Finding a “Fix” for Meth Addiction – Can Exercise Help?

Meth addiction is a particularly nasty addiction. Chronic meth abuse is associated with toxic effects to the neurological system, which can lead to severe structural and functional changes in areas of the brain associated with emotion and memory. Only some of these changes are known to be reversible following sustained abstinence, and available treatments for meth addiction “are at best only modestly effective.” That’s according to a recent review of the scientific literature on all things having to do with methamphetamine addiction by Kelly Courtney and Lara Ray, Ph.D. from the University of California, L.A. in Drug and Alcohol Dependence. (So-called crystal meth, also known as “ice,” refers to a highly purified form of form of meth, which, compared to forms of lower purity, is more addictive.)

When meth is used over long periods of time, health consequences include loss of appetite, tremors, “meth mouth” (severe tooth decay and tooth loss, caused by dry mouth), skin sores (the result of picking and scratching to get rid of imagined insects crawling under skin), insomnia, panic attacks, confusion, depression, irritability, impaired thinking, memory problems, paranoia, and hallucinations.

Having had the opportunity to work with clients addicted to meth at an outpatient dual diagnosis program, I’ve learned that these people come from all walks of life, suffer tremendously from the “pull” of the addictive substance and the shame that comes with using it, and feel miserable in the drug’s absence as they try to overcome its grip.

The Extent of the Problem

After meth use reached epidemic proportions in the early 2000’s in the western and mid-western parts of the United States, regulations reducing access to methamphetamine precursors such as pseudoephedrine led to a decrease in its use. Over the past five years, the prevalence rates of meth use have been relatively stable in this country. The latest National Survey on Drug Use and Health (2014) showed that among people aged 12 or older, an estimated 569,000 were current meth users.

The latest National Survey on Drug Use and Health (2014) showed that among people aged 12 or older, an estimated 569,000 were current meth users. But “use” isn’t the same as having a “use disorder” warranting addiction treatment.-Anne FletcherBut “use” isn’t the same as having a “use disorder” warranting addiction treatment. (The psychiatric diagnoses, methamphetamine abuse and methamphetamine dependence, in the DSM-IV were replaced in DSM-5 by one diagnosis, amphetamine-type substance use disorder, listed under the broader category of stimulant use disorders.) The latest Treatment Episode Data Set (2013) shows that 130,033 people were admitted to treatment related to methamphetamine, presumably for a use disorder/addiction.

While this may seem like a relatively small number of people compared to those treated for other substance use disorders such as marijuana/hashish, which brought about nearly 282,000 treatment admissions in 2013, a review on methamphetamine use disorders in the professional on-line publication, UpToDate, states, “… other sources of data, such as law enforcement groups, welfare agencies and substance use treatment programs, indicate that methamphetamine continues to be a significant public health problem.”

Moreover, Courtney and Ray express concern about supply reports warning of the potential for a “second wave of increased meth use and related problems.”  Also, significant regional variability in meth use continues to exist, with higher rates in such areas as the West and the Midwest.

A Dearth of Remedies

Unfortunately, no FDA-approved medications are available for treating methamphetamine addiction, nor are there any substitution medications for cravings, such as Suboxone and methadone, which are used for opioid use disorders. To make matters worse, meth cravings last long into abstinence, increasing the risk of return to drug use.

Evidence-based treatment approaches used for other addictions, including cognitive-behavioral therapy and contingency management (based on positive reinforcement, such as rewards, for positive behaviors) are often recommended for meth addiction. An approach called The Matrix Model – a 16-week comprehensive behavioral treatment approach that also offers family education, individual counseling, 12-Step support, drug testing, and encouragement for non-drug-related activities – has been shown to be effective in reducing methamphetamine abuse.

However, of cognitive-behavioral therapy and contingency management, renowned methamphetamine researcher Walter Ling, M.D. and colleagues from the School of Medicine at UCLA, Los Angeles said in a recent review in Current Psychiatry, “Outcomes are suboptimal.” They added, “Both interventions have a high rate of dropout during the first month of treatment and a greater than 50% relapse rate 6 to 19 months after treatment ends.”

Although somewhat controversial, there seems to be growing interest in using prescription stimulants to treat meth (a stimulant) addiction, as a “replacement” therapy.-Anne FletcherNoting possible benefits of residential treatment in a drug-free setting for more than 30 days, thus preventing access to drugs, drug cues, and drug-using acquaintances – along with group and individual counseling – Ling and colleagues point to the inevitable: clients are then discharged into everyday life in the community. Then their “battle to avoid relapse begins.”

Experts note that the interventions above may well prove more successful once suitable medications are available for treating meth addiction. Dr. Ling’s group states, “After decades of medication research, several drugs have shown promise for reducing methamphetamine abuse, although results have not been robust… Ending methamphetamine abuse and sustaining abstinence from stimulants require a change in the cognitive associations that have been laid down in a drug user’s memory. Relapse occurs because of recalled memories that can be cued, or triggered, by internal or external stimuli. Eliminating drug memories, perhaps assisted by medications… could be useful for suppressing the inclination to relapse.”

Although somewhat controversial, there seems to be growing interest in using prescription stimulants to treat meth (a stimulant) addiction, as a “replacement” therapy. A recent article in Alcoholism Drug Abuse Weekly discusses some of the research and controversy in this area, concluding, “Using stimulants to treat cocaine [also a stimulant] dependence has been found to be effective if the dose is adequate and could work for methamphetamine dependence as well, but more research is needed.”

Ling’s group added that alternative, non-drug forms of changing such cognitive associations have shown efficacy in preventing recurrences. For instance, they cite research showing that incorporating mindfulness has shown promise in managing meth cravings and decreasing reactivity to environmental cues for drug use.

Exercise for Meth Addiction?

Noting high drop out rates with behavioral treatment approaches for meth addiction and the inability for many to sustain abstinence, Richard Rawson, Ph.D. (one of the developers of the Matrix Model) has published a series of studies involving exercise as a possible treatment intervention. When I asked him how he came up with the notion of studying exercise to help with recovery from meth addiction, he replied:


“Personal experience. When I was working with patients at Matrix, those who would exercise would feel better and be less depressed, particularly during the extended period of anhedonia [inability to feel pleasure] in the early months of meth abstinence.  I think Nora Volkow [director of NIDA] was willing to support the studies, because there is good data for using exercise in the treatment of anxiety and depression, as well as for nicotine and alcohol dependence.  And there is good neuroscience to support the benefits of exercise on brain function.  Plus, Nora is a runner and I expect she personally experiences and appreciates the benefits of exercise.”

 

The overall goal of the research was to determine if exercise would be an effective adjunct to traditional behavioral approaches for treatment of meth addiction using an 8-week aerobic and resistance exercise protocol to reduce relapse during a 12-week follow-up period after discharge from residential treatment.

At the outset, 135 methamphetamine-dependent people, newly enrolled in residential treatment (using “treatment as usual” involving typical group counseling, cognitive-behavioral approaches, the 12 steps, etc.) were randomly assigned to either a 3-times-per week, 60-minute structured exercise program for 8 weeks or to an equivalent number of health education sessions. (We’re not talking knock-down, drag-out exercise here: Exercise sessions consisted of a 5-min warm- up, 30 min of aerobic activity on a treadmill, followed by 15 min of weight training and a 5-min cool-down/stretching period.) Researchers also evaluated improvements in health and mental health during and after the protocol.

Here are some of the findings, published in a series of recent studies, involving multiple researchers:

  • Among newly abstinent people in residential treatment, exercise had a significant effect on reducing depression and anxiety, with those attending more sessions receiving significantly greater benefits. (Published in the Journal of Substance Abuse Treatment)
  • Further analysis of the study data revealed that exercise participants with the most severe medical, psychiatric, and meth disorders upon entering the study showed the most significant improvement in depressive symptoms by the end of the study – suggesting that exercise is particularly beneficial to such individuals. (Published in the American Journal of Addiction)
  • Following treatment in the residential program, participants were interviewed and urine samples were collected at 1-, 3-, and 6-months. Fewer exercise participants returned to meth use compared to education participants at all three time periods, but differences were not statistically significant. However, lower severity users in the exercise group had a lower percentage of positive urine results and fewer days of meth use in the previous 30 days as measured by self-report, at the three time points than did lower severity users in the education group, leading the authors to conclude that their results support the value of exercise as a treatment component for people using meth 18 or fewer days per month (the cut-off for lower severity use.) (Published in Drug and Alcohol Dependence)
  • Meth use disorder is associated with brain changes known as striatal dopaminergic deficits that have been linked to poor treatment outcomes. Therefore, researchers involved a subgroup of this study’s participants in having PET (positron emission tomography) brain imaging scans. 10 of them were in the exercise group, and 9 were in the education group. After 8 weeks, those in the exercise group showed significant positive brain changes, but those in the education group did not. (Published in Neuropsychopharmacology)

What’s Dr. Rawson’s conclusion? “I think exercise can become an important component in addiction recovery.  Of course, as with exercise for all health conditions, the challenge is getting people to participate in exercise.  One of the next challenges is to develop strategies for promoting exercise with people substance use disorders who are working to reduce and/or stop their drug use.”

 

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