Iowa has the lowest rate of overall illegal drug use in the nation. Iowa Gov. Tom Vilsack cites the federal health department’s statistic in an online report to Iowans, and without a doubt, it sounds like good news. But the report also contains bad news: abuse of the extremely addictive drug, methamphetamine, is on the rise in Iowa.
Over the past year, Jane Caton, a certified addiction counselor in Chemical Dependency Services in University of Iowa Hospitals and Clinics, has seen an increase in the number of people seeking help with methamphetamine addiction. It’s a tough drug, she says, with addicts continuing to crave it long after they’ve undergone treatment, and with relapses, unfortunately, all too common.
Caton and her colleagues in Chemical Dependency Services, administered though the UI Carver College of Medicine’s Department of Psychiatry, join a campus-wide effort at The University of Iowa to address Iowa’s methamphetamine crisis. Researchers in the College of Public Health are studying the ways that the addiction has an impact on Iowa families and communities. Faculty experts in nursing, pharmacy, medicine, dentistry, and public health have teamed up in the University’s home office of the Prairieland Addiction Technology Transfer Center to find the best ways to treat an alarming increase in methamphetamine use among young Iowa farmers.
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| New Iowa laws make pseudoephedrine, an ingredient in meth, more difficult to acquire. |
With a multidisciplinary team that includes nurses, social workers, chemical addiction counselors, activity therapists, and occupational therapists, as well as a psychiatrist, Chemical Dependency Services each year sees between 2,500 and 3,000 patients addicted to drugs. Many of the addicts are young, with almost30 percent of those between 16 and 25 addicted to methamphetamine.
While other treatment centers of various kinds around Iowa deal with methamphetamine addiction, what sets the University’s program apart is its dual diagnosis nature, made possible by having onboard a full-time psychiatrist, Jill Liesveld, associate professor (clinical) in the Department of Psychiatry. According to David Barloon, a registered nurse practitioner in the program, 30 to 40 percent of addicts also suffer from mental illness. Failing to treat both the addiction and the mental illness, he notes, means one problem defeats treatment of the other.
fyi recently visited Chemical Dependency Services to talk with Caton and Barloon about their work in the struggle with methamphetamine addiction.
By all reports, methamphetamine addiction is an epidemic in the United States, but it seems to have hit Iowa and the Midwest particularly hard. Why?
Barloon: The rural setting is an easy place to hide meth labs. The chemicals, at least until recently, have been easy to get, especially anhydrous ammonia, a common farm chemical. There’s also speculation that the Interstate system, with two main arteries, I-80 and I-35, cutting right through the middle, brings a lot of drug trafficking through Iowa.
Gov. Vilsack and Iowa legislators are attacking the supply of methamphetamine to Iowa’s communities. Recent legislation, for example, restricts access to medicine containing pseudoephedrine, a main ingredient in the manufacture of methamphetamine. How does this affect the treatment of meth addicts?
Barloon: In other states where legislation has targeted the supply side (as in Oklahoma, which is held up as the model), this approach has cut into the number of meth labs. The problem in Iowa, however, is that 80 percent of all meth comes from out of state—from Mexico, southern California, Texas. Labs in the Midwest produce a few ounces or a pound of the stuff, whereas the super-labs in Mexico and elsewhere make hundreds of pounds. So it is commendable to go after the supply side of this equation, but the heart of the problem is the demand side.
Caton: The problem of drug abuse is a much larger cultural and social problem. You have to address the root causes for the desire for drugs in our country—poverty, education, violence, and abuse, among other things.
Studies show that treating a person for meth addiction takes much longer than treating someone with a cocaine or even a heroin problem. Why is that? What makes it so hard to treat?
Barloon: What makes meth addiction particularly difficult is that methampetamine affects the central nervous system, stimulating the reward center of the brain. The drug influences the levels of dopamine, a neurotransmitter involved in producing feelings of pleasure or euphoria, in the brain. After the initial high, methamphetamine users will “come down,” feeling depressed or irritable. Since the drug also suppresses regular production of dopamine, users physically demand more of the drug to return to normal. This pleasure versus tension cycle eventually can lead to addiction.
How do methamphetamine addicts recover?
Barloon: It’s not a dangerous withdrawal. It won’t kill you. But it’s a miserable one, and it lasts a long time. Meth addicts can literally burn up those pleasure centers in the brain like you use up gas in the car. As soon as the gas is gone, the car won’t run. After a while, those neural centers that create a sense of pleasure in response to a nice day or being around family or friends just won’t respond anymore. Those transmitters are empty. For some people, the capacity to experience pleasure will come back, although it may take a year or even more. And for others, they may have crossed the line where it won’t come back ever. And that’s what our therapy is for, to keep these people afloat during withdrawal.
Are there any prescription drugs to alleviate the withdrawal symptoms?
Barloon: There’s nothing. There’s Librium and Valium for alcoholics, methadone for heroin addicts. Methamphetamine is a stimulant, and there isn’t any medicine for people addicted to stimulants.
Chemical Dependency Services is an outpatient service. Unlike a residential treatment center, your patients go home at the end of each day. What is the motivation for addicts to come in and continue seeking your help?
Caton: They come to us from all paths, for all reasons. Often it’s because of the legal trouble their addiction has gotten them into, and the court has directed them to get treatment. Often it’s because their families have had enough and present an ultimatum that they seek treatment.
Barloon: Often they recognize that they’ve hit rock bottom and have no choice.
How do you help the addict?
Caton: We use a nonjudgmental approach to create a warm and supportive atmosphere. We offer three levels of care. The most intensive is our partial hospitalization program, or our dual diagnosis program, for people who need addiction and psychiatric care concomitantly. That runs Monday through Friday, from 8 a.m. to 3 p.m., and that’s generally two to three weeks long. After that, patients are transitioned to our intensive outpatient program, which runs three nights a week for about four weeks. Then they’re encouraged to participate in our extended outpatient program, which is a combination of individual sessions, ongoing groups, and family and other types of mental health counseling.
Given the length of time necessary to treat methamphetamine abuse, how much follow-up work do you do with recovering addicts once they leave your care?
Caton: These people aren’t abandoned when they leave our programs. We encourage them to participate in extended, outpatient treatment through our after-care program, which can continue eight weeks or longer, based on the individual’s need.
Barloon: We also want to make sure these people receive a lifetime of care. We hook them up with Alcoholics Anonymous or Narcotics Anonymous so they have somewhere to turn in their community for continued support.
How can people contact Chemical Dependency Services?
Barloon: To find out about treatment options for methamphetamine or other chemical substances, people can contact Chemical Dependency Services, 24 hours a day, at (35)6-1704.
by Gary Kuhlmann
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