LOVE IN THE TIME OF CRYSTAL METHAMPHETAMINE World Psychiatric Association Athens, Greece March 15, 2005 Petros Levounis, M.D. Director, The Addiction Institute of New York Chief, Division of Addiction Psychiatry at St. Luke’s and Roosevelt Hospitals

OUTLINE n The Biology of Methamphetamine n Epidemiology n The Crystal-HIV Connection n Treatment n The Public Health Campaign

1. THE BIOLOGY OF METHAMPHETAMINE

hr Time After Amphetamine % of Basal Release DA Accumbens AMPHETAMINE hr Time After Cocaine % of Basal Release DA Accumbens COCAINE hr Time After Nicotine % of Basal Release Accumbens DA NICOTINE Source: Di Chiara and Imperato Effects of Drugs on Dopamine Levels

COCAINE vs. METH [1] n COCAINE –Inhibits the reuptake of synaptic dopamine n METH –Inhibits the reuptake of synaptic dopamine –Promotes dopamine release

COCAINE vs. METH [2] n COCAINE –Metabolizes rapidly –Effects last 1-2 hours –Withdrawal can last 1-2 days n METH –Metabolizes slowly –Effects last several hours –Withdrawal can last several days

2. EPIDEMIOLOGY

STATISTICS n In 2002: 12 million US residents used methamphetamine at least once in their lifetime. 600,000 US residents used methamphetamine in the past month. 18,000 ER drug mentions (13,500 in 2000) n In 2003: 6% of 12 th graders had used methamphetamine in their lifetime.

DEMOGRAPHICS n 1980s:West and Southwest Blue collar workers n 1990s:Midwest Gay men, athletes, students n 2000s:East n 2004:Epidemic proportions in the NYC Gay Community

3. THE CRYSTAL – HIV CONNECTION

THE BASIC PATHWAY 1.Crystal intoxication 2.Extreme sexual arousal 3.Decreased inhibitions/judgment Plus Increased sensation seeking 4.Unsafe sex/barebacking 5.HIV transmission

CRYSTAL & SILDENAFIL n The “crystal dick” problem n In 1998, Viagra became commercially available. n Since 1999, new diagnoses of HIV in men having sex with men have increased almost 18%.

CRYSTAL & THE INTERNET n Sex, both virtual and real, both safe and unsafe, is only a click away. n Lingo: –PNP = Party (drugs) and Play (sex) –Chem Friendly = Drugs –Barebacking = BB = Unprotected anal sex –In the Raw = Unprotected anal sex n Manhunt.com, Gay.com, Gaydar.com, Match.com, etc., etc., etc.

4. TREATMENT

NIDA RECOMMENDATIONS n Cognitive Behavioral Therapy (CBT) –The Matrix Model –Relapse Prevention n Methamphetamine recovery support groups n Motivational Interviewing n CSAT TIP #33, available from

PSYCHOPHARMACOLOGY n No proven psychopharmacological interventions that reduce cravings associated with stimulants. n ? Vigabatrin –Gamma-Vinyl GABA [GVG] –16/18 subjects tested negative for methamphetamine during the last six weeks of the trial. ( Synapse. 2004;55: )

Dr. Jeffrey Guss: Sex Like You Can’t Imagine

CRYSTAL PSYCHOTHERAPY n “There is pressure to show how life can be exciting in sobriety. Sobriety for the patient becomes a dreary foreign land, to which he feels exiled, sent away from the marvelous party by his own doing, and resenting the look of the new landscape. He wonders if the therapist’s life is one worth identifying with.”

5. THE PUBLIC HEALTH CAMPAIGN

THE BASIC MESSAGE

SCARE TACTICS

THE FACTS

CRYSTAL GUIDE BOOK

THE MESSAGE IN SPANISH

CRYSTAL FREE AND SEXY

HARM REDUCTION n Harm Reduction as Moderation Management n Harm Reduction as Reduction of Medical Consequences n The curse of the word “Abstinence”

CRYSTAL CLEAR PROJECT at The Addiction Institute