1. Substance Use, Decision Making and the Testing Guidelines
The picture gets more complicated…

3. Natural Rewards Elevate
Dopamine Levels 50
100
150
200 60
120
180
Time (min)
% of Basal DA Output
NAc shell
Empty
Box
Feeding
Source: Di Chiara et al.
FOOD
100
150
200
DA Concentration (% Baseline)
Mounts
Intromissions
Ejaculations 15 5 10
Copulation Frequency
Sample
Number 1 2 3 4 6 7 8 9 11 12 13 14 16 17
Scr
Bas
Female 1 Present
Female 2 Present
Source: Fiorino and Phillips
SEX

4. …their Brains
have been
Re-Wired
by Drug Use
Over time…

5. Decreased dopamine transporter binding in METH users resembles that in Parkinson’s Disease
If DAT is decreased in young METH users (almost to that observed in Parkinson’s Disease), and DAT decreases with age, may we see an increase in the number of Parkinsonian patients over time?
Control Meth
Source: McCann U.D.. et al.,Journal of Neuroscience, 18, pp , October 15, 1998.

6. Cognitive and
Memory Effects

7. Dopamine Transporters in Methamphetamine Abusers7 8 9 10 11 12 13
1.0
1.2
1.4
1.6
1.8
2.0
Time Gait
(seconds)
Dopamine Transporter
(Bmax/Kd)
Motor Activity
p <
Normal Control
Methamphetamine Abuser 4 6 8 10 12 14 16 1
1.2
1.4
1.6
1.8 2
Delayed Recall
(words remembered)
Dopamine Transporter
Bmax/Kd
Memory

8. Differences between Stimulant and Comparison Groups on tests requiring perceptual speed

9. Longitudinal Memory Performance
number correct
test

10. Control > MA 4 3 2 1

11. MA >
Control 5 4 2 1 3

12. Drugs of Abuse Change the Way We Think
For example:
Alcohol has long been called the great social lubricant and disinhibitor
Meth and cocaine change memory and information processing
People make decisions in favor of their drug instead of in favor of their health

13. So what does this mean?
Tips for intervening with substance users to increase the likelihood of success…
Write down instructions/explain instructions visually
Slow down and repeat often
Break the information down into small, bite-sized pieces
Check for understanding

14. So what does this mean?
Tips for intervening with substance users to increase the likelihood of success…
Maintain calm and create an accepting environment
Prioritize risks and needs
Maintain support and vigilance for depression – even months after abstinence
Chaotic thinking may look like resistance or denial

15. In training other clinicians…
Familiarity with drugs of abuse and their impact on functioning is important
Resources include the National Institute on Drug Abuse ( and the National ATTC Network site (
These slides will be available at

16. In training other clinicians…
A tip sheet was developed for clincians working with methamphetamine using clients by the PAETC and the PSATTC…

17. Download the tip sheet at…
Contact me at…