2. 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 www.AddictionInstituteNY.org

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

7. 1. THE BIOLOGY OF METHAMPHETAMINE

8. 0 0 100 200 300 400 500 600 700 800 900 1000 1100 0 0 1 1 2 2 3 3 4 4 5 hr Time After Amphetamine % of Basal Release DA Accumbens AMPHETAMINE 0 0 100 200 300 400 0 0 1 1 2 2 3 3 4 4 5 hr Time After Cocaine % of Basal Release DA Accumbens COCAINE 0 0 100 150 200 250 0 0 1 1 2 2 3 hr Time After Nicotine % of Basal Release Accumbens DA NICOTINE Source: Di Chiara and Imperato Effects of Drugs on Dopamine Levels

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

10. 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

11. 2. EPIDEMIOLOGY

12. 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.

13. 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

14. 3. THE CRYSTAL – HIV CONNECTION

15. 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

16. 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%.

17. 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.

18. 4. TREATMENT

19. 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 www.samhsa.gov www.samhsa.gov

20. 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;55:122-125)

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

22. 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.”

23. 5. THE PUBLIC HEALTH CAMPAIGN

24. THE BASIC MESSAGE

25. SCARE TACTICS

26. THE FACTS

27. CRYSTAL GUIDE BOOK

28. THE MESSAGE IN SPANISH

29. CRYSTAL FREE AND SEXY

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

31. CRYSTAL CLEAR PROJECT at The Addiction Institute