: http://www.aafp.org/afp/20040601/2619.html . Accessed May 26, 2005.
6 For a popular description on the subject, see the 2004 Associated Press article, "Aphrodisiac' effect part of meth's deceptive charm." Available on the World Wide Web at: http://www.msnbc.msn.com/id/6646180/ . For a more thorough discussion of these and additional motivations, see "Payoffs" section below.
7 Based on my initial study, I found it difficult to decide if the payoffs of methamphetamine abuse fit better the patterns of Nakken's "Drive for Power" or "Drive for Pleasure" (68-84). I saw elements of both manifested in the research; this question deserves further investigation.
8 Nakken, 35.
9 See especially: John Murray, "Psychophysiological
Aspects of Amphetamine-Methamphetamine Abuse," The
Journal of Psychology. 1998, 132(2): 227-237. And Joan Zweben et al., "Psychiatric
Symptoms in Methamphetamine Users," The American Journal on
Addiction. 2004, 13:181-190.
10 NIDA, "Methamphetamine Abuse and Addiction," 4.
11 Nakken, 37.
12 ibid., 39.
13 Bonney Schaub and Richard Schaub. Healing Addictions: The Vulnerability Model of Recovery. Albany: Delmar, 1997: 10.
14 The documentation of national, state, and local
law enforcement agencies to address the methamphetamine epidemic is
profuse. For an editorial on the why and how for community education
and law enforcement, see James Copple, "Exploring the Explosive
and Addictive World of Meth," Catalyst (April 2001) from
The National Crime Prevention Council.
It is also the subject of professional
studies, like the report by William Stoops et al., "Methamphetamine
Use in Nonurban and Urban Drug Court Clients," International
Journal of Offender Therapy and Comparative Criminology. 2005.
49(3): 260-276. This study highlights the differences in drug-use
profiles, psychological functioning, self-reported criminal history,
and number of criminal offenses among urban and rural communities.
The addictive personality seems to manifest itself differently in
these two environments, at least criminally. This will have impact on
recovery ministry.
15 Lisa Greenwell and Mary-Lynn Brecht, "Self-Reported Health Status Among Treated Methamphetamine Users," The American Journal of Drug and Alcohol Abuse. 2003: 29(1), 76.
16 See Nakken's discussion on "The Community
and Rituals," 43-44.
17 ibid., 56-63.
18 NIDA, "Methamphetamine Abuse and
Addiction," 4.
19 Kathryn Wells, "Medical Aspects of Methamphetamine Abuse ," in Methamphetamine from the North Metro Task Force of Colorado. Available on the World Wide Web at: http://www.nmtf.us/methamphetamine/methamphetamine.htm . Accessed May 19, 2005.
20 ibid.
21 See the descriptions in Carol Falkowski,
"Methamphetamine Across America: Misconceptions, Realities and Solutions," SPECTRUM:
The Journal of State Government. Fall 2004: 30-31. Falkowski is
Director of Research Communications at the Hazelden Foundation.
22 Testimony of Sandra Piper. Her daughter died from aspirin overdose. Available from the Koch Crime Institute on the World Wide Web at: http://www.kci.org/meth_info/letters/2005/April2005.htm . Accessed May 19, 2005. This site collects methamphetamine related testimonies, sorted by date.
