Overcoming Crystal Meth Addiction
Overcoming Crystal Meth Addiction
Overcoming Crystal Meth Addiction
ADDICTION
An Essential Guide
to Getting Clean
STEVEN J. LEE, MD
Boston Public Library
Boston. MA 02116
PRAISE FOR OVERCOMING CRYSTAL METH ADDICTION
"Dr. Lee has managed the impossible: taking one of the most scientifically,
clinically, and socially challenging conundrums of the twenty-first century
and turning it into a great hook that provides real down-to-earth help for all
"In Overcoming Crystal Meth Addiction, Steven Lee performs a great service
audience. The result is a valuable resource that bridges the gap between the
consumer and the science of meth addiction."
— Scott Letendre, MD, Associate Professor of Medicine, HIV
Neurobehavioral Research Center and Antiviral Research Center,
University of California, San Diego
"This is the most comprehensive book on crystal meth I've seen. It answers
all of the commonly asked questions: what is crystalmeth? how is it made?
how long has it been around? how is it used? why is it so popular? what works
in treatment? and how do people stay sober? For the person using crystal
meth or contemplating using meth, it provides the most readable information
regarding what it does to the body, the dangers of use and abuse, exercises
for determining use and quitting, and resources for getting help. I highly
recommend this book and plan on providing copies for all the clinical staff
"Finally, a book that has a dual approach: stressing the danger of the drug
and its addictive nature and engaging everyone — people in recovery, users,
one's decision to use crystal meth. It pays respectful attention to the cul-
ture of crystal use in the gay community and offers thoughts applicable to
other communities affected by crystal. By describing 'the good, the bad, the
glamorous, and the ugly' aspects of crystal meth use, Lee not only provides
concrete strategies to stop using but also invites us to take a deeper look at
OVERCOMING
CRYSTAL METH
ADDICTION
An Essential Guide
to Getting Clean
AV A L 0 M
All rights reserved. No part of this book may be reproduced in whole or in part
without written permission from the publisher, except by reviewers who may quote brief
excerpts in connection with a review in a newspaper, magazine, or electronic publication;
nor may any part of this book be reproduced, stored in a retrieval system, or transmitted
The information in this book is intended to help readers make informed decisions about
their health and the health of their loved ones. It is not intended to be a substitute
for treatment by or the advice and care of a professional health care provider. While
the author and publisher have endeavored to ensure that the information presented is
accurate and up to date, they are not responsible for adverse effects or consequences sus-
tained by any person using this book.
Lee, Steven J.
RC568.A45L44 2006
616.86'406-dc22
2006018149
f
ISBN-13: 978-1-56924-313-8
9 8 7 6 5 4 3 2
littps://archive.org/details/overcomingcrystaOOIees
CONTENTS
Introduction 1
Glossary 297
References and Bibliography 3 1
Acknowledgments 327
Index 329
PREFACE
hy Marc Galanter, MD
The magnitude of the alcohol and drug abuse problem in the United
States is well documented. Eighteen percent of the population experi-
ences a substance abuse disorder at some point in their lives, and the cost
of addictive illness to the public has been calculated to be $246 billion
pharmacology and medical research. Cocaine was isolated from coca leaves
in 1844, and its use as a local anesthetic was introduced by the surgeon
William Halsted, who himself became addicted to the drug. Morphine
was popularized during the Civil War to allay the pain of wounded sol-
diers. When heroin was synthesized in the late nineteenth century, it was
thought to be a nonaddictive means of treating withdrawal from morphine.
Amphetamines were first synthesized around the same time, and during
World War II, their use was sanctioned by a number of governments,
Marc Galanter, MD
Professor of Psychiatry
Director, Division of Alcoholism and Drug Abuse
New York University Medical Center
PREFACE I xiii
Marc Galanter, MD, is Professor of Psychiatry and Founding Director of the Division of
Alcoholism and Drug Abuse at New York University (NYU) School of Medicine. He has
ser\'ed as president of several national organizations, including the American Society of
Addiction Medicine and the American Academy of Addiction Psychiatry. As the Division
Director of NYU's World Health Organization Collaborating Center and NYU's National
Center for Medical Fellowships in Alcoholism and Drug Abuse, he has guided the teaching
and training of addiction treatment at teaching hospitals and medical schools throughout
the United States. He is the author of over 250 articles, chapters, and books dealing with
addiction, addiction treatments, and spirituality.
INTRODUCTION
Missouri. He works at a gas station part time but spends most of his days
feeling bored, and frustrated that his life is going nowhere. The exciting
scenes he watches on television are a far cry from life in his quiet farm-
ing community. There is not much to do where Justin lives. The closest
town is an hour's drive away. He does not know who his father is, and he
lives with his mother, who is unemployed and spends most of her time
watching TV at home.
Justin started using crystal when his friend offered it to him one
afternoon while they were sitting on the couch channel surfing on the TV.
He felt amazing the first time he tried it because life suddenly seemed
interesting, fresh, and vibrant. Worries about not getting anywhere in life
or feeling bored disappeared, as even small things could catch his atten-
tion and seem fascinating. He stopped pitying himself and instead he felt
his computer lay in small piles of electronic pieces scattered around his
bedroom. The place was in chaos: to an outsider, his room looked crazy.
[ electronic parts strewn about in a mess that could never be put back
^ together into a working machine. Yet. while Justin kept smoking crystal,
^ it all made sense to him. and he was determined to get to the bottom of
r Justin would hang out with his friends at honne, and all of them would
I
smoke or snort crystal together Sometimes his mother would join them
and get high. Usually she sat with them and talked, but sometimes she
I
f
and Justin's friends started feeling extremely sexual. (Justin's mother has
had sex with most of his friends by now, but Justin denies ever having sex
-
with her) One day, he found out his mother was pregnant, carrying the
'
child of one his buddies.
Justin was upset at first, but he kept using crystalto try to make himself
feel better, and he distracted himself with other things. Gradually. Justin i
I
started believing that people were following him. Even though he was in a
j
small rural community where most people already knew each other well, i
he was sure that someone was following him. Although cars and trucks |
on the road were usually different, he was convinced it was the same
person getting into different vehicles to throw off his suspicions. When he
saw the people inside each vehicle were different, he decided there must
be a team of people conspiring to follow him, maybe because of what he l
someone might have bugged his room with a tiny electronic device hidden ?
in one of the little electronic pieces strewn about his bedroom. Eventually,
Justin started to hear voices that confirmed his suspicions. He was right!
But the voices were scaring him, telling him frightening things about what
other people wanted to do to him. He became withdrawn and rarely left J
his home, too scared and paranoid to go to work. Eventually he lost his
j
job and he stayed at home with his mother, collecting welfare and using |
, It to support his crystal habit. He became a recluse, even within his own
|
S house. Before. Justin's life was centered on hanging out with his friends |
and complaining of boredom. Now his life revolves around using crystal, |
and has a busy professional life. He is proud of the fact that he "works
hard and plays hard." After a difficult life as a closeted gay teenager grow-
ties liberating; they were places where he could be open about his sexual
orientation and bond with other gay men. After joining a gym and doing a
few cycles of anabolic steroids, he looked in the mirror and saw an attrac-
be. who had hidden his sexual orientation from his friends because the
homophobia in his school had made him feel so ashamed. In New York
City, he joined a circle of friends who went to discos and circuit parties,
where drugs such as Ecstasy, special K, cocaine, and crystal were the
norm. He considered himself a member of the "A list." a group of the most
attractive and successful gay men in New York City. Now, he thought, he
was someone that everyone else wanted to be. This felt so much better
than having to live a lie to avoid not being accepted by his peers. Now,
rather than be looked down on as a loser because he was gay. it was his
month. About five years ago. when crystal was becoming more popular in
New York, he saw others doing it more often, and he started using more
himself, almost every weekend. He discovered that crystal made him feel
great and even more confident. He became horny when he used crystal,
and his main objective at discos was to hook up. Sex on crystal was amaz-
ing, and for the first time in his life, he didn't have any hang-ups about
being gay or fearing HIV. He just enjoyed the sheer pleasure of sex.
stopped going out to the discos because he saved time just getting
crystal from his dealer and going online to find sex. An indulgence that
started out as one night of sexual pleasure quickly grew to staying up for
two to three days at a time. Instead of snorting bumps, which had actu-
hosted by his dealer. He'd often have sex without condoms. Sometimes
the way of the wild frenzy of intense sex, and he would rip the condom off.
When he was high and having sex. the only thing he wanted was more sex
from two days of continuous anal sex. or he would have painful abrasions
on his penis. One day. Brian went to his regular medical check-up. and
he was tested for everything. When his blood tests came back later that
in a small suburban town outside San Diego. She was born in Southern
California, the third of four children of parents who had emigrated from
Mexico thirty years earlier Her parents each worked two jobs, hoping that
their children would get good educations and be able to have better lives.
However, her mother and father were both busy working, and no longer
being the baby of the family. Ana felt neglected by them, despite their best
intentions. Ana was just a regular teenager who wanted to fit in. She went
to school regularly and did fairly well in her classes.
Though there were many Mexican Americans in Southern California,
there was a strong social pressure that "blond + thin = attractive." Social
pressure was so strong that many Mexican-American high school stu-
dents used to bleach their hair, even though the result looked unnatural.
Ana was never interested in being blond, and she had always considered
her thick black hair to be one of her best features. However, she became
concerned about her tendency to put on weight and did everything she
could to lose it. She found out from a classmate that if she snorted small
INTRODUCTION I 5
amounts of crystal, she would lose all desire to eat. Also, on crystal, she
felt so much better about herself that her weight almost didn't even mat-
ter As an extra benefit. Ana found that crystal made her more alert in
class, and she could get her work done much more easily. When she had
a test or paper, she could easily stay up all night on crystal and pass the
Meth felt like the perfect solution to Ana's concerns, and it was rela- I
tively cheap. Just doing occasional bumps, she would pay $40 for a little
bag. which would last her a couple of months. However, the occasional
small bump gradually turned into a daily habit because, on days that
she did not use crystal. Ana became tired, depressed, and hungry. On
those days, she also felt even worse about her appearance: looking in
the mirror was painful. Over time Ana lost a significant amount of weight.
Her plan worked too well— she was now not only thin but malnourished.
Regardless, on the days Ana used crystal, she felt great and saw an
attractive person in the mirror, and when people stared at her gaunt face
and sickly body, she knew that they were really looking at her because she
habit, and she began stealing. She didn't want to steal, but the trade-off
was too expensive— looking and feeling terrible, and falling into depres-
sion. Ana was caught shoplifting and was arrested. The court mandated
her to start a residential treatment program for drug addiction.
Justin, Brian, and Ana are case examples of three very different people
struggling with distinct issues of crystal addiction. We will revisit them
throughout the book to see how they coped (or were unable to cope) with
the issues I discuss in the various chapters.
Crystal methamphetamine is an extremely powerful drug. It crosses
social, cultural, and economic lines because it can cause such positive
feelings in so many different ways. However, it can also have devastating
effects on every aspect of a person's life. Crystal is an old drug that has
been with us for almost a century. There have been several waves of epi-
demics of methamphetamine (meth) use around the globe, so addiction
to it is nothing new. And now, worldwide, it is experiencing a new wave.
6 I OVERCOMING CRYSTAL METH ADDICTION
However, this current epidemic is worse than others because social cir-
cumstances in the world have changed: natural barriers that would have
kept it more contained no longer exist, and other illnesses, such as HIV
and hepatitis, make it more of a deadly, raging force.
globe, a drug that causes intense sexual cravings and makes people ignore
safer-sex practices continues to fuel the HIV epidemic, as well as the
spread of other sexually transmitted diseases such as hepatitis B and C,
which can all be deadly. The irregular and intermittent use of HIV medica-
tions by someone getting high frequently can breed strains of HIV that are
are spending billions of dollars trying to create new drugs to keep up with
the changing virus. "Virus swapping" by people having unprotected sex
and exchanging different strains of HIV make the situation even more
complicated.
The Internet and the explosion of gay sex hookup sites in the late
1990s and early millennium made the possibility of finding sex while
high on crystal as easy as ordering in dinner. In previous decades, people
felt oversexed on methamphetamine; with the Internet, the possibility of
sexual activity became almost limitless. The reinforcing effects of having
sex readily available then fuels addictive use of methamphetamine even
more.
The U.S. Department of Health and Human Services reported that in
2002, over 12 million people over the age of twelve reported having tried
methamphetamin. Of those surveyed, almost 600,000 were current users.
With a growth rate of about 300,000 new users per year, those numbers
are much higher now.
The people who use crystal methamphetamine are found in all socio-
economic and ethnic groups:
INTRODUCTION I 7
hard hit.
people who came to that clinic for testing, whether positive or nega-
tive for HIV, more than 10 percent admitted to using crystal —twice
as many as had been reported in 200 1
There have been reports of its use even in unexpected communi-
ties, such as among the Amish and Mormons, where strict moral
prohibitions and cultural isolation would be expected to protect
reduction —allowing people to make their own decisions and teaching them
how to use methamphetamine safely — is the best approach, whereas others
feel that harm reduction just allows more people to reach the point of severe
addiction, when it is too late to help them. The real answer Hes somewhere
in between, and this book is an attempt to find that midpoint.
I wrote this book for laypeople, to help them prevent crystal from taking
over their lives, and for those who are addicted, to help them achieve sobri-
ety. While treatment services are available —more are being developed and
refined every day —the average crystal user either is not aware of them or
does not want to use them.
It is know if you have a problem with crystal, and, even if you
difficult to
know that you do, it may be extremely difficult for you to ask for help. As
you read this book, it will become clear that recovery from meth addiction
involves reaching out to others and getting help from resources beyond this
book. But if you are not yet at that stage, or if you don't believe you are an
addict, you can also use this book to achieve a better understanding of why
you may be using crystal and what it may be doing to you. If you are an
addict, this book will show you the fundamental principles of overcoming
methamphetamine addiction, no matter what treatment option you may
choose to take.
This book is also intended for substance abuse specialists who want to
1 . Learn as much about crystal as you can. If you know what you are deal-
ing with, then you will understand why it makes you feel and be-
have the way you do. Only then can you fully judge whether you
are controlling your crystal use or vice versa. Also, if you know the
physiological actions of crystal, you can strategize better how to
fight back when it makes your brain crave more, even if rationally
you want to use less.
2. Take a close look at what role crystal plays in your life. Is it something
that you just use for fun, something that you control? Or has it
become something that has taken control of you without your even
realizing it?
INTRODUCTION I 9
3. Learn the basic steps to stop using crystal. If you are stuck in a pattern
of using and you can't get out of it, this book offers approaches
to stopping using, such as detoxing, something that many do not
realize is a possible way to ease the difficulty and pain of ending
a binge or a long cycle of crystal use.
4. Learn how to stay clean. What are the basic treatment options, in-
cluding programs, therapies, and medications? What are some
housekeeping tips for life that can lower your risk of falling back
into using crystal? Even after countless experiences of the highs
of cr^^stal, you can still enjoy life without it — the book suggests
strategies for relearning life, such as how to socialize without the
drug, and how to enjoy sober sex.
5. Make sure that you address major "holes " in your life that you may be trying
coping mechanism — will kick in and make you want to use again.
This book is divided into five major sections that follow these funda-
mental areas for overcoming meth addiction. Part 6 includes special topics
that may be of interest to specific populations, such as people who have
HIV, and loved ones of crystal addicts.
Overcoming Crystal Meth Addiction is not a blanket condemnation of
crystal, and it is not an endorsement of crystal use. Like nuclear power,
methamphetamine can cause powerful reactions, with some good effects,
at all. However, many crystal users are not willing or ready to part with it.
For those people, this book also serves as a guide to a better understanding
of crystal, so you know what you put into your body; how to reduce your
medical risks if you do use crystal; and how to monitor your use over time
to assess if you are developing an addiction.
This book was written using current medical understandings of meth-
amphetamine, the brain, and addiction behavior. In addition, I have drawn
on conversations with and stories of hundreds of people struggling with
crystal addiction, learning from their experiences of what crystal has meant
to them —how it helped them with many things, but also how it has devas-
tated many lives. They have also taught me what has been helpful to them
and have shared with me their success stories, which I will try faithfully to
pass on in this book. All names of cases mentioned throughout this book
have been changed to protect people s anonymity. If you have recently
tried or are even contemplating using methamphetamine, I hope that this
compilation of broad experiences and suggestions will help you find your
way to a life and lifestyle safe from the dangers of crystal addiction.
5. Address major "holes" in your life that you may be trying to fill
with crystal.
INTRODUCTION I 11
edification. For this reason, the chapters are written so that you can pick
and choose whichever strikes you as most relevant or interesting. You do
not need to read the chapters in any particular order, and I encourage you
to read them in whatever order seems most comfortable and meaningful
to you. However, if you realize that you are addicted, I strongly encourage
you to read all the chapters, to get the most balanced and complete under-
methamphetamine and how to overcome your addiction.
standing of
Methamphetamine has many street names, depending on the com-
munity where it is being used. These names include: crystal, meth, blue
meth, ice, hot ice, super ice, glass, crank, Tina, Chrissy, chalk, working
man s cocaine, chicken feed, and yellow barn. All names refer to the same
drug: crystal methamphetamine. Some people distinguish "crystal "
as a
form of methamphetamine that is purer than the usual powder that people
buy. However, most people do not make this distinction and use the term
"crystal" for any form of methamphetamine. Because the names "crystal
and "meth" are so common, for the sake of convenience, these two terms
will be used throughout this book.
Regarding the use of the word "addict," please refer to chapter 4 for
a full discussion of what addiction is. The term "crystal addict" is used
frequently in this book, and it is used without any judgment. There is no
implication that the crystal addict is a bad person or has weak charac-
ter. In fact, this book gives a strong message that addiction is a medical
12 I OVERCOMING CRYSTAL METH ADDICTION
and saying it out loud, you take away some of the power that it has held by
being a taboo word — ^^unthinkable to say, and therefore unapproachable.
Once you can approach the idea of being an addict, you have something
to work with, and you can really begin to fight the addiction. If this book
makes it a little easier for an addicted reader to admit that he or she is an
addict, then this small offense to a few is worthwhile.
__ PART
1
UNDERSTANDING CRYSTAL
METHAMPHETAMINE:
Getting to Know Tina
Up Close and Personal
STRATEGY:
Learn as Much about Crystal as You Can
Objectives:
• Learn exactly what you are dealing with— know thy
friend and thy enemy.
• Understand what crystal does in your body to know
why you feel and act the way you do.
under different names, including: crystal, meth, blue meth, ice, hot
ice, super ice, glass, crank, Tina, Chrissy, chalk, working man^s
cocaine, chicken feed, and yellow barn. Its an old drug, related to
though initially they were not popularly used. By the 1920s, people started
to use amphetamines to improve energy and to help with dieting and
weight loss. They were later used by the U.S. military during World War II
to help soldiers to combat fatigue during long hours of duty. However, their
use was complicated by many side effects, including anxiety, agitation,
Unfortunately, its problematic side effects were even worse than with
amphetamines. After the war, military surplus supplies of methamphet-
amine reached the public market in Japan, causing an epidemic of meth-
amphetamine abuse that was at least temporarily curbed by Japanese
government legislation that limited the public supply.
Similarly, in the United States, after World War II there was a surplus of
eventually to urban areas on the east coast. Meth abuse became particu-
larly heavy among people in rural communities, where its production is
volatile reactions, and the potential for dangerous explosions. This is one
reason that production flourished in rural areas rather than densely popu-
lated cities, where production would be dangerous and conspicuous to law
enforcement. The ingredients to make methamphetamine are simple and
easy to obtain, including substances such as over-the-counter deconges-
tants and a common chemical used as a fertilizer, another reason for the
drugs popularity in rural areas.
viduals in those areas have reported its easy availability as the reason they
became addicted. Others have described using it as a way to combat bore-
dom in small, isolated communities with "nothing much else to do."
body image issues that the drug so successfully hid. Even worse, the crash
can cause depression connected to body image, which can make the self-
far as the percentage of the community that has been affected, the gay
male community has been particularly hard-hit. Estimates of the number
of gay men in the U.S. who have ever used meth have been reported as
high as 20 to 30 percent, in contrast to 5.3 percent of the general U.S.
population. In addition, the association of crystal with unprotected sex
binges and the prevalence of HIV make this drug a particular concern for
this community.
Though the crystal epidemic started in largely heterosexual working-class
communities, it gradually became a party drug for certain middle- to upper-
middle-class gay men in urban communities, who used it to fuel their energy
in all-night dance parties called circuit parties, in which some people would
dance for twelve to eighteen hours. It has gradually become the drug of choice
at these parties, which attract up to eight}^ thousand people, and which have
become multiparty marathon events lasting for several days.
Before crystal. Ecstasy and ketamine had been the most popular drugs
at circuit parties. Those drugs were appealing because they induced feel-
more, and for some, "the circuit" itself became an addictive phenomenon.
Though people went to circuit parties with the notion that they were pur-
suing a sense of community, bonding, and better self-esteem, the positive
feelings didn't last long after the parties ended and the drugs wore off.
Many circuit parties that were actually fund-raisers for HIV organizations
became events where heavy drug use and unsafe sexual behavior resulted,
and this likely led to the transmission of HIV and other sexually transmit-
ted diseases in many of the partygoers.
At the turn of the millennium, a significant change occurred in the
way that gay men used crystal —more were smoking it. The circuit-party
high" than swallowing it. Smoking crystal was initially looked down upon
because it was reminiscent of the frightening crack epidemic of the 1 980s
that predominantly affected the urban poor. Gay circuit partiers, rave kids,
and people in rural areas didn't identify themselves with the crack-using
population. The stigma of doing something akin to smoking crack kept
most people from smoking crystal, and snorting crystal let them pretend
that they didn't have a drug problem: "We're not like those crackheads of
use the drug, and among some gay men, mixing crystal with a small amount
of water fluid into their rectums became a new method,
and squirting the
called booty bumping. In particular, booty bumping constricts the blood
vessels in the rectum, and there is less rectal pain during anal intercourse.
This allowed booty bumpers to have even longer, harder sex as bottoms
(partners receiving anal insertion) more easily, with the experience of hav-
ing a "hungry hole" that enhanced or increased desire for sex even more.
This also allowed for more damage during sex to the lining of the rectum,
which increased the risk of catching sexually transmitted diseases.
Another major social change happening around the turn of the mil-
lennium was the explosion of Internet sex sites. In particular, gay-male
sex sites made finding sex partners as easy as ordering food for delivery.
Internet surfing, Internet shopping, and Internet sex (aka cybersex) were
becoming their own addictive problems. Crystal meth, which intensifies
both sex and other compulsions, in tandem with Internet sex sites became
an unstoppable combination.
Internet sex sites developed their own culture and secret language, such
as PNP, meaning "party and play," a code meaning that people were look-
ing to have sex while using drugs, almost always with crystal.
This was also a time during which some gay men were becoming more
complacent about using condoms. There may have been a decline in the
HIV because of the development of so many effective medications.
fear of
The younger generation of gay men had grown up in the era of the "HIV
cocktail": By this time there were already several medications to fight HIV,
and many people started to think of HIV as a controllable chronic illness,
like high blood pressure. Young gay men of this era never had the experi-
ence of watching partners and loved ones die from AIDS, so the specter of
HIV was much less frightening. During the intensity of crystal sex, wearing
condoms just did not seem that important.
A description given by a heterosexual man who used crystal illustrates
the perspective of someone high on the dangers of HIV. This man had
regular sex with female prostitutes, never used condoms, and he gave the
following description of his experiences:
A SHORT HISTORY OF CRYSTAL METHAMPHETAMINE I 21
I was totally clear. I felt more clear than I ever felt without cr\'stal.
It's not like I was cloudy and fuzzy like with alcohol or heroin. It's
not like I forgot. I still knew about HIV, and I knew all the infor-
mation about how to keep safe and that 1 should use condoms, et
cetera, et cetera. I've been in rehab and I've been lectured about
HIV a million times. But if you think of a car rushing at ninety
miles an hour, if you're on the street and that car passes right by
you, it's scar\^ as shit, and you want to run for cover. But being
on crystal was like being in an airplane. The higher 1 felt, the
more exhilarating it was, and the more determined I was to have
sex. There wasn't anything else I wanted more at the time and 1
ninety mph looked smaller and smaller, looking slower and less
important. Really. Like when you look at little cars on the road
from an airplane window and they just look like slow little ants.
1 still knew about HIV 1 guess, but it was like one of those little
In fact, many people who use cry stal don't use condoms while having
sex. And this has had a direct impact on the spread of sexually transmit-
ted diseases. In particular, rates of HIV and hepatitis transmission have
increased, and various studies and health-care agencies estimate that about
one-third of recent HIV infections have occurred during cn^stal use.
'
I
I Finding out that he had HIV was devastating for Brian. Despite knowing
that HIV IS now a nnuch more treatable condition than in the 1980s. Brian
j
days, having marathon sex without even stopping to eat. He does not
22 I OVERCOMING CRYSTAL METH ADDICTION
recall how many people he had sex with, but he knows that he never used
a condonn. He recalls the sex feeling nnuch nnore intense, "topping" others
talked about more complicated feelings, such as relief: Brian had been
afraid of getting HIV for so long that he actually felt liberated. He could
have sex without worrying about getting HIV because he already had it.
He considered the possibility that one of the reasons he had sex without
condoms, in addition to the crystal high, was that he wanted to become
HIV-positive— if he were positive, he thought, his experience of having sex
While smoking crystal and having sex with one man, Brian had a sei-
zure. He does not recall what actually happened (typical of seizures), but
he assumes that the man called 91 1 and fled his apartment— he was told
by the hospital that the ambulance personnel found the door of his apart-
ment open, and Brian lying naked and unconscious on the floor
In therapy, Brian discussed how crystal helped him cope with the
depression, fear, and anger he felt about getting HIV. It allowed him a
brief relief from his sadness by elevating his mood, and it made him
feel confident and powerful rather than frightened and powerless. While
Brian believed some part of him may have wanted to get HIV, he also felt
Getting HIV, and his self-destructive binge, was a wake-up call for
j
well as the immediate possibility of dying, shook him awake: while HIV
could possibly kill him if he did not start taking better care of himself,
it is not clear how and where potential subjects were solicited. If ads were
placed in papers read more by men, or in places frequented more by men,
then this could explain the dramatically greater number of men compared
to women in the study. On the other hand, the UCLA study recruited
subjects from a methamphetamine treatment center. Hypothetically, sup-
posing women were more likely to seek help for addiction than men, the
greater presence of women in that study would not accurately reflect the
proportion of female to male meth addicts outside of treatment settings.
The absolute number of women using meth remains unclear, but it is cer-
tain that many women use meth and do so with serious consequences.
have fun, and to increase energy, which were similar motivations for men.
However, there were also some significant differences. While improving
energy was one of the most common reasons women reported, this was a
much less frequent reason for men. While 14 percent of women reported
using crystal to enhance sexual pleasure, 23 percent of men felt sex was
an extremely important factor in their use. The most striking difference
was that 36 percent of women identified weight loss as a reason they used
meth, compared to only 7 percent of men. Clinically, we see the use of
24 I OVERCOMING CRYSTAL METH ADDICTION
crystal for weight loss in drug rehabilitation programs and in hospital units
treating women with severe anorexia and body-image disorders.
Though the UCLA study did not find sexual pleasure to be one of the
primary motivations for women to use crystal, research consistently shows
that using the drug while having sex intensified sexual pleasure in women
similarly to how it has been reported by men. The powerful effect on
sexual desire and behavior caused by crystal puts women at a higher risk
almost anyone, including many people whom she would never even con-
sider she were sober.
if The drug changes her judgment so much that she
is literally "not the same person," and she would pursue sex much more
aggressively. It was likely she could also feel so compelled by sex that she
might disregard her normal precautions and put herself at risk for STDs
and pregnancy.
Given the hypersexual effects of crystal, unintended pregnancies are a
considerable concern. Unfortunately, there are few studies examining how
often this occurs. One study in Hawaii found that out of 546 deliveries,
1.4 percent of the babies tested positive for methamphetamine, which is
tion to the developing fetus), premature delivery, low APGAR scores (poor
color, breathing, and general responsiveness of the newborn at the time of
delivery), and abnormal development of the baby's nervous system. Studies
of rats exposed to meth during their gestation showed abnormal seizure
activity, reflecting abnormal development of the surface of the brain.
Women must be aware that crystal's sexual effects can cause unplanned
pregnancies, resulting in harm to the mother and child, with consequences
as serious as death.
group has shown a slight decline in meth use —although very modest— in
the past year. Adolescents have unique concerns about crystal use that
should be known by teens, as well as parents, teachers, drug counselors,
apply to teens in this country. Taiwanese studies showed that meth use
in teens was associated with general behavioral problems; lower quality
of caregiving, such as disrupted parental care and lower caregiver educa-
tion; having adolescent peers who also use meth; and an alarmingly high
rate of suicidal thoughts — 16 percent—within the past year. Research at
Duke University found that among American youth, recent meth users
were more likely to be female, aged sixteen to seventeen years old. Use of
meth in these teens was highly associated with criminal activity and recent
problems with alcohol.
Research shows that adolescents have a pattern of using meth that is
drugs cause, can differ greatly between adolescents and adults. Animal
studies have already shown that adolescent brains exposed to metham-
phetamine show more structural damage than adult brains, particularly
in areas such as the basal ganglia, and show greater deficits in cognition,
meaning ability to think and learn. While human studies have shown the
immediate problems associated with meth use in teens, animal studies
have shown that teens who use meth may experience significant long-term
Despite U.S. government efforts to stem the rise of crystal use, it con-
tinues to increase and cause problems. According to the Drug Abuse
Warning Network, the number of crystal-related emergency room visits
The initial concern about crystal and gay men was due to the increase
heterosexual men.
I STRONGLY EMPHASIZE that crystal can affect anybody While there has
been considerable media attention on crystal use in the gay male com-
munity because of its connection to HIV, gay men make up only a small
minority of the total number of crystal users in the United States. This is
o
POSTSYNAPTIC
D DOPAMINE
DOPAMINE RECEPTOR
ENHANCED TRANSMISSION
STRONGER
D D NERVE SIGNAL
1 .DOPAMINE
VESICLES RELEASED
2. MORE DOPAMINE
IN THE SPACE
3. STRONGER SIGNAL
TRANSMISSION
D DOPAMINE
DOPAMINE REUPTAKE
^-^ TRANSPORTER
Figure 2-3. Signal transmission in dopamine brain cells with enhanced dopamine release.
WHAT EXACTLY IS CRYSTAL METHAMPHETAMINE? I 31
that's become clogged. The second brain cell is bombarded with more
dopamine, and this results in increased stimulation of the cell and a much
stronger signal transmission.
ENHANCED TRANSMISSION
1 .BLOCKED
DOPAMINE REAPTOR
RECEPTORS
2. BLOCKED
DOPAMINE
RECYCLING
3. INCREASED
DOPAMINE
IN THE SPACE
4. INCREASED SIGNAL
, TRANSMISSION
dopamine. Crystal squeezes the sponge and grips it tightly, so that the
sponge can't reabsorb any of the dopamine. The outpouring of dopamine
when the saturated sponge is squeezed is the initial rush that meth us-
ers feel. This huge gush is also associated with the production of free
radicals, chemically active particles that cause damage to the body. Free
radicals have been implicated in causing genetic mutations, cancer, cell
death, and aging. I will talk more about this in chapter 22.
When the brain has been flooded with dopamine that is unable to be
recycled, the level of dopamine within the brain rises dramatically In com-
parison to brains without any drug exposure, cocaine raises dopamine to
Although dopamine affects many parts of the brain and body, the effect
most important to our discussion is upon the area called the nucleus
accumhens, which sends a dopamine-mediated signal to the ventral
tegmentum. These two brain sites connect by a bundle of brain cells
called the mesolimbic pathway, or the "brain-reward circuit." This is one
of the areas of the brain that is most powerfully associated with pleasure.
However, it is also highly associated with addiction.
individuals there are countless small differences in how these cells are
arranged. Each experience you have and each new piece of information
you learn causes small changes in the connections between brain cells.
Also, anything you expose your body to, including food, drugs, and chemi-
cals in the environment, has an impact on the way your brain develops.
So each person's brain is unique. In addition, your body is unique in the
way that your particular liver breaks down toxins, how easily your body
stores drugs in fat cells, and how well it excretes drugs from your kidneys.
Therefore, there is some variability in how each person experiences crys-
tal, physiologically speaking. Nonetheless, there are some experiences
that are common to most people, and in the following general descrip-
tion, the majority of people have many or most of the symptoms, though
perhaps not all:
crystal may quickly lift them out of the blues and into an
extremely happy state. Their senses are heightened, and sights
and sounds may seem sharper and more vivid. On the other
hand, just as if they have had too much coffee, some people
may also feel jittery and anxious, or even panicky. In general,
most people feel a tremendous boost of energy and confidence,
believing that they can accomplish almost anything. People who
were socially withdrawn suddenly are able to come out of their
shells and see themselves as outgoing, charismatic personalities.
and there's a strong need to talk to others about these ideas, with
people talking more and at a faster rate.
unproductive.
When people use larger amounts of meth, their goal-directed
behavior become extreme, resulting in the compulsive repeti-
tion of an activity. This could be a stereotyped motor activity,
meaning repeating a single type of movement over and over again,
such as rocking, chewing or grinding teeth, wringing hands, or
fidgeting with objects. The behavior may extend to more complex
activities, such as vigorously cleaning an entire house or search-
ing in a purse for a ticket stub for 30 minutes. While the person
is high, the activity makes sense, and there is a strong feeling of
determination and purpose to the activity.
not productive. When they are sober, they may look back at what
they've done, realizing that they've written volumes of nonsensi-
cal scribbling or spent hours rearranging a bookshelf that was
already organized. But when they were high, their inflated confi-
dence and strong determination tricked them into thinking that
I OVERCOMING CRYSTAL METH ADDICTION
and wasted. When the lights go on at the end of a club night, the
sight of the last stragglers still dancing on crystal is not pretty.
Crystal users may disregard precautions concerning safer sex, or
the quality of sex may be rougher, because they feel more aggres-
sive and powerful, or they feel an insatiable hunger for sex. The
chemicals that the body uses in the fight-or-flight response, which kicks
in when one s brain senses there is an emergency or a threat to one s sur-
vival. Dopamine makes the heart beat harder and faster, and it constricts
blood vessels in certain parts of the body, like the skin, nasal passages,
and the intestines, so that blood can be redirected to other areas, such as
muscles, which are more needed in a fight-or-flight situation. Blood pres-
sure increases, and pupils dilate to let in more light and enable one to see
via the blood). However, high blood pressure can actually prevent
blood from getting back to the heart because it makes it difficult
what is called a heart attack, and it's possible that crystal users
may suffer multiple tiny heart attacks over time, or more rarely, a
large and serious one with obvious chest pain. Other symptoms
of a heart in serious distress may include pain radiating from the
chest to the jaw, left shoulder, or left arm; dizziness; shortness of
breath; nausea; and vomiting. Any of these symptoms mean that
The kidneys: The kidneys filter all of the blood that flows through
the body. The blood vessels and filtering units, called neph-
rons, are delicate and require a delicate balance of blood flow
through them. They can be damaged by elevated blood pressure.
However, they also require a minimum constant blood supply in
order to stay alive. When people use crystal, they may initially
have high blood pressure, but when they binge and do not drink
fluids, they become dehydrated, and their blood pressure can
become low, resulting in low blood flow to the kidneys. With
an insufficient blood supply, kidney cells may die, and if there
is enough damage, the kidneys may go into failure. People who
use meth should remember to drink fluids regularly. If they are
dancing in a hot room and sweating, they are losing even more
water, and it's even more important to keep drinking liquids.
The muscles: Crystal cranks up the whole body's system, and
body temperature can become elevated. This, together with the
several-day dance marathons of circuit parties, can increase the
breakdown of muscle. Muscle breakdown products, such as cre-
atinine phosphokinase (CPK), are toxic to the kidneys when
they are present in high concentrations in the blood. This is
they were able to regain some activity in the thalamus, but the striatum
remained impaired.
Some people argue that crystal does not ''destroy" brain cells; however,
several studies demonstrate that it damages farts of certain cells, some of
them permanently. These cells can be compared to the long microfibers
that carry telephone signals. If the ends of the microfibers are destroyed,
the signal cannot reach its target. Similarly, even if an entire brain cell
does not die, the destruction of just the end of the brain cell has pro-
found effects on how well it is able to transmit the signal it is supposed
to. Scientists nicknamed the effect of crystal on brain cells "pruning,"
meaning that the tips of affected brain cells are "cut off," much as a
that have never been exposed to the drug. These differences are in areas
that use dopamine, as well as glutamate, which is used in the frontal cor-
tex. Recent studies show that longtime stimulant users may be more prone
to Parkinson's disease and other movement disorders, which are related
to damage in areas of the brain that function with dopamine.
Supporting the data from PET scans, studies that directly test the men-
tal function of heavy crystal users compared to nonusers show that the
former group demonstrate impaired mental function, particularly complex
thinking that involves adapting to changing situations, various aspects of
memory, weighing judgments, and decision making. Unfortunately, these
are areas of thinking that you must use to keep yourselffrom falling hack into
drug use. Without these faculties, it is much more difficult for an addict to
fight off relapses. Continued crystal use literally changes the brain so that
it becomes harder to mentally resist the urge to keep using.
Recently, research has found that the meth-related damage to sero-
tonin neurons is associated with less control of aggression and impulses.
If these functions are weakened, then an addict's ability to resist the temp-
tation of using a drug again is even harder. In even more ways, the brain
becomes hard-wired to keep itself on cr\^stal.
With high doses and frequent or regular use, people can become
paranoid, feeling that they are being followed or watched. They
—
WHAT EXACTLY IS CRYSTAL METHAMPHETAMINE? I 59
may start keeping the shades drawn and react to small noises,
fearful that someone is following or harassing them. Paranoia can
become quite elaborate, with beliefs that the CIA or neighbors
are following them. They can start to have hallucinations
hearing voices, seeing things, and feeling sensations such as
bugs crawling on their skin.The reason for these symptoms is
overstimulation of the dopamine system in the brain. Too much
dopamine is one of the brain malfunctions in schizophrenia, and
the behavior of people with severe stimulant toxicity can mimic
that of paranoid schizophrenics. Many meth users have been
admitted to psychiatric hospitals and treated with medications
for schizophrenia because the symptoms appear identical.
solvent used in paint, glue, and gasoline), methanol (an extremely toxic
form of alcohol used in industrial processing), ether (one of the first
chemicals used for surgical general anesthesia), lye, muriatic acid (con-
centrated hydrochloric acid, used to clean mortar and brick), iodine, and
rubbing alcohol. These ingredients are mixed and heated, and elements
are extracted to form methamphetamine.
In addition to problems associated methamphetamine itself, there are
dangers of using street meth because it is unlikely to be pure. Some of
the toxic agents listed above may not have been fully processed, and may
HOW IS CRYSTAL MADE? I 4I
out the country, particularly in rural areas, where the strong, noxious smells
and the potentially explosive reactions attract less attention. Recently, the
federal and local governments have been clamping down on meth labs,
product.
fiere is an unedited excerpt from a Web page of one "basement" manu-
facturer, describing how he makes meth:
Shake the jars till pills are completely broke down, then let
the jars sit again for 4 hours or until the Heats is completely
clear. Once clear cyphon the heat off (Not the powder stuff at
the Bottom you don't want this it will fuck your dope up). Well
anyways syphon the hear off with a piece of the sergical tubing
syphon this into a pyrodex baking dish... if it's this color you have
done good at cooking the dope now to add colemans fuel fill the
far full just anough room for shaking now add 1-2 teaspoons of
red devil lye let the jar site aofr about 5 mins then place lid on
the jar and shake the hell out of it.
Control Policy, reported that from 1994 to 2001, the average purity of
methamphetamine found in the United States had decreased from 71.9
to 40. 1 percent. That means that of the crystal that you buy on the street,
ers, other drugs you never intended to take, and toxic leftovers from the
production process.
At the time of this writing, several states and municipalities have
passed laws to limit the availability of pseudoephedrine to any single
individual. Since then, domestic production in basement labs has dra-
ing. Imagine how much less controlled foreign factory production of illegal
PART
t
UNDERSTANDING ADDICTION:
What Is It and Do You Have It? I
STRATEGY:
Take a Close Look at the Role
Crystal Plays in Your Life
Ob j ectives
• Learn precisely what addiction is.
so addictive.
• Learn about the nnany uses of crystal besides just
getting high. Is it really just a recreational, fun activity,
because the term is used so commonly in the English language. The word
is 'Tm addicted to soap operas," or
casually used in such situations as
''I'm addicted to chocolate. Even among different medical specialties,
'
define drug addiction. Using this new term with its specific definition
avoids the confusion of all the different meanings that "addiction" has. In
this book, the word "addiction" refers to the APA definition of substance
dependence.
In essence, DSM-IV defines substance dependence as a pattern of con-
tinued use of any substance despite the fact that it has become harmful to
the person using it. This means that even though a drug causes problems
46 I OVERCOMING CRYSTAL METH ADDICTION
such an unhealthy extreme. The longer a drug is used, the more distorted
the drug user's judgment becomes, and behavior that would never have
been acceptable now becomes tolerable if it is necessary to allow the
addict to keep using the drug.
For example, a successful attorney who had a perfect attendance record
at the office, often working later than her colleagues, starts occasionally
blowing off steam on Friday nights by doing a couple of bumps of crystal.
Eventually her Friday routines regularly include doing meth, then going
to bars to pick up men for casual sex. Over a few years, with increasingly
longer and frequent crystal binges, she gradually finds herself calling in
sick on Mondays because of crashing from weekend-long binges She
doesn't question it because she feels that she had always overworked, and
she believes that giving herself this enjoyment in life is a much smarter
way to live.
meth so that she can study longer hours for her exams. She starts using it
regularly to get her work done and gets hooked. Like most teens addicted
to crystal, she eventually stealing. Having no job and only a small allow-
ance from her parents, she secretly pawns valuables from her home so she
can buy more meth, even though in her precrystal days, she would never
have imagined herself stealing from her family.
three (or more) of the following, occurring at any time in the same 12-
month period:
WHAT IS ADDICTION? I 47
effects.
Reprinted with permission from the Diagnostic and Statistical Manual of Mental
Disorders, Fourth Edition, Text Revision Copyright 2000. American Psychiatric
Association.
In practical terms, the DSM-IV breaks down addiction into three broad
areas:
the point that it outweighs other things in your life, and when given the
choice between the drug and other pleasurable or important activities,
to get it, finding yourself doing things that you ordinarily wouldn't: spend-
ing money that should have been used for paying bills; going to danger-
ABOUT CRYSTAL?
Is It Really More Addictive Than Other Drugs?
are controlled by the primitive brain. This brain area controls your breath-
ing, maintains your heartbeat, and tells you when it is time to eat, sleep,
and wake up. It also controls behaviors such as eating and sex, of which
we are aware and over which we have some limited control. The primitive
brain functions are very powerful and difficult to override. For example, if
you try to stop breathing, assuming you don't give up from sheer distress,
you eventually pass out, lose consciousness, and start breathing again. The
primitive brains wins. Similarly, if you fly from New York to London, your
50 I OVERCOMING CRYSTAL METH ADDICTION
primitive brain is still functioning on New York time. Even if you know
its morning in London and you have to wake up, your primitive brains
insists that its still nighttime, and its a struggle to feel fully alert. This
phenomenon, commonly called jetlag,"
'
is an example of the primacy of
the primitive brain.
The brain-reward circuit, which lies in the primitive brain, is Mother
Nature's way of tricking animals to repeat behaviors that are important for
eat and have sex repeatedly. In this manner, the brain-reward circuit has
overweight people, "You need to lose weight, so you should stop eating so
much." fiowever, control centers for appetite and the drive to eat do not
reside in the cerebral cortex. They are in the primitive brain. This is one of
the reasons that it is so difficult to diet, despite the intellectual knowledge
that obesity is unhealthy —there is a constant struggle between the deeper
brain and the logical cortex..
As in the example of trying to hold your breath
and stop breathing, usually the deep brain wins.
This does not mean that it is impossible to overcome the deep brain
impulses. There are many success stories of people who overcame obesity
and lost impressive amounts of weight through diet and exercise. However,
the work is hard, as most success stories will attest. The battle between
the logical cortex and the primitive brain is a tough one.
WHAT IS ALL THE HYPE ABOUT CRYSTAL? I 51
All drugs that are addictive somehow affect the brain-reward circuit.
The more directly they tie into this circuit, the more they cause compul-
sive, uncontrollable use of the drug. Alcohol, nicotine, heroin, marijuana,
Because the brain-reward circuit sends its signals via dopamine, drugs that
increase the release of dopamine in this part of the brain are more addic-
tive. Cocaine and methamphetamine are powerful dopamine-enhancing
drugs, methamphetamine being the more powerful of the two.
The more often a drug stimulates the brain-reward circuit, the primitive
brain becomes more strongly programmed to repeat the behavior of using
that drug. Even months or years after stopping crystal use, people can still
have strong urges to use. Even after years of abstinence, when the craving
has been reduced to almost negligible thoughts, a small psychological trig-
all it takes to bring back the intensity of the compelling urge that has been
programmed into the brain.
go ahead and use the drug or to move along and do something else). This
process is mediated by a chemical called glutamate. Recent studies reveal
that addictive drugs, and in particular methamphetamine, cause destruc-
tion of brain cells that mediate these glutamate signals, and after that hap-
pens the signals do not work properly. Therefore, even if a person rationally
knows that crystal has been destructive to his or her life, the brain has less
of an ability to take this information and translate it into rational behavior:
it becomes much harder to resist doing the drug again.
52 I OVERCOMING CRYSTAL METH ADDICTION
ties, such as anxiety Crystal in particular can be a crutch for many dif-
lose weight. Most assume that people use drugs to feel high and to take
them away from reality. However, some people suffer so much from other
emotional struggles that drugs help treat the pain and "bring them back to
center," making them feel more "normal." For some people, drugs are a way
that they have found to deal with the reality of day-to-day living.
using it regularly to obtain emotional relief, your mind and your brain both
become accustomed to a "quick fix." There is an AA expression, "Hold your
belly," which encourages people to "stop your bellyaching and complain-
ing." This is not a cold and unsympathetic statement — it is a reminder
that you can tolerate some degree of frustration or uncomfortable feeling
without going straight to a drug to make it instantly disappear. "Hold your
belly" for a short time and let yourself sit with the feeling. Relearn that
you do not need the quick fix and that all problems do not need to be fixed
or erased immediately The strong need for immediate gratification and
a low tolerance for frustration are two psychological features that usually
develop in most drug addicts. Remember that you can survive if you wait
a little more productive route to address a problem, and
or take the longer,
that, you do something other than use drugs, you may be able to do more
if
than hide from the problem for a few hours ^you may even fix it! —
WHAT IS ALL THE HYPE ABOUT CRYSTAL? I 53
CRYSTAL may be particularly helpful with sexuality issues for gay men
I
because of internalized feelings that being gay is bad. Even those who are
I
completely "out and proud" may have deeply hidden notions that homo-
- sexuality is shameful. People have a tendency to internalize the values of
^ their parents and their community, even when they intellectually disagree
never be like them when grow I up! I can't believe they treat me this way!" i
^ However, when the boy grows older, he observes his own behavior and
remarks with surprise, "Oh my God, I'm turning into my father!"
Gay males have a natural attraction to other males, and they experi-
ence pleasure engaging in sex with other men. Yet, at the same time,
den emotional bombs that complicate sex with feelings of guilt and self-
by both the internal voices and the external attitudes of society, the re-
f
suit is ambivalence, confusion, and anxiety about having sex. The intense
hypersexuality of meth provides gay men an experience of unconflicted,
; unbridled sexual passion that many gay men have never experienced.
I Perhaps this is one reason why the gay male community has been par-
i ticularly affected by crystal. i
DO YOU THINK
YOU MAY BE ADDICTED?
one try, they feel so amazingly good that they know that have to use more.
However, for the vast majority of users, losing control of crystal is a gradual
process that is so subtle, it goes unnoticed until it is too late. This more
common experience of a slow development of addiction is consistent with
the current understanding of brain physiology. Each exposure to crystal may
cause a small but lasting change in the circuitry and function of brain cells.
After enough exposures, the neuronal pattern changes enough and the user
crosses a threshold where he or she can no longer resist the temptation to
use crystal. The brain pathways that mediate decision making have become
set so that using crystal is priority number one, regardless of what other parts
of the brain logically think or desire.
So how does this translate into practical terms? In general, addic-
tion means loss of control, but knowing when one has lost control can be
'
difficult to discern. There are several ways to assess whether you have a
problem with controlling crystal in The ''CAGE questionnaire,
your life.
If you answer yes to two or more questions, there is a very good chance
that you have a substance-use problem. The CAGE questionnaire was
originally designed to screen for alcoholism, and it has been scientifically
validated and found to pick up approximately 93 percent of people with
alcohol dependency. Because of its high sensitivity and studies that dem-
onstrate its usefulness in different scenarios, the CAGE questionnaire
has been used to screen for addictions to other drugs, such as crystal
methamphetamine.
In addition to the CAGE questionnaire, here are some additional ques-
tions to ask yourself to help examine your drug use and level of control:
1 . How often do you use crystal and has your use been increasing? Do you
use crystal once every few months, only when someone offers it
to you? Did you start out this way, but gradually your use has in-
creased to every other weekend? Did you plan the increase in use
or did it sneak up on you? Has your use increased to every week-
end, and do you find that you can't wait for the work week to end
so you can use crystal again? Are you using crystal every day?
2. How muct) crystal do you use? Do you only have one bump, and then
you're good for the rest of the night? Have you increased to doing
several bumps or snorting lines? Are you able to do a bump and
then put the bag away and leave it alone until another day, or do
you usually have to go back for more? Have you noticed that the
amount that used to get you high is no longer enough, and you
now need much more?
DO YOU THINK YOU MAY BE ADDICTED? I 57
3. How much money do you spend on crystal? Has the amount been in-
creasing? Have you ever been in a situation where you did not
have enough money but somehow had to scramble for the cash by
borrowing money, going into credit card debt, leaving bills unpaid,
or selling things in order to pay for crystal?
4. How do you use crystal? Has this changed over time? Did you start
out snorting crystal, but later you started trying new ways to get
events? Has become less of a social drug, and now you find
crystal
seeing fewer of your friends and family because you are too busy
using crystal?
6. Have you ever had health problems somehow related to crystal ? This could
include:
a. Chest pains that felt like you might be having a heart
attack
b. Catching a sexually transmitted disease because you were
having sex while high and not taking your usual safety pre-
cautions to protect yourself
c. Becoming pregnant because you felt so driven to have sex
while you were high that you didn't care that you weren't
using contraceptives
d. Panic attacks
e. Depression, anxiety, or suicidal thoughts after you stopped
using
f. Psychotic symptoms, such as paranoia that people were
watching you or eavesdropping, feeling that there was a plot
against you, hearing voices or seeing things, or feeling sen-
sations like bugs crawling on your skin
g. Dental problems from dry mouth, tooth grinding, and ne-
glecting your teeth
h. For people with HIV, finding that your CD4 count or vi-
If you answered yes to any of the above or have had any other
health problems related to crystal use, did you use crystal again,
even after realizing that crystal caused these problems?
7. Have you ever had trouble with your job because of crystal use ? Were you
ever late for work or had to call in sick because you could not
stop partying over the weekend, or when you did stop, you felt
too bad from the crash to work? Did your job performance ever
suffer? Did you ever get fired because of poor job performance or
poor job attendance due to crystal? Did you still use crystal, even
though you saw it affecting your work and possibly threatening
your livelihood?
8. Have you found yourself doing things to get crystal that you would never have
done in the past? Have you invited drug dealers who were unsavory
or potentially dangerous people into your home, or have you gone
9. Do you find that crystal determines the people you spend your time with?
Would you be spending time with the same people if you didn't
share the bond of using crystal. Have you invited people into
your life that the old you would never have considered as pos-
sible friends? Have you been spending less time with important
people in your life who don't use drugs?
1 0. Is crystal a "take-it-or-leave-it" option, or has it grown into a requirement?
Did it begin as an occasional fun treat at social activities but
gradually became something you needed to enjoy yourself? Is it
something that helps you get through a rare (two or three times
a year) day of hard work, or has it turned into something you
frequently use to do your job? Is it an occasional 'extra spice"
you add during sex, or has it become a requirement for sex to feel
satisfying? Is crystal an option or a necessity?
1 1 .
Has the number of reasons you use crystal multiplied? Perhaps you started
out using it just to have fun at special parties, but you found more
and more reasons or excuses to use it: it makes things more fun,
itmakes you more confident, sex is much better, it's great to cel-
ebrate happy events, it's a lifesaver that rescues you from a sad
mood, it helps you when you're bored. Gradually, crystal has be-
come the "drug of all seasons," appropriate for any occasion. Do
you always have an excuse to justify using?
DO YOU THINK YOU MAY BE ADDICTED? I 59
These questions are a good way for you to stop and closely examine how
you use crystal and how your use may have changed over time. If your
pattern has changed and grown over time while you have been blind to it,
If you've gone through this list of questions and you recognize that your
crystal use has changed over time and grown, but you are still unsure if
you are really addicted, the following exercises may help you check your
level of control:
FIRST, take a good look at your response to reading this challenge. Did
you feel that it would be no problem? Was your first reaction a sudden
pang of fear that it would be difficult? Like many people, did you think
this exercise would be no problem, but you didn't want to stop today be-
cause there was a special event coming up or you had already planned
a special weekend or just bought a bag from your dealer? The last reac-
I
tion, probably the most common, is a sign that you are rationalizing, tell-
;
ing yourself that you have control, though "now is just not a good time."
For an addict, despite any plans to stop someday in the future, there
is never a good time to quit. If you truly do not need crystal, then you
can make it through any "special event" or difficult time without it. You
should be able to commit to this exercise and say with conviction, "Yes, I
can quit drugs for one month starting right now," and you should be able
to follow through on your commitment.
60 I OVERCOMING CRYSTAL METH ADDICTION
WHEN you are sober, on a piece of paper, make a six-month plan by an-
1. On how many occasions do you plan to use crystal during the next
six months (how many total occasions in the next six months, or
how occasions per month)?
2. How long do you plan to use crystal on each occasion? Just a
quick bump to kick off a night out with friends, several bumps
spread over the course of a night, or a three-day "weekend war-
rior" event at a circuit party or on vacation?
3. How much crystal will you use on each occasion and how much
money is a reasonable limit to spend during each month of the
months. The upper limit should be similar to what your current use is,
or if you'd like to cut down, what you think is a smaller but reasonable
amount to use. Do not set limits that are more than your current use
because this is like planning to be "out of control."
paper, write:
; the limits, in any way and for whatever reason, indicates that am not I
Sign and date the paper, make a copy, put each copy in separate sealed
envelopes, give one copy to a trusted friend, and keep one for yourself.
On your calendar, mark the date six months ahead, and over the next six
On the appointed day in six months, open the envelope and see
how you did. Take a look at your reaction to how you did, as well
as whether you think your guidelines from six months ago still seem
reasonable. If you were able to stick to your limit or remain below it,
congratulations! You may still have some control over your crystal use.
To make sure that you maintain control, I strongly suggest repeating this
contract every six months to keep track of your use to make sure that
don't mind. Despite the clause "in any way and for whatever reason,"
they feel justified in breaking the contract, giving excuses such as un-
foreseen "special circumstances." This demonstrates how reasons to
trick the mind into using more. Addiction works silently in the brain, and
even though these people can't keep their meth use within their own
self-determined limits, they cannot see any problem.
Some find that their perspectives have changed over the six-month
period, and they decide that they grossly underestimated how much
crystal would be enough— they believe that they must not have been
thinking clearly when they wrote the contract. However, they wrote the
contract when they were in a distinctly clear and sober mental state.
Something in their minds is now different, and more crystal is now ac-
ceptable. This change is the process of addiction. While the person may
be unaware of any changes from six months prior, his or her need for
crystal has grown, and to accommodate the increased need, the per-
son's perception of what is acceptable has changed, as well.
Some people who were unable to stick to their contracts can clearly
see that crystal use is not in their control. They are fortunate because
this rapid insight is rare, and it can be a powerful tool that can be used
to overcome the addiction if they are motivated to stop.
If you exceeded the limits that you set for yourself, regardless of the
62 I OVERCOMING CRYSTAL METH ADDICTION
body nnade any unreasonable dennands. You set your own "fair" ground
rules. If you cannot even follow your own wisfies, then clearly you are not
controlling yourself-crystal is.
BUY a little notebook and keep a crystal log. When you are sober and
nnotivated, draw seven colunnns on each page and label each column
with the following:
Notable Events (Did anything notable happen? Did you finally ap-
proach the attractive person you've been too shy to meet? Did you
finally finish your work project? Did you catch an SID or uninten-
tionally become pregnant?)
Crash Rating (How intense was the crash on a scale of 0 to 10?)
DO YOU THINK YOU MAY BE ADDICTED? I 63
TABLE 6-1
Sample Log
Date How Amount Cost High Notable Crash
Rating Event Rating
8/9/2004 Smoked 1
g $125 9 Amazing sex
8/10/2004 Smoked 1
g 0— had sex 7 Amazing sex,
w/dealer blood from
anus
Keep it simple so that if you are using crystal or you are recover-
ing from a crash, filling in the information will require minimal effort. It
should take you one to two minutes maximum for each entry.
Periodically review your log. Over time, was there any change in
the frequency or amount that you used crystal? Even you don't see any
change, keeping a log, or even a more detailed journal, will help you see
more clearly what role crystal plays in your life and if that role is chang-
ing over time. Instead of turning a blind eye to your drug use, you will
you may have— both good and bad. This will help you to keep your use in
help combat feelings of shyness? Is it a way to help you feel better about
yourself? Is Tina the houseguest that was so fun and exciting when she
first arrived, but now she is torturing you because you cannot get her out
of your life?
one tied you down and spooned it into your nose, you chose to try it. If you
did it again after the first time, there must have been something positive
TAKING A LOOK AT CRYSTAL IN YOUR LIFE I 65
about the first experience that made you go back for more. What was that
reason for you? Did new reasons develop over time? After hearing so much
talk about crystal as a demon, let's look at how at times it may have seemed
like an angel, helping you feel better in some way
Studies find that social or cultural groups in different parts of the coun-
try have distinct usage patterns, though even within those groups, each
individual uses crystal for his or her own reasons
Gay men commonly report using crystal at circuit parties and discos
and in sexual contexts, such as sex parties/clubs, Internet hookups, or
other sexual encounters, as well as during nonsexual activities. Among gay
men, some who have HW also use crystal to avoid depressive thoughts,
loneliness, and concerns about physical attractiveness thought to be lost
because of their illness. In addition, the power and confidence that crystal
gives them is a strong antidote for the powerlessness many of them feel
about HIV.
Heterosexual men and women reported different motivations. A 2004
study by Semple, Patterson, and Grant at the University of California-San
Diego found that primary motivations in this group were "to get high, to get
sex acts during that time. A recent study by the California Department of
Health was the first to find that sexual activity among heterosexual men
appears similar to that of gay men, taking more risks: increased number
of female partners, more frequent anal sex with women, higher likelihood
of having sex with an injection drug user, and higher likelihood of having
exchanged sex for drugs. Clearly, even for heterosexual people, meth has
a powerful sexual effect.
Work is another common reason some people use meth. Manual labor-
ers working several jobs, as well as wealthier urban professionals in high-
pressure jobs with long hours, use meth to increase their productivity and
their ability to work longer hours.
In contrast, many people in the rural areas report using meth to combat
the boredom of living in quiet communities with little to do. It can help
even the most empty life feel vibrant and exciting.
Some, especially young females, seek meth's ability to decrease appetite
66 I OVERCOMING CRYSTAL METH ADDICTION
and cause weight loss. Severe obesity is still one reason that some doc-
tors in other parts of the world legitimately prescribe pharmaceutically
produced methamphetamine. Many people with eating disorders, such as
anorexia, and body image problems turn to meth as a diet aid. The clinical
disorder and their drug use. The reflection is a combination of good and
bad, ultimately reinforcing their belief that using meth and losing weight
is good for them.
If you use crystal a little more frequently but are not at the level of
partying every weekend or using every day, then be careful —watch for any
potential problems that may be lurking so that you can catch them as they
develop. You are in the blurry "intermediate zone," in which you actually
may not have problems with meth, or if you do, they are not obvious or
dramatic.They may seem so trivial that few people, including yourself,
would consider them alarming. This intermediate zone is a tricky place to
be because you may be teetering on the edge of addiction but there are
no big red flags to warn you of the danger. If you are in this stage, actively
assess your situation and how much control you really have. Your life may
seem fine now, but a downward spiral could be just around the corner.
If you are a hardcore user, using most days or using regularly with out-
of-control binges, and you have already experienced significant problems,
such as losing friends, becoming estranged from your family, losing your
job, failing in school, stealing or prostituting yourself to support your habit,
or jeopardizing your health and catching an illness, such as HIV, you are
"
an addict. You may realize this and sincerely want to stop. Many people,
however, even in the face of serious problems, are still in denial. They tell
"My family never really understood me anyway, who needs them?" "HIV
isn't so bad — it's a controllable disease that can be treated, so I don't have
to worry. What's the big deal?" Or "I was planning on quitting that job
affects you. An example of the matrix is shown in table 7-1 , and a sample
matrix with one person's responses is shown in table 7-2:
68 I OVERCOMING CRYSTAL METH ADDICTION
TABLE 7-1
Decision Matrix
Positive, Helpful Negative, Problematic
USING CRYSTAL: j
Immediate |
Consequences i
USING CRYSTAL: 1
Delayed
Consequences
STOPPING CRYSTAL:
Immediate
Consequences
STOPPING CRYSTAL:
Delayed
Consequences
TABLE 7-2
I got HIV.
My HIV or general medical
condition are worse.
I've begun stealing or pros-
tituting myself to pay for
more crystal.
1
rosiiive, neipTUi negdiive, rroDiemdiic
Immediate 1 can pay my rent this month. I'm bored out of my mind.
Consequences My appetite has returned. 1 can't work or study as hard
[Continued] or as long as i used to.
think of all the small and subtle ways in which crystal affects your life.
TAKING A LOOK AT CRYSTAL IN YOUR LIFE I ?!
can be good about them. From experience, however, you know that this
is not true. If there were nothing good about crystal, you would never
have tried it and continued to use it after the first time. When answer-
ing this question, think about how crystal makes you feel, what areas in
your life it helps you with, what good changes happen when you use it.
In addition to "It feels great!" try to be more specific. How does it make
you feel great? Does it give you more confidence? Does it make sex more
enjoyable? Does it break you out of your shell in social occasions? Does it
alleviate boredom or work or home? Some people say that using crystal
was the first time they felt happy in years. Think about your own per-
sonal reasons and how meth may have made you feel better.
IF you have read the preceding chapters in this book, you already know
the harm crystal can inflict, and you've probably heard other people say
what terrible things it has done to them. However, if none of those things
ever happened to you, then likely they don't have much personal impact
on you. In fact, if your experiences are completely different, you may feel
even more convinced that you don't actually have an addiction— how can
you believe all the bad hype if none of the things people say match your
experience? While it is helpful to hear about the many problems that
I become irrationally paranoid? Think about your behavior during and af-
I ter using. Did you ever do something that you later regretted when you
^
were sober—having unprotected sex, spending all your money, getting
angry and yelling at a friend? Consider the effect crystal has had on peo-
ple in your life— how are your relationships with your friends, your fam-
ily, or your romantic partner? Has it had any affect on your work— have
you ever come to work late, not felt up to the job, or completely avoided
work and called in sick? Did you ever lose a job or come close to it be-
cause of meth? Did you start taking it to help with schoolwork but doing
schoolwork gradually seemed less and less important than doing meth?
Did you ever have any medical problems related to using? Did you spend
more money on crystal than you wanted to, perhaps putting yourself into
debt? Did you ever have to sell things, steal, or trade sex for money or
think of every possible aspect of your life where craving, using, or crash-
THIS question may seem similar to Question 2, but with a twist. One way
to gain a deeper understanding of how something affects your life, imag-
ine what life would be like without it. Even if you don't think you need to
you stopped using? If you have intense crashes, could quitting help you
feel less depressed or irritable? If getting high or crashing has disrupted
i
your job, school performance, or relationships, could they be recovered or
t improved? If you add up all the money you spend on crystal in one month,
I
what other things could that money buy? How about the money you would
'i
spend on crystal in one year? If you haven't been eating so well or taking
your medications as regularly as you should when you are high, how do
you imagine your health would be if you stopped using?
TAKING A LOOK AT CRYSTAL IN YOUR LIFE I 73
^
: DESPITE Nancy Reagan's well-intentioned tactic to fight drug addiction, ]
"Just say no," the battle is not so easy. While you identified many poten- ^
ant things about stopping, whether it's the crash, finally facing difficult
problems that crystal made you blind to, or the sheer torture of trying to
resist the cravings. Would you miss it? If yes, then why? Would you miss
the excitement? Would you miss the self-confidence it gives you? What
would sex be like without crystal? If your social circle is a network of other
meth users, what would it be like if you stopped getting high with them, or
even worse, if you had to stop seeing them altogether? If you use crystal
to help you work, how would stopping affect your productivity? Would you
be able to keep up the fast pace that you'd set for yourself while using
crystal? Would you be able to keep up with your boss's expectations after
working as a meth-driven machine known for your extremely high level
hurdles that will be difficult to jump over. If you don't examine the hurdles
in an organized way and systematically figure out how to clear them, they
may seem overwhelming and insurmountable. If that happens, you may
just surrender and decide to keep using.
If you are having trouble coming up with 20 answers for each question in
life crystal affects? If you use crystal more than just a couple of times a
year, then likely it's had some effect on many, if not most, of the general
categories listed in the suggested guidelines for this exercise.
This section provides some ways to use the information from the
Decision Matrix to explore your relationship to crystal even further. It
If you are unsure if you have a problem with crystal, starting with your
positive experiences with may feel like a safer place to begin self-explora-
tion. This book does not write off crystal as something completely evil.
sides to protect yourself from the extremely high risk of addiction. How
significant are your positive experiences? If positives outweigh the nega-
tives, you may decide not to stop using crystal — at least not now. If the
positives don't seem worth the problems that crystal causes, then you may
decide to stop using crystal. Get all the information you can about the drug
and yourself, including the pleasures of crystal, so that you can try to make
a rational assessment of the drug's place in your life.
Even if you know that you need to stop using meth, identifying and
acknowledging your positive experiences on crystal is important. Sometimes
when people are so strongly determined to stop using, they actually block
out the good memories, saying with firm conviction that there was never
TAKING A LOOK AT CRYSTAL IN YOUR LIFE I 79
anything good about a drug that caused them so much harm. This is called
long process similar to mourning, in which you reflect upon your memories
and experiences, struggle with the idea of living without your old friend,
and eventually learn how to move on with your life. If you don't acknowl-
edge the good memories, you never go through the emotional challenge of
letting them go, and the happy memories stay hidden inside you, holding
on strongly to the hope that you will use again. With time, those lingering
positive memories grow into idealized fantasies that downplay the uglier
depression. Maybe using meth was the only way you could function at a
job that made unreasonable demands on you. Once you clearly see the
problems that crystal hid, you have an opportunity to actually fix them and
make a profound improvement in your life.
On the other hand, if you don't address the fundamental problems that
crystal covered up, those difficulties will never get better, and the urge to
reach for drugs will keep coming back. If you realize that you use crystal
goals —take a class in something you've always wanted to learn about, pick
up a new sport, volunteer and learn more about the people and the world
around you —whatever sparks a little interest, go for it. Address the cause
of your boredom.
If this exercise has identified significant problems in your life, it is
bad again, if not worse. Left untreated, the brain tumor will eventually
kill you, so hiding the symptoms is actually harmful. Now the importance
of Question 1 becomes even clearer. Take t list and use it to identify areas
in your life that you can improve. By addressing them with healthier and
more effective means, you can improve your general quality of life, as well
you were writing a movie script —include where you were, what you were
doing, how you felt, what kinds of thoughts were running through your
mind, and how painful the experience was. This is a technique called "play-
ing the tape." When people crave crystal, their memory is often selective,
and they have euphoric recall, remembering the enjoyable parts of their
the primitive brain, compels you to use again, sending signals to the logical
cortex and tricking you to rationalize why you should use meth again. To
counter this, you need more than logical reasoning — try to activate other
deep brain structures, such as the amygdala, where emotional memories
are stored, to more fully recall the painful consequences of using meth.
Unfortunately, the amygdala is not as deep, primitive, or powerful as the
brain-reward circuit, so it is still a tough battle. However, its a battle that
What improvements can you imagine in your life if you stopped using
crystal? Would you have more money to buy other things? Would your
how far they've fallen, and they feel a hopelessness that they will never
be able to be the successful and functional people they once were. Then
the sadness of this realization becomes another reason to get high again.
Giving yourself positive goals will remind you that you don t have to be an
addict and that your life can be better. They can give you optimism that
will pull you out of hopelessness that would otherwise keep you trapped
in a cycle of using even more crystal.. Quitting is not just about avoiding
tragedy. It is also about recovering lost people and opportunities, getting
your life back, moving forward, and achieving even greater things in life.
When trying to stay sober is a struggle that makes you feel that life is empty
without crystal, use this list to remind yourself of the wonderful things that
can happen if you quit,
Are there any negative aspects to stopping crystal? If not, then you
should quit. Considering the risk of developing a powerfully destructive
addiction, if stopping were to cause no problems, why not stop before you
develop an addiction?.
fiowever, if you cannot think of any difficulties with stopping crystal but
you use fairly regularly, you may be one of those people who says, ''I can
stop anytime I want to, I just don't want to right now." See exercise 6-1 in
never addressed, obstacles such as these could frighten most people right
back into using.
Question 3 may seem as if it were meant to discourage you from stop-
ping crystal, but it is another important tool to help you manage your
TAKING A LOOK AT CRYSTAL IN YOUR LIFE I 83
recovery. In the past, doctors were afraid to ask their depressed patients if
they felt suicidal. They thought that asking about suicide might introduce
the idea and create suicidal thoughts. Could they cause their patients to
attempt suicide by mentioning it? Fortunately, psychiatrists found this was
not true. If a person does not want to kill himself, then uttering the word
"suicide" will not magically make him want to die. But if the doctor asks,
and the patient admits that indeed he has been feeling suicidal, then both
the patient and the doctor are now prepared to address the problem and
keep the patient safe. Similarly, mentioning the difficulties of stopping
crystal will not prevent you from quitting. If you try to stop using, then
you will face the same difficulties whether or not you've written them
down. However, if you forecast the difficulties that lie ahead and carefully
prepare yourself, then you will be much better equipped to deal with the
obstacles when they happen. If instead, you are completely unprepared
and a difficult situation catches you off guard, it is hard to think on your
feet because your addicted primitive brain is overwhelming you with sig-
nals telling you to use meth again; However, if you are prepared for the
situation, you can kick into autopilot, and even if it feels as if you are
reading lines from a script, you may be able to navigate your way out of a
potential relapse.
For example, if you predict that you will feel terribly bored if you stop
using, you should structure your schedule ahead of time to make sure
you are busy. Arrange your day with a balance of work or classes, exercise,
relaxation, and "working the program," meaning going to twelve-step meet-
ings or recovery groups. Keep yourself occupied and interested, but not
overloaded. Boredom and having nothing to do are common reasons that
people relapse especially early in recovery.
If you know that disappointment in sober sex will make you long for
crystal, you may have to take a break from sex entirely for a little while.
When you are further along in your sobriety, you can work on relearning
how to have sober sex.
If you know that you will feel lonely without your network of meth
buddies, then this would be a good time to reach out to family and sober
friends and try to rekindle old relationships that were casualties from your
drug addiction. Alternatively, it may be time to start cultivating new friend-
ships, ones that are based on something more meaningful to you than a
drug. Community activities and sports that you enjoy are good places
84 I OVERCOMING CRYSTAL METH ADDICTION
where you can meet new people with similar interests. Volunteering for a
cause important to you will give your life new purpose and meaning, and
you can meet new people who share your passion. If you can't find activi-
as you of getting sober. They personally understand the struggles you are
going through, so from the outset, you know that you share some important
things with these people. Be creative and look around your community for
different opportunities to meet new people who have something in com-
mon with you and who don't do drugs.
If you have put sincere effort into completing the exercises as honestly
as you can, you should have a good idea of how crystal affects your life.
Hopefully this will clarify whether you must stop using crystal or if you
feel that you can continue to use with caution. If you are still unsure, go
back to chapter 6 and read it again with the information that you gained
from the Matrix Model, then see how things stack up.
PART
3
HOW CAN YOU HANDLE
CRYSTAL IN YOUR LIFE?
STRATEGY:
Learn the Basic Techniques for Stopping Crystal
Objectives:
• If you are not ready to stop, learn ways to handle
crystal safely while you monitor your use to see if you
are able to keep control.
• If you are ready to stop, learn some basic strategies
to break the cycle of use.
I
you should avoid it completely Nonetheless, the truth is that not every-
one is ready or willing to stop, and many of those who continue to use
still care about their health and want to take precautions on their own
terms —perhaps this is why you picked up this book.
This chapter is written for those of you in this group, recognizing that
not wanting to stop crystal in no way makes you 'evil" or ''bad." You may
be sincerely committed to being as healthy as you can, but you need to
do it your own way, which may include not stopping drugs right now. If
you are going to use, here are some suggestions on how to keep yourself
as safe as possible.
88 I OVERCOMING CRYSTAL METH ADDICTION
In this chapter, you will learn specific strategies designed for the con-
tinuing user to monitor his or her meth use and to minimize any harm that
might result from the drug. This approach is called "harm reduction."
ing drug use, but also a person's general life goals, such as relationships,
friendships, career, and finances. The form of harm reduction treatment
can var)^, tailoring itself to help each person achieve what he or she wants.
Focusing on people's personal goals helps to keep them motivated in the
treatment — it is really their personal quest for health, as they define it. In
this treatment model, a crystal user may strive for limiting crystal use to
rare, occasional partying, more frequent but regular and controlled use, or
it has started to get out of control. You may want to know if you have any
medical or emotional problems due to your meth use, so you can decide
for yourself if you need to stop using. And you should be able to get these
services in a nonjudgmental setting that will not turn you away if you're
not quite ready to stop yet. The decision to stop needs to be yours, not
WHAT IF YOU USE CRYSTAL AND YOU DON'T WANT TO STOP I 89
about their drug use or their intentions to stop. But lying can be dangerous
because the treatment that they receive is based on false information. If
l sion and cravings for crystal. However, taken together with crystal, it can
;
cause seizures.
';
Lying also sets up a poor relationship between the meth user and the
health-care provider because it lacks sincerity and trust. Ideally your health-
care provider should be your confidant and advocate, someone who will
not judge you but will try to give you the best advice.
Most continuing crystal users do not lie about their use. They simply
don't bother to seek any care. Some are blind to their health problems
because they are so caught up in meth use. However, many people who
fully realize they are medically ill have lost trust in the medical establish-
ment. Their wariness of the medical system may prevent them from getting
necessary treatment, even when they know they are seriously ill. Harm-
reduction programs try to prevent addicts from developing this attitude so
; that they are willing to get help when they eventually need it.
management.
as well as to continue other behaviors you may associate with it, such as
90 I OVERCOMING CRYSTAL METH ADDICTION
sex, Internet hookups, or going out dancing. Before partying with crystal,
prepare yourself ahead of time to maximize your ability to stay within the
limits you set for yourseli when you are sober. If you are completely honest
with yourself, you know that you may not have complete control over your-
self when you are high, so before you start partying, set up some external
controls to keep things in check. A little planning can go a long way.
stick to it. When you are tweaking (high on crystal), your per-
ception of how much is "healthy" will probably be much higher.
If you have ever found that doing more than a certain amount of
crystal made you feel anxious or paranoid, or if it s ever made you
hallucinate and hear, see, or feel things that were not there, set
your limit below this.
When setting your limit, don't forget to consider what the crash
will be like. Many people feel tired and blue after partying, but
if using more than a certain amount of crystal has made you
extremely depressed or even suicidal, set your limit below this.
If possible, buy your crystal before you go out, so you already have
the maximum amount you plan to use. When you leave home,
don't take your wallet, ATM cards, or credit cards. Carry an ID
for emergencies and enough cash to get you home in a cab. Better
yet, if you are going with a friend who is not drinking or using
drugs, he or she can drive you, and you can leave the cab fare
If you are using at home, set aside the cash to buy the amount
you decided to use, and if possible, give your wallet, ATM card,
credit cards (you get the picture) to someone you trust to hold
on to them so that when you reach your limit, you won't be able
to buy any more, even if you want to. This may seem extreme,
but be honest with yourself: if you've ever done crystal, finished
WHAT IF YOU USE CRYSTAL AND YOU DON'T WANT TO STOP I 91
If you are going out and will be with people you don't know, keep
your emergency money in a safe place (under the insole of your
shoe, in a hidden pocket, or elsewhere on your person).
Decide how long you plan to use crystal, and decide on a length
safe but are too consumed by the drug high to take them. For
whatever reason, many people skip their meds completely when
they use meth. However, even brief drug holidays can allow HIV
to become resistant to the medication. If you find that when-
ever you are out using crystal you never take your HIV meds on
time, plan to finish partying before your next scheduled dose of
meds.
When you are partying, you may become so engrossed in doing more
crystal and other activities that you forget to take the precautions you
would ordinarily to take good care of yourself. Here are some important
reminders:
If you slam, never share needles and syringes. If you must share,
clean your needles and syringes with bleach and water before
the next user's turn, drawing the mixture through the needle and
into the syringe to make sure that the inside of the needle is fully
Take a break every hour to rest and hydrate. Crystal makes you
feel so energized that you don't detect your body's usual signals
telling you that you need rest or fluids. Drink liquids with sugar
and electrolytes, such as fruit juices or Gatorade, that will give
WHAT IF YOU USE CRYSTAL AND YOU DON'T WANT TO STOP I 93
your sweat. These are very important for your heart to keep work-
ing properly Since crystal gives your heart a big workout, make
sure to provide the optimal conditions for it to work its best.
Fluids are also important for oral health. Dry mouth sets up
a comfortable environment for bacteria to grow, and cavities
The intensity of sex is exponentially higher when using meth. For some,
this is one its most appealing draws. Studies looking at motivations of dif-
ferent types of users have found that gay men in particular sought more
intense sexual pleasure from crystal. In contrast, heterosexual men and
women reported other factors as more appealing. More recently, however,
studies have shown that heterosexual men and women experience pro-
found intensity when they have sex on meth. While sex may feel amazing,
it poses two significant problems: (1) the more you have sex on crystal,
the less appealing sober sex becomes, and eventually you may not be able
to have sex without the drug; and (2) on crystal, the drive to have sex
becomes so strong that important safer-sex precautions feel unimportant
94 I OVERCOMING CRYSTAL METH ADDICTION
and even bothersome. Keep the following in mind when planning your
next crystal-sex adventure:
When having sex, especially if you are continuing for a long time,
periodically check to make sure the condom has not come off or
though crystal can mask much of the pain from injury. The fric-
condoms.
Even if you are the one penetrating others, if you have sex with
someone with HIV, hepatitis, or any other STD, the germs are
now all over the condom, and the next person you penetrate will
be exposed to all those dangerous organisms. No matter what
your role is in sex, whether penetrating or receptive, change con-
doms with each partner.
If you see any blood, stop. You may not feel any pain, but if there
is any injury, your risk of getting a sexually transmitted disease
is high. If you are HIV-positive or have hepatitis, then there is
When having oral sex, keep drinking liquids because the dry
mouth that meth causes makes your oral mucosa more suscep-
tible to cuts and abrasions, which can be entryways for STDs
such as HIV and hepatitis viruses. Meth mouth is already full
People have tried all sorts of remedies to help manage a crash, from
taking high doses of vitamins and antidepressants to taking herbal supple-
ments and drinking special teas. While many of these remedies are based
on some theoretical knowledge about meth, it is not possible to make
definitive suggestions because no rigorous studies have been found yet
96 I OVERCOMING CRYSTAL METH ADDICTION
that support any of these anticrash methods. For example, it had been
theorized that vitamin C, a powerful antioxidant, would protect the brain
from damage by free radicals released when taking Ecstasy However, one
animal study found that vitamin C actually increased brain damage. Other
studies have been inconsistent. And how do these animal studies translate
are biologically active —meaning they cause biological changes, just like
Other natural elements, such as arsenic, lead, and mercury, are frankly
dangerous and potentially deadly. Regarding herbs and plants, be wary.
Recall that hemlock and countless varieties of mushrooms can be deadly
Even kava kava, an herb and root commonly sold in health food stores for
anxiety, has been found to cause liver failure and death. Rather than look
for a magic pill, try to use these commonsense ways to soothe yourself to
manage your crash:
your meth doses further apart, or take smaller amounts. This may
be extremely difficult for some of you because you won't get as high,
which is what your body and mind will be begging for, but tapering
off more gradually will make the crash less sudden and severe.
Make sure you are somewhere comfortable when you are coming
down — ^your own home or a friend's place may be the best choices.
WHAT IF YOU USE CRYSTAL AND YOU DON'T WANT TO STOP I 97
quiet place. Too much stimulation can keep your mind running
and not allow you to slow down. However, if a quiet place makes
you more aware of your restlessness, try watching TV and flip-
ping channels with the volume low to occupy your mind with the
television and your restlessness with the remote control, without
again!) Keep your mind focused on these things, which will help
keep your thoughts from sinking into darker places.
When tiredness finally sets in, let yourself relax, sleep, and rest
Do make any major life decisions while you are high or com-
not
ing down from crystal. Getting into arguments, ending relation-
ships with friends or partners, or deciding to quit a job or move
out of your home during a crash would be a big mistake. If you
are feeling upset about something or someone, tell yourself you
will deal with the problem after the crash is over. If the problem
is real, it will still be there when you are feeling better, and you
will be in better shape to make careful decisions.
If you are feeling extremely depressed and you have any suicidal
98 I OVERCOMING CRYSTAL METH ADDICTION
is a part of the crash and that suicidal feelings will pass, and it
is crucial that you keep yourself safe until they do. In this situa-
tion, medication can be very helpful, and in an ER, you can get
medication that is helpful but safe.
that you set for yourself, or you continue to put your health, relationships,
or job at risk, then your meth use is out of your control. Speak with a harm-
reduction counselor to get other suggestions, and discuss whether now is
the time to think about stopping the drug, before it completely takes over
your life.
How much control do you have over crystal, and how much control does
it have over you? When you are sober and well over the effects of a crash,
make a list of things that you want in your life. Consider all areas: your gen-
eral emotional well-being, intimate relationships, your sex life, your family
and friends, school, your career, and whatever else is important to you. List
to what extent crystal has helped you in these areas, and how much it has
hurt. Be as honest as you can. Meth may help with many things on your
list, such as boosting your self-esteem, improving your mood, and helping
you to lose weight. But there are also a number of ways it may hurt you.
Review your lists: Are the benefits a fair trade for the problems? How
many negative effects are you willing to tolerate? How many occasions of
missing work are acceptable to you? How bad a crash is tolerable? How
much risk are you putting yourself at for HIV and hepatitis? After decid-
ing what is acceptable to you, don't just think about them, write them
down —because if you become addicted, the order of your priorities will
change: the pleasure you get from using will climb the charts to number
one, and you will forget which things in Hfe were most important to the
non-addicted you. At that point you will lose the ability to rationally dis-
If you find that the balance of control has shifted, that crystal now has
more of a grip on you than you have on it, then the surest way to regain
power over your own life is to stop using —and that means completely If
you have reached this point, then read chapter 9 to learn about ways to
stop.
STOPPING CRYSTAL—
When You Feel That You Have Lost
Control of Your Life and You Want It Back
require intense work from the nonaddicted parts of your brain to battle
and overcome the addiction. But if you are willing to make the effort,
then you can win.
Through studies on humans and animals, through what scientists have
learned about methamphetamine's physiological effects in the brain, and
through accounts of people using crystal, it is clear that this drug is power-
fully addictive. One of crystal's primary biological functions in the brain is
to make the animal exposed to it (in this case, that would be you) continue
to seek more. Crystal meth is an insidiously clever parasite whose primary
goal is to get you to take even more of it.
STOPPING CRYSTAL I 101
—
A good comparison is HIV an ingenious virus that hijacks a person's
immune system, the same system that a person uses to fight infections.
HIV uses the immune system to its own advantage, luring immune cells
to engulf it in its usual attempts to destroy invaders. However, HIV hides
inside immune cells and then takes control of them so they do all the work
of making more HIV and spreading it throughout the body.
Meth works almost identically It hijacks the user s brain and eventually
takes control, using it to control the mind and body to keep taking more
meth. Like HIV, meth lives and works in the part of your body that would
normally fight problematic behaviors, so it has weakened its most danger-
ous opponent. Repeated use of meth causes neuroadaptations —changes
in brain structure and chemistry — altering the user's brain function so that
immune cells and HIV, the brain becomes blind to the danger of ingesting
the drug (e.g., by going into denial, rationalizing, or making excuses for
why crystal is not so bad). Because the addict is less consciously aware of
the problem, crystal can take control. The brain's craving for it eventually
becomes compulsive and automatic, and the degree of its control over a
person's mind can be shocking. A person's life may be falling apart, with
loss of job or severe deterioration in health, but the altered brain still con-
vinces the addict to just keep on doing more crystal and that everything
is just fine.
I
102 I OVERCOMING CRYSTAL METH ADDICTION
DETOXING
Note: There is currently no FDA-approved medication for the acute
and the need to sleep increases but it is irregular: often someone crashing
will sleep during the daytime, then have trouble sleeping at night. If you
have these problems, it can be extremely difficult to reestablish a healthy,
structured lifestyle. The frustration alone can spark a strong urge to start
there are many different strategies that doctors can use to help ease you
through the experience. A good detox regimen should cover three basic
areas. It should:
STOPPING CRYSTAL I 103
3. Regulate sleep so that you fall sleep when you should (at night)
ety. There are several medications that can provide quick and safe relief
the edge when meth causes too much anxiety or insomnia. In a detox,
they are prescribed in a very controlled manner to make sure they are used
therapeutically, instead of becoming another drug to abuse.
There are also other medications that are calming but do not carry the
potential for addiction. Clonidine (Catapres), most often used as a blood
pressure medication, works by blocking the release of adrenaline signals
from a nucleus in the brain that can cause anxiety and distress. Clonidine
is so effective that it is used in heroin detoxification, which can be excruci-
It has also been used as a nonaddictive treatment
ating. for the hyperactive
the reserves are depleted and dopamine function in the brain is signifi-
cantly impaired, and it may take several days to weeks to restore enough
dopamine to improve mood, energy, memory, and clarity of thinking.
recent studies, and some of the subjects reported less of a dramatic high
from crystal, perhaps resulting in using less and shortening the length of
binges.
Another dopamine-like medication is ropinirole (Requip), which targets
dopamine receptors, it may satisfy brain cells that feel the lack of dopa-
mine. This use of ropinirole in this manner is theoretical and has not been
proven in any clinical studies at this time.
not clear what this means in the long term. Will crystal addicts continue
to stay clean and sober, or are there other risks that methylphenidate may
cause? This is only the first study, and the validity and the interpretation
of the results are not yet clear. Before meth addicts rush to their doctors
asking for methylphenidate, here is a cautionary example to keep things in
(GHB), a popular club drug, was very effective in treating withdrawal and
decreasing cravings in alcoholics. Taken at face value, this study implies
that alcoholics should use GHB to stop drinking. Unfortunately, GHB has
also been found to be a much more addictive and dangerous drug than
alcohol, with many deaths related to its use.
The last medication I will discuss in this section is modafinil (Provigil).
normally low in heavy crystal users. It also improves energy and attention,
which is a benefit that many meth users miss during recovery, feeling flat
and tired without the drug. It may also help balance brain function that
would otherwise have led to cravings and relapse. However, modafinil
does not have significant dopamine activity, so it is considered to have low
addiction potential. While this seems like the perfect medicine to help
crystal addicts, there have been a handful of case reports of people feel-
ing some euphoria from modafinil, which reminded them of crystal, and
they experienced heightened cravings. This occurred with one of my own
patients, who started taking increasing doses of modafinil in an abusive
way. Fortunately, he was extremely motivated to stay clean and he never
106 I OVERCOMING CRYSTAL METH ADDICTION
relapsed to using crystal. Another patient who had a history of past drug
use but was not a crystal user tried modafinil and experienced severe LSD-
like visual hallucinations that were terrifying. The lesson is simple: be cau-
tious with any drug; even the most promising remedies have some risk.
doze off in the middle of the day, nighttime often brings frustrating insom-
nia and fitful sleep. Instead, strive to establish a sleep/wake schedule that
is well structured and leaves you feeling well rested. Structure is crucial
to recovery, and this includes the simple act of sleeping at night and wak-
ing up in the morning. Put yourself back on schedule with the rest of the
world so that you stay out of the ''drug addict" routine. This will help you
get back on your feet so that you can begin to work on important things
in life — your drug recovery program, going to work, and taking care of the
day-to-day business of life.
or they quickly find out. Therefore, the principle of ''if one works, two
should be better" definitely does not apply with these medications.
In addition to hallucinations, benzo-like medications have been associ-
ated with a number of unusual activities that seem out of the users con-
trol. This has been reported moreso for Zolpidem (Ambien). For example,
one woman woke up to find had she dismantled all her remote controls
and neatly organized the parts on the kitchen counter. In another example,
a man drove to his ex-girlfriend s home at four am and banged on the door
came and shook him awake. These people were completely
until the police
unaware of their actions, yet some of them ended up behind the wheel of
a car, driving in traffic! These are not fun experiences because the people
who have them can't remember them at all. However, they put themselves
(and others) at risk of serious harm. If you are trying to clean up and stay
sober, who knows where your unconscious mind could lead you in the
middle of the night? These medications are even more dangerous because
they are advertised as completely safe. They are not. Stay clear of them.
If you decide to try a detox regimen, you must do it under the supervi-
sion of a physician, ideally one with experience with addiction. When
discussing possible regimens, be sure you tell your doctor everything that
you take — recreational drugs, prescribed medications, over-the-counter
drugs, herbal supplements, and even vitamins. The last thing you want
when you are dealing with the challenge of quitting meth is an accidental
drug interaction that could have serious medical consequences.
this should be in conjunction with a drug counselor, who can support you
through the process of detoxing and coordinate other relapse-prevention
services to make a comprehensive and effective program that is tailored
to your specific needs.
Many experienced addicts know how to obtain the medications IVe
108 I OVERCOMING CRYSTAL METH ADDICTION
can control everything, then how did you get so addicted that you need to
be detoxed? It is time to hand the reins over to someone else.
Your physician should set up a 10-day detox schedule for you after
possibly relevant —medical conditions you have, what drugs you've been
using, and what medications you take.
is not a scam for get drugs, something that many physicians are wary of
and try hard to avoid. If your doctor sees that you are earnestly trying to
get better and are disciplined enough to stick to this structured treatment,
tion cases. In addition, knowing that you are going to have a urine drug
test gives you even more incentive to try to stay clean. Shore up as many
reasons as you can to be mindful and keep away from crystal.
If things are going smoothly with the detox, your physician should give
you prescriptions to last you the remaining 5 days. Small prescriptions with
no refills decreases the temptation to use more than your schedule directs.
During a detox, you should see your doctor often. Picking up prescriptions
for the rest of the detox is a good incentive to continue your contact so that
someone is following your progress.
Your physician should draw up the following contract with you:
2. If you lose your medications, they fall down the sink, or you run
out of medication for any other reason before 5 days, I will not
provide you with any extras pills, prescriptions, or refills. The set
help you find a drug treatment program where you will receive
more intensive treatment for your addiction.
This contract is important for several reasons. First, your doctor needs
to feel that he or she can trust you. Most physicians are uneasy about
working with drug addiction, and many have been burned by patients ly-
ing to them in order to obtain controlled substances that they then abuse.
Most doctors have had patients say they *1ost their medications," or "ac-
cidentally dropped their meds down the sink," and they repeatedly ask
for more prescriptions. While this happens frequently with controlled
substances —medications that patients should be most careful with — for
rarely get misplaced. Hence, most doctors are extremely wary of addicts
seeking drugs. After such experiences, many doctors may not be willing
even to consider trying a detox regimen. However, presenting your physi-
cian with this contract sets up parameters that can make your doctor feel
confident that you are making an honest and sincere plea for help and
that you are committing to work within a strict and safe plan that you
both agree upon.
Setting a Hmit on the number of times that you can request this detox
regimen prevents you from using it as regular way to end crystal binges,
making you feel more comfortable bingeing more often. Even if you do
not intend to keep bingeing, such a pattern can still develop. Making a
explain the reasoning behind the treatment. If your request seems logical
and medically sound, your doctor will be more likely to help you.
:
PART
0
NOW THAT YOU HAVE
STOPPEDp HOW DO YOU
STAY CLEAN?
Working on Keeping Crystal Out of Your Life
Ob j ectives
• Learn the concept of "relapse prevention" — not just
a treatment but a way of Living that will protect you
over your lifetinne.
occurs even if, intellectually and emotionally, you want to stay as far as
possible from drugs. But do not despair — things become much easier
with time.
The ambivalence and temptation to use crystal will always be a part of
you, to some extent. Imagine two parts of you —
one part wants to be drug
free and healthy, while the other part wants to use meth again. Think of
the addicted one who will eventually run the business into the ground.
As aggressive competitors, both shareholders relentlessly vie for control.
on patients with high blood pressure, diabetes, and drug addiction — the
statistics for how well people stick to treatment, how often they "relapse,"
or how often they have periods of worsening symptoms — it is difficult to
discern any significant differences. All three are biological processes. The
important take-home point is that like other chronic illnesses, addiction
requires ongoing monitoring and care. Even after you achieve sobriety, you
should not simply return to li\ang life the way you had been before. Just as
if you have been diagnosed with asthma, once you treat the acute illness,
you need to make lifestyle changes to minimize the risk of another asthma
attack. You must accept the fact that you need to treat and monitor your
health for the rest of your life.
to fall back into full-blown out-of-control drug use is still there. The brain
circuits of addiction may be quiet, but they are still there, and they can be
activated and quickly return to a full relapse. There are countless stories
of alcoholics and drug addicts who stayed sober for decades, but once
they let their guard down and convinced themselves they were no longer
addicts, they found themseh es just as out of control with drugs as they
had been decades before.
A helpful model is to think of addiction as an escalator that is constantly
moving downward. You are standing in the middle of the addiction esca-
lator, and if you don't move your feet, the rolling staircase will take you
lower and lower, to the depths that addiction takes you. You have to walk
or even run up the steps to rise to safety. Even when you are higher on the
escalator, you must continue to climb just to stay in place and to prevent
the escalator from bringing you down again.
In this model, climbing represents the work you put into recovery.
RELAPSE PREVENTION I 115
Given time, effort, and the length of your sobriety, the escalator will slow
down, and it will feel less arduous to maintain your current level on the
escalator. Eventually it will be even easier to climb and to move higher up
in life, rather than just to stay in the same position. But never forget that
the escalator is always running. If you convince yourself the escalator has
stopped moving, you will stop climbing, meaning that you will forget about
your awareness and your recovery skills. And the escalator will gradually
bring you back down to the depths of your addiction.
The medical model emphasizes that much of the basis for addiction is
they are damaged, the behavior is difficult to control, f^owever, the dif-
ference between addiction and other medical illness, such as high blood
pressure or asthma, is that the location of the malfunction is in the brain,
so the illness affects feelings and behavior. For this reason, it is easy to
understand why most people, including addicts themselves, see addiction
as a personality issue, and they attribute it to bad choices made under free
will, rather than to biological process. Society tends not to blame people
for having high blood pressure or diabetes, and there is little shame in
the illness is not *'bad"; in a chronic illness, we expect that a slip is bound
to happen at some time, though we work hard to minimize the possibil-
ity. Just like a patient with asthma, the addict should not focus on "being
a failure" for relapsing — this is demoralizing, and delays treatment and
recovery. Rather, a relapse or setback is an important time to investigate
what caused the flare-up and how treatment needs to be adjusted or inten-
sified to quickly get things back on track.
crystal. " Quite the opposite. If a woman with diabetes found that her
blood sugar was too high, it would sound unwise, if not ridiculous if she
responded, *'So what's the point of this insulin? I may as well forget about
these meds and eat as much sugar as want because
I Til never get my sugar
under control!" During a disease flare-up, whether the illness is diabetes
or addiction, the affected person needs to tell his or her doctor what has
happened. Together they can consider what changes in lifestyle and treat-
Older views of addiction were harsh and critical — sobriety was success,
and if you relapsed, you were a failure. You were either sober or you were
a hopeless addict. Without much room in between, many addicts felt that
if they slipped back into drug use, they were hopeless failures, and addic-
tion was their only lot in life. There was an unrealistic expectation that
sobriety was as simple as understanding that there was a problem —the
"epiphany" would magically take away the cravings and dangerous loss of
control. Needless to say, this perspective on addiction was discouraging
and demoralizing because the majority of addicts who try to stop eventually
and other health care professionals reluctant to work with addicts because
addicts were almost all destined to be failures.
The modern concept of addiction does not consider a relapse to be a
failure. In fact, relapsing is almost inevitable in the process of recovery.
Many addicts use their frustration and feelings of hopeless failure as a
rationalization or excuse to continue using drugs —why bother quitting
if you will never succeed? Instead, falling down should motivate you to
get up, dust yourself off, and try harder. Keep trying and eventually it gets
RELAPSE PREVENTION I 11?
easier — that's how babies eventually learn to walk. If babies gave up after
their first few falls, we would all still be crawling.
out ways to avoid them. This is best done with the assistance of someone
experienced, such as a counselor, a therapist, or a group, who can point
things out that you may not see. The addicted part of your mind works
insidiously and can distort your thinking and create blind spots, even when
your conscious motivation to stay sober is strong. Ideally, you should avoid
all things that pose a risk. However, in real life, it is not possible to avoid
all risks. Therefore, relapse prevention also includes working on how to
cope with risky situations effectively until you can get yourself to a safer
in figure 10-1.
ADAPTIVE
COPING
\
HIGH-RISK
SITUATIONS
REACTION
; MALADAPTIVE)
EMOTIONAL STATES
COPING „^
AVOID
HIGH-RISK
SITUATIONS
The ways you live your life, or your emotional state, can bring you into a
situation that is a high risk for relapsing. When you find yourself in those
situations, how do you react? Right now your automatic reaction may be
to use crystal, but there are other, better ways of coping that can get you
through a high-risk situation without resorting drugs.
YOUR LIFESTYLE
How DO YOU live your life and what impact does that have on your emo-
tions? Is your job too pressured and stressful? Are you unemployed or
underemployed, feeling bored all day? Are you around people who use
drugs, and do you feel pressure to do the same in order to feel part of the
group? Are you unhappy or depressed and want to feel good again? Do
you have low self-esteem but are tr}dng to find ways to feel better about
yourself? Do you have HIV and feel like a prisoner of it, wishing you could
forget about HIV, even for a little while? Are you tense, irritable, and frus-
These are only a few of many important aspects of life that all people
Take inventory of your lifestyle —the way you lead your daily life, the
way you feel about yourself, and the way that you interact with other
people. Are any of these things situations in which you have used meth
to feel better?
HIGH-RISK SITUATIONS
you so that you can steer clear of them. Having your crystal dealers tele-
phone number in your cell phone puts you at risk. The physical presence
of your dealer, as well as friends and acquaintances who use, put you at
risk. Simply seeing your dealer's number on your caller ID puts you at risk.
RELAPSE PREVENTION I 119
Places where you used to use crystal, such as your meth buddy's house,
discos, sex clubs, and circuit parties may put you at risk. Access to the
Make a list of people, places, and things that are a high risk for you.
This is your personal list of high risks to avoid. In particular, when you are
newly sober and just beginning to develop better coping skills, you need
to stay as far from these risks as possible. Give yourself a breather from
those friends who use crystal. Stay away from clubs, sex parties, and cir-
cuit parties. Take a break from the Internet, where you may find yourself
searching sex sites and then run off to a crystal-sex hookup. Throw out
your dealer's telephone number and erase it from your speed diak If your
dealer sometimes calls you, tell him or her not to call you anymore, and if
your dealer persists, change your telephone number. This may seem like a
tremendous hassle, but the mere sound of your dealer's voice on the phone
can bring back a powerful rush of feelings that may overwhelm your best
intentions to quit. See exercise 10-2, "Identifying High-Risk Situations,"
(page 131) to explore this further.
There will likely be some items on your list of people, places, and things
that are unavoidable. Your dealer may be someone in your neighborhood
who passes you occasionally on the way to the store. You may need to
use the Internet regularly for work. Consider which items on your list are
unavoidable. If you are truly unable to get these things out of your life,
sex sites, which could trigger old feelings and a strong desire to
get high. If your job does require Internet access, have someone
install a web filter (like "parental controls") on your computer
that restricts any sex-related sites. You should not install it your-
self because you can easily turn off the filter if your willpower
is weak. Ask your company information technology staff to do
120 I OVERCOMING CRYSTAL METH ADDICTION
view adult sites, and you want to stop this from happening any
further.
tal, the next big circuit party, or anything that may be a trigger,
think of standard responses you can fall back on, such as: ''Can
we talk about something else? ' Or politely change the topic to
something that's not a trigger for you, such as: "Hey, how's your
brother doing?" Practice the lines, even if they start to sound
like a script. Eventually you'll get used to saying them, and if you
always have the same response, eventually your friends will learn
that you don't respond to conversations about their drug use or
other drug-related topics. mouse keeps pushing a
If a lever for
food but nothing ever comes out, eventually the mouse will give
If the people you can't avoid ask you directly to use crystal with
them or invite you to a place where you know people will be
using crystal, say "No thanks." Refusal skills are essential —you
are firmly saying no to the people who are tempting you, but you
are also firmly saying no to the addict part of you that always
wants to take control. See the section called "Refusal Strategies"
(page 121) for a detailed discussion of this topic.
If the people you can't avoid are people who live with you, such
as a parent, a spouse, or a partner, and they refuse to stop using
will trigger memories and feelings that can powerfully pull you
back to crystal. Short of moving to a new home, you will have
to make some changes. Paint the walls a different color. Get dif-
RELAPSE PREVENTION I 121
did when you were using crystal, and it will be less of a reminder
of those times. Think of Pavlov's dog, which salivated every time
he heard a bell because the sound of the bell was paired with
receiving a steak. In this case, the bedroom is the bell, and meth
is the steak that was paired with it. If you can't get rid of the
bell, at least change the sound enough so it stops making you
salivate.
There are many people, places, and things that can increase your risk
of relapsing. However, as you can see, there are as many ways to deal with
them if you aren't able to completely avoid them. The best strategy is to
plan ahead so you can be prepared. Learn the danger zones you can avoid,
and for the unavoidable, create a specific plan for how you will deal with
each situation —even if you don't use that exact plan in the real situation,
in a high-risk situation, the urge to use may be so strong that you can't
think well on your feet. Or more likely, the desire to use may become so
strong that you will not want to think. If you are prepared, you won't have
to think much because you'll already know what to do. You just need the
inner strength to do it.
REFUSAL STRATEGIES
"Just Say No." The catchphrase from Nancy Reagan's well-intentioned
antidrug campaign sounds oversimplified, underestimating the power of
addiction. However, combined with other strategies of relapse prevention,
the ability to say no is extremely powerful. And difficult. This is why it is
automatic, they will be even easier to say, regardless of whether you sin-
cerely mean them at the time. Early in recovery, you will be struggling
against a powerful temptation to say yes. But that is irrelevant here. Your
single goal is to get away from this powerful danger. Just say no. Avoid any
interaction in which the powerful cue of meth that is being dangled in your
face could possibly overpower any rational thought. You may continue to
struggle against the wish to say yes, but without the crystal within reach,
your logical side will have a better chance of staying in control.
Think of a common scenario in which someone offers you crystal, such
as passing old drug pals on the street, or at the beginning of a hookup with
someone you meet online. Think about how you want to come across to
other people and what action would effectively end this dangerous situa-
tion. You want to feel and appear firm and unwavering, not indecisive and
unsure. A dealer or other crystal users can sense ambivalence, and they
know how to target your vulnerabilities. Don't be fooled by their generos-
ity. Whether they are dealers or friends, they have selfish reasons to get
you to use: The dealer obviously wants to make money Even the generous
freebie that gets tossed your way is just a ploy to get you hooked and back
to being a regular paying customer. Other users want you to join in because
it makes them feel less guilty about their own use
— "Crystal can't be that
bad if someone else is doing it, too, right?" Disregard whatever they tell
you, and focus on your primary objective — to be clean and healthy Tell
them no. State it clearly and succinctly, without reservation.
Some possible ways to refuse are:
to stop. I don't want you to sell it to me, and I don't even want
you to talk to me about crystal again."
. Or simply, "No, thanks."
Make eye contact when you say no, which shows sincerity and gives a
nonverbal signal that you do not welcome a challenge to this statement.
Never use expressions such as "I think" or "It seems like"; leave no room
for possibility in your refusal. Keep the interaction brief. If you are in a
situation where you have to talk to these people, change the subject com-
pletely and don't take the bait of being drawn back to it. Be a wall. They
will keep trying to steer the conversation toward meth to undermine your
determination. If they still do not respect your clearly stated refusal, it is
clear how little regard they have for you. If you are surrounded by people
who have no regard for you, if they are relentlessly pushing you toward
danger, how does that picture look to you? Give yourself the respect you
deserve and remove yourself from harm's way — leave.
Once you've written out your script, practice it with someone in a role-
play. At first it may feel silly and you may joke about it. That is fine —enjoy
yourself! Just remember that the reason you are doing it is serious — to
save your life. Practice it over and over until it rolls off your tongue natu-
rally and you hear yourself saying the words with natural confidence. In
a real situation, you are not just saying these words to your dealer or your
friend —you are also reminding yourself of your strong conviction. In a
high-risk situation where your craving may be piqued, hearing your own
voice state definitively that you will not use will remind you that the strong
and healthy part of you is in control. Every time you say it, it emphasizes
your determination to recover.
least one whole week after quitting, and be especially careful to be safely
occupied during the times you used to get high, such as on the weekends
124 I OVERCOMING CRYSTAL METH ADDICTION
or after work. Make the activities a mixture of productive work and fun.
This will keep your mind occupied when, left to its own devices, it would
gravitate toward thoughts ahout crystal. Do something interesting with
friends rather than stay at home feeling bored, lonely, and sorry for your-
self because you otherwise would be out getting high on meth during that
time. Other activities may not feel as satisfying at first, and that's alright.
However, they will help get you through the rough initial period.
Even after you have made it through the early stages of stopping crystal,
Structure prevents boredom, a big trigger for drug use; it keeps your mind
occupied when all it wants to think about is crystal; and it helps you feel
productive, and positive about yourself. A structured life is the opposite
of the addict life, which is organized on whim and the need for immediate
gratification. So structure takes you into a healthier lifestyle and gives you
a balanced framework that encourages moderation and discipline.
To fill your schedule, think of activities that take you out of the house,
such as playing a sport or taking a class in something that has always
interested you. Think of people with whom you can spend time in healthy
and enjoyable ways. Keep your schedule organized and realistic. Include
time for work, exercise, rest, and most important, healthy fun. Balance is
the key to making your structure work — it prevents you from burning out.
With the correct balance, structure will eventually feels stabilizing and
comfortable, not restraining.
REWARD YOURSELF
Calculate how much money you used to spend on crystal. When
totaled up, this can be a shocking amount. Calculate how much money
you would have spent on meth in a single month. Make a list of ten differ-
ent things that you could buy with that amount of money. Pick one of those
items on the list as a reward you promise yourself at the end of the month
if you stay clean. To make sure this stays an active motivator during the
course of the month, set weekly goals for yourself. For example, suppose
you used to spend $400 per month on crystal, or approximately $100 per
week. At the end of each week that you stick to your sobriety, take $100
and buy a gift card at a store that sells the item that you want to buy. Put
the gift cards somewhere visible so you can remind yourself how well you
RELAPSE PREVENTION I 125
are doing and what kind of reward you are building up to. At the end of one
month, you will have $400 in gift cards to purchase the item you want.
The rationale for buying gift cards each week is that you need to have
frequent small rewards throughout the month to keep you motivated, and
by putting the cash into gift cards, you will not be able to use the money
to buy crystal if you are suddenly hit with a strong craving. Many places,
such as Starbucks, Sears, Circuit City major clothing stores, many restau-
rants, and even nail salons and spas, offer gift cards. Many gift cards can
be purchased online, so they are convenient and easy to get.
to the more primitive part of the brain and doesn't require logic or higher
brain processing. Research has repeatedly shown that this technique, called
keep addicts clean. A recent study by the National Institute on Drug Abuse
found that almost 50 percent of people who were rewarded for drug-free
urine fondly called "peeing for prizes, were able to complete a twelve-week
"
increased the likelihood that the person would stick with treatment, even
if they slipped.
Positron emission tomography (PET) scan shows images of how the
brain reacts during different thinking tasks. A study of what parts of the
brain are active during states of happiness looked at the brain while sub-
jects focused on different "happy" things. Warm and positive memories
about family and childhood activated particular parts of the brain, while
money and material goods activated different brain centers —the same
areas of the brain activated by cocaine and methamphetamine. In addition
to the psychological effects of contingency management, there seems to
be a biological basis for the efficacy of rewards —they may stimulate brain
regions that are impaired and less active after chronic drug use. Gently
stimulating these areas with rewards may increase chronically low dopa-
mine activity satisfying a biological need, and thereby stave off further
craving and relapse.
126 I OVERCOMING CRYSTAL METH ADDICTION
knowledge that you cannot have the thing you want. Cravings vary from
mild, passing thoughts about using to intense and overwhelming feelings
with bodily reactions, such as tingling skin, rumbling in the stomach,
intestinal cramps, and even diarrhea. Cravings can feel irresistible, as if
you are compelled to act on them. When craving is intense, you may feel
that you have no option, that you must use. But no matter how urgent the
feeling, if you don't use crystal, you will still be alive the next day. And
you'll be much healthier.
The first time you do this exercise, have a friend read you the instruc-
tions as you do the steps. Choose a friend with a calm, relaxing voice w^ho
can slowly lead you through each step. After one or two times, you will be
able to do this exercise alone from memory. However, if hearing another
person giving you soothing instructions feels more effective, have your
friend read the instructions on a tape that you can play whenever you do the
exercise. Hearing your friend's voice may also be a nice reminder that you
are not alone, and that other people care about you and your sobriety
INSTRUCTIONS:
Find a comfortable and quiet place where you can lie down. Lie on your
back, close your eyes, and place your hands at your side. Take a slow, deep
breath through your mouth over 5 seconds, then exhale slowly through
your nose over 5 seconds. Take 3 deep breaths like this, slowly inhaling and
exhaling.
.
Continue to breathe this way throughout the entire exercise. With time
it will feel natural, and you won't even have to think about it.
Tighten your fists, squeezing them as hard as you can. Keep holding
them tightly for 5 seconds . . . and relax. When you unclench your fists,
focus on the sensation of the blood rushing back into them and feel the
and your arms. Tighten and hold them all for 5 seconds . . . and relax. Take
another slow breath in and out.
Press your knees together, pushing as hard as you can. Now you are
squeezing your toes, your knees, your fists, and your arms. Hold the posi-
tion for 5 seconds . . . and relax. Take another slow breath in and out.
Now, lift your shoulders up toward your head and tense up your neck
(skip this step if you have any history of neck injuiy or pain), tensing up
every part of your body and hold the position for 5 seconds —focus your
mind on the tension in your fists, your arms, your toes, your knees, and
your shoulders. Then relax. Take another slow breath in and out.
Scrunch up your face, tightening your eyes and your mouth as hard as
you can. You should be tensing every possible muscle in your body now,
squeezing them as hard as you can. Hold for 5 seconds . . . and relax.
Feel the waves of blood flowing back into all your body parts. Focus on
the sensations and try to be aware of every part of your body.
Now, imagine that your head, shoulders, arms, and legs are made of lead
and are extremely heavy. Feel them sinking into the floor or the cushions
under you. Let your shoulders drop as your feel their weight, and relax
The Wave
This exercise deals with urges and cravings by using a relaxation and
visualization technique. Sit in a comfortable chair and close your eyes. Take
3 slow, deep breaths, just as you did in the muscle relaxation exercise. Now
imagine yourself standing on a beach ankle-deep in the water. Visualize
your cravings as a wave that is building up to a crest. The wave may be very
high, depending on the intensity of your cravings. Watch the wave come
closer, but stay where you are. Do not run away from it. In fact, imagine
yourself sitting down in the shallow edge of the water, waiting for the wave
to come. When it arrives, it may buffet you with a strong force at first, but
sitting in the sand, you are stable and are able to hold your ground. The
wave keeps moving and you can feel it wash over your body Gradually it
passes over you and runs past you, disappearing into foam on the beach.
Then watch it gradually recede into the ocean, taking your cravings out to
sea. Take 3 more deep breaths and slowly open your eyes.
Each time you successfully let a craving pass, the tension will become less
intense and the next wave will seem smaller. This is a convenient exer-
cise because it is simple and it can be done whenever you feel a craving,
knowledge that you can get high when you get home may comfort you in a
tough situation. Giving up drugs completely takes away your most familiar
and comfortable way to ward off bad feelings. Before using drugs, you had
other ways of dealing with problems, but after a long time of depending on
crystal, you may have forgotten them and will need to relearn them.
If you feel upset, frustrated, sad, or angry, what are some ways that you
RELAPSE PREVENTION I 129
can deal with your feelings without resorting to crystal or other drugs?
Think of answers to this question when your mood is good and you are
thinking rationally because when unhappiness suddenly hits you, you will
the most familiar solution to your problems may be crystal, if you have
not prepared any alternative plan of action, doing crystal may be the only
solution in sight.
Think about what you can do immediately when you get upset. What
are things that can distract yourself from unpleasant feelings, help you to
relax, or help you blow off some steam? One technique is to immediately
stop what you are doing and take ten deep breaths while repeating a calm-
ing phrase, such as "Everything is all right," or "I am still a good person."
Other examples include taking a slow walk around the block to clear your
head, doing some exercise like jogging, calling a friend or twelve-step spon-
sor, taking a long, hot bath, trying one of your relaxation exercises, going to
a yoga class, or attending the nearest twelve-step meeting. Make a list with
several techniques that you know can soothe you, so that you have a long
list of options other than drugs that are possible in any situation.
Also consider intermediate interventions that can help you cope. This
includes making plans during the week that you can look forward to, so
that despite whatever unpleasant event you are going through now, you
can expect relief sometime soon. Using intermediate interventions is a way
to practice tolerating frustration for short periods of time. You will gradu-
ally be able to tolerate longer periods of time without needing immediate
gratification and instant relief. Examples include getting regular massages
each week, watching a movie or a show, seeing an exhibit at the local
museum, or having dinner at your favorite restaurant. Choose realistic
activities that you enjoy. Anticipating the enjoyment later in the week can
pull you through a difficult situation in the present. When you finally make
it to your planned activity, it also feels Hke a well-deserved reward, which
reinforces the success of your new coping skill.
contemplating your long-term goals will pull you out of your current emo-
tional chaos and give you a broader perspective on your own life. Despite
whatever unpleasant thing is happening to you right now, step back and
see your life moving in a good direction as you keep working toward your
long-term goals. Think of the old sailor's remedy for seasickness — if you
keep your sight fixed on the steady horizon in the distance, you will not
feel so sick from the rocking of the boat right under your feet.
See exercise 10-3, "Coping Skills," (page 132) to make a list of activities
tailored to your personality and needs.
OR EMOTIONAL ISSUES i
crystal? I
Think about all areas of your life (general emotional state, job, rela-
MAKE a list of people, places, and things that remind you of using
crystal:
People:
ii
Things: '{
I
132 I OVERCOMING CRYSTAL METH ADDICTION
Use to:
' ' -
i •
List five things you can do immediately (today) to make yourself feel bet-
1.
2.
3.
4.
5.
List five things you can do this week to make yourself feel better (e.g., go
to a museum, get a massage):
1.
RELAPSE PREVENTION I 133
List five things you can do in the future that will make your life more
satisfying (e.g., improve your relationships, go back to school, advance
in your career, cut down the stressful things in your life):
1.
2.
3.
4.
5.
—
11
will look at specific activities that can help you move forward along the
road to a drug-free life. All the activities discussed follow the guiding
TALK ABOUT IT
Talk with people about your experiences with crystal. Find a person
that you trust, someone with whom you feel safe sharing this information.
Talking about drugs with sober friends and family may not be comfortable
if it were easy, you would have done it already. Possible people include your
partner or spouse; a family member;who knows you well, even if
a friend
you have not spoken with that friend for a long while. Whoever you chose,
be sure the person does not use drugs. Former drug users who are in suc-
cessful recovery can be extremely helpful because they have been in your
THINGS YOU CAN DO TO BEAT CRYSTAL ADDICTION I 135
shoes —they can understand the highs and the lows you Ve felt on meth, as
well as the difficulty of your current struggle. People who have never tried
crystal are also helpful, but they must be open-minded, without automati-
cally condemning you for your past drug use. They can listen to your story
with a thoughtful ear, offer you compassion and support, and remind you
what your own life was like before crystal, which may seem like a com-
pletely different person s life. The process of explaining your drug history
and your feelings to someone drug-naive, trying to get them to understand
what it was like, may actually help you clarify your own thoughts. Whoever
you choose — a former meth user, someone in recovery from other drugs,
or someone who's never tried drugs — will have something to offer if you
open up to them. The more people you can talk with, the better. When
temptations are strong, they can support you through difficult times, when
you might otherwise be led to relapse.
Open yourself up and be honest. Whoever you speak with needs to hear
everything, both the good and the bad experiences: your feelings, desires,
and fears of using crystal, as well as your feelings, desires, and fears of stop-
ping. To benefit from talking with others, you should end the conversation
feeling understood. While it is rare to find someone who can understand
you completely, if you feel the other person can't see the picture at all, find
someone else. Do not let the frustration of feeling misunderstood grow into
a rationalization to use again. On the other hand, if people respond with
words that don't sit quite right with you, before disagreeing or trying to
correct them, try to keep your ears open and examine what they are saying.
This follows the AA adage "Take the cotton out of your ears and put it in
your mouth." Before you say anything, take a minute to ponder their words,
consider if this may have anything that
completely different point of view
might be relevant to you, and then give your response. You may be so used
to your old view of your drug use and sobriety that new ideas that initially
the drug-using world. In time, they weave their way into an addict's life
even when there is no reason to hide the truth. At that point, the addict
may be unable to connect with anyone in an honest and sincere way.
An interesting note to add here is that while crystal makes your brain
think you are happy, psychologists have found that one of the strongest
determinants of "happiness" is meaningful interpersonal connections,
which are usually lost when people become severely addicted to crystal. So
reestabhsh those connections, and don't listen to the addicted brain telling
you that you'll never feel happy without crystal. Staying clean and improving
interpersonal connections may be the best way to recover true happiness.
tal, even if it has completely destroyed your life, and that desire to deny
will always be lurking, waiting for you to believe it. The moment you let
your guard down, the lurking addict takes the opportunity to trick you,
concocting an innocent excuse to try crystal again: "It's been four years
without cr}^stal, and I can't remember the last time I even thought about
it. Everyone is going to be partying tonight, so what's the harm in doing
just one bump? After four years, I should be fine."
Sharing the story of your addiction with others makes it real. It is like
the old question, "If a tree falls in the forest and no one is there to hear it,
does it make a sound?" Make sure someone else hears your admission. The
tree fell, and you both heard it, so you know it made a sound —you both
know that you have an addiction, and it is real. Down the road, when you
may feel weak, it will be harder to deny the past so that you can rationalize
using again. This is another step toward successful recovery.
If you still can't talk about your addiction with anybody, ask yourself why
not. The addict side of you may be rationalizing and making any possible
excuse to avoid things that would help you quit. This is a cardinal sign of
addiction: despite knowing you need to stop using, you can't control the
part of your brain that still wants to use — rather, that part controls you.
Fighting that part of your brain is difficult, so enlist the help of others. This
is another important reason that talking with others will help you overcome
the addictive forces in your mind.
Research shows that the more social support one has —the more friends
and family who are aware and supportive of the recovery —the better the
chances of becoming controlling the addiction. There are many possible
reasons for this, though nobody knows the definitively Whatever the
THINGS YOU CAN DO TO BEAT CRYSTAL ADDICTION I 137
reason, the numbers speak for themselves. Involving friends and family in
INDIVIDUAL COUNSELING
and lend you their experience in coping with the difficulties of recovery.
An effective counselor must have experience working with addicts,
recognizing addictive behaviors, and being familiar with skills to cope with
cravings. A counselor needs to be supportive and empathic but also needs
to when you veer toward drug thinking. Confrontation is usu-
confront you
ally uncomfortable, and if you become defensive, it can seem downright
offensive. A defensive reaction tells you, "This person doesn't know what
I'm going through and has no respect for me!" But counselors are actually
being empathic with the part of you that wants to stop crystal, the part
of you that is asking for help. They are showing you tremendous respect
by believing that the sober part of you is strong enough to succeed. The
counselor's job is to point to subtle signs that addictive behavior may be
sneaking back into control.
If your counselor says something that makes you angry, think again of
that AA expression "Take the cotton out of your ears and stick it in your
138 I OVERCOMING CRYSTAL METH ADDICTION
If this is so, your counselor may be doing excellent work — making your
addict side feel so threatened means that your hard work is paying off and
the addict side is losing control.
While having a drug counselor experienced with cr\^stal is ideal, many
areas still lack health care professionals who are very knowledgeable about
meth. Nonetheless, a general drug counselor can still be helpful. The
principles of recovery apply to all addictions, regardless of the specific
drug. Crystal-specific knowledge can provide additional benefit, but if it's
not available, dont turn away from the valuable resource that you do have.
Take the opportunity to learn the basics of addiction recovery.
Some of you may find that you know more about meth than your drug
counselor, and you may have to teach him or her a few things about the
drug. Avoid the assumption that this person is therefore unable to help
you.The fundamental problems of all addictions are the same, and you
need someone who understands addictive behaviors and has experience
in helping people overcome them.
If you are already seeing a psychotherapist who was not aware of your
crystal addiction, and now you need to work on sobriety, you should keep
the focus of your sessions on achieving sobriety and learning relapse pre-
vention skills before moving back to the other life issues you usually dis-
cuss in your therapy. While it may be tempting to talk about your troubled
childhood that led to your difficulty with relationships today, you need to
shelve that important topic for later. There are three reasons for this:
Most important, you need to devote all your mental energy to getting
off crystal and learning specific skills, which you need now to cope with-
out crystal. It takes tremendous work, so take it seriously, and devote the
time to it that it deserves. Your brain is in the physiological grip of a strong
originally buried them because it was too uncomfortable for you to keep
them at a conscious level. In long-term therapy, uncovering issues is nec-
essary in order to examine and address them. However, this is a long-term
process. When you are first trying to achieve sobriety, adding additional
stress just when you are trying to stay away from drugs can make you fall
right back into them. At this time, you should focus on developing skills
Finally, issues other than sobriety may seem important in therapy, but
they may just be distractions created by the sneaky addicted part of your
brain, trying to divert your attention away from sobriety The insidious
addict in you may try to convince you, "If only I could resolve my troubles
in this one particular relationship, then I wouldn't need crystal anymore."
Meanwhile, focusing all of your sessions on the ups and downs of your
relationship rather than developing skills to stop meth leaves you vulnerable
to keep using. The addict in you quietly hopes that this tactic can buy you
months to years more of crystal use before you and your therapist realize
that therapy has just been going in circles, while your addiction to meth has
gotten worse. Wait until you have acquired the skills to face stress without
relapsing. Then you are ready to work on other life issues safely.
TWELVE-STEP PROGRAMS
Twelve-step programs are probably best known by their earliest incar-
nation. Alcoholics Anonymous (AA). This group was designed as a
''spiritual" way of dealing with addiction by Bill Wilson AA as
(known in
Bill W.), a Wall Street market analyst, and Dr. Robert Smith (known in AA
as Dr. Bob). Both Bill W. and Dr. Bob had been active alcoholics. Bill W.
had been through multiple treatments and attempts to stay sober, at times
being told that he was a hopeless case because of his repeated relapses.
In 1935, Bill W. and Dr. Bob met each other, and during their long dis-
it from his own personal experience was something that neither of them
had ever encountered in the past, either in the medical system or religious
communities. That moment is considered the birth of the original AA.
Since its meager beginnings with a small group of alcoholics gathering in
Akron, Ohio, AA has now grown to more than 2 million members, with
more than 100,000 groups in over 150 countries.
Originally AA was heavily influenced by religion and incorporated a
Christian-centered devotion to God; however, the fundamental ideas have
been useful to people of all religious or nonreligious backgrounds, and
AA groups are successful in non-Christian countries, such as Cambodia,
Israel, and Dubai.
The following are important concepts that address the core issues of
addiction:
Addicts usually do not recognize, or will not admit, that they have a prob-
lem, often until it is too late. Even when meth addicts suspect that their use
is growing beyond their control, they keep themselves in denial, and so are
reluctant to talk about crystal as if it were a problem. As they try to hold on
to the fantasy that they still have control, their addiction grows stronger. A
key concept of twelve-step programs, which is echoed several times in this
book, is the ability to "let go." Addicts teach themselves through repeated
drug use that they can "control" their world. When something does not feel
right, there is always a pill, a drink, or another drug that can make them feel
better. The fact that crystal users often know more about the drug than many
physicians reinforces their conviction that they know better than anyone
else what they need, and that they can control everything in their lives.
This is one of the biggest obstacles that addicts face, and it is the first of the
twelve steps: admitting one is powerless and letting go of the control.
"^In the United States, depending on which meeting you attend, the language of the group
may still have a heavily Christian feel, but belief in a Christian God is not an essential part of
the current AA philosophy. one group seems too extreme in its religious orientation
If for your
comfort, tv)' another, and hopefully you will find one that is a better fit.
THINGS YOU CAN DO TO BEAT CRYSTAL ADDICTION I I4I
the irresistible lure of the drug, and the gradual destruction it can cause
in your life as you watch things fall apart, unable to resist the draw to
use it again. People whoVe never tried meth can only try to imagine what
you've experienced, whereas these people knoiv because they have been
there. At twelve-step meetings you hear other people tell stories similar to
yours, and you have the opportunity to share your experiences and receive
support from understanding peers. Telling your stories, good or bad, can
inspire others to stay clean, and hearing the tragic stories of others may
give you more motivation to stay clean.
repeating behaviors that have gotten you into trouble with crystal before,
or rationalizing and allowing dangerous triggers of meth back into your
life. Peers can confront you and "call you on your B.S." with a convincing
authority that non-crystal users can never have. It is much easier to ignore
the advice of someone who does not know what it is like to be hooked
on crystal. However, when the same words come from another addict in
recovery, they may shake you up enough to actually stop and listen.
Every new member of a twelve-step program finds a "sponsor," a senior
member with a substantial length of sobriety to whom the new member
can look for support and mentorship. The sponsor is supposed to be avail-
able whenever the new member is feeling weak, trying to fight off cravings.
Rather than reach for a drug, the member can reach for the phone, and
often, speaking with the sponsor helps to abort a potential relapse.
Twelve-step groups now exist for all types of addiction, even non-drug
addictions, such as addictions to food and sex. When Crystal Meth
Anonymous (CMA) was first formed, there were few meetings, and those
were poorly attended. Now in most major cities, CMA meetings are plenti-
ful and often packed to standing-room capacity. Clearly there is a need for
142 I OVERCOMING CRYSTAL METH ADDICTION
even more CMA meetings, as existing meetings are over capacity; in many
towns, CMA meetings don't yet exist. For specific information about the
closest CMA meetings to you, visit the Web site www.crystalmeth.org,
which frequently updates lists of meeting locations and times throughout
the country. Fortunately, the list of CMA meetings continues to grow to
try to meet the expanding need.
Many people underestimate the power of peer-led support groups such
as CMA and AA. Initially the medical community was extremely skeptical
about twelve-step groups, with many physicians feeling that addicts getting
advice from other addicts was like the blind leading the blind. However,
studies have shown the tremendous impact of twelve-step meetings. A
study by McKellar and colleagues in 2003, and another by Moos and Moos
in 2004, demonstrated that people who were more involved in AA were
more likely to be sober than those less involved, and this effect persisted
up to eight years from the time of joining AA. Another study by McKellar,
Stewart, and Humphries in 2003 looked at the effect of attending AA in a
group of 2,319 men in the Veterans Affairs hospital system. Interestingly,
The message is that peer-led twelve-step meetings are helpful, and sta-
tistically speaking, even if you don't like them, they significantly increase
your chances of staying clean. Without an answer to how or why they work,
for whatever reason, they are associated with a better outcome, which is
"open" to anyone who would like to come. Others are "closed" meetings,
only for people who are established CMA members. There is an implicit
understanding that CMA, and all other twelve-step groups, are completely
confidential. What happens in "the walls," referring to the meetings, stays
within the walls, and identities are never revealed outside. The safety of
Because ClMA meetings are relatively new and pockets of the crystal-
using community in major cities are relatively concentrated, CMA meet-
ings do not always feel anonymous. Even in large cities, such as New York
and Los Angeles, you may recognize many faces people in your social —
circle or people you may have even hooked up with on the Internet or at
sex parties. On the one hand, this can be a good thing. Seeing familiar
faces strongly reinforces the message that you are not alone. You can
already see this by the crowd of people at many of the meetings. However,
seeing people that you already know in your life drives the point home.
Maybe you thought that among your group of ciystal buddies, you were
the only one with a problem. However, by seeing them at CMA, you know
that you are not the only one struggling with meth addiction.
On the other hand, when people are still too afraid to let their friends or
family know about their cn^stal use, seeing familiar faces can create more
fear than reassurance. In that case, the chance of seeing people you know
may deter you from ever visiting a CMA meeting. In that case, tiy an AA
group or a Narcotics Anonymous (NA) group first. All twelve-step groups
use the same principles, though the flavor and the stories may var}^ a little. At
the beginning, the most important task is to join a group of peers with whom
you feel comfortable who share the determination to be sober. Even with
AA and NA meetings, it usually requires attending several different groups
to find one that feels comfortable for you. After developing more strength
in your conviction to stay clean and less shame about your addiction, it may
matter less that you recognize people at CMA, and if it is helpful, you can
tiy to attend a CMA meeting again. Because it is specific to your drug of
choice, you will hear stories and can share experiences that you may relate to
more strongly. For example, cr)^stal can give people uncontrollable, intense
144 I
OVERCOMING CRYSTAL MET'
are difficult
sexual experiences that ^^^^ understand. Sharing
advice about deaiiu^^
one's difficulties and getting ^^^.^^
whatever feels b^^
CMA meetings. But decide
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Even if you decide you are ^.^^ recognize that not
appropriate
every CMAmeeting is
^^^^ individual. Again, find the
that feels like the best fi^ example, if you are newly
meeting
fc^.
sober and you are looking ^.^jg j-^odels and success stories to inspire
you, then groups with ^;/;[y ^^^^ members may overload you with too many
stories of \icious struggles with sobriety and frequent relapses. Also, seeing
recent crystal-sex partners in meetings may be a strong a trigger rather
than a source of support. Some meetings may feel like people are coming
just to pick up someone for crystal sex. The unfortunate reality is that it
another group. Now there are enough meetings that groups have taken on
different flavors, and you have more of a choice. If that's not yet the case
where you live, try AA meetings, which, because of their long history, have
a much wider variety from which to choose.
One of my patients working on alcohol addiction was an upper-middle-
class former beauty pageant winner in her midforties. Initially she insisted
on attending meetings with people whom she described as "totally down-
and-out." Many of the members were homeless, and some were schizo-
phrenic. She rationalized that seeing how badly addiction could affect
people would motivate her to stay sober. However, in reality she used the
dramatic difference between her and the group members to convince
herself that she was not nearly as addicted as the others in the group, so
was not open to their support, and she convinced herself that she did not
really have any problem with addiction. She relapsed very quickly. After
detoxing, she found it was much more difficult for her to attend groups
with people who were similar to her because she had to confront her
own addiction more directly — at those meetings, she could see different
aspects of herself in the other people in the room. This was frightening
at the beginning, but eventually she was better able to admit her own
addiction, and eventually she was able to accept both her own illness and
the support and advice of people in the group because they were more
similar to her.
Unfortunately, some places have ver\' few CMA, AA, NA, or other
THINGS YOU CAN DO TO BEAT CRYSTAL ADDICTION I 145
twelve-step meetings. In this case, you may not have the luxury of choos-
ing from a long list of meetings to attend. Finding the best fit is optimal,
just like choosing the right-size coat. However, even the wrong-size coat
may give you some protection from the cold. In the same way, you may
still benefit from a twelve-step program with people who are not exactly
like you. At least give the twelve-step meetings a try, and attend at least
five different meetings before you give up and say there's no possibility
of getting any help from these groups. The other pieces in your recovery
program, such as a drug counselor, can help you look for useful elements
in the groups. However, do not let yourself fall into the trap of rational-
izing, like the patient I described. Describe the group and discuss your
reactions with an addiction professional to discern whether the group has
any beneficial or potentially harmful effects on you. If you are clear on its
limitations, you may still be able to benefit from a group that isn't exactly
a perfect fit.
that address addictions are the next step up. Usually lOPs consist of a
more intensive and structured schedule of individual counseling, support
groups, education about drugs and addiction, and twelve-step meetings.
The frequency and intensity of the activities vary, and programs are usu-
ally tailored to each person's needs. Some people require daily treatment
to keep themselves away from crystal and some just go a few days a week.
Some people's daily treatment eventually trim down their participation to
only two or three evenings each week, which keeps them in a structured
While the majority of lOPs are general and include people with addic-
tions to all kinds of drugs, a program designed specifically for the needs
of crystal users would be even more helpful to you. This makes intuitive
sense, because crystal-specific programs focus more attention on the prob-
146 I OVERCOMING CRYSTAL METH ADDICTION
Let's take gay male crystal users as an example. Some closeted gay men
were first introduced to the gay community in the setting of nightclubs and
circuit parties, where many of these men were first able to feel comfortable
and excited about their sexuality, rather than ashamed. In these settings,
club drugs such as Ecstasy, ketamine, GHB, cocaine, and crystal were
commonly used, and drug use in these places was the norm. For these
men, crystal, as well as the use of other club drugs, was attached to the
joyously liberating experience of coming out and finally feeling free about
their sexuality. For these men, the emotional meaning of crystal is much
more complicated than just feeling high or enjoying sex. Rather, crystal is
crystal gives is difficult by itself. But these men are also being forced to
reject a social scene with strong emotional meaning. And for those whose
social network is still primarily drug-using club-goers, the ver)^ people who
made them feel accepted —how will they turn their backs on them? And
without them, will they be as isolated and alone as they had been before
coming out? Again, Nancy Reagan's Just Say No campaign oversimplifies
explored to help people quit. In this case, these gay men needed to find
healthier ways to accept their sexuality, find healthier peers, and improve
their self-esteem.
The example of gay male crystal users is only one of many. Every type
of crystal user —from teenage girls with eating disorders to young men in
the rural South, struggling with boredom and low self- worth —has a story
in crystal addiction. He explored his gay identity and the significance of his
guilt for turning his back on the social group that finally allowed him to 5
accept himself as a gay man. His fellow circuit partyers were his family.
i The entire social scene surrounding his use of crystal was extremely
important to him. Trying to convince him to "avoid people, places, and
things" to completely kick the drug and everything that came with it was
much harder than he had imagined.
he felt that non-meth users had no idea what crystal-sex was like, and
they didn't comprehend the intensity of the compulsive need to feed his
tal. In this group, the members started from a point of common under-
standing. There was mutual support, but in addition, the group worked
on specific strategies for dealing with sex: understanding the different
ing the loss of crystal-sex, and exercises to relearn aspects of sex that
were lost when he was using crystal. Mourning crystal sex continues to
be a struggle, but Brian felt more hopeful, glad that he was actively work-
ing on something important to him rather than simply being told, "That's
seen at circuit parties and sex clubs. Some had been sober for over a
year, and some who recently joined were going through a lot of the same
early struggles that Brian had experienced. In groups with gay men who
were just recently clean, he was able to give and receive mutual support, f
However, at times Brian found those groups difficult because they stirred
up old memories and triggers. Many of the newly sober men kept relaps- |
ing, and some openly invited Brian to have sex with crystal. Fortunately
148 I OVERCOMING CRYSTAL METH ADDICTION
r
j he was smart enough to change to an early-nnorning group, with other
i professional men who were more like Brian. They were motivated to stop
because they had long, successful careers that were in jeopardy. Brian's
law firm was still unaware of his drug-use problem— he was extremely
^ discreet and paid for all his treatment with his own savings. He never filed
health insurance claims, and he used vacation and sick leave to take time
I
off from work for his rehab. Brian watched some of his crystal buddies
; who had also been successful professionals in their late thirties lose their
jobs, lose their professional licenses, and move back in with their parents
as if they were teenagers. He knew his job was on the line, and after work-
ing so long to be an attorney, he was determined not to let crystal take
Men and women who used crystal primarily during sex often fear that
sex will never be enjoyable without crystal. Sex itself becomes a tremen-
dous trigger to use again. For human beings, sex is a natural desire that
will always be there. How do these people cope? Do they ever have that
level of pleasurable sex again? These questions need to be discussed be-
cause the issue of sex will never go away and cannot be ignored — it is one
of the toughest aspects of crystal addiction. What are some coping skills
to handle sex during the early stages of recovery? How can one relearn
how to have sober sex and enjoy it? A comprehensive treatment program
identifies these areas and teaches skills to cope with problems as well as
exercises that may improve these areas. In this example, sex is the issue,
but for others, the issue may be body image, self-esteem, stress manage-
ment, and self-expectations. Specific topics, when effectively addressed in
a supportive environment, have been shown to improve abstinence rates
for crystal addicts.
times but, no matter how hard they try, they continue to relapse, and they
begin to face increasingly dangerous consequences —problems with their
/
150 I OVERCOMING CRYSTAL METH ADDICTION
any urges to use, addicts are physically unable to relapse as long as they
remain in the program. Sometimes breaking the cycle of use, getting com-
pletely through the crash, and simply reexperiencing sober thinking again
helps tremendously to clear their perspective about the effects of addic-
tion on their lives. During both the high and the crash, addicts' thinking
is impaired, and their judgment is affected by extremely strong cravings.
Forcing themselves to clean up in a protected, drug-free environment gives
addicts a much better start on recovery.
The intensity of inpatient treatment gently but firmly confronts meth
addicts and forces them to look at how the drug controls them and how it
has affected their lives. Optimally, this is done in a supportive way, because
harsh confrontation is usually met with strong resistance and denial —the
addict just becomes more adamant that he or she has no problem with
drugs. However, through a more gradual process of working through edu-
cation, self-examination, and learning from other addicts, many skepti-
cal people leave inpatient rehabilitation with improved insight into their
addiction, and, it is hoped they have internalized some of the skills to help
them stay in recovery.
The actual length of stay at these programs is not necessarily twenty-
eight days. Each program sets its own standard, and within each program,
the length of stay usually is determined by the severity of each person s
addiction. Often, insurance plans will partially cover the expense of a reha-
bilitation stay. Rehab facilities can vary from low-cost city hospitals to ex-
treatments issues are addressed. In addition, make sure that any program
you are considering is certified by the Substance Abuse and Men-
tal Health Services Administration (SAMHSA), a U.S. government
agency that ensures that programs meet or exceed the standards of care set
by its state government. This means that the program has been approved
by the local state alcohol and drug abuse authority as a substance abuse
treatment facility and has responded to the most recent annual National
Survey of Substance Abuse Treatment Services. Be wary of programs that
are not accredited. While they are usually cheaper, this is because they cut
corners in necessary treatment modalities and medical supervision. Spend-
ing money on a program that does not offer effective clinical treatment
is a tremendous waste and risks turning you off to trying other treatment
programs that may benefit you greatly. Visit the SAMHSA Web site at
ther information and to check if a program you are considering has been
accredited by JCAHO.
Over the past few years, several addiction programs have sprouted up,
specifically addressing the treatment of addiction to crystal meth. This is
2. Have you already tried going to CMA meetings and seeing a drug
counselor or a therapist experienced with addiction, but you still
keep relapsing?
3 . Are you having significant medical or psychiatric problems because
of crystal use, e.g., possible heart or lung problems, dental problems
4. Have you tried intensive outpatient drug programs but they have
not been enough to get you to stop using?
If you answered yes to one or more of these questions, then you should
consider inpatient treatment. If you answered yes to question 4, then you
THINGS YOU CAN DO TO BEAT CRYSTAL ADDICTION I 155
Many private and group health insurance programs cover some addic-
tion treatment, Usually the most important requirement for insurance
ance company whether it covers inpatient treatment and what the criteria
are, because the definition of failing outpatient treatment is arbitrary — it
could mean relapsing after seeing a therapist weekly and going to CMA,
or it may require a trial of an lOP before inpatient care is even considered.
Significant medical or psychiatric illness resulting from drug use will also
strongly support your case for coverage.
Unfortunately, most insurance companies are difficult to navigate,
and when you are struggling with an illness, it is even harder to negotiate
the system. If you are working with a therapist or counselor, ask for help
getting through the insurance maze. You can also ask for assistance from
your doctor's office manager, a family member, a friend, or a coworker.
At firstp Ana had a very difficult time with treatment. She was sent
thinner and prettier. Even worse, she blamed her withdrawal symptoms
of depression, irritability, and hunger on the program staff, using this
as evidence that she was correct in her use of the meds. The doctors'
advice to stop meth had only made her feel worse. Ana began hang-
ing out with the teens who were the rebels of the program. Some of
or challenge the group leader. Ana was one of a handful of girls who
just sat silently, staring angrily at the floor and refusing to contribute to
the discussion. After a week, when the irritable depression of her crash
began to wane. Ana began to listen to some of the teens who spoke
i
constructively in the group. Although she had originally been angry
I OVERCOMING CRYSTAL METH ADDICTION
and had resented the teens who "shared," she started to hear some of
what they were saying. Once in a while she heard things she strongly
identified with, things she had thought nobody else understood.
Ana made friends with Karen, a sixteen-year-old middle-class
Caucasian from San Diego, who had also been trying to lose weight and
never felt that she was pretty enough. She understood exactly what Karen
meant when she shared in group her frustration with her parents and
other adults who she felt had never taken her seriously when she'd com-
plained about how competitive and vicious her high-school classmates
could be. Crystal not only made her thinner than her classmates [and
prettier, she believed), it also made her feel more confident, immune to
the catty stares from the "princesses" m her class. She loved the way the
drug made her feel so much better about herself, but she dreaded when
its effects would wear off. At times, she saw how trapped she was in using
crystal to survive high school, but it was a jungle, and she needed a way
to survive. Karen spent most of her time focused on getting more meth.
Even when she was feeling anxious and irritable from getting high, she
still wanted to keep doing it.
Karen told the group that on meth, she had been gradually deteriorat-
ing: one day she passed out in a shopping mall from dehydration and
malnutrition. An ambulance brought her to the hospital, and a social
worker transferred her directly to this addiction treatment unit. She would
never have come on her own. But now that she had been in the program
for three weeks, she was beginning to look back on her life with crystal
through clearer eyes. Although she had put on weight, her face was still
gaunt, and without the rosy glasses of meth she saw m the mirror how
sickly she had become. Finally she saw in her own reflection the ugly side
Karen's story was so familiar to Ana, even though she was one of
this girls whom Ana would have resented at her own school in L.A. She
was surprised how similar she felt. Here, someone that she would have
envied for seeming "perfect" was talking about her own weaknesses and
fears, which were identical to Ana's. The sense of connection seemed to
give Ana permission and courage to open up about her own feelings, and
she began to share her own experiences in groups. She distanced herself
THINGS YOU CAN DO TO BEAT CRYSTAL ADDICTION I 155
from the rebellious teens and began to focus more on trying to feel bet-
ter about herself. Without crystal to magically transform her, she had to
work hard at changing her feelings, Even though this was a slower, harder
process. Ana realized that crystal was only a mask she hid behind to look <
pretty, but she was the only one fooled by the mask. j
'
Self-esteem, people told her, was something that would take years for
her to build, and for many it would be a lifelong process. There were plenty
of times when Ana longed for crystal because she remembered the quick
relief it gave her She craved meth the most when she was feeling tired,
and she learned to talk to Karen when she really wanted to use. That
helped some.
After six weeks. Ana finished the program and returned to her family
in L.A. in the middle of that summer She went to teen AA meetings and
stayed sober, keeping in contact with Karen as her "sober sister" However,
in the fall, when she returned to school, she started to buckle under the
pressure of the competitive girls in her class. Once again she felt unat-
tractive and worthless. Quickly, she fell back into her old pattern of using
crystal to cope. She stopped calling Karen because she was embarrassed
to tell her that she had relapsed. Part of her also didn't want to hear what
Karen would tell her— that she should stop the crystal.
Ana ended up in rehab a second time, and afterward she was referred
to an intensive outpatient program to help her make the transition back
friends who are sober and supportive, she finds it extremely difficult in
drugs. She has already slipped a few times, using crystal on a few occa-
sions, but fortunately she keeps going to meetings and groups, and none
of the slips have turned into a full-blown relapse yet. After a slip, she is
sometimes able to call Karen, and she thinks this may have saved her
from another full-blown relapse. Every day Ana reminds herself what she
learned during her first rehab: self-esteem is something that can take
years to build, and for many it's a lifelong process.
136 I OVERCOMING CRYSTAL METH ADDICTION
ACUPUNCTURE
In recent years, increasing numbers of people are turning to alternative
medicine to treat physical and emotional problems. Because of my work
in addiction, I try to teach people to learn new ways to manage emotional
discomfort without automatically resorting to pills, though sometimes
medication is truly necessary. The addiction-treatment community has
long turned to acupuncture as a nonmedication alternative for some of the
problems associated with addiction and withdrawal.
One of the earliest pioneers in introducing acupuncture to the addiction-
treatment community was Dr. Michael Smith at Lincoln Hospital in the
South Bronx of New York City. He opened a drop-in center where people
wishing to stop heroin could come for acupuncture to ease their withdrawal
symptoms without resorting to medications. Dr. Smith has been criticized
by many who say that acupuncture is a scam. However, Dr. Smith also has
a large group of supporters: people coming off the streets, almost all of
them heavy heroin addicts, many of them homeless. They come in feeling
dope-sick and distressed, they line up for acupuncture, and after receiving
treatment, they appear remarkably calm and comforted. While the use of
acupuncture for medical uses is hotly debated, there is no question that
many people receiving treatment at Lincoln Hospital in the South Bronx
feel relief.
Most heroin treatment centers that use acupuncture only target needle
points in the ear. These points seem to offer heroin addicts the most relief,
and because the area is so limited, certification is easy and staff can easily be
trained, making the service available to a large number of people. If you are
able to see a practitioner who is fully licensed in acupuncture, you can get the
additional benefit of treatment with points other than just the ears, balancing
the entire system and providing even greater relaxation and relief.
MEDICATIONS
tions for detoxification from acute withdrawal. Here I will discuss several
confusion, drugs that increase dopamine stimulation and drugs that block
dopamine stimulation both seem to have beneficial effects on reducing
stimulant use in animal studies. Most recently, studies have found that the
best effect comes from dopamine partial agonists, which share properties
of both the dopamine stimulators and the dopamine blockers.
Other brain structures, such as the striatum, the cingulum, and the
cerebral cortex, have been found to have their own important roles in
Because of this early stage in drug trials, it is not possible to make exten- \
has been prescribed for pain from nerve damage, migraine headaches, and
anxiety. It was later found to reduce alcohol cravings and relapses. Further
research showed that it had a similar effect in reducing cocaine relapses.
The positive effect on cocaine addiction makes it a good candidate for
crystal addiction, because of the similarities between the two drugs. While
Topiramate is not addictive, it must be used carefully. It is started at a low
dose and gradually increased, because sudden increases in dosage can
cause severe mental confusion. Other side effects are decreased appetite
and weight loss, countering the hunger and weight gain that often occur
when you suddenly stop using crystal. If you are taking topiramate and
decide you want to stop, make sure to taper off gradually Because it is
ings for alcohol. For people who have stopped drinking, it was believed to
prevent relapses by decreasing the intensity of the craving through its effect
and stop breathing. Naltrexone, which is taken as a pill, has been used with
success in some alcoholics, possibly blocking opiate receptors at reward
and pleasure centers that are stimulated by alcohol. With less of a reward,
people may not feel as strong a desire to drink. There are other theories
THINGS YOU CAN DO TO BEAT CRYSTAL ADDICTION I 159
about how naltrexone works, such as balancing out the opiate receptors
in the brain at its resting state so that the user is happier in general, thus
requiring less self-medication to elevate a low mood. Using this theory, nal-
trexone is now being investigated as a medication for crystal addiction. As a
the ability to resist temptations to relapse. While dopamine and the meso-
limbic pathway are responsible for establishing the initial addiction, the
maintenance phase of addiction is believed to be mediated by glutamate.
Glutamate is used to communicate between the brain-reward pathway and
the prefrontal cortex, where logical thinking and judgments are carried out.
The function of this bridge is important because it determines how well a
person can make rational judgments in reaction to strong signals from the
brain-reward pathway telling it to use drugs.
In crystal addicts, the baseline level of glutamate activity is low, mean-
ing that the ability of the brain to make proper judgments is impaired, for
example, deciding whether to go to a party where all your old meth buddies
will likely be getting high. Modafinil seems to increase glutamate in areas
where it is too low, and perhaps it improves the ability of addicts to assess
their circumstances and make logical judgments.
Crystal users also have an abnormally high spike in glutamate when they
see a cue reminding them of crystal. They may experience the spike as a
rush of excitement when they hear their dealer's voice or see a picture of
a glass pipe that reminds them of times they've smoked. It is possible that
modafinil also lowers this spike, which may help addicts to resist sudden
urges brought on by the usual triggers that lead to relapse.
These are all theoretical conjectures about modafinil. The exact mecha-
nism in which it works is still unknown. Nevertheless, the early results of
PI level becomes too low, it is not able to kill HIV, and strains of the virus
that are resistant to the medication can develop and severely worsen the
person's health. Dr. Judith Rabkin at Columbia University studied the use of
modafinil for fatigue in patients with HIV. In that study, doses were kept to
a maximum of 200 mg per day, and there was no effect on the HIV medica-
tions in any of the study participants. I recommend caution if you take a PI:
be cautious with modafinil, and do not take more than 200 mg per day.
Another significant effect of modafinil is that it can reduce the concen-
trations of some oral contraceptives in the bloodstream. Women who wish
to take modafinil must be aware of this and discuss it with their g}^necolo-
gists so they can either adjust their oral contraceptive dose or consider other
methods of birth control.
etary combination of three medications that have been in use for a long
time, though never for the treatment of meth addiction. The foundation of
the treatment appears to rest on the use of flumazenil, a benzodiazepine
receptor blocker (i.e., an antidote for medications such as Valium and
Xanax). The theory behind this treatment is that flumazenil changes the
structure of the GABA receptors in brain cells, which become misshapen
from long-term drug use. By changing the shape of the GABA recep-
tor back to its original form, the hope is to decrease cravings for meth.
Flumazenil is administered in daily infusions by vein, in conjunction with
162 I OVERCOMING CRYSTAL METH ADDICTION
reduction of meth use. This figure is impressive, but consider the powerful
effect of placebos (fake pills) when the person taking the placebo is in the
right frame of mind. The subjects in this particular study were likely des-
nesses were often treated by separate medical specialists, but because each
illness affects the other so profoundly, addiction experts strongly advocate
treating both illnesses together.
THINGS YOU CAN DO TO BEAT CRYSTAL ADDICTION I 165
If a person has a dual diagnosis, and one of the two illnesses is left
untreated, it is highly likely that both conditions will get worse. For exam-
ple, if meth addiction is not adequately treated, then continued crystal
use can trigger depression, bipolar mania, psychosis, obsessive-compulsive
thoughts and behaviors, panic attacks, and anxiety Meth is so powerful
that it can render antidepressant medication useless, and people who
already suffer from major depression may become even more vulnerable
to severe depression and suicide.
Conversely, an untreated psychiatric illness significantly increases the
risk of relapsing on drugs. For example, if a person in recovery who has
been sober for years becomes severely depressed and suicidal, she may
remember the times when she used meth and her mood instantly lifted.
In a moment of desperation, she could easily slip, and if she stopped using
crystal, she would become more depressed, so she is then locked into a
full relapse, unable to stop using crystal. Another example is a man with
bipolar mania. In his manic state, his confidence is overinflated and he
forgets all he has worked to learn about powerlessness. In addition, mania
almost completely eliminates his impulse control — not only is he grossly
inappropriate in public, but when the urge to use crystal enters his mind,
he may not be able to stop himself. Once he starts using meth, the drug
chemically magnifies the manic symptoms, and he spins out of control.
With the excessive dopamine released by crystal, he may be at even more
risk of a psychotic mania, with hallucinations and delusions. These are
only two of many examples that demonstrate how significantly addiction
and psychiatric illness can affect each other, and they underscore the
importance of treating both illnesses at the same time.
This section will review some basic psychiatric illnesses that commonly
occur with addiction and can significantly increase drug relapses, and
conversely, these illnesses can be worsened by meth use.
Major depression is a clinical state that includes low mood, among
several other symptoms. Depression or low mood can be experienced dif-
arbitrary and even 7 to 10 days of these symptoms without any clear reason
to feel sad should prompt you to seek psychiatric treatment.
There are numerous antidepressants on the market, each affecting vari-
ous neurotransmitters and neuropeptides (small proteins that are active
in the brain), including dopamine, norepinephrine, and serotonin. These
neurotransmitters may help balance mood and decrease the anxiety that
may contribute to craving for all addicts, with or without a dual diagno-
sis. Studies with various antidepressants have had mixed results as far as
treating addiction. A recent study of nondepressed meth addicts treated
with sertraline (Zoloft) actually showed a dramatic increase in relapses in
those who were taking sertraline compared with people taking a placebo.
There are many theories to explain this surprising effect: the sertraline
may decrease the depression in a crash, so people are more likely to use;
the increased transmission in some serotonin fibers may block certain
dopamine signals, which could make addicts crave meth even more. There
are many more theories, but the answer remains a mystery for now. The
major lesson is that the neuropharmacology of addiction is complicated,
and people should be wary of taking a friend's psychiatric medications or
other supplements to try to protect their brains, when they use drugs. This
does not mean that antidepressants increase relapses in everyone —the
subjects were nondepressed addicts. When used in appropriate situa-
ers. This is one reason schizophrenics are at higher risk for cocaine and
crystal addiction —during their first experience with cocaine or crystal,
trol makes it almost impossible to resist the urge to use crystal. The most
extreme forms of bipolar disorder may seem obvious to most people (e.g.,
the stereotypical comedy representation of two men sharing a jail cell who
both believe they are Jesus); however, there are still a surprising number
of people who do not believe it is a medical illness, but rather a difficult
personality. In its milder forms, when mood swings are not as extreme, it
PART
5
OTHER IMPORTANT AREAS
IN YOUR LIFE TO KEEP YOU
CLEAN AND SOBER
IdentifyMajor "Holes" in Your Life
That You May Fill with Crystal
Ob j ectives
• Learn about specific psychiatric conditions such as
social anxiety disorder, depression, and attention-deficit/
hyperactivity disorder, which can significantly increase
OF crystal's appeals
ONE is its ability
about yourself by masking them with drugs will leave you constantly
needing more drugs to protect you from the pain that low self-esteem
causes. Semple and colleagues at the University of California at San
Diego conducted a study looking at 157 heterosexual male meth users
and found that negative self-perceptions strongly predicted the intensity
170 I OVERCOMING CRYSTAL METH ADDICTION
of their meth use and depression. Do you have a distorted, low self-image
that puts you at risk for relapsing?
Hamlet, "The lady doth protest too much, methinks." The queen was quite
astute, in realizing that the woman in the play she was watching protested
so much because she was trying to hide something. (Unfortunately, she
was not astute enough to realize that the character in the play she was
watching was parodying her\) Similarly, all people are capable of respond-
ing this way when we try to convince ourselves and others that nothing is
esteem?" doesn't allow you time even to consider the question with any
thought. A quick reply avoids taking the time to examine yourself and pos-
sibly seeing something that you don't line. On the other hand, if you took
a couple seconds to ponder the question before answering, your response
was probably closer to the truth.
WHAT IS SELF-ESTEEM?
How DO YOU feel about yourself? As a child, what kind of person did you
imagine you would become? Have you become that person of your fanta-
sies? One way to conceptualize self-esteem is to measure how successfully
you lived up to your self-expectations. Low comes from the
self-esteem
disappointment of failing your expectations. Good self-esteem comes from
SELF-ESTEEM I I7I
or at least being satisfied with why you have not met them yet.
Perhaps you have not wed the prince charming of your childhood dreams
because you were busy pursuing a promising but demanding and successful
career. Maybe you couldn't finish high school, against your parents' wishes,
because they died and your younger brothers and sisters needed you to earn
money to feed and shelter them. Perhaps as a child you had fantasies of
becoming a professional basketball player, but you grew to be only five and
a half feet tall. If childhood fantasies never turned into reality, is it because
you truly are a failure, or is this just where life ended up taking you, while
you deal with life in the best way you can?
is the healthiest. Options 2 and 3 are dangerous because they are stressful
and unrealistic, and can lead to drug relapses. For example, if you hold
on to the same expectation, which you repeatedly fail to meet, you may
treat the disappointment with drugs, rather than change the source, which
is the distorted expectation. In the third example, if you try to take extreme
measures to meet the unrealistic expectation, such as trying to meet an
impossible deadline, then you may resort to drugs like crystal to accom-
plish this. Only the first option, making your expectations more realistic,
most cases, we are not entirely aware of why we have them. Perhaps this
trying to prove to herself. These are not unusual examples. In fact, they
are quite common illustrations of how much of our beha\dor is influenced
by these mysterious self-expectations.
Most of our expectations, both conscious and unconscious, are shaped by
our earliest life experiences. Like sponges, babies and small children absorb
everything from their environment. During this early stage of human devel-
opment, babies and children begin to form a rudimentary understanding
of good versus bad, and the actions and words of the people around them
help them figure out what falls into each category. Along with a general
concept of right and wrong, children have both internal fantasies — their
SELF-ESTEEM I 175
father worked so hard to build the family business, and when you're an
adult, you'll take over the company! We'll be so proud of you! You know,
that company is what this family is built on, and it's very important for you
to keep it going when you're older and it's your turn." Another message that
used to be commonly heard, both at home and in some school home eco-
nomic classes was, "If you want to be a happy woman, you have to be able
to cook well for your husband, so make sure you learn how to cook!" More
subtle messages that children pick up are statements as simple as: "Don't
do that! What will others think?" The majority of messages children hear
are attached to strong emotions, as well as judgments of right and wrong:
the little boy feels pressure to take over the family business because any
desire to do anything else would disappoint his beloved parents, even if
he were not interested in the company at all; the girl hears a message that
her happiness is determined by marrying a man and then doing whatever
it takes to please him — a compelling message for any human being who
wants to be happy. Even as we grow older, develop our own interests, and
have rational ideas of what would best make us happy, those childhood
messages, so heavily weighted with our earliest beliefs about what deter-
mines happiness or sadness, quietly linger and affect how we feel about
ourselves and what we expect ourselves to be and to do.
The most significant role models for children are usually their parents.
marriage, and children, and the ultimate goal in life is to continue the
family name." Even the most "out and proud" gay man may struggle with
I
t
PARENTS are the people with whom babies and small children have the
most social contact. Because children have a natural desire to please
tions for winning the silver medal! Too bad you couldn't get the
gold." Did you feel they were beaming with pride? Did you think
they were disappointed? How did you feel about your parents at
well? Did you feel that your parents generally weren't concerned
about you?
How did your parents react to your school performance? Were
they proud? Were they indifferent? Were they worried at times but
encouraging? Were they angry? Do you remember this ever affect-
ing how you felt about your intelligence or your own abilities?
Did your parents help you whenever you needed assistance,
or did they encourage you to be "strong" and to do things for
m Did your parents ever ask you about who you were dating? Were
they uninterested? Were they intrusive, asking a lot of questions
m What did your parents imagine your life would be like when you
reached age thirty?
I
J
176 I OVERCOMING CRYSTAL METH ADDICTION
When your parents innagined their own later years in life, how did
norms as they grow up, absorbing general society's ideas as if they were
axiomatic truths. As adults, we are taught to think rationally, and most be-
lieve that logic governs our behavior more than the older ideas we picked
most, people attend them feeling excitement that is mixed with feelings of
anxiety and dread. Reunions are unusual occasions when old, uncomfort-
able beliefs about former classmates' judgments and expectations come
back to the surface. Many feel a pressure to prove their success, that they
regular job feel acceptable at other times, but at a reunion it might feel
like a source of shame? The influence of other people's expectations may
have seemed dead and buried, but at a reunion, you realize that they have
always stayed with you, and only now are they so apparent.
What were the expectations that you learned from your peers when you
were growing up? Answer these questions to clarify what they might be.
^
Playing video games? Dating? Going to parties and drinking alco-
hoi or doing drugs?
I
I What did you like to do in high school— were they the same things
I as everyone else, or were they different? If they were the same,
how did you feel about that? If they were different, how did that
SELF-ESTEEM I
make you feel? Did the differences have any effect on how you
saw yourself? Did you feel smarter, dumber, prettier, uglier, less
popular, or an outcast? Did you wish you could fit in better or did
beat that you could feel cool in your own way and avoid the worry
about being like everyone else?
How did other kids in school treat you? Were you a popular student
with a large following? Did this make you feel confident and free
or did you feel pressure to behave a certain way because you
were afraid of losing people's respect? Were you somewhere in
the middle, with a group of nice friends but wanting to be with the
more popular kids, striving to look and act like them and hoping to
How did your classmates' treatment make you feel about yourself?
rare that kids in your school attended college? Did most of your
classmates go to college or graduate school? How far did you go
in school, and how did this make you feel about yourself?
What kinds of jobs and lives did your classmates imagine for
themselves? Did they want to stay in their hometown and get any
job that would pay the bills? Did they want to move away, get a
that make you feel? Did you talk to your classmates about how
different your plans were? If not, what thoughts and feelings held
you back?
What are your classmates doing now? Are they working? What
kinds of jobs do they have? Are they single, married, or divorced?
tions to them —how they made you feel about them and yourself. Did you
feel content and satisfied, or did you feel different? Did you want to fit in
more or to please your parents better? Did you try to free yourself of those
expectations and take a completely different path? These two exercises
are not in-depth explorations of your personality, but they help you to un-
derstand that some of your self-expectations are from people, places, and
times outside of your immediate awareness. Knowing this, you can search
beyond the surface appearance of your motivations to look at what they
really are. Regardless of your job success, number of sexual conquests,
accumulated wealth, or whatever you have achieved, according to the
deeper self-expectations which you may still hold, are you a success or a
digging themselves deeper and deeper into addiction. The better way to
evolve into what it is now. That is why quick-fix remedies, such as repeat-
ing the mantra "I love myself!" or simply telling yourself, ''Everything's
fine!" do not really work. They may give you a temporary boost, and remind
you that you should love yourself and feel worthwhile, but they do little to
actually change how you see yourself. If you never address those nagging,
hidden self-expectations, they will continue to haunt you and make you
feel inadequate.
Psychotherapy can make profound and lasting improvements in your
self-esteem, but the process can be long, and ongoing therapy may not
be a realistic option for you. There are also cognitive strategies that take
a different approach, which is still effective for many and can also have
long-lasting effects.
LIST expectations you currently have or used to have about your own life
any childhood fantasies you may have had (e.g., I wanted to be an as-
tronaut; I used to dream about becoming Miss America; want I to be the
next Donald Trump; I wanted to be the first black, female president of
Education
Appearance
Occupation
Income
Relationships
'
Education
Appearance
Occupation
Income
Friendships
Romantic relationships
IF certain aspects of your life did not turn out as you had expected, what
are the reasons? Here are some possible explanations: Did you have
poor grades in school because you never actually gave it a good fry?
Were you afraid that if you tried and failed, then this would prove that you
were undeniably stupid? Did you try a particular job but, even with your
best efforts, you couldn't do it? Did other job opportunities come up in
life, which you chose instead because they seemed more promising? Did
your interests change over time, and you decided to pursue something
more interesting while your parents" expectations remained the same?
Were there unavoidable reasons for not being able to fulfill the expecta-
tions? For example, if telling your family and classmates you were gay
caused violent reactions and rejection, did that affect your performance
in school or make you rebel against your family and peers and pursue
the opposite of their expectations? Did angry or abusive parents kick you
out of the house and take away the financial support that would have
helped you finish school? Did you wish to be a beautiful, blonde-haired
woman with blue eyes, but being in an ethnic minority and having black
hair and brown eyes, were you never able to see yourself as pretty? Did
you think you wanted to be a doctor because your parents and all your
brothers and sisters were physicians, but biology bored you and the sight
of blood made you faint?
Education
Appearance
SELF-ESTEEM I
Occupation
Income
Friendships
Romantic relationships
CONSIDER the reasons you gave in exercise 12-3c for not meeting your
expectations. Are they justifiable? Are there areas that you think you
should still work on? Consider your life experiences; your knowledge
about yourself, your interests, and your abilities; the challenges you
face each day; and the other unavoidable circumstances of your life.
With these in mind, go through the same categories and write realistic
Education
Appearance
Occupation
Income
Relationships
THERE may be some expectations that you find still make sense, and
though you haven't met them, you wish you could., With a logical un-
derstanding of your expectations, your abilities, and your challenges,
what specific things can you do to meet those expectations? If you always
wanted to get a college degree, can you return to school or take night
classes while working? Are there ways that you can advance in your ca-
reer? Have you fully investigated job opportunities, talked with a career
healthy way? In summary, are there realistic ways to reach the goals you
have set for yourself? If you have unmet expectations that are achiev-
able, then making a concrete plan and seeing that they are attainable
will give you a sense of hopefulness and control, and you will already be
on your way toward higher self-esteem.
Education
Appearance
Occupation
Income
186 I OVERCOMING CRYSTAL METH ADDICTION
Relationships
and helps correct "cognitive distortions, ' which are unrealistic thoughts
that you held on to, silently affecting the way you experience yourself and
the world around you.
Digging up old and buried expectations and addressing them directly,
rather than hiding from them, will help you improve your self-esteem. If
you find that your self-esteem is extremely low, it may take a long time to
raise, but this exercise can serve as a springboard for more intensive work
in psychotherapy. Working on yourself over the long term doesn't sound as
easy or as attractive as drugs, but it will be far more rewarding as you begin
to feel truly happy with yourself. Repeat this exercise from time to time
to see if your answers to any of these questions have changed. You may be
surprised at how your answers change as your self-esteem rises.
shame about his sexual orientation, guilt for disappointing his parents,
SELF-ESTEEM I 18?
was angry and disappointed at his inability to be what his parents wanted,
by beconning a successful attorney. "Was that the fire that kept me fueled
|
Brian also found that some of his anger mimicked the hatred toward gays
that he witnessed growing up. He had always thought that joking with his gay
friends about effeminate men and casually using works such as "queen."
"queer." "fag," and "Mary." were ways of accepting his sexual orientation. But
they were also ways that he held on to the homophobia he had learned as a
child. Sometimes his anger became an intense, irrational rage toward himself
career, and good looks. Suddenly he recalled a time in high school when he
felt such self-loathing and despair because of being gay that he contemplated
he was gay, and Brian found that he had not been as comfortable with his
sexual orientation as he had thought. All of the negative feelings and self-
and desire to be with men. This made sex and relationships terribly
need crystal to help him with that aspect of his life anymore. Brian still had
urges to use and had a few slips. But he stuck with his treatment program
ways other than drugs and circuit parties. He felt connected, accepted, and
validated, both as a gay man and as a human being. At the time of this writing,
it has been two years and five months since Brian has used crystal.
n
SOCIAL ANXIETY:
When It's Difficult to FeeL ComfortabLe
Around Other People
ficult or impossible to face people and get through day-to-day life. These
people withdraw or rarely go out of the house because their anxiety is so
disabling. This doesn't mean they don't want to be around others —on the
contrary, they want desperately to interact with people. However, their
SOCIAL ANXIETY I 189
fear imprisons them in their loneliness, and they feel miserable. While
meeting all of the criteria for social phobia may be extreme, a great number
of people suffer from a lesser degree of social anxiety or shyness that still
The DSM-IV criteria for social phobia are listed in table 13-1:
TABLE 13-1
< A. A marked and persistent fear of one or nnore social and performance situations in
^
which the person is exposed to unfamiliar people or to possible scrutiny by others.
: The individual fears that he or she will act in a way (or show symptoms) that
anxiety
^
will be humiliating or embarrassing. Note: In children, there must be evidence of
I
the capacity for age-appropriate social relationships with familiar people and the
anxiety must occur in peer settings, not just in interactions with adults.
B. Exposure to the feared social situation almost invariably provokes anxiety, which
;
may take the form of a situationally bound or predisposed Panic Attack. Note: In
^
children, the anxiety may be expressed by crying, tantrums, freezing, or shrinking
;
from social situations with unfamiliar people.
I'
C. The person recognizes that the fear is excessive or unreasonable. Note: In children.
I
this feature may be absent.
j
D. The feared social or performance situations are avoided or else are endured with
i
intense anxiety or distress.
1 E. The avoidance, anxious anticipation, or distress in the feared social or performance
situation(s) interferes significantly with the persons normal routine, occupational
(academic) functioning, or social activities or relationships, or there is marked
distress about having the phobia. j
Reprinted with permission from the Diagnostic and Statistical Manual of Mental I
Association. I
190 I OVERCOMING CRYSTAL METH ADDICTION
Whether you meet full criteria for social phobia or have a significant
degree of social anxiety, you may be using crystal as a way to cope — ^you Ve
found something that makes you feel and function better when you use
it. But the effect is only temporary It doesn't change the person you are
or your fundamental fears of what people think of you. You know from
experience that once the high disappears, you will return to the same shy
person you were before. You may feel even worse during the crash after
using. It eventually becomes a trap, because you see that you can func-
tion well socially and feel acceptable, but the only way to keep this up is
to keep using.
One way to address problems with socializing that is healthier and
longer-lasting than using crystal is to examine your self-esteem (see chap-
ter 12) and change the negative core feelings that you have about yourself.
Most of your shyness is probably based on false beliefs about yourself and
your fear of how other people see you. An anxious reaction to these beliefs
turns it into a self-fulfilling prophecy. You think you appear awkward, you
become increasingly nervous, and when forced to speak, you may be so
overwhelmed by anxiety that your voice trembles, you become red or cov-
ered in sweat, or you blurt out something strange which you would never
have said under normal circumstances —you are too distracted by your
anxiety to think clearly and say what you mean. You aren't a fool, but if you
allow it, your fear will convince you that you are.
opponents and growl, saying that they are going to destroy the other fighter.
Both fighters say the same thing, though it is impossible that they will both
win. Some of this is bravado and showmanship —they need the fans, the
ratings, and the ticket sales. But much of this is to prepare themselves
mentally. They need to elevate their self-esteem, and they cannot allow
themselves to be distracted by fear. In the same way, if they can scare
their opponents and can fill them with self-doubt, the opponent will not
perform as well.
Self-perception has a tremendous effect on a person's performance.
SOCIAL ANXIETY I 191
even if that person is truly skilled. If you use crystal to artificially ease your
social discomfort, you will never address how you actually see yourself,
and without the drugs, your negative self-perception will always be there,
making you uncomfortable around other people. On the other hand, if
you directly address your fears and reactions, then you give your true
strengths a chance to shine. This becomes a self-fulfilling prophecy, as
well. The more you see yourself socially effective without drugs, the more
you believe in yourself, and the more your confidence shows, and the
better you function in social situations. And this no drug — this is a real
change in you.
i!
j!
The first step in lowering social anxiety is to examine your real thoughts
and beliefs about yourself. How do you see yourself? Where do those
thoughts and beliefs come from? Are they based in reality? See chapter
12 for a detailed discussion on this topic and exercises on how to improve
your self-esteem.
One of the most basic and most effective treatments for social anxiety
13-3 help you to find any cognitive distortions and correct them.
192 I OVERCOMING CRYSTAL METH ADDICTION
EVEN if you feel fine about yourself when you are alone, your comfort and
confidence nnay evaporate when other people are around you. Answer the
following questions about how you imagine you appear in social settings,
try to be as honest as possible about your thoughts and fears (e.g., "Every-
one is looking at me" or "I seem so boring and nobody cares what I have
to say"). Use these questions to help you consider different ways you may
view yourself, and feel free to include any areas not listed.
How do you imagine you sound when you talk in a group? Do you seem
intelligent? Do you seem nervous? Do you seem as if you know what you
are talking about? Do you seem stupid or silly?
Do you ever say anything interesting? Are you concerned that people are
bored or annoyed when you speak?
SOCIAL ANXIETY I 193
Do you think that anyone has ever been attracted to you? Why or why
not?
What are things that other people may lil<e about you?
Do you think there are any other positive things that people think about
Do you think there are any other negative things that people think about
you when you talk with them?
194 I OVERCOMING CRYSTAL METH ADDICTION
j
PEOPLE ACTUAIilY SEE ME?
ASK the following questions of family members and friends with whom
you are comfortable and familiar These are the same questions as in ex-
Is there anything else positive that you notice when we are together?
WERE there any differences between what you imagined about yourself
in exercise 13-1 and what your fannily and friends thought in exercise
13-2? This will help you to understand how different your fears can be
j
the distortions need to be corrected. Simply knowing that the fears are I
t
cognitive distortions to work on, you have a focus and can address your
fears constructively.
For each of the differences that you found in exercises 13-1 and 13-2,
ONCE you know the false assumptions that you make, use them in this
act a total of at least fifty times. Make the task simple and quick. For ex-
ample, if you are in a party, go up to ten different people you don't know,
casually introduce yourself, and say, "Hello, my name is Pat Smith. Nice
to meet you." Keep the interaction brief and say something positive and
simple, such as, "This is a great party, isn't it?" Have a standard exit line,
such as "Oh, no! Please excuse me, I need to find my friend Jamie. It was
a pleasure meeting you." and move on. Remember, in this exercise, your
only goal is to say hello, not to make new friends. Limit your interactions,
behavior— approaching strangers and saying hello. If you linger and try
to interact further, other sources of anxiety may arise, and the benefit of
you become to it. After each exposure, you will find that your level of
succession for your mind and body to learn from the experiences. If you
do this exercise only once every two weeks, every day that you do not do
the exercise, you reexperience your old fearful reaction, and you relearn
your fear response. The next time you do the exercise two weeks later, it
Expect that the first few times you do this exercise, your anxiety will be
high, and indeed you may appear a little awkward to others. Nonethe-
less, continue to repeat the exercise. Remind yourself that even if you
feel stupid at first, it is not because you are stupid— it is because you
don't feel confident. The more times you repeat the behavior, the clearer
it will become that even if you blunder, nothing terrible actually hap-
pens. Intellectually you learn this through observing yourself. Biologi-
The first few times you do this exercise, concentrate solely on com-
pleting the task. After a few repetitions, if your anxiety has decreased
somewhat, you will feel less overwhelmed each time you expose yourself
to the situation. At that point, you can observe yourself and the people
around you, and you are better able to compare your cognitive distor-
tions to what actually happens when you do the exercise. In our example
of approaching people to say hello, take note of the following:
1. What was the other person's response to you? Was the response
what you had imagined?
2. How do you think you seemed to the other person?
3. How uncomfortable or anxious was the situation for you?
As you continue the exercise, continue to gather data about your cog-
nitive assumptions and distortions.
This is a labor-intensive exercise, much more that doing a bump of
some people feel a high from the confidence and rush of accomplish-
ment. In addition, this exercise teaches you a way to deal with anxiety
of any type, demonstrating that you can overcome it yourself. If you are
persistent with this exercise, you will gradually start to incorporate this
Medications
the more dominant baboons have higher brain levels of serotonin, while
serotonin levels in brains of those at the bottom of the chain were the low-
est. It is not clear if serotonin causes dominance or, conversely, if social
Both groups struggle with experiences of social rejection, and the social
short-lived.
take some time to resolve, while the therapeutic effects begin after sev-
eral weeks — this is the price for taking a medication that is effective but
alternative to SSRIs, if you can't find one that works well for you.
returns, the small decrease in your dose should allow only a small increase
in anxiety, and this less intense anxiety will be easier to address with
behavioral exercises, such as exercise 13-4. As you become less anxious
again, try another small decrease in medication, and repeat the behavioral
exercises. Eventually you may find that you do not require medications at
do not want tomake your addiction worse, and you certainly don't want
to pick up a new one.
(2) the distant past from childhood, which forms the template for how
people experience the world as adults; and (3) the relationship between
the patient and the therapist as a model of how the patient experiences
and interacts with people in general. The fundamental concept is that
problems arise when things that your mind wants to do differ from what
your conscience thinks is the morally right thing to do. This "conflict" cre-
ates an inner crisis, so the unconscious tries to find a compromise, which
often results in problematic behavior that we can't seem to stop.
the right man to marry. She wants a husband who is kind, honest, and
treats her well— not too much to ask for, she thinks. However, for some
unknown reason, whenever a man she dates turns out to be truly honest
and caring, she discovers something else about his personality that is so
SOCIAL ANXIETY I 201
annoying that she cannot tolerate him anymore, and she starts Looking
elsewhere for love.
the explanation, her reaction was anger at the driver who killed her father.
However, when she was seven, all she could think of was her intense
> sadness and confusion when the person she loved most in the world was
suddenly gone. In therapy she also recalled feeling tremendous rage at
In the therapy, Christina began to see her own fear of getting mar-
ried because falling in love would put her at risk of being abandoned and
devastated again. The connection became clearer when she was talking
about her anger, and her thoughts associated to her last boyfriend and
her intense anger at him for occasionally coming home late from work.
In the therapy, as she felt more connected with the therapist and
for things she had seen him do many times before without any emotional
at her boyfriend of the time. The quality of her relationships improved, and
I at age thirty-four, she met a man she eventually married.
therapy for later in recovery because I discourage exploratory therapy during the
initial stages of sobriety, until addicts have stronger relapse prevention skills and
are able to handle the emotional stress that usually arises as you uncover deep
and unconscious feelings. However, later in recovery, when sobriety skills are
Some people who have been medically diagnosed with major depression
take antidepressant medications. These medicines increase the availability
of such neurotransmitters as dopamine, serotonin, and norepinephrine
by preventing their removal (termed 'reuptake") from the spaces between
brain cells. While they do not increase production of these neurotransmit-
ters, they help the brain to maximize the usage of what is already in the
brain in order to maintain stable mood. Cr^^stal, on the other hand, releases
so much dopamine that it depletes the brain of its dopamine reserves. In
not able to replenish its depleted supply. With little dopamine left, there
—
DEPRESSION I 203
is nothing for antidepressant medications to work on, thus, they may lose
WHAT IS DEPRESSION?
"Depression" is such a commonly used word in the English language
that its exact meaning is unclear. In the medical field, we use the term
major depression to refer to a specific biological state of the brain.
for years.
to therapy.
of the euphoria of crystal can make the desire to use again irresistible,
seeming like the only way to find relief.
TABLE 14-1
A. Five (or more) of the following symptoms have been present during the same
2-week period and represent a change from previous functioning; at least one of
the symptoms is either (1) depressed mood or (2) loss of interest or pleasure.
Note: Do note include symptoms that are clearly due to a general medical condi-
tion, or mood-incongruent delusions or hallucinations.
1. Depressed mood most of the day, nearly every day, as indicated by either sub-
jective report (e.g., feels sad or empty) or observation made by others (e.g.,
the day, nearly every day (as indicated by either subjective account or observa-
tion made by others) '
>
,
|
[
3. Significant weight loss when not dieting or weight gain (e.g., a change of more
DEPRESSION I 203
9. Recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation
without a specific plan, or a suicide attempt or a specific plan for committing
I suicide
D. The symptoms are not due to the direct physiological effects of a substance (e.g., a
I
I
E. The symptoms are not better accounted for by Bereavement, i.e., after the loss of a
loved one, the symptoms persist for longer than 2 months or are characterized by
marked functional impairment, morbid preoccupation with worthlessness, suicidal
ideation, psychotic symptoms, or psychomotor retardation.
Excerpted from the Diagnostic and Statistical anual of Mental Disorders. Fourth
Edition '
;
is how life is supposed to feel. Table 14-2 lists the DSM-IV criteria for
dysthymia.
TABLE 1A-2
A. Depressed mood for most of the day. for more days than not. as indicated either by
subjective account or observation by others, for at least 2 years. Note: In children
and adolescents, mood can be irritable and duration must be at least 1 year.
U. Low self-esteem
6. Feelings of hopelessness
C. During this 2-year period, the person has never been without the symptoms in
D. No Major Depressive Episode has been present during the first 2 years of the
disturbance; i.e., the disturbance is not better accounted for by chronic fvlajor
Depressive Disorder, possibly in partial remission.
E. There has never been a Manic Episode, a Mixed Episode, or a Hypomanic Episode,
and criteria have never been met for Cyclothymic Disorder
F. The disturbance does not occur exclusively during the course of a chronic Psychotic
Disorder, such as Schizophrenia, or Delusional Disorder
G. The symptoms are not due to the direct physiological effects of a substance (e.g., a drug
because the drug is a quick fix that can make that depression disap-
pear instantly. In the long run, however, it actually worsens depression.
If a person is biologically depressed when using, then the crash can be
even worse. If a person has had major depression in the past but is not
depressed when he or she uses crystal, the crash can trigger another major
depressive episode, and what starts out as just a crash can turn into an
intense, long-lasting depression. If you have a history of depression, using
meth is playing with fire — it may seem exciting, but it is dangerous and
can leave you burned. It is particularly risky for you, and you should avoid
it altogether.
[
greater chance of relapsing on crystal.
WORK:
When You Need
Keep Your to
Job Performance and Productivity High
the responsibilities of
your job? Are you usually too tired to finish your work, or is the job is
really the problem. Almost all jobs have periods of increased or decreased
intensity —deadlines, due dates, seasonal fluctuations in businesses and
markets. However, if you find that your job always seems difficult to
keep up with, then this is a problem. If you need crystal or some other
stimulant to be able to perform your normal workload, is that really the
right job for you?
Many people have used meth to help themselves accomplish more
work: cramming for exams, writing last minute papers, or completing work
projects by their deadlines. But what starts as a one-time work aid for a
special project can become a constant requirement to be able to function
WORK I 209
at school or work. Some may quickly become addicted to the drug itself,
and their constant use keeps them working at an inhuman pace. For most,
however, it is a gradual process, in which, having seen what they were
able to do on meth, they begin to impose higher expectations on them-
selves.They accomplish more and more projects with meth, eventually
they become used to operating in high gear with little sleep and long work
hours. If crystal-fueled productivity becomes your new standard for work
performance, it can be an impossible standard to maintain without cr\'stal.
At first, this technique may seem to work Over time, the same amount
of meth becomes less effective, and you need to use more to accomplish
the same job. As you increase your use, you also start suffering more of
meths toxic effects, such as anxiety, distractibility, paranoia, irritability,
and disorganization, which, ironically, make your work suffer as well. But
by that point, your addiction is so strong that it is difficult or impossible
to stop using. The crystal that once made you a star at work may now lose
whether your job is able to help you achieve the life you want. You are
human, and you have Hmits — it is all right if you can't do everything in life.
dentally turned to meth for help. Read the next chapter if you suspect this
ATTENTION-DEFICIT/HYPERACTIVITY
DISORDER:
You're Not Lazy or Depressed,
So Why Do
You Still Have Trouble
Getting Things Done?
so powerful that it goes beyond treating the ADHD and causes addiction.
212 I OVERCOMING CRYSTAL METH ADDICTION
lems with attention has this disorder. The reality is that many things can
impair attention, including anxiety, depression, bipolar disorder, schizo-
phrenia, dementia, brain injury, prescription and over-the-counter medi-
cations, drug and alcohol use or withdrawal, physical pain, and countless
medical illnesses; (2) In small doses, stimulants improve concentration in
American culture emphasizes the quick fix and the easy solution. The idea
that taking a pill could instantly improve one's mental function is extremely
appealing to many. Similarly, physicians pressured to see more patients in
less time may feel eager to find the simplest and quickest solution to help
their patients. The result of all of these factors has been the unintentional
overprescription of stimulants. However, when people with ADHD are
correctly diagnosed, the appropriate treatment can dramatically improve
their lives.
type, and a combined type. The formal criteria are listed in table 16-1.
TABLE 16-1
1
A. Either (1) or (2): j
j
1 .
Six (or more) of the following symptoms of inattention have persisted for at least
I
6 months to a degree that is maladaptive and inconsistent v\/ith developmental
j
level [i.e., that is more than would be expected compared to a child's same-age
1
peers]:
ATTENTION-DEFICIT/HYPERACTIVITY DISORDER I 213
Inattention
a. often fails to give close attention to details or makes careless nnistakes
in schoolwork, work, or other activities
b. often has difficulty sustaining attention in tasks or play activities |
d. often does not follow through on instructions and fails to finish school- {
g. often loses things necessary for tasks or activities (e.g., toys, school
assignments, pencils, books, or tools)
h. is often easily distracted by extraneous stimuli
i. is often forgetful in daily activities
Hyperactivity
a. Often fidgets with hands or feet or squirms in seat
b. Often leaves seat in classroom or in other situations in which remaining
seated is expected
c. Often runs about or climbs excessively in situations in which it is inap-
propriate (in adolescents or adults, may be limited to subjective feelings
of restlessness)
d. Often has difficulty playing or engaging in leisure activities quietly
e. Is often "on the go" or often acts as if "driven by a motor"
f. Often talks excessively
Impulsivity
a. Often blurts out answers before questions have been completed
b. Often has difficulty awaiting turn
c. Often interrupts or intrudes on others (e.g., butts into conversations or
games)
d. Some hyperactive-impulsive or inattentive symptoms that cause impair-
ment were present before age 7 years.
e. Some impairment from the symptoms is present in two or more settings
(e.g.. at school [or work] and at home).
f. There must be clear evidence of clinically significant impairment in
Excerpted from the Diagnostic and Statistical Manual of Mental Disorders, >
^
Fourth Edition
214 I OVERCOMING CRYSTAL METH ADDICTION
If you think that you might have ADHD, here are some important
points to consider:
If you suspect that you have ADHD, you should see a psychiatrist or
psychologist and have a formal evaluation. If indeed you have ADHD, then
you should seek appropriate treatment. Fortunately, there are now many
nonaddictive, nonstimulant treatments for ADHD, which can improve
your quality of life, enhance your mental functioning, and decrease your
risk of relapsing onto crystal. In addition, there are many nonmedication
behavioral strategies that can help you to keep organized and optimize
your focus. If you have an addiction to crystal, then using stimulants to
treat ADHD is not a good option for you because it mimics the activity of
meth too closely and puts you at serious risk for relapse.
n
LIFE IS A BALANCING ACT:
Stress Management
A CARDINAL RULE
crystal addiction, other
in relapse prevention, for
chemical depen-
dencies, and as a general rule for life, is to minimize or manage stress.
Anxiety and stress are natural feelings in life. Mother Nature gave our
bodies the ability to feel stress to motivate us to do things, whether we
are running from a predator for survival or working in hard in school to
get good grades. Cortisol, one of the hormones involved in stress, illus-
trates how stress functions in our lives. The adrenal glands secrete the
hormone Cortisol in response to physical or emotional stress. A person
with inadequate Cortisol function, also called adrenal deficiency, gener-
ally suffers from fatigue, dizziness, and weight loss, among several other
symptoms. However, in the setting of a severe stress, such as a bacterial
infection, the inability of the body to mount a normal stress response by
increasing Cortisol production can lead to dangerously low blood pres-
sure, shock, and possibly death. Clearly, stress has its place in life.
However, all good things must be kept in moderation, or they cause prob-
lems. Feeling overloaded from stress can also be extremely problematic. With
—
216 I OVERCOMING CRYSTAL METH ADDICTION
regard to crystal addiction, too much stress that is not managed properly can
lead to a crystal relapse. In addition to giving you energy that can help you do
more work, meth can offer an escape from the drudgery of your job to a state
of artificial happiness, it can distract you away from unpleasant feelings, it can
boost a low mood caused by chronic frustration, overwork, and fatigue, or it
can feel like a well-deserved reward for your hard labor. When you are vulner-
able from too much stress, there are so many attractive fruits hanging from the
forbidden tree of Eden that it can be extremely difficult to resist the temptation
virus. Brain imaging studies give visual proof of the physically toxic effects
of anxiety and depression, showing destruction of brain cells in certain
areas, compared to people who were treated for these conditions. Most of
us can recall some experience in which stress affected our bodies: intense
physical or mental stress may have caused some women to miss their men-
strual period; both men and women may have more outbreaks of herpes
or acne during particularly difficult times. Excessive stress is dangerous in
many ways because of the increased the risk of relapsing onto crystal and
its myriad negative impacts throughout the human body.
There are two different ways to approach managing stress: ( 1 ) prevent-
ing it from overaccumulating, and (2) finding ways to counter it when it
your job? Your relationship? Family conflict? Whatever the cause, you need
LIFE IS A BALANCING ACT I 21?
investigation.
office because you are reluctant to go home, where you dread the angry
arguments you regularly have with your spouse?
how can you effectively address
After pinpointing the cause of stress,
it? Ifhome is usually a battleground where you usually argue with your
partner, how can you communicate more effectively? Have you considered
accomplish the work —perhaps setting a more practical time frame, hir-
ing an assistant or additional employees to work on a project with you, or
restructuring the project.? If you have been silent about your frustration
at this job but nothing has improved, and talking with your boss is not
helpful, should you consider working somewhere else?
Just the initial act of creating a plan of action to deal with a problem
can be therapeutic because it gives a framework to your stress, which may
have been somewhat vague and unclear; it keeps your attention focused
on reaching a better state, and making a list of strategies to address the
problem may give you some sense of taking control. If you hide from
the problem, for example by mentally escaping through drugs or physi-
cally avoiding the stressful place, the problem will continue, and growing
feelings of powerlessness and hopelessness simply compound the stress.
218 I OVERCOMING CRYSTAL METH ADDICTION
no more. Clearly understanding your own likes, dislikes, and voilnerabilities will
not only help you get out of stressful situations, but it can also help you avoid
getting into them in the first place.
allow you to redirect feelings of frustration and anger in a safe way. For
example, hitting a punching bag can symbolically represent your boss who,
while angry about something unrelated to you, yelled at you last week.
LIFE IS A BALANCING ACT I 219
Complaining about it right then might have cost you your job, but if you
never address your feelings, you will carry around the anger, which will
add to other stresses that accumulate over time. Fighting sports can help
you redirect your unexpressed frustrations in a meaningful but safe way.
They can help you feel more in control because in addition to expending
energy, practicing a "fighting art" can counter the feelings of powerlessness
from your situation.
on it does not bring you relief but makes you ruminate on your problems
even longer, then this is not a helpful activity In this case, aggressive fight-
ing sports only perpetuate your anger and prevent you from letting go of
your negative feelings. In that case, find a different activity to relieve stress
before you build up so much anger that you find yourself in trouble.
RELAXATION
you need to find an activity that fits you well. For example, some people
find meditating by chanting in a group to be extremely soothing and relax-
ing. Some may feel it is not their style and makes them feel awkward and
uncomfortable — rather than help you feel better, it could increase your
stress. Some suggestions for easy strategies to clear your head when you
need to calm down include strolling through the neighborhood, taking a
leisurely drive (not speeding), sitting on a park bench watching the squir-
1 . Do the activity a leisurely pace, and give yourself enougt) time to do it. If you
only give yourself 30 minutes to take a break and go to the park,
but it takes 10 minutes to get there and 10 minutes to get back,
then the whole experience becomes a hurried task — ^just another
burdensome task on your list of things to do. Either give yourself
more time or pick a place to relax that is closer.
2. Keep your focus on the relaxation activity. If you are walking or driving,
look at the road, at the scenery around you. Be more aware of your
surroundings and enjoy the break from your day —take in the view.
ties. While you are walking, you don't need to reach a certain goal
in a certain amount of time. As you look at the scenery around you,
you don't have to feel the joy of resplendent nature — if you expect
your walk in the park will be like Walt Disney's Bambi, you'll likely
feel disappointed and annoyed that you wasted your time. While
the ultimate goal is to make you feel better, the activity itself
ity itself. It is all right not to feel anything. If you set up another
expectation, your effort to relax becomes just another test to see
if you will pass orfail. The mere fact that you are engaging in the
activity means you have already met your goal, so feel satisfied
with that and focus on the activity.
4. Empty your mind of anything outside your activity and let the other things
go. Focus on each step of what you are doing, where your body is,
what is around you. Observe your surroundings and just take them
in. Diverse schools of thought from widely different philosophies
all seem to converge on this point. Western psychology describes
it as refocusing your attention away from stress. Zen Buddhism
LIFE IS A BALANCING ACT I 221
In addition to the quick fixes listed above, the following are some ex-
specifically meant to help you to relax. These are only cursory descrip-
tions, but if any of them pique your interest, I encourage you to find out
more and give them a try. You may be surprised that you like something
completely new. If not, move on to something else. You should have at
least one or two activities that you can turn to for relaxation. Whatever
activities you choose, make sure they feel right for you.
Yoga
to attain a higher state of consciousness and freedom from the cycle igno-
rance, worldly suffering, and rebirth. Modern yoga has evolved into several
body in ways that are unusual in ordinary sedentary life. The breathing
techniques help with relaxation because of the amount of oxygen and car-
bon dioxide that your body accumulates or breathes off. Certain breathing
techniques stimulate the vagus nerve, which runs through the chest and
lower neck. Through various neural connections, the vagus nerve connects
to several parts of the brain, including certain fibers in the thalamus that
decrease activity in the frontal cortex and lower anxiety; the hypothalamus,
improving alertness and attention, and producing feelings of satisfaction
and pleasure; and the limbic system and forebrain-reward systems, induc-
ing feelings of pleasure and bonding.
The effects of vagus nerve stimulation have been well documented in
survivors of the 2004 tsunami in Southeast Asia and the victims of Hurricane
Katrina in 2005, and these interventions were found to be powerfully effective
in reducing symptoms of posttraumatic stress disorder.
The way that yoga is practiced, focusing your mind on your own body,
concentrating on your physical being (some positions are very difficult and
require intense effort), and carefully manipulating your breathing patterns,
you become entirely focused on the here-and-now. This is completely
opposite to the way people normally operate when they are anxious, either
ruminating about problems from the past or worrying about the future.
Rarely do people let go of these thoughts and simply look at themselves
just at the present moment in time. Previously, I discussed the concept
of letting go and strategies of relaxation aimed at relieving you of past and
future worries. Yoga is one of many ways to achieve this state of mind.
Whether you believe in the spiritual aspects of yoga, are intrigued by its
physiological effects on the brain, or are just generally curious about the
practice, I encourage you to try it. Many people practice yoga, and even
without understanding the "real" way that it causes change in them, they
LIFE IS A BALANCING ACT \ 223
Women who are pregnant and people who have medical conditions, such
as uncontrolled high blood pressure, seizure disorder, significant heart dis-
ease, recent injuries or surgery, or any other serious medical illness, should
consult his or her physician before considering a yoga program. Bipolar
disorder and psychotic disorders such as schizophrenia may be worsened
by SKY breathing techniques.
If you decide to try yoga, be aware that at this time there are no stan-
dard certification or licensure requirements to be a yoga instructor, though
many instructors attend yoga institutes, where they are certified after
of yoga for six months, total abstinence from alcohol and other drugs,
and adherence to a strict vegetarian diet; obtaining certification from
these training programs therefore demonstrates a high degree of personal
dedication and experience in yoga. Nonetheless, keep in mind that there
is no regulation of the quality of education at yoga schools. Until clearer
standards are set, make sure that your yoga instructor is at least certified
by a yoga school, and obsewe a class before deciding if you are comfort-
able participating in it.
Massage
work ethic today, a good example being the expression "no pain, no gain,"
which became popular in the 1980s. However, there are some enjoyable
and indulgent activities that can also be good for you, such as massage.
There are various schools of massage. Examples include Swedish mas-
sage, deep tissue massage, sports/medical massage, qi gong, shiatsu, and
224 I OVERCOMING CRYSTAL METH ADDICTION
sion and emotion our muscles hold after the terrorist attacks on September
11, 2001. The American Red Cross set up a vast disaster relief service
center in New York for all people affected by the disaster. Volunteer ser-
assistance, and provision of various social services. Among the many dis-
help for someone else. The response of all people, regardless of why they
came, was dramatic. Some of those who had come for others' sake and
who had thought they were strong and unaffected by the attacks found
themselves in tears in the middle of a massage session. They had been
holding in so much stress that the massage literally kneaded out the pent-
up feelings. When I witnessed this, I realized how powerful a tool massage
could really be.
Unlike yoga, massage therapy is regulated by each state government,
requiring specific training and licensure. However, there are so many styles
of massage, and the experience of touch is so unique, that you can have
a completely different experience from two licensed massage therapists
practicing for the same length of time. Make sure your massage therapist
is licensed. Ask what kinds of massage techniques he or she uses and how
long he or she has been practicing. If the response to these questions is
vague, find another therapist —anyone who is truly trained and licensed
would be able to answer these questions in detail. Consider what kind of
massage would be more relaxing —the more superficial Swedish massage
(which can still be vigorous depending on the massage therapist) or the
much harder and sometimes painful deep-tissue massage. Pick a therapist
LIFE IS A BALANCING ACT I 225
with a gender you are most comfortable with — this is a nonsexual experi-
ence, and your comfort with the therapist is essential for the massage to
reduce your stress. And make assumptions about gender and the
don't
for when you speak with a potential massage therapist. And most impor-
tant, if you have had any kind of injury, recent surgery, or illness check with
your physician to see if massage is safe for you
Acupuncture
changes, along with other eastern remedies, can help restore you to health.
Many people report leaving an acupuncture session feeling relaxed and
tranquil, with a general sense of well-being.
and discuss this with your physician first, as they can be just as powerful as
pharmaceutical medicines and drugs (remember that cocaine, marijuana, i
heroin, and opium are all from plants) and may chemically trigger a relapse
^
Reiki
Reiki is both an ancient and a new form of holistic healing with roots
dating back several thousands of years in Tibet. It is a system of healing
that involves the placement of hands directly on the recipient, as well as
holding one's hands near the recipient's body without any actual physical
contact. The "laying on of hands" as a treatment for ailments has existed
practice of Reiki in the late 1 800s, looking for a spiritual system of healing
through study, research, and meditation. He reported that at one point, he
experienced a metaphysical transformation, and based on that experience
he developed a system of healing using what he called the "Universal Life
Force," which is channeled into a recipient's body. Ailments are concep-
tualized as an obstruction of the flow of the Universal Life Force, and
the Reiki practitioner acts as a conduit to direct the energy back into the
recipient.
By tradition, the Reiki healing system was passed down from master to
disciple in Japan. However, all of the original masters in Japan died, except
for one master, who immigrated to Hawaii, where she continued to teach
Reiki to Americans. For this reason, Reiki is now more developed and
widely practiced as a healing art in the United States than it is in Japan.
While extreme Reiki enthusiasts believe that Reiki can heal almost
any physical ailment, many people, including some Reiki practitioners,
feel that its greatest use is for relaxation, which in turn improves overall
health. 1 do not recommend that people use Reiki as a primary treatment
with certain physical injuries or people who feel more anxious from too
much physical contact. In this regard. Reiki may be a nice alternative, with
minimal to no physical contact.
^„
Meditation
'*
Because meditation can be done in so many ways, the best kind is what-
ever method fits your personaHty, Hfestyle, and personal philosophy. Your
goal is to feel more tranquil, so finding a good fit, like the right size shoes,
tion and relaxation techniques. Try to do this exercise twice a day— once
in the morning to start the day in a tranquil state of mind, and once in -
the evening to help yourself unwind from the stresses of the day. Allow
'
Find a comfortable, dark, and quiet place to sit or lie down and close your
^
eyes. The first time you do this, you may want someone else with a calming ^
voice to read you these instructions and guide you through the steps.
1 . Sit or lie comfortably with your eyes closed. If you are lying down, i
lay your arms and hands at your sides. If you are sitting, place the
Notice how you may have been tensing them and holding them up,
and try to appreciate their heaviness as you let them fully relax.
5. Take in another slow deep breath and visualize the air coming in
6. Slowly exhale through your nose and visualize the air coming out
in streams of slightly grayish vapor from your nostrils, carrying
out any bad feelings, stress, tension, and "impurities"— the gray-
9. After saying these statements, repeat the deep breathing again for
5 more breaths
10. Slowly count backward from 10 to 1, and when you reach 1, slowly
drugs, you have an extra challenge in trying to stay sober. Remember the
mantra 'people, places, and things" reminding you that the people you
associate with crystal are dangerous because they can easily pull you
back into using again. People who used crystal in private —hidden from
family and friends, doingmeth only with strangers, sex hookups, and
their dealer —
may still know several sober people who are not triggers
and who can support them through their efforts to stay clean.
But what if your main social circle is a group of other drug users, people
with whom you used to spend most of your free time, whether it was just
hanging out at home getting high or going out together to parties where
everyone was using drugs. What if you are a gay man, and your social
circle is all circuit boys who talk mostly about clubs, the best DJs, and
what drugs they plan to do for the weekend? If any of these resembles
your situation, then trying to separate yourself from these people can be
difficult because it means giving up your entire social network, the people
WHO IS IN YOUR SOCIAL CIRCLE? I 231
you are accustomed to calling whenever you are bored, lonely, or looking
for something to do. If you have to cut ties with these people, then how
are you going to make it through each day?
Whoever you are, and however you identify yourself it is essential to under- ,
stand the personal significance of your own social group. Who are the people in
your social circle of drug users and why are they so important? Whether gay or
straight, ask yourself this question and consider whether other people can meet
these same needs. If you are a straight young man in a small rural town and just
out of high school, you may have a core group of friends you know from school.
You've been friends since freshman year, which feels like a lifetime, and in your
small town there don t seem to be many people to choose for friends. But are
there really no other people, or is it just easier to keep hanging with the same
crew you always did? Unless you and your friends were the only people in your
graduating class, there are probably other people that are potential friends. The
easiest way to meet sober friends is to go to the nearest twelve-step meeting.
Even if you aren't exactly the same age, you may find that you have more impor-
tant things in common than your age, especially your wish to stay clean!
Ifyou are a gay man in the club/circuit scene, believe it or not, there
are other fun, attractive, and gay-affirming people in the world who do
not use drugs, and they can offer you the same support you had from your
party friends. In fact, they can probably offer you even better support
because they may be more interested in the person you are, unlike many
club friends whose main concern is whether you are have any E and K to
share or if you're going to give Tina a call this weekend.
Gay men who were introduced to the party scene when they were just
coming out may have an even greater challenge separating from their social
group. Before coming out, they may have been completely closeted and
unable to be their true selves with anyone. Alternatively, their peers may
have known they were gay and ostracized them, making them feel they
were worthless outcasts. The group of partying friends may be the first
people ever to fully accept them, the first to make them feel liked and to
welcome them into their group. More than just people with whom they
are accustomed to passing time and doing drugs, these friends have strong,
positive emotional meaning in these men's lives.
Similarly, circuit parties, which are huge gatherings wath thousands of gay
men, most of them high on club drugs, are places where many gay men first felt
they could openly and wholeheartedly celebrate their sexuality, feeling happy,
252 I OVERCOMING CRYSTAL METH ADDICTION
closeted pasts. Therefore, the entire scene — the friends, the parties, and the
drugs —has a monumental emotional significance to these men.
Asking these gay men to stop seeing their party friends and to stop going
to circuit parties is asking them to turn their backs on the first people
who made them feel accepted and not to go back to the place where they
remember first truly feeling part of a community While all these fond
memories have some validity, in reality, drugs were likely the real glue that
held much of this group together, and ultimately, the drugs and sex became
the main draws to the circuit parties. The positive associations to these
people and places are so deep that it can be incredibly difficult to let go.
As positive as their feelings may be, however, this group of friends who
once seemed like a lifeline gradually turned into a ball and chain dragging
them to a drowning death by crystal addiction.
If these gay ex-party boys have no significant friends outside the club
and circuit scene, then completely separating themselves from this social
will discover what it is like to have gay friends who truly like them for who
they are, not just because they do drugs together at parties.
If you are an offbeat club kid, marginalized at school as "that strange
chick," but considered "the cool, cute babe '
in the rave scene, you may be
surprised to find other teens like you who swim outside the mainstream
but still think they are cool, and are clean and sober. When you hear the
obnoxious Barbies at school make fun of your different clothes, if you stop
going to raves, where the scene and the drugs remind you that you are
still that cute, cool, babe —now you are forced to look at how you really
feel about yourself and admit how much of an effect those vicious girls
at school really had on your self-image. You felt cool at the rave parties,
but if you can't go back to the scene, will the cool babe you were at the
Hold on to the pride and self-esteem you remember from the parties, but
don't resort to club drugs to erase the nasty words of the Barbies. It will
be a hard struggle, but learning that you're still cool, no matter what those
girls say, shows how powerless the Barbies really are. Now you've devel-
oped real personal strength and confidence —and you don't need meth to
chemically brainwash you into believing it. A lot of the teens at raves are
in the exact same situation you are. Some of them are stuck on rolling
and are too addicted to stop the partying. But you may find some who are
willing to forage outside the rave scene to see if they can still feel good
about themselves without the drugs. If none of your rave friends can see
things the way you do, go to a teen AA meeting, and you'll find many young
people just like you. The friends you make there will share your desire to
stay clean and will also join you in the process of finding the cool, cute
babe inside each of you.
especially when you know that old friends are going to try to get you to use.
Design your own mental exercises tailored to what situations you imagine
i you will be in, and practice them again and again to help you resist the
urge to use if you know that your friends will still be using around you.
234 I OVERCOMING CRYSTAL METH ADDICTION
This does not necessarily mean your friends are "bad" people. It sim-
ply means that being with them results in an unhealthy situation that is
dangerous for you. Again, consider the asthma analogy — suppose you
had asthma and an allergy to cats, and you walk into a room with a litter
of five adorable kittens. They are cute and fuzzy, asking you for affection
and love. Despite how cute and affectionate they are, being with them
will trigger an allergic reaction and a severe asthma attack that could land
you in the hospital —you know this from previous experiences with cats.
The kittens are not bad per se, but being near them is dangerous, and you
need to stay away from them. This is how you should view your drug-using
friends —without judgment but with clear acknowledgment of the risk
While it may seem that there are other reasons that you are friends, drug
use may be the most significant reason. It's only when you stop using meth
that its role in your friendship becomes clearer. Which do your friends
seem more concerned about —protecting your health or the next time they
are going to do meth?
I
'
Justin became such a recluse, staying in his roonn doing crystal, that he
couldn't work, and he ran out of nnoney to pay for the drug, even though i
his friend made it and sold it to him very cheaply. He also started to
M become paranoid and suspicious about his friend. To avoid dealing with
WHO IS IN YOUR SOCIAL CIRCLE? I 235
him, he decided to try making his own crystal, using the recipe his friend
meth labs. One day two police cars drove up and uncovered Justin's secret
lab. They arrested him. and he was convicted of manufacturing illegal
substances.
Justin was sentenced to prison, where he was treated by the prison psy-
chiatrist for his psychotic paranoia and hallucinations. Justin's prison time
was shortened with the stipulation that he participate in a court-mandated
residential drug-treatment program in a town one hour from his home. After
completing the program, he was clean from meth for two years.
with a new boyfriend. He resumed his life where he had left off, working
at a gas station part time. He was happy to see his old friends again, no
longer paranoid and suspicious of them. However, they were still using
meth, smoking it to while away their free time. When he first saw them
high after he had been clean for so long, Justin didn't like what he saw
and realized how far he had let himself go. He had an even stronger
After two months back at home, Justin was still clean. He wanted to stay
away from crystal, but it was difficult. He didn't know anyone else to hang
out with, because his community was so small— it was difficult to meet new
people that he liked. With only a part-time job to keep him busy, he soon found
himself in the same dilemma as before— having nothing to do, he felt bored
when using crystal— not just mental images but even bodily sensations. All
he could focus on was how ever^'thing felt so vibrant and interesting when
he was high. Though he also recalled the anxiety, paranoia, and malnutrition
strong, visceral feelings of how good it felt to be high. Eventually the draw
became overwhelming, and one day when he was hanging out with his friends
while they were smoking crystal, he asked them to pass him the pipe. They
were surprised but happy to have their old friend back in the fold and relieved
not to have a teetotaler hovering around them, making them feel judged and
I Justin started with just doing crystal on his days off fronn work, but
^ within a month he was snnoking every day again, and soon his paranoia
^;
had the telephone number of the drug treatment facility he had gone to
after prison, and he called his old counselor. Justin returned to rehab.
During his second rehab, Justin had even more material to talk about
with his counselor and with the groups, looking at what exactly caused
most of his days, which intensified his cravings. He complained about how
difficult it was to find friends who didn't use meth. making excuses for
why he kept hanging out with people who were smoking right in front of
him. Even though he had talked about these same issues during his first
he worked closely with his counselor to develop a plan for what he would
psychotic as he had gotten, his friends kept smoking meth in front of him
while he struggled not to use so that he would never have to hear those
terrifying voices in his head again. He left rehab with a new desire to make
sober friends with whom he could stay clean.
Justin found an AA meeting that was in a town one hour away. There
were no CMA meetings in his area, but a group recovering from alcohol-
ism was close enough — he could still talk about addiction and get support
from other people trying to get sober He was surprised to find another
person from his community at one of the meetings, and they become
"sober friends." Now, when Justin felt lonely he did not have to call his
meetings every day that he was not working at the gas station, and even
on some days after he finished work. He had a more regular schedule,
and life didn't seem so formless and lacking in direction. While he regret-
ted not having a better job, he felt he was working hard to move forward,
when he feels disappointed with himself and frustrated with his life. However,
whenever he feels this way, he calls his sponsor or one of his sober friends, j
When cravings are intense, he goes to town and waits for the next AA meeting.
None of his old friends cook meth anymore because all the local basement
labs were shut down by the police. Still, Justin heard that crystal was available
in town from an outside source, but he has resisted asking about it so that
there is no possibility he can find any crystal if his temptation to use becomes
irresistible. Eighteen months have passed since Justin last used crystal, and
he IS still struggles with occasional cravings, but he "fights the good fight" and ;
remains motivated.
ASOCIAL EXPERIMENT
See what happens when you spend time with your friends and do not use
drugs. In this experiment, I refer to any drug except alcohol. That includes
Ecstasy marijuana, cocaine. Special K, and crystal, as well as any other
illicit substance or even prescription medications, such as OxyContin, that
are not used according to the medical instructions. Consider yourself the
investigator of this small sociology' experiment. The purpose of the study
is to obsen^e what happens to a group of friends who regularly use club
drugs together, when one person decides that, for health reasons, he or she
wants to stay away from all drugs. During the experiment, the designated
sober person steadfastly refuses all drugs for two weeks (at least two cycles
ofweekend partying), while the others are free to choose whatever they
want to do.
You are the sober person in this experiment —remember that you must
remain completely sober for the experiment to work. Focus your attention
on what happens among the group members while you remain sober. Note
but try not to dwell on the nagging feeling that if you just did a little crystal,
238 I OVERCOMING CRYSTAL METH ADDICTION
or even just a tab of E or a bump K while the rest of your friends were
of
partying, your interactions would be much more comfortable. In fact, the
discomfort you notice is one of the things you are trying to understand in
this study. This exercise requires you to step outside yourself and look at
complete this exercise, you will learn important things about yourself and
your friends, and you may make some significant changes in your friend-
ships and your life.
If you are fortunate during the time that you remain completely sober,
you may discover that there are many non-drug-related activities that you
enjoy doing with your friends. Maybe you already knew this, but perhaps
your friends realized they could enjoy themselves together without neces-
sarily using drugs. Your friends must also be sober when engaging in these
activities with you. Participating in activities and connecting with each
other without any drugs, you may form deeper, more meaningful friend-
ships that are not distorted by chemical highs —anyone can be fun to
hang out with if you take the right drug, but if you need drugs to tolerate
these friends without using drugs. Some people in your social circle may
be uncomfortable, feeling that you are judging their drug use: "If he thinks
bad for him, he must think I'm bad for doing it." You may also find
it's
some friends who keep pushing you to do drugs, even after you've told
them repeatedly that you don't want to. After so many refusals, why do
they keep pushing? Do they have any respect for your wish to stay clean?
How important to them is your health, which you are trying to protect
from drug use? Or do they even care about your desires, clearly repeated
several times? How do their concerns about you compare to their need
to get you to do drugs with them? Some people need to have others use
drugs with them because it makes the act seem more acceptable they —
are helping themselves feel less guilty about their own drug use. Does this
need to justify their own drug use overshadow their concern for you and
their respect for your wishes?
WHO IS IN YOUR SOCIAL CIRCLE? I 239
You may find that when you take drugs out of your friendships, there
is little else left that you actually have in common. When Boys Fly is a
documentary that follows four very different gay men as they go to the
same circuit party. One young man promises his roommate at home that
at the circuit party he will not use drugs because, despite serious problems
with drugs in the past, he is determined to prove that he does not have
a problem with drugs, and that circuit parties are not just about drugs.
They are spiritual and communal experiences for gay men. Before arriv-
ing at the party, he tells the camera about his "closest friend," a slightly
older man who he says understands him deeply, better than anyone else
in the world. The friend is a "circuit buddy," someone he only sees when
he goes to circuit parties around the country. The two run into each other
only briefly every couple of months at circuit parties when they are both
high. Nonetheless, the earnest young man firmly believes the two are soul
mates. After a long, frustrating search among thousands of men, he finally
finds his friend. The young man is sober and jumping with excitement but
the friend is almost mute, staring with a smiling yet empty expression, with
glazed eyes as large as saucers. It is clear to the viewer that something does
not match. While the young man is jumping with glee, his 'closest friend
in the world" appears frozen, almost without any reaction. The viewer
wonders what actually makes these two men so close. Only after the young
man breaks his promise and starts using drugs do the two "friends" relate in
any significant way —the old friendship is rekindled. So is it really friend-
ship, or are drugs the real bond that connects these two?
When you consider the friendship in this documentary, you may realize
thatsome of the people in your own life may just be drug friends. When
you first group
join a of partyers, big differences may seem like a positive
thing
— "Wow, developed I've a group of really diverse friends from all dif-
ferent backgrounds!" However, when you try to sustain some of these rela-
tionships without drugs, it becomes clear which relationships are based on
drugs and which have real substance. Consider carefully how you define a
"friend." Then think about which people in your group of partyers fit this
definition. If these people are not really your friends, and they are putting
you at risk for relapsing, you need to let go and move on.
Socializing in circles of drug-using friends makes it easy to always have
people around you. Drug users consciously or unconsciously find each
other, quietly assessing people and asking themselves, "Is he one of us or
240 I OVERCOMING CRYSTAL METH ADDICTION
not? Does he even know what Tina is?" The ease of finding drug friends is
back on this group can be strong if you are alone and trying to find a new
group of friends who are sober. Forming friendships based on something
real can take much longer than friendships based on drugs. But patience
and hard work pay off because you will develop real friendships with
people who have a real connection to you, rather than an artificial sem-
blance of a friend that is really just another excuse to use drugs, disguised
in human form,
LETTING GO
cessful recovery. If these people are your primary friends, you are making a
tremendous sacrifice, much more than just crystal —you are giving up your
main social network and your usual social support system.
Gay men living closeted lives in homophobic areas of the country may
look to their drug-using club/circuit friends as their supportive brothers
and their only connection to the gay community. It may be difficult to
believe that they can find many other gay men who are sober, whether
they simply do not use drugs or are ex-partyers like themselves who are in
recovery. In fact, sober friends would likely be even better supports, pos-
sibly being more available to you when you really need help, not just when
you are looking to have fun and party.
a drug culture, and the underground nature of illicit drug use gives drug
users a common bond. For those drug users who don't feel connected to
any other group, the sense of belonging to the drug community can be
difficult to let go.
Your sober network will provide you with supportive backup while you
test out your old friendships with your new sober life, help you to assess
whether you need to end certain harmful friendships, give you the skills
and courage to break away from old destructive relationships, and be there
for you to give you support when you finally let go.
withdrawn, and not at all interested in reaching out to new people right
now. Others may crave connection and want some handholding through
this difficult stage of early sobriety. No matter what your situation, you
should reach out for support because remaining isolated puts you at risk
for relapsing. If you feel withdrawn right now, at the very least, use your
sober treatment supports (AA, CMA, drug counselors, therapists, and so
on) to maintain healthy contact with the outside world while you gradually
develop a new circle of friends.
distant state for a new job. The initial transition is difficult, but eventually
they find new friends.
social circle become good friends, sharing many things in common with
you, especially the difficult task of sobriety and all the obstacles that come
along the way.
The process of making new friends may be gradual and take a long
time. As frustrating as it may feel, this is actually a great opportunity to
significantly improve your life. Take the time to think about what you really
want from friendships, and make a list of what characteristics are most
important to you. Your experience with ''drug friends," an extreme version
of fake friendships that happen to most people, taught you a lot about what
makes a friendship satisfying and real. If you are prepared with your list of
what you expect of real friends, whenever you meet someone, you have a
better ability to assess how this person may fit into your life, and you can
decide who you want to incorporate into your social network. Gradually,
you will fill your life with healthier and more meaningful relationships.
Here are a few questions to think about when considering whether
someone has the potential to be the kind of friend you want in your life:
more about?
J Is this person different, but is interested in learning more about
you?
Is this person so different that you both find it difficult to under-
stand each other?
Is this person caring and sympathetic?
I Can this person listen or is this person mostly a talker? Does he
or she have the capacity to really listen when you need someone
to talk to?
Does the person ask about you, as well as talk about him- or
herself?
WHO IS IN YOUR SOCIAL CIRCLE? I 243
M Does this person have the capacity to care about you, sympathize
with you, or support you emotionally if you need help? Or does
the person keep changing the direction of the conversation back
to him- or herself?
Does the person use drugs or is the person in recovery?
Does this person seem like he or she can handle knowing that
you are in recovery?
, . Is this person trustworthy and dependable?
These are only a few examples of questions that you might ask. Think
of other questions about the qualities that are most important and mean-
ingful to you.
Making new friendships may not be as quick as it was when you were
using crystal or other party drugs, when the common bond of the drugs was
what brought people together easily. Dr. Edward Khantzian, a well-known
psychoanalyst and addiction specialist, believed that the actual friendship
was between the addict and the drug. Cijstal was your real friend, and
the people associated with it were objects that you and "Chrissie" used
to enjoy your time together. In this light it is even clearer why it is so dif-
ficult to make new friends — it is as if you were married to someone for
several years, during which you were no longer dating —the relationship
turned bitterly destructive, so you divorced, and now you're back on the
dating scene. But it's hard to put yourself out there and meet new people
again. You feel lonely, awkward, and out of practice in the social scene.
Also, when you meet new prospects, sometimes you remember the best
things about your ex, and new relationships seem dull and dissatisfying in
comparison. Divorced people often have rough starts, but eventually they
start meeting new people again.
Sober people who would make good friends may be right under your
nose. Non-crystal-using friends who had been in your life but who fell by
the wayside during your crystal years may still be around, and they may
be glad to hear of the return of the old friend they thought they had lost
harmed" include those that you may have rejected and broken ties with
because of your addiction. The Eighth and Ninth Steps remind you of
important people you may have lost as a result of crystal. They confront you
with the ugly truth that your addiction damaged and potentially destroyed
those relationships, and they give you an opportunity to repair them.
Developing new friendships now may feel different and much more
difficult than earlier experiences because instead of adding new friends
to your existing group, you may have to start completely from scratch.
Keep a list of ideal qualities in mind when forming new friendships, but
also remember that these qualities are not always apparent the first time
your meet someone. You may have to meet a lot of people before you find
any that seem even remotely "friend-worthy" according to your criteria.
However, even with the "right" people, it takes time to get to know each
other and to develop a trusting and caring bond —no one can meet all the
requirements of your list at first meeting. Keep yourself open to different
people, even those you might not have considered in the past, and try to
stay optimistic. While you are getting to know people, always keep your
wish list of criteria in mind. You may even decide to make changes as
you meet more people and further clarify your definition of a satisfying
friendship. If you get the sense that the person uses drugs, say good-bye
immediately. You are in recovery and your health is too important. No mat-
ter how interesting that person seems, he or she poses a great risk to you.
The crystal-craving part of your mind may sense the possibility that the
person is a drug user, and unconsciously the person may seem even more
appealing, because you know that spending time with that person will lead
to using crystal again. Before this happens, if you start to feel this smallest
you are still feeling lonely but aren't getting yourself out of the house, force
yourself out there. If you are really feeling stuck, see a psychiatrist to see
low energy, and poor motivation — all of which can be keeping you stuck
WHO IS IN YOUR SOCIAL CIRCLE? I 245
in a rut, preventing you from making new friends, and putting you at risk
for relapsing on crystal Appropriate treatment for depression can get you
back on your feet and starting to rebuild your social network.
even if you don't find a new friend, you will be doing an activity that inter-
ests you. The fact that the other people at those activities chose to be there
means that they share at least one interest with you. Hopefully there will
Another avenue worth exploring is volunteer work. Find a cause that you
believe in, whether it is helping the homeless, fighting the HIV epidemic,
supporting your favorite political cause, helping to organize the local Walk for
Breast Cancer, or whatever is meaningful to you. Picking a cause that holds
strong personal significance to you may help you meet others who share not
only an interest but a passion —perhaps the shared passion will reveal even
more similarities that will make the person seem more interesting as a friend.
Making a positive interpersonal connection and doing something personally
meaningful are both activities that most consistently stimulate the parts of
the brain involved with happiness —both psychologically and physiologically,
you are improving your mood and your experience of living sober.
Just a side note about volunteer work: volunteering is wonderful because
246 I OVERCOMING CRYSTAL METH ADDICTION
at the same time that you help others, you also improve yourself. Being
productive in a way that clearly benefits others is associated with improved
self-esteem. Additionally, by helping others, you cognitively redirect your
attention away from yourself and your own troubles, and you remind
yourself that other people are suffering as well. Many people in recovery
choose to volunteer or even devote their careers to addiction services and
helping other addicts to stay sober. They find that this kind of work helps
to keep their own sobriety under better control by letting them witness the
dangers of addiction without having to relive it themselves. It also requires
sober, and shows them the positive results of sobriety in the people that
they help. Addiction work keeps one s relapse prevention skills honed and
provides strong motivation and reinforcement to stay clean and sober.
19
SEX ON CRYSTAL
For many crystal users, sex is their primary activity when they get high.
One reason for such a close association between this particular drug
and sex is that they both stimulate the dopamine-mediated mesolimbic
pathway. As discussed earlier, stimulating this pathway is nature's way of
tricking animals to repeat behaviors, such as sex and eating, that help the
animal, and ultimately the entire species, survive. Therefore, when the
mesolimbic pathway is so powerfully overstimulated by methamphet-
amine, the drive to have sex is also stimulated to a pathological extreme.
Viagra and similar medications that facilitate erections, men on crystal can
now perform both the penetrative and the receptive role in anal sex. Since
both partners are now able to use crystal and have equally long-lasting sex
drives, the duration of sexual activities has increased significantly, and sex
hookups or sex parties can last from hours to days.
Within the gay community, sex clubs have seen a dramatic change in
sexual behavior. Many patrons now stay at the clubs much longer than in
the past because they remain high on crystal for long periods, and during
extended binges some patrons stay over twenty-four hours. Some sex clubs
have resorted to strictly enforcing time limits when patrons must leave or
pay another entrance fee. In the past, it was hard to imagine people staying
for more than eight hours in a sex club, but as long as there is a supply of
[PNP = "party and play" —using crystal and having sex; SLAM =
injecting drugs intravenously]
Because he was so agitated and his pupils appeared dilated, a urine drug
I
i
screen was performed and tested positive for methamphetamine. He
j
:'
admitted to the ER physician that he had been smoking meth and then j
masturbated for six hours, resulting in serious abrasions and tears in the
j
skin on all surfaces of the shaft of his penis. Prior to that evening, the \
patient had only used methamphetamine intranasally, but that night was
his first experience smoking it. ;
Prior to the night of this ER visit. Kevin used to snort crystal alone in
his room because it often made him sexually preoccupied. His usual rou-
< tine was to masturbate while watching pornographic videos for a couple
up a woman for sex. He was curious about smoking because his friends
recently changed from snorting to smoking, and they said it was so much
better. Because Kevin became so sexually preoccupied just from snort-
ing, he wondered how he would feel smoking meth, but was terrified of
; on sex with the same intensity as Kevin. Usually while smoking they sat
around joking until they became restless enough to take their cars to a
large empty parking lot. where they drove wildly m figure eights.
That night Kevin felt particularly curious and borrowed his friend's
;
glass pipe. Alone in the privacy of his room he tried smoking meth for the
•
'
first time, and he found his sexual desire was far stronger than he had
ever imagined it could be. He had taken 200 mg of Viagra (four times the
J
average dose) so that he could maintain an erection while masturbating.
He was engrossed in watching his video, stopping every fifteen minutes
I
^ take another hit from the pipe. After each orgasm, it was more difficult
j to achieve the next, so his masturbating became more and more aggres-
I
sive. Kevin was using a lotion containing alcohol, and some time after \
I
that they were little patches on his penis that were irritated from the »
r
1
and resumed where he had left off. After his fifth orgasm, it was extremely
difficult to achieve another, but he compulsively smoked more crystal,
and masturbated with even more determination, trying to have one more
orgasm. After a total of six hours of smoking and masturbating. Kevin ran
out of meth. and over the next ten to fifteen minutes, the compulsive drive
and he was becoming more aware of pain all over his penis. He looked
down, and saw that the lotion on his hand and on his penis was streaked
with blood. He had been so preoccupied with watching the video and try- f
ing to have an orgasm that he didn't notice that the irritated spots were
starting to bleed or that he'd rubbed off some superficial layers of skin,
leaving some patches of skin pink and raw. An hour after he had smoked
the last of his meth. the discomfort in his penis had turned into excru-
ciating, burning pain. When he started screaming, his roommate ran in,
experiences in their lives, and they long to repeat it. For some people,
crystal sex feels so amazing that, in comparison, sober sex seems dull
and unfulfilling. Many gay men start using crystal as an occasional way to
spice up sex. but they find themselves relying on it more often, and some
of them reach a point where they are unable to have sex without it. If you
are trying stay meth-free, but crystal had become a necessary part of sex
Life without crystal means life without crystal sex. It's that simple.
Many people who used to combine sex and meth recall intense, aggres-
your body at least one more time, something you can't afford to do. Once
that happens, you know it won't be just a one-time indulgence. It can
CRYSTAL AND SEX I 251
quickly spin into a full relapse that brings you right back into the full grip
of addiction.
If your mind keeps going back to crystal sex, don't try to ignore it and
pretend it never happened. The memory only fights harder to come back
until you acknowledge it, and it may grow in power as the memories
become even more idealized, like a little child calling out to you, jump-
ing up and down, screaming louder and louder because he can't get your
attention. It's all right to acknowledge this —but as a very special memory.
You can recall it as an amazing time, like a trip to Antarctica with breath-
taking sunrises over colossal glistening snow peaks, unlike anything you
could see elsewhere on this planet — it was a grueling trek to get there,
that very few people can ever have — or even imagine. What an amazing
memory you have to carry with you for the rest of your life. But it was a
once-in-a-lifetime event, and you can't go back. That realization does not
diminish the amazing things you experienced. In fact, it helps to put them
in perspective —the immense physical effort and financial cost to get there
remind you that this is a place not meant for humans to see. That makes
the memory that much more precious —the realization that you saw the
unseeable. You remember the amazement you felt, and you hold on to the
beautiful memories, but you also know that you can never go back.
Crystal sex is like this amazing journey. Acknowledge the powerful,
amazing pleasure you felt, costly in so many ways, to experience something
that felt so amazing because the human brain was never meant to feel
that. Unlike most people in this world, you were able to experience it and
have incredible memories. But you can never go back. This is an important
admission you need to make to yourself, because any hidden fantasy that
one day you will have crystal sex again is a seed that can grow into an
uncontrollable craving and a relapse.
When you are just starting to quit crystal, if sex is a significant trigger
for you, then you may want to hold off on having sex for a while. This does
not mean that you will never have sex again. Just for now give yourself a
252 I OVERCOMING CRYSTAL METH ADDICTION
chance to work on basic recovery skills before you have sex again. Try for
a month and see how well you do. It may take several months before you
feel ready to tackle sex without crystal and feel safe that it will not lead to
a relapse. Many people in CMA feel that if you are not currently in a rela-
tionship, it's best to try to stay away from sex for an entire year. For people
who used to have frequent binges of crystal sex, who spent every weekend
getting high while searching the Internet for sex, or who regularly used and
did some other sexual activity, making a commitment of no sex for a year
helps them to break those other habits that go along with crystal, which
on their own can be addictive. Since sex is such a powerful trigger, those
people may do better working on staying sober, learning relapse prevention
skills, and practicing their ability to resist smaller urges before moving up
to the challenge of sex, which will be tough, but eventually possible, and
definitely enjoyable.
If one year sounds too long to you, set a shorter time limit that sounds
tolerable for you, and see how you feel. At the end of that time, if you sur-
vived it and you think you would benefit from a little more time, then you
can choose to wait a little longer. It is a good idea to give yourself a break,
but set your time limit in bite sizes that you can swallow.
pathway which are associated with pleasure during sex, are damaged. Trying
to stimulate the circuit again with sex just doesn't create the same charge it
used to. This is true, not just for sex, but for many other activities that used
to give you pleasure. Most of these things will improve over time. Your brain
will gradually replenish its stores of dopamine, and some of those particular
brain cells may recover, though unfortunately, some of the damage may be
permanent. Lack of pleasure is worst right after stopping crystal. However, by
one to two weeks, a good degree of your ability to feel pleasure should return
as your dopamine stores are refilled. Recovery from damage to your brain cells,
may seem empty. While this may be due in part to the neurological expla-
nation described above, much of the difficulty is that, in comparison to sex
on crystal, even imagining regular sex seems so dull. Figure 19-1 shows a
scale of sexual pleasure experienced at different points in your life, from
before your first sexual experience, through the time you were using crys-
tal, and all the way to the time you are long into sobriety. The shaded area
represents the normal range of pleasure that your brain experiences from
different activities in life. Zero reflects no pleasure, and 10 is the highest
pleasure that you normally feel, what should be extremely satisfying, such
as having an orgasm.
Think back to the first orgasm you ever experienced, whether you were
masturbating or having sex with another person. It was so new and intense
that it was probably off the pleasure scale compared to anything you had
previous experienced, probably scoring a 1
5 — off the charts if your normal
pleasure scale is 0 to 10. That is why you very likely wanted to have an
orgasm again. After repeating sex several times, it stopped feeling so new,
but it remains extremely enjoyable, remaining at the top of your normal
scale of pleasure, scoring your maximum of 10.
The first time that you had sex on crystal is similar to the first time you
ever experienced an orgasm — so high that it is off the chart again. However,
it is likely much higher than 1 5 because it is a physiological state that your
254 I OVERCOMING CRYSTAL METH ADDICTION
brain could never reach on its own. On your scale of 0 to 10, sex on crystal
would score a phenomenal 30 —way off the charts. Looking at your previ-
ous experiences of sober sex, what seemed completely satisfying as a 10
now appears so low in comparison that it is like looking at a 0 —bleak and
empty. If it is so lackluster and boring, why would you want to do it again?
Nonetheless, the drive to have sex will eventually return because it is a part
crystal for you, sex will become a strong trigger for crystal because regular
sex will likely not satisfy your sexual appetite at first. After repeated experi-
ences of intense sex with crystal, the first several attempts at sober sex may
feel like a pale shadow in comparison. However, this is from the perspective
of a distorted comparison, from an expectation of pleasure that your brain
was never meant to experience. Regular sex may feel like a 0 at first, but
with time, it will feel enjoyable again and work its way back up to 1 0. It will
never be as intense as the 30 of crystal sex, but it will feel good again and
can return to being one of your great pleasures in life.
RELEARNING SEX
— —
Having sex again sober sex may require a process of relearning to
make it satisfying again. Take it slowly and monitor your expectations.
Remember, this is not crystal sex, so you should not expect it to be the
same. If you rush yourself or become frustrated that you are not having the
same experience, you may quickly turn back to the drug.
When you have sex, it is important not to have it in the same settings
or situations in which you had crystal sex. You need to have different
environmental cues, so that you do not trigger strong urges to use again.
Stay clear of sex clubs, sex parties, telephone sex lines, Internet sex sites,
any other places and activities that remind you of meth, or places where
you know people are likely using it. Unless it is with your partner, do not
have sex with people with whom you used to have crystal sex. Remove
as many reminders of crystal sex from your life as you can. Even though
you are not a virgin, imagine yourself starting something new and fresh.
Detach yourself from all your older associations to sex that were in any
way associated with crystal.
When first starting to have sex again, try to have it with someone who
is not a random sex-only hookup. Set a rule of not having sex the first two
CRYSTAL AND SEX I 255
times you meet someone, so you can get to know the other person and
hopefully form a connection even before sex. Then when it's time to have
sex, take your time and go slowly. Do not jump into the sex aggressively like
a tiger pouncing on its prey — thatis too much like the aggressive aspect
of crystal sex, and you are exploring something different this time. Also, if
you start the sexual encounter as you normally would with crystal sex, you
start setting up expectations that it will feel like crystal sex. But it can't.
Doing this sets yourself up for disappointment and frustration, and creates
a trigger to go back to crystal.
If you are both big kissers, don't just dive in as if you're fishing for pearls
with your tongue in someone's throat — take your time and appreciate the
the light touch of someone's lips against your own, or even the feeling
of someone being so close that you feel the other person's warm breath
against your lips or face, even before your lips ever touch. Again, go slowly,
and take in what ever warm or happy emotions you may be feeling along
the way. These are all the more intimate aspects of sex that trigger parts
of your brain outside of the brain-reward circuit. They are more related to
the parts that are activated by "connection" and "personal meaning," which
have been found to be most closely associated with happiness. They are
often forgotten or thrown by the wayside during the aggression of crystal
sex, as the behaviors related to the brain-reward pathway crowd out most
other things. Many people who have forgotten about the intense pleasure
from the other parts of sex now realize that while sober sex will not be the
same as crystal sex, it is not just a pale, weaker version — it is something
different that has its own values that crystal sex will never have.
The first couple of times you have intimate physical contact with
another person, restrict yourself to nongenital contact, even if you want
to go further. Fully explore the intimacy and let the natural desire for sex
build. You may find that you are much better able to feel an emotional
pleasure that you may have been missing with crystal.
Many believe that crystal helped them feel "connected " to others when
256 I OVERCOMING CRYSTAL METH ADDICTION
they had been feeHng isolated. However, this is an illusion. While you may
have been physically connected to someone while having wild, aggressive
sex, it was the meth and the sex that you were really emotionally connected
to, not the person, who could have been almost anybody. Consider how
crystal was able to make almost anyone seem appealing, including people
that you ordinarily would never have considered having sex with. Now
you have the opportunity to experience a genuine connection to another
person, and this is a wonderful feeling that crystal is not able to give you.
Sober sex will begin to have its own positive associations, distinct from
your memories of sex on crystal. However, be cautious. While relearning
sober sex, if you slip and start to incorporate drugs into your sexual routine
again, you are just contaminating your meth-free world with associations
to meth and making the possibility of relearning satisfying sober sex more
difficult.
When you are comfortable and enjoying the intimacy of sex without
drugs, you can start to incorporate other things into your sexual activity to
make it more exciting. Communicate with your partner about what feels
good, or ask what your partner wants. Try role playing. Experiment and
have fun. However, as much as possible, avoid activities that explicitly
While you will always have memories of sex on crystal, the desperate
need to have it become less intense. Memories may return in
will gradually
flashes, but the flashes will become briefer and less frequent if you do not
succumb to them by relapsing. Sex will eventually become the wonderful
thing in your life that it had been before.
break the associations of crystal and sex, because the compulsive aspect
of this kind of sex is neurophysiologically tied to the pathways stimulated
CRYSTAL AND SEX I 257
by crystal. You may need to address sex on a much slower time frame when
trying to reintegrate it into your life.
One aspect of sex that is discussed above, the intimacy aspect, takes
away the clandestine, secretive, and forbidden aspects of sex that is often
part of the high in sexually compulsive behavior. Some psychologists
theorize that, for sex addicts, the compulsion to have so much sex is an
unconscious reaction against another unconscious force —the ''superego"
or conscience telling you that sex is bad. By going slowly with one partner
and exploring intimacy and deep connection, you may be able to experi-
ence the sex not as something bad but as something beautiful, and this
may lessen the desire to pursue sex compulsively. However, you should
work with a specialist on this coaddiction to make sure you can keep it in
control.
p RT
6 !
SPECIAL TOPICS
Topics are presented here for individuals with specific concerns in addi-
tion to the basic treatment program information presented. This is a small
list of additional questions out of many that you may have about your
own situation. encourage you to think about any other questions and to
I
be active in your search for answers. The process of doing and learning
are important in your own recovery and in helping someone you love.
More information is always helpful, being active in your pursuit of knowl-
edge keeps the motivation alive, and any opportunity to understand the
things that affect your life is important. After this section, there are
resources listed in the appendices that may be able to assist you in pursing
answers to more questions.
Topics:
• What if you slip and use crystal? Disaster and failure
A slip
try to stop using crystal
meaning they eventual-
can be anything from
accepting a single bump offered by a friend to having an entire weekend
binge. The danger is that even a little slip can turn into a full relapse.
What doesit mean when you let your guard down and, after weeks,
months, or years of working on staying clean, you use crystal again?
Before answering this question, it is important to remember that crystal
addiction is a chronic relapsing and remitting medical illness. In everyday
English, this means that it is a lifelong medical illness that can be treated
but not cured. With treatment it gets better, though there will likely
be periods when it worsens again. Similar common medical illnesses
include high blood pressure and diabetes. Examining all three illnesses
addiction, high blood pressure, and diabetes —there is a remarkable
similarity in the statistics of the three, most notably the rate of treatment
treatment for diabetes and hypertension, as well as the high rate of flare-
ups, suggests a high probability, that most meth addicts will slip at some
time during their recovery.
In the past, people thought of staying clean versus slipping as equiva-
lent to being cured or failing. However, according to the medical model,
a slip is not failure. Few would call a diabetic whose blood sugar reading
was high a failure, and while the person with diabetes, as well as friends
"forever and always" — as opposed to the 'just take each day as it comes"
approach — creates a significant stress that can build up self-expectations
to unrealistically high levels. If pressure is too intense, when a relapse
loses hope, and the addicted side uses this as the perfect rationalization to
keep using drugs and to forget about recovery. The addict in you now has
free rein, since it has fooled the healthier part of you to surrender.
Take away the expectation that you will nei^er slip. Lose the notion that
a slip means failure. This does not mean you shouldn't hope that you will
never slip. But getting rid of unrealistic expectations may alleviate much
of the psychological pressure that can destroy your morale. Consider a
twelve-year-old boy who dreams of becoming a basketball star. He loves to
play on the courts every day after school. But if he expected to be perfect
from the beginning and accepted no room for improvement, then after the
first or second missed shot at the basket, he would give up, throw away his
basketball, and never return to the court. But even this twelve-year-old-boy
has more sense than to have such unrealistic and unforgiving expectations.
To this kid who holds on to his dream of being a famous basketball player,
missing the shot is disappointing, but it makes him want to practice even
harder. High hopes are not the same as impossible expectations. Just focus
on staying clean and sober in the present moment while you hold on to the
Accepting the possibility that you may slip does not mean that if you
slip, you should keep using, because this is how the illness is supposed
to be. The boy on the basketball court knows he will miss a lot of shots,
but he never stops trying to make the next basket. In the medical model,
a diabetic whose blood sugar has been rising wouldn't use this as a reason
to gorge on more candy and toss away her insulin. Both the boy and the
diabetic woman see their "slips" as signs that they need to work harder to
improve. If you slip with crystal, or any other drug, it is appropriate to feel
disappointed, but don't use it as an excuse to destroy your recovery. Move
on and focus on how to get better.
this was approaching? Had you been under more stress and how were you
coping with it? Had you been spending more time in places or with people
that were risky? Had you been keeping up with "the program," meaning
going to CMA meetings, seeing your therapist, calling your sponsor, and
so on? Had you been monitoring your stress level? How well were you
managing it?
If you slip but don't try to learn from the experience, the likelihood of it
happening again increases. Drug use may occur more frequently, and soon
you may find yourself completely relapsing. On the other hand, if you use
each slip as a learning opportunity, these setbacks can actually be steps that
continue to lead you forward in your path to recovery. While slips are an
expected part of addiction, if you continue to work hard at addressing them,
they should gradually decrease in frequency and become easier to avoid.
YOU ARE WHO YOU ARE,
AND THAT'S OKAY:
Acceptance— the Cornerstone of Staying Clean
God grant me the serenity to accept the things I cannot change; the
courage to change the things I can; and the wisdom to know the
difference.
—from The Serenity Prayer
"accepting," "coming clean," and so on. In one form or another, they all
faith in God and to accept his plan for his people. Buddhism teaches that
suffering stems from ignorance and worldly desires, therefore knowledge,
mindfulness, and acceptance of what you have will end suffering. The origi-
place in the universe and the natural flow of events. In the West, cognitive
psychologists reframe automatic thoughts that people have in situations
that make them uncomfortable, finding ways to look at them that are more
YOU ARE WHO YOU ARE, AND THAT'S OKAY I 265
desire (the id) conflicts with what the person feels is morally "good (the '
peace.
"Feeling sad? I can cheer up with crystal. Going to a party where I'll be
shy? I can feel social with crystal. The day feel boring? I can spice it up with
crystal. Gradually you learn that if you keep using meth, as well as other
drugs, you can control your feelings, which seems so much easier than
tackling real-world problems that make you unhappy. Eventually you forget
you have your drugs. And after so much experience fine-tuning your mood
with drugs, it seems as if nobody else could possibly have as sophisticated
addition, if you are a daily user, it has made you physically dependent, so
you can't stop using it without feeling terrible. Though you had thought
266 I OVERCOMING CRYSTAL METH ADDICTION
Accepting the fact that you are addicted to cr}^stal and that you do not
have control over it is one of the hardest admissions for an addict, because
it contradicts the laws that govern this illusionary universe you live in. But
acceptance is the starting point for recovery. Without it, as long as you don't
wholeheartedly believe that crystal is controlling you, then nothing else in
treatment will make any sense.
Accepting that one is 'powerless" over crystal, and ''surrendering"
control, are extremely difficult, but once you accomplish these acts and
sincerely believe them, you can feel surprisingly liberated. Keeping up the
illusion that you are the "All-Powerful Controller," while the rational part
of you watches your life fall apart from crystal, takes a lot of work. Letting
go of the lie can actually be a tremendous relief.
if some things don't turn out exactly as you had hoped, the world will not
fall apart, and in most cases, you will be just fine. The world is supposed to
be imperfect. If you understand and acknowledge the truth, rather than
hide from it, you will be much better equipped to deal with it. With more
realistic expectations, your disappointments will be fewer and easier to
tolerate. Then coping with problems will be even easier and you may feel
things in the world. People have tried various ways to translate the term
impermanence, transience, humility, asymmetry, imperfection —but none
quite catch the essence. Wabi-sabi embraces the fact that nothing in
nature is perfect, and this aspect of the natural world is not only accepted,
it is revered. Japanese Zen Buddhism has even turned this into an art, priz-
ing things that are imbalanced, rusted, or in some way reveal the decaying
changes of time. The fleeting existence of things — all a flower, a person s
youth, or life itself —makes them more precious. Therefore, it is all right
that they are imperfect or that they will die because this is the natural way
of the universe. If you can see your own imperfections as nature's wish,
if you are able to accept not getting the job that you tried so hard to get,
if you are able to accept that you may someday die — if you can let go of
trying to control everything and making everything perfect, then the ups
and downs of life come and go much more easily. With acceptance of the
real world and more realistic expectations, you can live a happier life with
more satisfaction.
stage of acceptance that crystal is no longer a part of your life, and you
will be able to feel peace.
CRYSTAL AND HIV:
How Do They Affect Each Other?
in the general population, the rate of new HIV infections continues to rise
among the gay men, despite the fact that many, if not most, of these newly
infected people already knew how to protect themselves.
Doctors working in the gay community have seen a frightening associa-
tion between crystal use and HIV. The medical director of Callen-Lorde
Community Health Center, for lesbian, gay, bisexual, and transgendered
people in New York City, estimates that in 2004 approximately one-third of
the clinic s patients who tested positive for HIV admitted that crystal was
somehow related to their becoming infected. Other New York City physi-
cians in private offices report similar statistics.
A joint study conducted by the University of California at San Francisco
(UCSF) and the Centers for Disease Control (CDC) showed that of the
gay men who reported using crystal meth between 2000 and 2001, 6.3
percent had been recently infected with HIV, compared to 2.3 percent
of those who did not report using crystal. In other words, crystal almost
tripled the chances of contracting HIV among these men. A study by Dr.
Steven Shoptaw, an addiction specialist at UCLA, found that 61 percent
have sex so intensely that concern for their health and protecting them-
selves from STDs, especially HIV, gets tossed out the window. Because
sex and crystal stimulate the same brain-reward pathway, the compulsive
drive to use crystal, against all logical sense, can also create a seemingly
unstoppable drive to have sex.
Sex on crystal is amazing. There's nothing else like it. I feel like an
animal on the hunt, and I'm determined to get my prey. I feel sexy
and attractive, and the normal shy me is not really thinking about
270 I OVERCOMING CRYSTAL METH ADDICTION
get fucked for hours, and it was amazing. It was like I had this bot-
tomless pit, this hunger to get fucked more. But once I started using
Viagra with crystal, getting hard wasn't such a problem and I could
top again—and fucking someone's ass, like I was attacking it, was so
amazing, could do I hours — it for the feeling was so intense. Then
when I'd finish with one person, I'd still be horny, so I'd move on to
the next guy and continue my hunt [in a sex club or online].
that HIV can infect someone by opening more doors for the virus to pass
through. The risk of becoming infected with HIV is also higher for the
person penetrating the partner, or the "top," because hours of continuous
rubbing of the penis against anything-hdnd, anus, vagina, and so on — will
create small cuts and abrasions on the surface. Without a condom to shield
them, those small cuts are also entryways for HIV into your body
As described by the crystal user above, the drive to have sex can be so
overwhelming that it causes many people to disregard their usual precau-
tions, because sex is their number one priority. The mind-blowing sex on
meth feels so important, and even urgent, that everything else seems trivial:
users ignore the need to rest, drink, or eat, let alone take the extra effort to
use a condom. Many users already know the risks of HIV, but when they
are having sex on crystal, any interference with sexual pleasure, such as
CRYSTAL AND HIV I 2?!
more rapidly than in cats not given any drug. It likely has a similar effect
in the human body Both test tube and animal studies consistently show
that crystal increasesHIV replication. The implication is that the same
is true for humans. One human study clearly showed that levels of HIV
increased when people used crystal; however, those people also stopped
taking their medications, so it is not possible to conclude that cr\^stal itself
the stronger the initial CD8 response, the more effectively the body fights
the initial HIV infection. The less overwhelmed the body is by the first
set point, and a longer period of good health. A weak CDS response may
have a higher viral set point, and HIV may progress to AIDS more quickly.
CRYSTAL AND HIV I 273
Using crystal when one is infected with HIV may result in serious health
Crystal disrupts the function of the immune system in many other ways,
as well. For example, it is also associated with lower levels of chemicals
that immune cells use to communicate with each other, such as interleu-
kin-2 and gamma-interferon. It is also associated with an increase in tumor
necrosis factor (TNF), a chemical that has been found to accelerate the
progression of HIV. All of these derangements significantly prevent the
immune system from functioning properly.
If you have HIV, you should optimize your immune function. Clearly,
Similarly, HIV is toxic to the brain. The combination of the two can result
in even greater brain damage.
To review briefly, crystal damages or destroys cells in the thalamus
(affecting numerous functions ranging from attentiveness to the percep-
tion of pain) and the basal ganglia (involved with movement, motivation,
learning, and impulse control).
HIV affects similar parts of the brain, in particular the basal ganglia,
ish, and assist the function of brain cells. Without astrocytes, many brain
cells cannot function properly and many of them die. Similar to crystal,
regions. The pattern of brain damage caused by both HIV and crystal
is called ''subcortical dementia," meaning that they damage deep-brain
structures, unlike Alzheimer s disease, which affects the superficial cortex.
Subcortical dementia is characterized by slow mental processing, impaired
decision making, and difficulty performing complex mental tasks.
In animal studies using cats with FIV, as well as monkeys with simian
immunodeficiency virus (SIV —thought to be the direct ancestor of HIV),
methamphetamine caused a significant increase in viral replication, and \
this increase was even greater in the brain than in other areas of the body. \
In humans, the level of HIV in the brain can be as much as ten times
greater than the level measured in the rest of the body. Therefore, people
taking HIV medications who have ''undetectable ' levels of HIV in the
blood may still have a significant amount of virus in the brain, and crystal
use can make the HIV already there multiply even faster.
William F. Maragos and colleagues at the University of Kentucky con- ^
'
was measured one week after exposure to crystal and Tat, showing that
these were effects that persisted after crystal exposure. Another animal |
study by Chapman and colleagues showed that brain damage in mice was
notable even three weeks after exposure to meth.
The lesson here is that crystal and HIV each cause brain damage, and,
in combination, the toxicity is extremely high and persists even after the
drug is stopped.
boost the blood levels of other medications to make them more effective.
CRYSTAL AND HIV I 275
levels that can be deadly. At least one published case report attributed a
There are other non-HIV medications that can also inhibit the break-
as well.
your reaction? If you even consider the possibility of stopping the life-
saving medications so that you can take crystal, is that a strong enough
indication of how much power crystal has over you? Why would you be
willing to trade your life for a brief high?
its severe form is called rhabdomyolysis. This is even more likely to hap-
pen when someone uses crystal on the dance floor, where he or she is con-
tinuously active and overheated, does not rest, and is dehydrated. These
conditions increase the risk of rhabdomyolysis, which can potentially turn
into an uncontrollable cascade of muscle breakdown. The muscle byprod-
ucts of rhabdomyolysis are toxic to the kidneys, and if they overwhelm the
kidneys too quickly, kidney damage could turn into kidney failure.
Like all stimulants, crystal increases heart rate and blood pressure. Both
of these changes make the heart work harder, trying to pump an adequate
supply of blood to the entire body, including the blood vessels that nour-
276 I OVERCOMING CRYSTAL METH ADDICTION
ish the heart itself. When the heart works harder, it requires more oxygen,
which is carried in the blood that it pumps. For people with certain heart
diseases, such as coronary artery disease (clogged arteries in the heart),
crystal is particularly dangerous because there is already a problem deliver-
ing enough blood to their hearts under normal circumstances. Increasing
the heart s need for more blood increases the likelihood of a heart attack.
People with HIV who are taking an HIV cocktail (highly active anti-
retroviral treatment, or HAART) also are at risk for heart problems
because these medications, especially the protease inhibitors, can cause
astronomical increases in cholesterol and triglyceride levels. These are
associated with clogged arteries, heart attacks, and strokes. For people
taking HAART, there is a 5 percent cumulative annual risk of having
some heart-related illness. This means that each year you continue to
price is potential toxicity — in this example to the heart —and people taking
HAART still need to be careful about their health.
Heart disease caused by HIV medications may never be recognized until
an actual heart attack or stroke occurs. Therefore, if you are taking HAART,
you may not even realize that you have some heart disease. For you, using
crystal is particularly risky. This is not just a theory —unfortunately, there
have been several cases of young HIV-positive men who had heart attacks
while using crystal. There are likely many cases of small heart attacks that
are never reported or documented. Most meth users are younger than the
elderly people that we associate with heart attacks, so some meth users
who experience mild chest pain may not even consider the possibility
that they are having a heart attack —they may let it pass without giving it
who you think is hooked on meth. You may be worried, sad, frustrated with,
or even exasperated by this person and the addict he or she has become.
The prospect of dealing with someone so controlled by a drug may seem
impossible because his or her behavior is so stubborn and resistant to change.
Meanwhile, you are left feeling powerless to help as you watch the addiction
destroy your loved one. Each person who has an addiction is different and
should be approached according to his or her unique situation. This chapter
is intended to be a general guide to help you structure your own approach,
to provide a basic framework to your plan so that you can feel that there is a
logical rationale to whatever your do. Keep in mind that there are many ways
of dealing effectively with addicts, and this chapter discusses only some of the
many possible strategies to consider.
actually using the drug yourself. Read the chapters in parts 1 and 2 to
learn as much as you can about crystal —what it is, how it works, and how
it makes people feel, both the good and the bad. Also read the chapters
that define addiction and see if this reflects what you see in the person
who concerns you.
Armed with that knowledge, if you see true addiction, this chapter may
offer you some useful guidance on how to deal with the addicted person
in your life.
person from your life, and worse yet, he or she could even die as a result
of the drug. If the addict issomeone you care about, stepping in to help
is one of the best things you can do, even if it means being rejected.
To lay the groundwork, I hope you have read the other chapters mentioned
above and understand that both biological and psychological processes are
dictating the behavior of your loved one. He or she did not become addicted
because he or she is stupid, weak, or bad. Something pleasurable or psycho-
logically helpful about crystal enticed the person to start using crystal, and
that helpful quality, together with its strong neurophysiological basis, keeps
this person continuing use it, despite all of the obvious problems that you
see it has caused. Try to find out what those positive things, are so that you
can understand why it is so difficult to quit meth.
Think back to what your loved one was like before crystal and look
at what you see now. If there is a dramatic difference, you can see the
power of meth on the human mind and body. The person that you knew
before crystal took hold is still in there somewhere. However, many of the
behaviors and moods you see — lying, hiding, withdrawing, moodiness,
irritability, paranoia, rageful outbursts, depression, and so on — are a result
of crystal highs, crashes, and cravings. Most of these behaviors are resolved
when addicts become sober, though addiction also causes some changes
in character that are difficult to change back.
a
WHAT DO YOU DO IF SOMEONE YOU KNOW HAS A PROBLEM WITH CRYSTAL? I 279
essential to give you clearer vision when you observe them. When you
confront your loved one, if you meet angry resistance, you can better see
what behaviors and words are symptoms of the addiction, which may
help you not to take angry words too personally. If a friend broke his leg,
would you expect him to accompany you on a mountain hike? Of course
not. You consider his limitations based on what he has to work with —
bum leg. Similarly, addicts are working with a chemically altered mood, a
quit. If you make your expectation more realistic, you can be less emotion-
ally vulnerable if your loved one responds to your goodwill with anger and
denial. You may feel less of the bite of angry personal attacks against you,
and this may allow you to feel more compassion than frustration.
There are several ways to tell a loved one that you are concerned about
his or her crystal use: a private one-on-one conversation, a group discus-
sion with other friends or family members, or the traditional intervention.
There is no one single right way to do it. You may need to experiment with
different tactics. I usually prefer to test the waters with a one-on-one
talk because it is less intense and confrontational. The response can give
Choosing the right time to talk can have a significant impact on how
receptive your loved one is to your words. When addicts are high on crystal
or any other substance, this is obviously not the right time. If they have not
used crystal for several weeks, they may be in a more rational state. However,
they may also be feeling so well because the pain of the crash has waned
and denial is easy. Because they feel all right at the moment, they can easily
rationalize their behavior. Consider talking to them during a crash. They may
be feeling tired, depressed, anxious, or generally miserable. At that particular
moment they may actually welcome an offer for help because they feel so
distressed and vulnerable. Take advantage of the times when they are so
aware of the bad effects of crystal that they are impossible to deny. On the j
other hand, they may be feeling so tired and irritable that they crave more ^
cr\^stal to help themselves feel better. Being so focused on that, they will not
be at all receptive to outsiders' comments. Perhaps the best time to talk is
soon after the crash,when they feel better enough to have a conversation,
but have the recent memory of an unpleasant crash still very fresh in their
minds. During that particular period, addicts may be the most motivated to
stop using drugs. Because motivation and insight change constantly, be on
the lookout for a good window of opportunity.
Before you have your talk, be prepared. Make a list of all the things you
want to cover and how you are going to say them, choosing wording that
is honest about your feelings but nonjudgmental. You know the situation
will be uncomfortable for both of you, and strong emotional reactions can
throw you off guard. A defensive person may try to engage you in circular,
illogical arguments, and you will quickly find yourself derailed from your
original plan. Keep yourself close to your framework and use a mental
script (or a written script —write it as if it were a letter, and it won't sound
so unnatural if you have to read your own words) that will allow you to
What to Discuss
Start the conversation with positive comments, for example, "I love you
ver)' much," or "You are one of the most important people in my life, and
WHAT DO YOU DO IF SOMEONE YOU KNOW HAS A PROBLEM WITH CRYSTAL? I 281
our friendship means so much to me." Use your first comment to establish
a supportive tone for the rest of the conversation. If you begin with criti-
person matters dearly to you, and vice versa. Hopefully a loving and sup-
portive start will soften up the person's defensive reactions a little, and if
Keep reminding yourself about this point so that you can step back and try
she has been missing days of work every week; he has admitted to having
unprotected sex and has contracted several sexually transmitted diseases.
The more specific you can be, the less room you leave for argument or
denial.
Frame these behaviors as concerns that you have for someone you
very much care for, not as accusations. Monitor your language and tone
of voice —speak slowly, and keep your volume low and the pitch of your
voice from getting higher and tighter. This will prevent you from sounding
critical or attacking and will reduce the likelihood of a defensive reaction.
Remain calm and caring.
Remind your loved one about his or her own goals and desires in life:
to convince you, that you are only interested in yourself. Resist the urge
to feel guilty or to question your own motives. You already know that you
are trying to show your loved one his or her own problems, not yours.
Have list of recommendations prepared — possibilities include working
282 I OVERCOMING CRYSTAL METH ADDICTION
truly feel like criticism and can leave the person feeling hopeless.
Your addicted friend or family member may not immediately accept
your message that there is a problem. He or she may still be in too much
denial or may be feeling so defensive that it may take a little time alone
to digest your comments. At the very least, having the conversation shows
the person that you are available as a caring support around the issue of
crystal addiction, and that if he or she ever wants to address the addiction,
son may retaliate by trying to provoke the same angry or hurt feelings in
you. Remind yourself that this is part of the addiction, and if you start
feeling anger well up, stop talking, take a deep breath, and go back to the
discussion framework that you prepared. If you let yourself become angry,
What to Expect
Friends and relatives have all sorts of reactions to "the talk. ' Some may
be able to listen and feel grateful for your support. Unfortunately, most
people are not so receptive. Despite your best efforts to keep the discus-
sion from turning into an argument, you will usually encounter some
defensiveness and denial. However, that does not mean that the person
did not hear you. If you see a severe problem, more than likely he or she
sees it, too. Even when the person is able to admit to some of the points
WHAT DO YOU DO IF SOMEONE YOU KNOW HAS A PROBLEM WITH CRYSTAL? I 283
you bring up, do not expect to end your discussion in total agreement.
Knowing that complete agreement is not the goal will help you to back off
at the right time and not feel so frustrated. When you end the discussion,
accept that there may still be disagreement between you, mentally step
back, let the person know that you are still there for support, and leave the
person to think about the things you have discussed. The conversation may
take place several times in a variety of ways. But keep giving a consistent
message: you care about this person, he or she has a problem, and you
think he or she can get better.
Now that you have voiced your concern, follow though with what you
said. Do not disappear, but remain present as a support. If the person
decides to take the plunge and quit meth, he or she will be going through
an arduous period of physical, emotional, and mental changes. Your loved
one may need your help now, more than ever, to get through the depres-
sion, moodiness, and agonizing cravings of quitting.
Spend time together and show how important it is to you that this per-
son is trying to clean up, and engage in activities that do not involve drugs
or alcohol.Remind each other what your interpersonal bond is really about
and enjoy each other's company in a meaningful way. You are literally com-
peting with crystal, which may have become your loved one's new "best
friend." But the friendships are different —one is chemical, compulsive,
destructive, and out of control, while your is deep, meaningful, emotional,
and supportive. You hope that at some point the person will see this.
When you spend time together, do not constantly focus on drugs, always
monitoring the other person's behavior and asking what he or she has been
doing. The person may feel overly scrutinized, self-conscious, or embar-
rassed, especially right after being confronted. Allow a little breathing
room after your discussion. But if you detect new problems or a downward
^
h spiral into the old, have another talk.
,
; Above all else, if you yourself do drugs, do not use crystal or other drugs
t in front of the person you are trying to help. How can he or she take you
seriously if you are not able to stop using drugs? Model healthy, drug-free
behavior and demonstrate that you can enjoy yourselves without drugs.
Also, keep in mind that the even the sight of anything associated with
"
drugs can trigger physiological reactions in the brain that cause intense
craving. Why would you put this person through that agony? Using drugs
in front of recovering addicts is disrespectful of their efforts to stay clean,
and it is downright cruel. Would you insist that a friend with severe asthma
visit your grandmother and her twenty cats? Don't do things that will
increase your loved one's risk of relapsing, and give him or her great respect
Setting Limits
If your loved one is not able to stop using crystal, set some limits as to
what you A buddy who never shows up, lies, or asks for money
will tolerate.
and never pays back can become an annoyance. A sister who constantly
it
calls up for support because she fears she caught another STD after
you stop making excuses for your loved one, he or she may get into trouble
at work or even get fired. Without your financial assistance, he or she may
WHAT DO YOU DO IF SOMEONE YOU KNOW HAS A PROBLEM WITH CRYSTAL? I 285
get evicted and become homeless. As horrible as it sounds to let this hap-
pen to someone you care about, it may take just such a dramatic loss to
break the illusion that crystal creates — that everything will be all right, as
long as there is more crystal.
Think about what your limits are. What can you tolerate, and which of
your behaviors may be enabling? Carefully decide what you believe is help-
ful support versus what will fuel the addiction. Expect that your loved one
will try to put a lot of emotional pressure on you and make you feel guilty
for bailing him or her out of trouble. Being prepared with your limits will
let you withstand the emotional pressure and help you to feel confident
that the help you give — or refuse to give — is for a good reason. For example,
you may offer to be available to your friend at any time, day or night, for
emotional support; however, you will not lend any money, and you will not
participate in any activities with this person that may involve drugs.
After you decide what your limits are, explain them to your loved one
making the terms as explicit and concrete as possible, with no room for
tor." Make your limits so clear that there is no question. You are never the
only option for an addict. Even in worst-case scenarios, there is almost
always another option: for the sick, there is the emergency room; for the
homeless, there are shelters. Sometimes it takes extremes such as these
to make addicts understand how much their lives have changed because
of crystal.
Whatever limits you set for yourself, stick to them. Be gentle and caring,
but be firm. If your addicted son tries to manipulate you with guilt, find
other ways to help without overstepping your limits. If your addicted friend
is sick but has no insurance and can't afford medical care, take her to the
free city clinic or offer to help take her to the nearest Medicaid office, where
she can apply for help herself. These are not glamorous options, but this is
exactly what your loved one needs to see. Addicts needs to face up to just
how ugly things have really become. Only then will they realize that they
need to change.
286 I OVERCOMING CRYSTAL METH ADDICTION
Do not exceed your limits, thinking, 'Just this once, when he really needs
my help." Doing so may actually worsen the situation. Consider the clas-
sic behavioral science experiment with mice. Mice can be trained to hit a
lever by pairing it with a reward, such as receiving a pellet of food. If they
receive food after hitting the lever five times, they continue to hit the lever
in order to get more food. If food pellets are no longer delivered, the mouse
keeps trying, but after numerous unsuccessful attempts, the mouse eventu-
ally gives up and forgets about the lever. The behavior is 'extinguished." If,
however, instead of completely stopping the food supply, you allow some food
pellets to fall at random times when the lever is pushed, the mouse will con-
tinue pushing the lever. This is called "intermittent positive reinforcement."
Randomly giving the food pellet actually makes the mouse continue to push
the lever even more tenaciously than if you w^ere giving it at a predictable
rate. The mouse does not know when the food will come, but he knows that
if he diligently keeps pushing the lever, food will eventually come.
The exact same phenomenon occurs in humans. If you set a limit but
on rare, "extreme" occasions, you ignore your restrictions "because it was
a special situation," the addict then learns that, if he or she is persistent
enough, you will eventually cave in and do what he or she wants. Then
the limits become meaningless. Rather than understand your limits as
an important part of recovery, the addict will focus on how to get you to
relapsing and remitting disease, meaning that once people have it, they
have it forever — there will be stable periods, but there may also be flare-
ups. When a woman with hypertension has been able to control her blood
pressure for years, but her blood pressure spikes, is she a failure? No it's —
the nature of the illness. She needs to tr}^ to get it back under control and
change or intensify her treatment.. For friends and family, this model is
despite the most sincere desire and efforts to stop. Instead of feeling
frustration and despair, tr)^ to help the addict use the initial relapses as
learning opportunities.
Get Support
that you set, or if your friend or relative continues to push you, manipulate
you, or treat you badly, and all attempts to change this have failed, then
your relationship with this person may have turned completely toxic. If
continuing your present relationship has not been productive but instead
it has been destructive to you personally and to the relationship itself,
then it may be time to pull back. Pulling back does not mean giving up on
the addict, though he or she may experience it as such. It means putting
an end to a way of interacting that is harmful to both of you. If you have
questions about whether you have reached this point, ask other people in
288 I OVERCOMING CRYSTAL METH ADDICTION
your support network, especially other people who have been in the same
situation as you, or discuss your situation with an addiction specialist.
If you decide to pull away, you are not deserting your loved one. To make
this clear, explain exactly what you are doing: 'Tm sorry, but I can't spend
time with you anymore. It seems like no matter what we plan, you keep
disappearing because you're getting high, or it seems like you're always
asking me for money. Nothing has really changed, and I won't go on hke
this. You are my friend (or brother/whatever), and I am here for you if you
want to get better from this addiction. But I've tried everything I can to
help you, and nothing has worked. So you need to change in order to be
in my life again."
to get around them. When she invited her son over for dinner, she later
discovered he had stolen some of her expensive possessions to sell for
crystal. Once her son took her car without permission. Despite the love
that the mother and son felt for each other, the addiction was so strong
that the son betrayed his mother repeatedly to feed his need for crystal. As
difficult as it was, the woman had to sever ties with her son. She realized
that unless she stopped enabling him, he would never find his way out of
his addiction. Losing this precious relationship was one of the major nega-
he came to see that crystal cost him more than money — it almost cost
him one of the most important people in his life. Two years later the son
decided to go to rehab. Now he is working seriously on recovery and he
has reestablished contact with his mother.
more complicated. If you live together, you are much more emotionally
interdependent, and you may be financially intertwined with joint bank
accounts and property. For all these reasons and more, your behavior and
emotional reactions have a greater impact on each other.
Is your partner lying to you, using up the money in your joint account,
stealing from you, or cheating on you? If you have a sexually open rela-
tionship, is your partner having more sex outside the relationship? Is your
partner having unprotected sex with others and potentially exposing you to
STDs? Is your partner getting high and forcing you to have sex when you
don't want to or in ways that are so aggressive that you don't enjoy it?
With all these questions running through your mind, do you feel you
can trust this person with whom you share everything? You may feel angry,
frustrated, or cheated. If your partner really cared about you, how could
he or she act with such blatant disregard for you? And if you cannot trust
your partner, why should you even stay together as a couple? These are
some of the heart-wrenching questions that partners of crystal addicts
struggle with.
To make sense of this confusing situation, keep in mind that some of
the behavior you are seeing is likely the addiction rather than the person
you used to know and love. Ask yourself if your partner was like this before
using crystal. Try to distinguish the difficulties in your relationship from
the symptoms of crystal addiction. If some of the behavior is clearly due
to drug use, withdrawal, or uncontrollable craving, then the enemy may
be the addiction, though it seems as if it's your partner. In that case, try to
address the addiction before packing your bags and calling it quits.
Have "the talk " described at the beginning of this chapter. When dis-
cussing what your partner's goals are in life, include your joint goals as a
loving team. Remind your partner of what the two of you used to dream of
having together. And remind your partner that crystal is ruining not just his
or her life, but also the life that the two of you have built together.
Protect Yourself
While you are trying to be compassionate and caring toward your partner,
always be sure to take care of yourself. This is not being selfish. If you are not
healthy or safe, you cannot help your partner. And if you are finding that your
290 I OVERCOMING CRYSTAL METH ADDICTION
relationship is destructive to you, then in the long run it is hurtful to your part-
diseases.
therapist, or Al-Anon.
Set limits for yourself and your partner. What are you able to tolerate?
What limits are healthy for the relationship? What limits do you need to
address the crystal addiction? When you draw the line, be compassion-
ate but firm. If necessary, seek the assistance of a couples' therapist who
specializes in addiction.
In the end, the relationship may not survive, at least not in its present
state, while your partner is heavily addicted. Losing a partner to crystal is
painful, but hitting that rock bottom may eventually motivate that person
to change and get help.
On the other hand, your relationship may survive. It will be different,
and it may become even stronger than before as the two of you learn how
to navigate the treacherous seas together. This requires communicating
well, learning new ways to support each other, and understanding each
other's needs more clearly. These are all assets that make any relationship
stronger and deeper.
APPENDIX 1
Abstinence-Based Treatnnent
and General Information Resources
The following resources are facilities and Web sites that provide infor-
Al-Anon/Alateen (Canada)
States. Canada, and Puerto Rico. Phone: (613) 723-8484 Fax: (613) 723-0151
meeting.html
292 I OVERCOMING CRYSTAL METH ADDICTION
(CSAP) (240)276-2420
www.crystalmeth.org CALIFORNIA:
AIDS Project LA (APLA) Crystal Metham-
A Key to Methamphetamine-Retated Lit- phetamine Program
Institute.
(800) 930-METH
KnowCrystal.org www.crystalmethtreatment.com
Rockville, MD 20852
www.nida.nih.gov
APPENDIX 1 I 293
www.callen-lorde.org
www.motivationandchange.com
Gay and Lesbian Community Center of HIV. At the time this book is going to press.
MASSACHUSETTS: 543-5331
(212) 523-6491
294 I OVERCOMING CRYSTAL METH ADDICTION
www.gnnhc.org/progranns/suce.htnnl
www.gaycenterorg
APPENDIX 2
Harm-Reduction Resources
The following resources are facilities and Web sites that provide infor-
www.atlantaharmreduction.org www.apla.org
NEW YORK:
BOSTON: The Lesbian, Gay. Bisexual & Transgender
www. f e n way h e a It h 0 rg
. www.gaycenterorg
(212) 367-1354
www.gmhc.org/programs/suce.html
296 I OVERCOMING CRYSTAL METH ADDICTION
(212)465-8304. x33
Exclusive drop-in hours for gay and bisexual gender Community Center
www.harmredux.org http://wwc.org
www.dancesafe.org
www.knowmoremeth.com
GLOSSARY
"chronic pain," which is long lasting. An acute event, which starts sud-
denly, can become chronic if it continues for a long time
ADD: See attention-deficit/hyperactivity disorder
ADHD: See attention-deficit/hyperactivity disorder
amygdala: A part of the brain where emotional memory is stored.
anabolic steroids: A class of drugs that mimic testosterone and are used
to treat hormone deficiencies, low libido, severe weight loss from HIV
and cancer, and anemia. They are also misused by health people to
words and needing to move about constantly There are three subtypes:
ADD. Children are more commonly seen with the combined type. This
condition is usually called by its simpler acronym ADHD. Note that there
are many other conditions that can cause difficulty with concentration,
such as depression, anxiety, drug effects, medication side effects, fatigue,
basal ganglia: A part of the brain with many functions, including move-
ment, as well as relaying brain signals between the body and the rest
one of the two things without the other until the associated reaction
they are stopped, sleep and anxiety worsen. In some cases, withdrawal
can be severe, including extremely uncomfortable physical symptoms
and possibly seizure.
GLOSSARY I 299
dose and use small, measured doses of powdered drugs, such as crys-
tal, cocaine, and ketamine.
bump: Nickname for a small amount of crystal or other powdered drug
(cocaine, special K, etc.) that is snorted. A bump can be snorted from
the tip of a small object, such as a a key, or from a snorting device
nicknamed a "bullet."
Campral: Brand name for acamprosate.
carbohydrates: A class of foods made of small to large chains of sugar.
This includes table sugar, fructose from fruits, potatoes, pasta, and
rice.
also the target of HIV, which disables the central organizer of the im-
mune system. In this way, HIV cripples the entire immune system.
CD<4 count: A measure of the number of CD4 cells in a sample of blood,
which is used as a measure of the health status of the immune system
in people with HIV.
CDS Cells: A type of immune cell, a subgroup of T lymphocytes, also known
as T-cells that attack foreign invaders such as bacteria, parasites, and virus-
es. They are called into action by signals from CD4 cells, which stimulate
them to multiply and attack the foreign invaders.
cerebral cortex: The outer wrinkled surface of the brain, which is where
most of logical thinking and judgment are performed.
500 I GLOSSARY
cingulum: A specific part of the brain that has been associated with mo-
tivation and initiating behavior.
circuit parties: Large dance parties with thousands of gay men held in
cities throughout the world, where gay men travel from long distances
to celebrate. These parties started as ways for closeted gay men to
ty gave the feeling of celebrating their sexual orientation. Drug use be-
came extremely prevalent at these parties, where many gay men used
this venue to "escape" the painful reality of living in a homophobic
society. The understanding that social dictums such as the "evil" of
crash: The period after using a drug, which is usually unpleasant, like a
"car crash."
creatinine phosphokinase: A substance that is in muscles, which is
toxic to the kidneys, and in large amounts can cause kidney failure.
potentially fatal.
destigmatize: To take away the negative feelings that society has closely
associated with something. E.g., destigmatizing addiction is important
to allow addicted people to stop feeling shame and to be more willing
to admit their problem and seek treatment.
detoxification (Detoxing): The process of stopping a drug (including
alcohol) and allowing the body to adjust to functioning without the
drug in the body.
cells that cause changes in body function. E.g., dopamine affects sig-
only slightly higher than the amount required to cause the high. In
overdose, or when combined with other brain-supressing drugs, such
as alcohol, benzodiazepines, ketamine, and opiates, it can be fatal.
enough information and education. This model works best in the early stag-
es of crystal use, before neurological changes occur that disrupt the ability
and destroy the foreign invaders. Helper T-cells are also the primary
targets for HIV, which therefore destroys the immune system s ability
to fight infections.
in vitro: A type of biological study that uses chemicals and/or cells but
does not involve animals or humans. These studies are helpful, but
animal studies are considered a better approximation of what happens
in humans. Human studies are the best at showing what actually hap-
pens in people.
insight: Clear knowledge about oneself, one's thoughts, and ones be-
havior. E.g., a person can have good insight into the fact that he is
addicted to crystal. Conversely, a person can have poor insight into his
addiction and justify his weekly use as recreational and "totally under
my control," though he has not been able to pass a weekend without
crystal in six months.
ketamine: A "club drug" that is usually in cr\^stalline white powder form,
derived from a liquid drug used for injection. Ketamine is a drug used
as a general anesthesia for surger\' on children and on animals in vet-
killer T-cells: A specific type of immune cell, also known as CDS cells,
that are activated by helper T-cells (CD4 cells) to multiply and destroy
foreign invaders, such as bacteria, viruses, and parasites.
limbic system: A grouping of brain circuits that are linked and regulate
emotions.
line: A rough measure of a powdered drug that is snorted. The powder is
laid on a flat smooth surface and divided into lines of various lengths
and widths. This is a very inexact measure because the size of the line
can vary with the user, and as an addiction worsens, the size of one line
can become much larger than it had been in previous years. Therefore
the statement that "I do the same number of lines in a night as I used
to" does not necessarily mean that drug use has not increased.
lymphocyte: A type of blood cell that is part of the immune system, which
destroys foreign invaders, such as bacteria, viruses, and parasites.
has low mood, together with disturbed sleep, change in appetite, de-
creased energy and motivation, poor concntration, or a decreased abil-
dicted to crystal.
MDMA: See methylenedioxymethamphetamine.
mesolimbic pathway: A brain pathway leading from the ventral tegmen-
tum in the brainstem to the nucleus accumbuns in the brain. The
mesolimbic pathway is associated with pleasure, as well as compulsive
repetition of behaviors that may not necessarily be pleasurable.
meth mouth: A dental condition of softened, severely decayed teeth
that results from poor nutrition and osteoporosis with weakened tooth
structure; dry mouth, which increases bacterial growth that destroys
teeth; and tooth grinding and jaw clenching caused by crystal
brain and throughout the body This subtype is most commonly known
for its euphoric and pain-killing effects when opiates, such as heroin
and morphine, are taken.
mushin: A Zen Buddhist concept meaning "no mind." Through mushin
one tries to achieve a higher spiritual state by emptying the mind,
which involves letting go of worries of the past and the future.
of the body.
NMDA receptor: See N-methyl-D-aspartic acid receptor.
N-methyl-D-aspartic acid receptor: A protein in the cell wall of brain
cells that is activated by glutamate to cause a series of subsequent ac-
tions within the brain cell. It is thought to be an important receptor in
addiction, affecting cravings and the ability to make judgments neces-
sary to avoid relapse.
nonoxynol-9: A chemical developed as a spermicide that is used in lu-
mucous membranes inside the rectum and vagina that it was thought
506 I GLOSSARY
party (v. to party): A slang term meaning to use drugs, most often refer-
ring to using crystal.
PET scan: A test similar to X-rays and CAT scans that makes images
of parts of the body. PET scans of the brain show how active differ-
ent areas are during different activities, such as resting, concentrat-
ing, performing specific mental tasks, etc. PET scans are often used
to compare the brain function of a particular group compared to the
general population. E.g., PET scans can compare the brain function
of crystal users to non-crystal users.
physiological: Referring to the biological workings of the body.
placebo: An inactive pill or other sham treatment used in research with
PNP: Slang abbreviation for 'party and play," referring to having sex while
using crystal.
Positron emission tomography scan: See PET scan.
prefrontal cortex: A specific part of the cerebral cortex that is located in
front of the part of the brain that controls movement. The prefrontal
cortex is believed to coordinate thoughts, goals, and behavior. People
who have damage to this area of the brain have been observed to intel-
lectually know "right from wrong" but in their behavior, they act upon a
of this area of the brain is crucial for being able to maintain sobriety.
Even if an addict intellectually knows that crystal use will destroy his
with many other medications and drugs. The interaction could result
in a dangerously high level of drug in the body, or certain drugs and
medications could result in a low level of protease inhibitor, which
would then allow HIV to grow and multiply.
cause it had been several months since he had used any drugs, and he
was entertaining friends he hadn't seen in four years. He didn't want
to spoil the fun and thought doing a couple of bumps wouldn't be a
problem."
rave: A large gathering of teenagers and young adults, from hundreds to
thousands, where people dance to techno music. Raves are a setting in
which use of club drugs is a normal part of the culture.
recovery: A state of actively trying to remain sober and in control of an
addiction. "Alison has been an alcoholic since she was seventeen, but
she has been in recovery for the past five years.'
relapse: Falling back into drug use after achieving a period of sobriety.
relapse prevention: A type of addiction treatment with the ultimate goal
308 I GLOSSARY
realize that his drug use is a serious problem that needs to stop.
actively working on fighting addiction. E.g., the expression ''Clean but not
sober ' means a person is not currently using drugs but is not "working the
program" or actively working on keeping addiction under control.
sobriety: See sober.
social anxiety disorder: A psychiatric illness in which a person has a
of the brain
therapist: A person who works with people to help them sort out prob-
lems. Therapists can be of various disciplines, such as drug counselors,
clinical social workers, psychologists, and psychiatrists. Within each
discipline, there are different styles of therapy, including cognitive
you find a therapist with good experience who works in a style that fits
out things that you may know but do not allow yourself to see. For
example, when you start to rationalize and begin to fall back into drug
use.
top: A slang term among gay men, which means the "active '
person in a
sexual couple. In anal sex, the "top" penetrates the "bottom."
trick: A slang term among gay men, which means a person that you meet
for sex only Similar to a ''quickie" or a ''hookup." A trick is a casual sex
can cause many changes in the brain, including changes in mood, mo-
tivation, and thinking.
ventral tegmentum: A small area in the brainstem that is connected by
nerve fibers to the nucleus accumbens. These signals are mediated by
dopamine and are often associated with pleasure.
viral Load: The amount of a virus that is measured in the blood. This
term is most commonly used in reference to HYV because it is a ba-
rometer for how healthy a person with HIV is. A low or "undetectable"
viral load usually signifies that HIV infection is under good control.
GLOSSARY I 311
presence of a drug. When the drug is no longer present, the body feels
sick. A crystal addict in withdrawal can feel tired, depressed, hungry,
anxious, and even suicidal. Symptoms of withdrawal vary for each par-
ticular drug.
works: A slang term for needles and syringes used to inject drugs such as
crystal, cocaine, and heroin into the bloodstream (intravenous drug use).
REFERENCES
AND BIBLIOGRAPHY
Haning, W.; Huestis, M.; Strauss, A.; Grotta, S.D.; Liu, J.; and Lester,
Haning, W.; Huestis, M.; Strauss, A.; Grotta, S. D.; Liu, J.; and Lester,
Huber, A.; Lord, R. H.; Gulati, V; Marinelli-Casey, P.; Rawson, R.; and
Ling, W. The CSAT Methamphetamine Treatment Program: Research
Design Accommodations for 'Real World' Application. Journal of
Psychoactive Dm^s, April-June 2000, 32(2): 149-56.
Hythiam, Inc. Hythiam's PROMETA™ Protocols Featured in Article on
Addiction in The New York Times Magazine on Sunday, June 24th.
Press Release. June 26, 2006.
Howard Brown Health Center Starts Crystal Meth Program.
Illinois:
162:A38.
Kalivas, P. W.; and Volkow, N. D. The Neural Basis of Addiction: A
Pathology of Motivation and Choice. American Journal of Psychiatr)>,
August 2005, 162: 1403-13
Kingston, S.; and Drug Use and HIV Prevention Team, Public Health-
Seattle and King County. When Your Partner Has a Drug or Alcohol
Problem: A Guide for Gay and
Men. September 2005.
Bisexual
Kita, T; Wagner, G. C; and Nakashime, T. Current Research on
Wongtan, T.; and White, J. M. The Nature, Time Course and Severity
Li, S. H.; Elkashef, A.; Chiang, N.; and Kahn, R. Safety of Intravenous
Methamphetamine Administration During Treatment with Bupropion.
Psychopharmacology (Berlin). November 2005, 182(3): 426-35. Epub
October 19, 2005.
NIDA Campaign to Send Teens the Message About the
Unveils
Link Between Drug Abuse. And HIV. News. November 29, MH
2005. http://www.nih.gov/news/pr/nov2005/nida-29.htm (accessed
November 30, 2005)
O'Connor, Anahad. Scientists Explore Meth's Role in Immune System.
New York Times. The Body: The Complete HIV/Aids Resource.
February 25, 2005.
Office of National Drug Control Policy. Bush Cabinet Officials Highlight
junl6_05/.
Slamberova, R.; and Rokyta, R. Seizure Susceptibility in Prenatally
Methamphetamine-exposed Adult Female Rats. Brain Research.
October 26, 2005, 1060 (1-2): 193-7.
Slamberova, R. Pometlova, ;
M .
; and Charousova, P. Postnatal Development
of Rat Pups Is Altered By Prenatal Methmaphetamine Exposure.
Progress in Neiiropsychopharmacological and Biological Psychiatry.
January 2006, 30(1); 82-8. Epub 2005 July 19.
Sommerfeld, J. Beating an Addiction to Meth: Researchers Zero In on
Brain Effects, Treatment Approaches. MSNBC. http://u^w.msnbc
.msn.eom/id/3076519/print/l/displaymode/1098/.
State and Local Leaders Call for Action on Alarming New Latino HIV/
AIDS Trends. Bienestar (Press Release, March 21, 2006.
Stewart, J. L. and Meeker, J. E Fetal and Infants Deaths Associated with
Maternal Methamphetamine Abuse. Journal of Analytical Toxicology.
October 1997, 21(6): 515-17.
Stoops, W. W; Lile, J. A.; Glaser, P E.; and Rush, C. R. A Low Dose of
Ariprazole Attenuates the Subject-rated Effects of D-amphetamine. Drug
and Alcohol Dependence. March 13, 2006. [Epub ahead of printing]
Taylor, M.; Aynalem, G.; Simth, L.; Bemis, C.; Keeney K. and Kerndt P.
Correlates of Internet Use to Meet Sex Partners Among Men Who Have
Sex with Men Diagnosed with Early Syphilis in Los Angeles County
Sexually Transmitted Diseases. September 2004, 31:9: 552-56.
The 2004 National Survey on Drug Use and Health. Substance Ahuse
and Mental Health Services Association (SAMHSA), September 8,
2005, http://www.thebody.com/nida/meth_brain.html,
Urbina, A. and Jones, K. Crystal Methamphetamine, Its Analogues, and
HIV Infection: Medical and Psychiatric Aspects of a New Epidemic.
Clinical Infectious Diseases, March 15, 2004, 38(6): 890-94. Epub
2004 Mar 1.
L.; Brown, C. A.; Skelton, M. R.; McCrea, A. E.; Rock, S. L.; and
Williams, M. T. Periadolescent Rats (P4i-50) Exhibit Increased
324 I REFERENCES AND BIBLIOGRAPHY
Thank JW, for being a wise role model who quietly and gently
you,
encouraged me throughout my life. am grateful to the many individuals
I
who were brave and generous enough to share their valuable experiences
and wisdom, which have tried in this book to share with others. Thank
I
that special combination —the courage to push forward together with the
acceptance of the limitations life gives us —we can accomplish anything,
including controlling addiction and finding happiness in life.
INDEX
A alprazolam, 103-4
aluminum, 41
AA (Alcoholics Anonymous), 139-40,
amantadine, 104
144
Ambien, 106-7
Abilify, 165
American Soceity of Addiction
abstinence, 297
Medicine, 26-27
acamprosate, 158, 297
Amish, 7
acceptance, 264-67
amphetamines, xii, 15, 105, 211, 272
acupuncture, 156, 225-26
amygdala, 297
acute, 297
anabolic steroids, 297
Adderall, 30, 105, 211
anhydrous ammonia, 40
addiction
anorectics, 66
addict terminology, 11-12
antidepressants, 164, 202, 275
biological basis, 115
antipsychotic drugs, 165
brain effects, 51
anxiety, 265
defined, 45-48
APA (American Psychiatric
developing, 66-67
Association), 45
discussing, 279-84
appetite supressants, 34
of family, friends, partners, 278-90
aripiprazole, 165
neurochemistry, 51
astrocytes, 273, 297
overcoming, 8—10
Atarax, 106
physical dependence, 53-54
Ativan, 103, 199
psychological aspects, 52
recognizing, 55-63
sexual addiction, 256-58 B
understanding, 114-16 B cells, 273
ADHD (attention-defit/hyperactivity baclofen, 159
disorder), 210-14, 298 basal ganglia, 273, 298
adrenaline, 28 behavior therapy, 196, 298
See also norepinephrine Benadryl, 106
330 I INDEX
destigmatize, 301 F
detoxing, 102-10, 301
See also withdrawal
family members, 278-90
Federal Controlled Substance Act of
Dexedrine, 28, 105
1970, 16
diazepam, 103
digestive system, 36
fertilizer, 40
diphenhydramine, 106
FIV (feline immunodeficiency virus),
271-72, 274
discussing addiction, 134-37, 279-84
flumazenil, 161
doctors,108-10
Focalin, 30, 105
dopamine
and addiction, 164
free radicals, 31, 302
157, 160,
Freud, Sigmund, 200
antagonists, 159
defined, 28, 35, 301
friends, 230-46
effects of crystal meth, 30-32, 35,
addicted, 278-90
51, 104
frontal cortex, 302
schizophrenia, 39
transporters, 31, 301 G
dope-sick, 301 GABA (gamma-aminobutyric acid), 157
dry mouth, 34 GABA receptors, 104, 161
DSM-IV {The Diagnostic and Statistical gabapentin, 158
Manual of Mental Disorders), 45, Gabitril, 159
47, 301 Galanter, Marc, xi-xiii
attention-deficit/hyperactivity disor- gay men
der criteria, 212-14 drug use, 7, 11, 17-22, 65
depression criteria, 204-5 parental expectations, 174
dysthymia criteria, 206 party scene, 231-32
social phobia, 189 psychological considerations, 53
dual diagnosis, 162-65 (GVG) gamma-vinyl GABA, 159
dysthymia, 205-7, 302 Geodon, 165
See also depression GHB (gamma-hydroxybutyrate), 105,
302
E ginseng, 30
glossary, 297-311
Ecstasy, 18, 198, 302, 304
glutamate, 51, 160, 302
ego, 265
electrolytes, 302 Grant, I., 65
ephedra, 30
ephedrine, 30 H
ERP (exposure with response preven- HAART (highly active anti-retroviral
tion), 196-97 treatment), 275, 303
Eskalith, 165 Haldol, 165
ether, 40 hallucinations, 39, 302
euphoric recall, 79, 81 haloperidol, 165
expectations, 171-87 Halsted, William, xii
332 I INDEX
269-71
Rabkin, Judith, 161
sexual orientation, 308
ramelteon, 106
sexuality, 308
rationalizing, 307
Shoptaw, Steven, 269
raves, 19, 198, 307
shyness. See social anxiety
Reagan, Nancy, 73, 121, 146
288-90
significant others,
reasons for crystal meth use, 64-66
SIV (simian immunodeficiency virus),
recovery, 307 274
rectal crystal meth use, 20, 32
SKY {Sudarshan Kriya Yoga), 222
refusal strategies, 121-23
slamming, 20, 92, 308
Reiki, 226-27
sleep, 106-7
relapse, 261-63, 286-87, 307
Smith, Michael, 156
prevention, 113-33, 215, 307
Smith, Robert, 139-40
relaxation, 219-21
smoking crystal meth, 19, 32
relaxation exercises, 126-28
snorting crystal meth, 19, 32, 92
remitting, 307-8
SNRls (serotonin-norepinephrine
Requip, 104
reuptake inhibitors), 198-99
residential programs, 149-55
sobriety, 309
residential rehabilitation, 308 188-201, 309
social anxiety,
resistance, 305 230-46
social circles,
resources, 291-96 136-37
social support,
reuptake, 202 176-77
societal expectations,
Revia, 158, 308
solvents, 40
rewarding yourself, 124—25
Sominex, 106
rhabdomyolysis, 37, 275, 308
Sonata, 106
Risperdal, 165
Special-K, 303, 309
risperidone, 165
spouses, 288-90
Ritalin, 30, 105, 211
SSRIs (selective serotonin-reputake
ritonovir, 274
inhibitors), 198, 308
rock bottom, 308 264-67
staying clean, 113-33,
ropinirole, 104-5
stereotyped motor activity, 33
Rozerem, 106
Stewart, 142
stimulants, 28, 309
s toxicity, 38-39
safe use of crystal meth, 89-99 street names of crystal meth, 11, 15
Symmetrel, 104
syringes, 92
vagus nerve, 222, 310
Valium, 103, 199
valproate, 165
T-cells, 271-72 valproic acid, 165
See also CD4 cells ventral tegmentum, 32, 310
Tagamet, 275 Viagra, 248, 270
Taiwan, 25 viral Load, 310
talking about drugs, 134-37, 279-84 vitamin C, 96
Taoism, 264 Vivitrol, 159
Tat protein, 274 VNS (vagus nerve stimulator), 222
teenagers, 7, 25-26
Tegretol, 165 w
thalamus, 37, 273, 309
wabi-sabi, 267
therapist,309
the Wave, 128
therapy, 137-39
weight loss, 66
Thorazine, 165
Wellbutrin, 104
tiagibine, 159
Wlien Boys F/y,239
Timko, 142
Wilson, Bill, 139-40
TNF (tumor necrosis factor), 273
withdrawal, 47, 100-110, 310-11
tolerance, 47
medications, 103-10
toluene, 40
See also detoxing
tooth grinding, 34, 93
women, 23-25, 65
top, 310
work, 208-10
Topamax, 157-58
works, 311
topiramate, 157-58
trazodone, 106
trick, 310
triggers, 310 Xanax, 199
tweaking, 90, 310 Xanax XR, 103
twelve-step programs, 139-45, 265, 310
u
yoga, 221-23
UCLA (University of California), 23 Yoga Sutras of Patanjali, 221-23
UCSD (University of California, San Young, Eddie, 169
Diego), 23
UCSF (University of California at San
Francisco), 269
Unisom, 106 Zen Buddhism, 267
Universal Life Force, 227 ziprasidone, 165
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