American Academy Addiction Psychiatry 2009

For the next several days I will be presenting some highlights from the 2009 annual meeting of the American Academy of Addiction Psychiatry recently held in Los Angeles December 3-6. I did not attend the meeting. I don't usually attend this meeting as it is always in December and I am already taking some time off for the holidays. I also don't like going out of town in December. I did attend the meeting several years ago when it was held in Phoenix, Arizona and it was interesting and worthwhile.

A study conducted at the University of California is interesting as it looked at a group of methamphetamine addicts that were "pure". That is they had no other substance abuse except for nicotine and had no co-occurring psychiatric disorder. This is not a patient population we normally see in the "real world" but it did give a chance to look at the effects of methamphetamine itself uncomplicated by other factors.

They recruited 56 volunteers who stayed at an inpatient clinical research center for 5 weeks. Generally at time of admission they had high levels depressive, mood, and psychotic symptoms which resolved in 2-3 days. The withdrawal was mild, consisting of red and itchy eyes, poor memory, lack of energy, lack of motivation and irritability and lasted from 2-6 days. The most important finding though was that at the end of 5 weeks 30% of the patients had drug cravings as intense as they were when they came in to treatment. This magnitude of continued intense cravings has not been found for other drugs except for possibly nicotine. It is also probable that in the average methamphetamine dependent population in which there are high levels of co-occurring psychiatric problems and other substance abuse problems this percentage of continued intense cravings may be more than 30%.

At the moment there are no medications available to treat methamphetamine cravings. Cognitive behavioral therapy has been shown to have some efficacy in other studies but it is not always easy to obtain and the results take time. We don't know how long the cravings persist after 5 weeks but it does remind us that methamphetamine addicts in particular need very close follow-up after inpatient treatment, active psychotherapy, and strong early participation in Narcotics Anonymous or other support groups.

Thought for the day

Methamphetamine use is increasing.