Breaking the Ice (Nicole Lee)

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Breaking the Ice

Solutions to the unique challenges of methamphetamine for treatment settings

Dr Nicole Lee Associate Professor, NCETA

Director, LeeJenn Health Consultants

March 2014

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Risks & Harms

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‘Amphetamines’

Methamphetamine

Powder/Pills

Base

Ice

Amphetamine Dexamphetamine Other

pharmaceuticals…

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20

10

ND

SH

S

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de

Gra

aff

& B

run

o, 2

01

3 (

IDR

S)

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Using speed Not dependent

Swallowing, snorting Working

Young Mental health

Sleep problems

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Occasional users Regular

users

Using crystal meth

Dependent

Smoking or injecting

Mental health

Sleep, nutrition issues

Brain changes

Dopamine

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Limbic system

(emotional, social and memory) Frontal lobe

(thinking, planning decision making)

Dopamine

pathways

www.methinsideout.com

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Dopamine

The dopamine system ‘wears

out’ and the brain can’t

produce enough on its own

Flat, depressed, unmotivated

High levels of

dopamine linked to

psychosis

Dopamine regulates thinking processes such as

attention and working memory, planning, decision

making, emotion regulation

Hard to concentrate, pay attention and store

things in memory, plan, make good decisions and

regulate emotions

Dopamine regulates

motivation and the reward

system of the brain

Cravings

Need more dopamine (relapse)

Depression

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Noradrenaline Arousal, mood, concentration,

attention, learning and

memory

Activates the flight or fight system

Anxious, jumpy and hypervigilant (flight)

Suspicious and aggressive (fight)

Serotonin Regulates mood (optimism), focus,

appetite, sleep, cognition, perception,

motor coordination, temperature

regulation, pain control, sexual behaviour

Flat, depressed, unfocused, negativity, edgy

Low levels of energy, motivation and

interest, unusual exhaustion at odd times of

the day, inability to attend to specific tasks

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Cognitive deficits

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Decision making

Impulse control Emotion regulation

Focus, attention and concentration

Memory

Planning ability Flexible thinking

Mood

Energy levels

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Completing tasks (focus, planning)

Taking on new information (attention, memory)

Thinking about consequences (planning, decision making)

Goal setting and working towards goal (planning)

Stopping inappropriate behaviour (impulsivity)

Switching from one topic to another (flexible thinking)

Unexpected outbursts (emotion dysregulation, impulsivity)

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Impaired functioning

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Long term and regular users

Significant brain changes that result in:

• Strong cravings

• Variable motivation

• Impaired ability to manage emotions

• Impaired thinking processes

• High risk of relapse

• Long recovery/withdrawal time

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Cravings

Focus on managing cravings early

Motivation fluctuates

Closely monitor motivation

Motivational interviewing

Empathy

Relapse

Focus on the behavioural relapse prevention,

especially Psychoeducation about impairments,

focus on structure

Emotion regulation Assess and monitor closely

Eat well

Exercise daily

Behavioural activation

Evidence based therapy if needed

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Cognitive changes More frequent shorter sessions (attention)

Repetition (memory)

Use written materials (memory)

Slower pace (concentration)

Essential material and concrete skills (abstraction)

Long recovery time Extended withdrawal time

Assertive follow-up

Priority on treatment retention

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Withdrawal

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Other drugs Methamphetamine

7 day withdrawal 10-14 day withdrawal

Withdrawal starts on cessation Account for 3 day crash

Waiting times for appointments Immediate appointments

1 hour counselling sessions Shorter more frequent sessions

Groups Specific meth groups?

Psychoeducation Nutrition and sleep hygiene

Light follow-up Assertive follow-up

Talking Written materials

Appointments Regular appointments

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1300 988 184

[email protected]/[email protected]

sign up at www.leejenn.com.au

leejennhealthconsultants

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nicoleklee

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