I never thought I would become addicted to methamphetamine when I first used it recreationally 15 years ago, often in combination with MDMA (common known as Ecstasy), to increase my energy and stamina for dancing and celebrating. As a physician, I felt immune to the possibility of having a substance control my behavior.
Yet, meth insidiously hijacked my brain and took control of my life to the extent that I lost my career, home, relationships, and ultimately my liberty. In 2014, I was arrested, convicted, and sentenced to 37 months in federal prison for the sale and distribution of methamphetamine. This life-changing event finally made me face the horrors of my addictive lifestyle and its impact on my family and relationships.
Three months ago, I was released from prison, and I have been blessed to have a safety network of supporters who have provided moral support for my continued recovery. I have also learned that I am not alone in my struggle against meth addiction, as it affects millions of people worldwide and has been one of the more devastating problems in the gay male community in recent decades.
Methamphetamine acts on the brain to cause excessive release of dopamine, the neurotransmitter that mediates pleasure, leading to a prolonged excitation phase, which leads to total depletion of the neurotransmitter. That in turn leads to a state of craving and anxiety and, if not supplemented, a crash characterized by sleepiness, extreme exhaustion, and depression.
Among gay men, the drug is used to enhance and prolong sexual activity, often in combination with the drugs GHB and GBL. Meth is snorted, inhaled, or injected, and it leads to binge partying for days and often weeks at a time. This is often associated with sexual activity with multiple partners, which has been associated with increased rates of HIV transmission and, in some studies, more rapid progression of HIV disease including one documented case of the development of multi-drug resistant virus.
Psychologist and contributor to TheBody David Fawcett, Ph.D., LCSW has written probably the best analysis of the effects of meth on gay male behavior in a book called Lust, Men, and Meth: A Gay Man's Guide to Sex and Recovery. In the book, he outlines the seductive appeal of the drug and its impact on high-risk behaviors and sexual desire, resulting in the fusion of sex and meth in the brain. The author describes the impact of neuroplasticity, the ability of the brain to rewire neural connections, and its role in both hijacking healthy pleasure and restoring it.
Related: Back on the Outside
Can Medicine Make Meth Recovery Easier?
Unfortunately, no approved pharmacological treatment interventions exist for meth addiction -- as they do for heroin use, such as methadone and Suboxone (buprenorphine and naloxone) -- to help users combat physical and psychological cravings and lessen the withdrawal symptoms of depression and fatigue. However, some treatment strategies are finally being studied to complement the behavioral and self-help interventions that Fawcett describes in his book.
Since being released from prison, I have been fortunate to be hired as a research assistant for the first national multicenter study of methamphetamine treatment in the U.S. The ADAPT-2 study is being conducted through the Clinical Trials Network (CTN) of the National Institutes of Drug Use (NIDA). It has sites in Los Angeles; San Francisco; New York; Minneapolis; Portland, Oregon; Pickens (near Greenville), South Carolina; and Houston, and it will recruit 370 moderate or heavy users of methamphetamine.
Participants will be randomly assigned either to a combination of oral bupropion (Wellbutrin) up to 450 mg once daily plus intramuscular injections of extended-release naltrexone (Vivitrol) every three weeks or to placebo, and then they will be followed for 12 weeks to evaluate the effects of the interventions.
Participants will use a smartphone app to record the ingestion of the oral medication to monitor adherence, and they will be compensated for each of the two weekly clinic visits.
How Does Meth Use Affect Brain Function in HIV-Positive Gay Men?
There are two additional studies currently enrolling at the NYS Psychiatric Institute. The first is looking at cognitive functioning in HIV-positive gay men with or without a history of substance use. It will compare those who use meth with both those who use other recreational drugs or alcohol and those who don't use drugs to determine the comparative effects on cognitive functioning, such as ability to carry out plans, as well as memory and attention.
Participants will be screened on the phone and then asked to come in to complete a series of neuropsychological tests on an iPad, a face-to-face interview, and questionnaires, and they will be compensated in cash for their participation.
Finally, NYS Psychiatric Institute is also conducting a "Return to Work" research study with individual counseling for HIV-positive persons who are medically stable and unemployed and are hoping to find paid or volunteer work. For those whose major barrier to work is fatigue, the drug modafinil (Provigil) is being offered for up to four months. HIV-positive persons in early recovery from meth use are eligible for this study and can call (646) 774-8075 to be screened.
All of these studies are extremely important for advancing our knowledge about the neuropsychiatric effects of meth use, and in the case of the treatment study, in providing drug therapy to help users kick meth. Currently, many of us in recovery struggle daily to maintain our abstinence through self-help groups, 12-step meetings, sponsors, and recovery programs. These studies may soon allow us to use drug therapy to lessen the cravings and anxiety associated with withdrawal, and they hopefully will assist users to decrease and eventually stop using meth altogether.
The author can be reached at firstname.lastname@example.org.