Crystal meth (methamphetamine) is a potent amphetamine that has received a reputation as being highly addictive. Chronic use of the drug results in serious physical, mental, and emotional decline and the development of physical and psychological dependence.
Abusers of this drug typically manufacture it in makeshift “meth labs” that are known to be quite volatile and prone to explosions. The drug can be manufactured by purchasing simple ingredients that local pharmacies, supermarkets, or even hardware stores.
Crystal meth has a number of street names, such as ice, crank, shards, and glass. It is typically injected, smoked, or snorted. Its appearance is related to a number of the street names the drug goes by, as it typically looks like pieces of glass or bluish white rocks.
The Withdrawal Process from Crystal Meth
Research indicates that there are significant effects that occur when an individual goes through withdrawal from chronic use of methamphetamine. Research also indicates that there is a relatively stable predictability associated with withdrawal from crystal meth and that the symptoms are primarily emotional.
The designation between physical dependence and psychological dependence is somewhat artificial because psychological processes are driven by physical mechanisms. Part of the inaccuracy that results when withdrawal symptoms are referred to as psychological withdrawal symptoms is that many individuals automatically consider the symptoms to be “in the person’s head,” made up, or manufactured. As it turns out, the effects of withdrawal from methamphetamine are primary emotional and related to the physical mechanism affecting the neurotransmitters that methamphetamine abuse produces.
Withdrawal symptoms are quite variable from individual to individual. They are influenced by various factors, such as:
- The length of time the person had been using the drug, with individuals taking drugs for lengthy periods of time most often experiencing more complicated withdrawal syndromes
- The dosage or amount of the drug, with individuals who typically used higher dosages on a regular basis experiencing lengthier and more intense withdrawal symptoms
- Physical variations in metabolism
- Individual differences in psychological and emotional makeup
- Method of administration, with those who inject or inhale (smoke) drugs having more complicated withdrawal syndromes
- Discontinuation method, with abruptly stopping use resulting in withdrawal symptoms more rapidly
- Using multiple drugs of abuse
The timeframe for methamphetamine withdrawal is relatively consistent in users. Most often, it occurs according to the following pattern:
- Symptoms appear within 12- 24 hours following discontinuation.
- The symptoms of withdrawal peak within one week to 10 days after the person has stop using crystal meth and then begin to decrease in intensity.
- The duration of the withdrawal syndrome typically lasts 2-3 weeks, with most individuals reporting the syndrome has significantly run its course within two weeks of last use of methamphetamine.
The withdrawal syndrome from methamphetamine is not generally considered to be physically dangerous or fatal in the same way that withdrawal from alcohol or benzodiazepines may produce serious physical consequences and even fatalities; however, some individuals become extremely emotionally unstable and may be prone to harm as a result of poor judgment, accidents, or even suicidal intent. Therefore, it is a good idea for anyone attempting to discontinue their use of methamphetamine following a significant period of abuse to consult with a physician before doing so.
The major symptoms associated with the withdrawal process from methamphetamine are relatively well documented.
Feelings of extreme fatigue, excessive sleepiness, increased appetite, and weight gain are common.
Significant depression and intense apathy may occur initially and then begin to decline over time (the “crash”). The use of methamphetamine results in drastically increased levels of the neurotransmitters dopamine and norepinephrine in the individual’s central nervous system. These neurotransmitters are responsible for the extreme feelings of euphoria and energy that individuals experience when using the drug; however, when the drug is discontinued, the levels of these neurotransmitters and other neurotransmitters affected by the drug decline significantly. Feelings of apathy, depression, hopelessness, and extreme cravings are associated with this decline. Extreme depression, hopelessness, and apathy may be associated with potential self-harm and are considered to be the most dangerous symptoms related to methamphetamine withdrawal.
Some individuals may begin to feel suicidal as a result of the “crash” mentioned above.
The majority of individuals will experience cravings for methamphetamine. Research has indicated that the intensity of the cravings is often directly related to the severity of the depression and apathy that individuals experience initially once they stop using the drug.
Psychosis has been reported in some individuals withdrawing from methamphetamine. The symptoms are typically severe paranoia or suspiciousness, visual or auditory hallucinations, other forms of hallucinations, and even delusional behaviors. These individuals may need immediate attention.
In rare cases, seizures have been reported; however, seizures developing from withdrawal from methamphetamine are often associated with polydrug abuse (e.g., methamphetamine and alcohol abuse).
Long-term changes in the brain as a result of chronic use of methamphetamine is associated with long-term cognitive changes in a number of individuals that have not resolved after significant periods of abstinence. These effects are typically issues with the speed of one’s mental processing, issues with attention, problems with short-term memory, and complex reasoning abilities.
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Medical Management of the Withdrawal Process
Withdrawal management or medical detox refers to medical management of the symptoms of withdrawal that occur in individuals with substance use disorders and those who have developed physical dependence on drugs that are used strictly for medicinal purposes but are ready to discontinue them. Because detoxification is a natural process that occurs in the body whether an individual continues to take drugs are not, most professional sources prefer the term withdrawal management as it more correctly describes the intervention that addiction physicians use to decrease the intensity of the withdrawal process in individuals who discontinue drugs or medications. The general approach to withdrawal from methamphetamine is to use different types of medications and other interventions for specific symptoms.
A number of antidepressant medications can be used to assist in the withdrawal process from stimulant medications. Wellbutrin (bupropion) is an antidepressant that is useful in reducing the cravings for amphetamines, and it is often used in the withdrawal management of methamphetamine. A number of selective serotonin reuptake inhibitors (e.g., Prozac) may also be useful in reducing the cravings associated with methamphetamine withdrawal. Remeron (mirtazapine) is an antidepressant medication that affects the neurotransmitters norepinephrine and serotonin. Remeron may be used to prevent relapse during methamphetamine withdrawal.
Individuals who stop using powerful stimulants, such as methamphetamine, often experience extreme lethargy, drowsiness, and a lack of motivation. Mild stimulants such as Provigil (modafinil) can be used to counteract this extreme lethargy.
There are no drugs that are approved specifically for treating withdrawal from methamphetamine; however, a number of other drugs can be used to address specific symptoms, including antipsychotic medications and even benzodiazepines.
Supportive interventions, such as Cognitive Behavioral Therapy and other forms of therapy, are combined with medications to assist in the control of cravings and other symptoms that occur during withdrawal from methamphetamine. Cognitive Behavioral Therapy is also useful in addressing many of the symptoms of depression and apathy that occur in individuals going through the withdrawal process. Antidepressant medications typically do not begin to exert their antidepressant effects for several weeks after they have been initiated, and these medications are typically not useful in the short-term treatment of severe depression.
Addiction medicine professionals who work with individuals who are going through withdrawal from methamphetamine will attempt to adjust the withdrawal management process to fit the needs of the individual. Individuals going through withdrawal from methamphetamine require close supervision and positive social support to assist them in getting through the initial stages of withdrawal and avoiding relapse. Nonetheless, relapse rates are typically high for substance use disorders in general. Individuals in recovery are taught in therapy that lapses and relapses should be avoided, but if they occur, they are opportunities for the individual to learn.
Just going through withdrawal from methamphetamine is not sufficient to assist the individual in their recovery from a substance use disorder. Individuals need to become involved in long-term aftercare programs, consisting of therapy, focused relapse prevention programs, stress management training, and psychoeducation in order to prepare themselves for the long road of recovery they will face. In addition, other interventions, including participation in social support groups (e.g., 12-Step groups,) family therapy, vocational rehabilitation, and other therapies as needed can increase the individual’s chances of long-term recovery.