Successful prevention and treatment of alcohol and substance use disorders (AUD/SUD) often demands unraveling a tricky knot: co-occurrence with mental health disorders such as co-occurring anxiety disorder. Many anxiety disorders first appear in youth, pre-adolescence, or early adolescence, before exposure to alcohol or drugs that lead to SUDs.

Not all anxiety disorders appear before addiction disorders, though. Specific subsets of anxiety disorders, such as generalized anxiety disorder or panic disorder (GAD or PD) often emerge after an individual develops an AUD or SUD. Recent studies into the interaction between anxiety disorders and addiction show how each disorder can intensify the other.

These studies also recommend ways providers might fine-tune intervention, screening, and treatment strategies to serve people diagnosed with co-occurring anxiety and addiction disorders.

Rates of Co-Occurrence of Anxiety and Addiction

When anxiety and addiction co-occur, one common outcome is that the life-interrupting aspects of the disorders reinforce one another. In other words, each disorder exacerbates the other. The symptoms of an anxiety disorder lead to self-medication with alcohol or drugs in order temporarily ameliorate uncomfortable symptoms. Over time, tolerance and dependence may develop. Once that happens, the path to misuse and addiction becomes more likely.

Here are the latest statistics on alcohol use disorder (AUD) or substance use disorder (SUD), collectively known as alcohol or drug addiction, and anxiety disorders among adults in the U.S.

SUD,  AUD, and Co-Occurring Anxiety Disorder

• Substance Use Disorder:
  • 12 and older: 6.6% or 18.4 million people
  • 18-25: 14.6% or 4.9 million people
  • 26+: 5.6% or 12.3 million people
• Alcohol Use Disorder:
  • 12 and older: 10.2% or 28.3 million people
  • 18-25: 15.6% or 5.2 million people
  • 26+: 10.3% or 22.4 million people
• Anxiety Disorder:
  • 18+: 18.1% or 40 million people
• Co-Occurring Anxiety Disorder and AUD/SUD:
  • Among people with anxiety disorder: 15% report AUD/SUD
  • Among people with AUD/SUD: 18% report anxiety disorder

Given the significant prevalence of co-occurring AUD/SUD and anxiety, it’s important to understand how addiction and anxiety are related. We’ll now offer a general discussion of anxiety and anxiety disorders.

Anxiety Disorders: Where Do They Come From?

A diagnosis of an anxiety disorder very generally means that an individual is experiencing excessive fear and/or anxiety in relation to daily life. Both anxiety and fear are useful emotions that regulate successful interactions with the world by indicating danger and potential harm. Fear tends to be about a present, specific object or event, while anxiety is triggered by a future event that may or may not be specific.

For example, seeing a snake on a path in the woods may evoke an instant reaction: fear. In response, an individual takes action to avoid the snake. That’s the simple function of fear, in most cases. It enhances safety, and therefore, survival.

On the other hand, anxiety in advance of an important meeting with a boss for a work performance review might also evoke an instant, fear-type reaction that most of us would identify as anxiety. In this case, the anxiety/fear may cause an individual to tighten up their work habits, increase performance, and prepare thoroughly for the review.

In both cases, the anxiety and fear are productive.

That’s helpful – but what’s the relationship between anxiety and addiction?

Which Comes First? Anxiety or Addiction?

The subtypes of anxiety disorders that researchers have been able to identify as developing before or after the onset of addiction are social phobia, generalized anxiety disorder, panic disorder, and agoraphobia.

Here’s when they most commonly develop, in relation to addiction:

• Social phobia is most likely to develop before the onset of alcohol use disorder (AUD)/substance use disorder (SUD)
• Generalized anxiety disorder is more clearly likely to develop after the onset of AUD/SUD.
• Panic disorder and agoraphobia most often develop before the onset of AUD/SUD, but in some cases develop after AUD/SUD

The earlier onset of social phobia, now known as social anxiety disorder, may be explained by the fact that it typically emerges in childhood and early adolescence, before most people experiment with alcohol or drugs. Here are the symptoms of social phobia/social anxiety disorder:

• Heightened fear of interacting or talking with strangers
• Heightened fear that others judge one negatively
• Excessive worry over embarrassment or humiliation in social/public situations
• Excessive fear that others will notice physical symptoms (sweating, shaky voice, trembling, etc.)

The symptoms of generalized anxiety disorder include physical symptoms that overlap with the symptoms of withdrawal. This explains why this diagnosis is often made after an individual develops AUD/SUD. These physical symptoms include:

• Difficulty sleeping
• Muscle tension
• Easily startled
• Nausea, diarrhea, or irritable bowel syndrome

The fact of co-occurrence and the overlap between the symptoms of anxiety, addiction, and withdrawal often complicate an accurate diagnosis of both addiction and anxiety. That’s why it’s important for clinicians to offer a complete assessment of any individual with addiction: there may also be anxiety present.

Insightful Intervention and Innovative Treatment

Clinicians working with individuals with AUD/SUD may need to enhance anxiety screening to best tailor treatment plans. Most initial assessments for addiction do attempt to assess mental health disorders. With that said, the high prevalence of co-occurring anxiety disorder and AUD/SUD makes additional assessment for anxiety logical.

For example, if a given AUD/SUD appears alongside a panic disorder, clinicians may need to consider different pharmaceutical treatments in addressing both disorders. While the panic disorder may have preceded the addiction, earlier treatment of the panic disorder with benzodiazepines may have accelerated the development of the AUD/SUD.

In addition, the people who create public health and addiction awareness campaigns designed to prevent or reduce AUD/SUD among certain populations should consider special features among these populations that make individuals prone.

For example, campaigns that target adult professionals in high-stress jobs can clearly elucidate the problematic interaction of medications such as benzodiazepines – often prescribed to manage anxiety – and alcohol.

An accurate diagnosis of both the addiction and the anxiety is crucial for a full and efficient recovery. When one disorder is treated and the other is ignored, both disorders get worse: that’s a fact backed up by decades of research.

However, when co-occurring disorders are treated simultaneously with a holistic, integrated treatment model, like at top treatment centers in Ohio, such as The Ridge, the likelihood of full recovery from both disorders improves dramatically. The Ridge also offers detox programs and an inpatient rehab facility to help in complete recovery.

In 2017, the Department of Health and Human Services (HHS) declared the opioid crisis a national health emergency. This triggered nationwide, coordinated efforts to stem decades-long increases in opioid misuse, overdose, overdose fatalities, and other opioid-related deaths. The response involved the public and private sectors. Federal, state, municipal, and local authorities participated, from the White House all the way to neighborhood groups. Progress was made. Before the coronavirus pandemic arrived in the U.S., total opioid overdose rates began to decline. Although deaths from illicit, synthetic opioids increased from 2017 to 2018, the template for an effective response to this increase is in place.

It’s still a bad situation, but we’re going in the right direction with the opioid crisis.

During the period when opioid use and overdose deaths rose at alarming rates – 2012 to 2018 – the use of another dangerous and addictive drug also increased, also at alarming rates: cocaine. The opioid overdose and addiction numbers dwarf the cocaine addiction numbers, but that doesn’t change the fact that in the U.S., right now, cocaine use, cocaine-related overdose, cocaine-related deaths, and cocaine addiction rates are more than double those reported in the 1980s, when cocaine use was prevalent across a wide range of demographic subgroups.

This article presents the latest statistics on cocaine use, discusses cocaine addiction and withdrawal, and ends with information on the treatment of and recovery from cocaine use disorder, a.k.a. cocaine addiction.

Statistics: Cocaine Use, Cocaine Use Disorder, and Cocaine Overdose in the U.S.

The Department of Health and Human Services (HHS), in collaboration with the Substance Abuse and Health Services Administration (SAMHSA) and the University of Michigan, conducts an annual research effort called the National Survey on Drug Use and Health (NSDUH).

The purpose of the NSDHU is to collect and analyze “…information for youths aged 12 to 17 and adults aged 18 or older on drug, alcohol, and tobacco use, as well as substance use disorder (SUD), risk and availability of substance use, treatment, health topics, and alcohol consumption.”

Policymakers, health officials, and medical professionals use the results of the survey – which includes data from over seventy-thousand people – to make evidence-based, data-driven decisions on matters regarding substance use, mental health, and treatment.

The following two sets of statistics were reported in the 2018 NSDUH.

Cocaine Use: Age 12 and older, Age 18-25, Age 26 +

• An estimated 5.5 million people age 12 or older reported using cocaine in the 12 months prior to taking the survey
  • That’s about 2.0% of people age 12 or older in the U.S.
• An estimated 2.0 million young adults age 18-25 reported using cocaine in the 12 months prior to taking the survey
  • That’s about 5.8% of young adults age 18-25 in the U.S.
• An estimated 3.5 million adults reported using cocaine in the 12 months prior to taking the survey
  • That’s about 1.6% of adults aged 26 or older in the U.S.

Now we offer data on cocaine use disorder, a.k.a. cocaine addiction.

Cocaine Use Disorder: Age 12 and older, Age 18-25, Age 26 +

• About 977,000 people aged 12 or older in 2018 had a cocaine use disorder in the 12 months prior to taking the survey
  • That’s 0.4 percent of people age 12 or older in the U.S.
• About 212,000 young adults age 18 to 25 in 2018 had a cocaine use disorder in the 12 months prior to taking the survey.
  • That’s 0.6 percent of young adults age 18-25 in the U.S.
• About 760,000 adults aged 26 or older had a cocaine use disorder in the 12 months prior to taking the survey
  • That’s about 0.4 percent of adults in this age group

To round out the data section of this article, we offer the numbers on cocaine overdose in the U.S. published by the Centers for Disease Control (CDC).

Cocaine Overdose: Trends from 1999-2018

• Age adjusted rates for cocaine overdose deaths rose from 1.4 per 100,000 in 1999 to 2.5 per 100,000 in 2006.
  • For 1999, that’s 4,000 overdose deaths
  • For 2006, that’s about 7,500 overdose deaths
• Age adjusted rates for cocaine overdose deaths decreased from 2.5 per 100,000 in 2006 to 1.5 per 100,000 in 2011.
  • For 2006, that’s about 4,000 overdose deaths
  • For 2011, that’s about 4,500 overdose deaths, representing an overall increase, but a decrease as a percentage of the total population
• Age adjusted rates for cocaine overdose deaths rose from 1.4 per 100,000 in 2012 to 4.5 per 100,000 in 2018.
  • For 2012, that’s about 4,400 overdose deaths
  • For 2018, that’s about 14,500 overdose deaths

That last set of numbers – the increase in cocaine overdose deaths from 2012-2018 – represents a total increase of around 200 percent, or over 25 percent per year. That’s why it’s important for us to keep an eye on the trends in drug use for all drugs of misuse – not only opioids. That’s an alarming increase because cocaine use disorder – like opioid use disorder – can cause long-term damage to cocaine users, their families, and society at large.

Now that we’ve presented the latest data on cocaine use, cocaine use disorder (cocaine addiction), and cocaine overdose, we’ll talk about how cocaine works on the brain and body, then offer tips to spot problem cocaine use.

How Cocaine Works

Cocaine is an addictive stimulant derived from the leaves of the South American coca plant. Using cocaine results in short-term euphoria, a burst of energy, and extreme talkativeness. Cocaine also causes a dangerous increase in both heart rate and blood pressure.

Cocaine is most often used in powdered form. Users inhale cocaine powder through the nose, where it’s absorbed into the bloodstream through nasal tissue. Cocaine can also be dissolved in water, smoked, or injected directly into the bloodstream. A cocaine high from inhaling or drinking lasts about 15-30 minutes, while the high from smoking cocaine lasts from 10-15 minutes.

When the cocaine high – which users report is intensely euphoric – begins to fade, the user often begins to crave more of the drug immediately.

Cocaine use disorder develops when users take the drug repeatedly, over short periods of time, in order to achieve and maintain its euphoric effects. However, this binge pattern – due in large part to the short duration of the cocaine high – can quickly lead to a state of disordered use. Significant changes in the brain occur – and occur quickly.

These changes cause cocaine users to seek more of the drug at increasingly higher doses.

Inside the brain, cocaine increases the level of the neurotransmitter dopamine, a chemical that regulates pleasure and movement in the body. Typically, dopamine is recycled back into brain cells relatively quickly. Cocaine, however, prevents dopamine recycling (called reuptake) and causes excessive, unnatural, and atypical amounts to accumulate between neurons. The dopamine then disrupts normal communications within the brain, causing the euphoria associated with the cocaine high. In addition, cocaine impairs cognitive function and rational decision-making, which can lead to impulsive, risky behavior.

Cocaine Use Disorder: Signs and Symptoms

While the signs and symptoms of cocaine use vary from individual to individual, they manifest in three general categories: physical, behavioral, and psychological.

Physical symptoms of cocaine use include, but are not limited to:

• Dilated pupils
• Impaired sense of smell
• Nosebleeds
• Runny nose
• Gastric ulcers
• General gastrointestinal difficulties
• Impaired sexual function

Behavioral symptoms of cocaine addiction include, but are not limited to:

• Excess energy
• Rapid, excited speech
• Financial problems
• Impaired interpersonal relationships
• Difficulty managing work, family, and school responsibilities
• Lying about cocaine use
• Lying about financial problems
• Legal issues

Psychological symptoms of cocaine addiction include, but are not limited to:

• Paranoia
• Hallucinations
• Delusions
• Anxiety
• Depression
• Panic

The signs and symptoms listed above may appear obvious in some cases, but in other cases, they may not appear. It’s possible for an individual to develop a cocaine addiction and keep it hidden from almost everyone in their lives. When that happens, the cocaine use disorder may not become visible until the user tries to stop using cocaine – which results in withdrawal or an attempt to detox.

Cocaine Withdrawal: Signs and Symptoms

The signs and symptoms of cocaine withdrawal include, but are not limited to:

• Intense cravings for cocaine
• Agitation
• Fatigue
• Anhedonia: reduced ability to feel pleasure
• Increased appetite
• Decreased energy
• Vivid, unpleasant dreams
• Tremors
• Chills
• Depression
• Anxiety

The prolonged disordered use of cocaine can, in some instances, lead to a condition known as Post-Acute Withdrawal Syndrome (PAWS). PAWS refers to a group of symptoms that continue to bother an individual after initial withdrawal symptoms pass. PAWS can persist for weeks, months, and, in rare cases, for years.

Characteristics of PAWS include:

• Confusion
• Mood swings (including an outward defensiveness)
• Inconsistent energy levels
• Low enthusiasm
• Impaired cognitive function
• Insomnia
• Anxiety

The difficulties of withdrawal, the intensity of cravings, and the long-term effects of PAWS make recovery from cocaine addiction challenging. Decades of research show the best way to achieve sustained sobriety after cocaine addiction is through clinical treatment delivered by mental health professionals.

Evidence-Based Treatment for Cocaine Addiction

The most effective treatment for cocaine use disorder follows an integrated treatment model. Integrated treatment addresses the entire person, which means it accounts for and supports all areas of life, including biological, psychological, and social factors that may be at play. If an individual with cocaine use disorder is also diagnosed with a co-occurring mental, behavioral, or mood disorder, than any treatment plan must address that diagnosis as well: integrated treatment plans, by definition, must be customized to meet the specific therapeutic needs of each individual.

Evidence-based treatment plans for cocaine use disorder include, but are not limited to:

• Individual counseling
  • Cognitive behavioral therapy
  • Motivational Interviewing
  • Dialectical behavioral therapy
• Group Counseling
• Family Counseling
• Medication (if needed)
• Community/peer support
  • 12 Step groups such as Narcotics Anonymous (NA)
• Lifestyle Modifications
  • Mindfulness
  • Experiential activities
  • Exercise
  • Expressive therapies (art, music, journaling)
• Relapse Prevention
  • Aftercare plans
  • Ongoing community support

When seeking treatment for cocaine addiction, it’s important to locate a treatment center that includes the elements above. Each piece is important. Each contributes to long-term, sustained sobriety. Well-respected treatment programs – residential, partial hospitalization, intensive outpatient, or outpatient – include the elements above, although they may call them by slightly different names.

Finding the Right Program

While effective cocaine addiction treatment options share many common components, each treatment center has its own identity approach to treatment. The best way to find the right program is to gather all the available information, then call or visit to get a feel for the clinical staff, support staff, and general atmosphere of the treatment center. Committing to an addiction rehab program is the first step in a life-changing process. Choosing a program and treatment center that offers the best possible professional support provided in an atmosphere that matches the unique personality, circumstances, and therapeutic needs of the person in treatment increases their chances of creating a sustainable life in recovery.

Methamphetamine – commonly known as meth or crystal meth – is a common drug of recreational misuse that poses a serious health risk to anyone who uses it. Methamphetamine is a central nervous system stimulant derived from its chemical cousin, amphetamine.

Rates of methamphetamine addiction and misuse are not as high as those of other common recreational drugs in the U.S. However, the health consequences and behaviors associated with the misuse and disordered use of amphetamine make it disproportionately dangerous, a matter of concern for addictions professionals, and a matter of urgency for anyone with a friend or loved one experiencing meth addiction.

If you’re in such a situation, consider enrolling in a detox program or an inpatient rehab facility at your earliest.

Here are the latest statistics on meth misuse and addiction in the U.S. in 2018:

Methamphetamine Use

• About 1.9 million people aged 12 or older reported using methamphetamine in the past year.
  • That’s 0.7% of the population in that age group.
• About 43,000 adolescents age 12-17 reported using methamphetamine in the past year.
  • That 0.2% of the population in that age group.
• About 273,000 people age 18-25 reported using methamphetamine in the past year
  • That’s 0.8% of the population in that age group.
• About 1.6 million adults age 26 or older reported using methamphetamine in the past year.
  • That’s 0.7% of the population in that age group

Methamphetamine Use Disorder

• About 1.1 million people age 12 or older had a methamphetamine use disorder in the past year.
  • That’s 0.4% of the population in that age group.
• About 18,000 adolescents age 12-17 had a methamphetamine use disorder in the past year.
  • That’s 0.1% of the population in that age group.
• About 134,000 people age 18-25 in 2018 had a methamphetamine use disorder in the past year.
  • That’s 0.4% of the population in that age group.
• About 899,000 people age 26 or older had a methamphetamine use disorder in the past year.
  • That’s 0.4% of the population in that age group.

It’s true that the rate and prevalence of meth use and misuse do not rise to the level of rates and prevalence for alcohol, opioids, and cannabis. Nevertheless, meth addiction and misuse is an important issue to understand – it’s one of the most commonly abused recreational drugs in the U.S.

A Quick History of Methamphetamine

German scientists created amphetamine in a laboratory in 1887. Shortly thereafter, in 1893, a group of Japanese scientists synthesized methamphetamine. Both groups of researchers discovered the compounds in an effort to manufacture an alternative to the alkaloid chemical found in the ephedra plant.

Most people know about ephedra from the widespread use of its derivatives, ephedrine, and pseudoephedrine. Physicians first prescribed ephedrine for weight loss in the 1950s. It was available over the counter until 2004, when the Food and Drug Administration (FDA) banned its use due to a growing body of research indicating significant adverse effects on the human brain and body.

Pseudoephedrine is well-known because of its widespread use as a decongestant. It’s a common ingredient in many over-the-counter drugs used to treat runny nose, nasal congestion, and sinus headache. It works by narrowing blood vessels in the nasal passages, which become swollen and inflamed due to allergies, the common cold, or a typical sinus infection. People know about the drug because it’s effective: almost everyone has taken one of the several medications containing the chemical.

Methamphetamine, however, is completely different. First used as a treatment for asthma in the 1930s, its use as a potent stimulant quickly eclipsed its use as a decongestant. In World War II, military personnel on all sides of the conflict used methamphetamine. Foot soldiers used it for energy before combat, and pilots and naval personnel used it to stay awake on long missions and duty watches.

After the war, recreational use of methamphetamine gradually increased until it became a common drug of recreational use, misuse, and addiction in the U.S.

The Dangers of Methamphetamine Use

Methamphetamine is an odorless crystalline powder that can be swallowed, inhaled, or smoked. It’s also possible to prepare the powder for intravenous injection, similar to the way powdered heroin is prepared for injection.

The effects of one dose of methamphetamine last from four to eight hours and include a decrease in appetite, an increase in energy, and a general sense or euphoria and wellbeing. Methamphetamine causes a surge of dopamine in the brain – about twelve times more than is released during any typical activity – but over time the drug destroys the cell surface receptors that bind to dopamine and regulate reuptake into brain cells. This causes methamphetamine users to develop a tolerance to the drug, meaning that over time, they need to take higher and higher doses to achieve the same euphoric effect.

Tolerance can quickly lead to physical and psychological dependence, which, in turn, can lead to a wide range of behaviors known as addiction or substance use disorder (SUD). Clinicians refer to methamphetamine addiction as a stimulant use disorder-amphetamine-type substance. This type of SUD has three classifications: mild, moderate, and severe.

For the purposes of this article, we’ll refer to all three classifications as methamphetamine addiction, methamphetamine use disorder, or substance use disorder. It’s critical for everyone to understand that any recreational use of methamphetamine is dangerous. Short-term use can cause immediate negative side effects, while moderate- or long-term use leads to significant physical, psychological, and emotional damage.

The following bulleted lists include most, but not all, of the negative effects of methamphetamine use, misuse, and addiction.

Consequences of Methamphetamine Use

1. Cardiac Issues (Heart)

• • Chest pain
  • Tachycardia
  • Hypertension
  • Arrhythmias
  • Myocardial Infarction
  • Coronary artery disease
  • Cardiomyopathy

2. Neurologic Issues (Brain)

• • Headache
  • Seizures
  • Stroke
  • Cerebral vasculitis
  • Hyperkinetic movement
  • Neurocognitive impairment

3. Psychiatric Issues (Emotional/Psychological)

• • Paranoia
  • Hallucinations
  • Depression
  • Anxiety
  • Insomnia
  • Suicidality
  • Aggression
  • Poor quality of life

4. Additional Physiological Issues

• • Skin ulcerations
  • Dermatologic infections
  • Dental caries
  • Anorexia
  • Pulmonary hypertension
  • Pulmonary edema
  • Hyperthermia
  • Fetal growth restriction
  • Increased risk of hepatitis C and HIV

Although the recreational use of methamphetamine is not as prevalent as that of other substances of misuse such as alcohol, opioids, and cannabis, the negative effects of methamphetamine use and misuse make it dangerous, and in some cases, life threatening.

Now we’ll discuss the signs and symptoms of meth addiction.

Meth Addiction: What to Watch For

While using methamphetamine only once can be risky, methamphetamine addiction doesn’t happen instantly. That’s a myth, based on media hype and misinformation. Most people who experiment with methamphetamine don’t develop an addiction, but those who do face serious physical, psychological, and social problems. Meth addiction affects every facet of life, from work, to school, to family – that’s why it’s important to know how meth addiction might look in a friend or loved one.

The signs of methamphetamine addiction – those that come with a sudden or prolonged increase in meth use – vary widely from person to person. Within this variety, however, there are three broad categories of symptoms: behavioral, physical, and emotional. We list the signs and symptoms associated with these categories below.

Meth Addiction: Signs and Symptoms

1. Behavioral symptoms of meth addiction may include:

• Preoccupation with obtaining and using meth
• Hiding meth use
• Lying about meth use
• Hyperactivity
• Twitching/facial tics
• Rapid, darting eye movement
• Isolating or withdrawing from friends and family
• Impaired work or school performance
• Relationship problems
• Decrease in personal hygiene
• Impulsive, risky behavior
• Aggressive behavior
• Excess energy
• Constant, rapid talking
• Violent behavior
• Impaired cognitive function
• Memory problems
• Erratic sleep patterns
• Sudden unexplained weight loss

2. Physical symptoms of meth addiction may include:

• Shaking and trembling
• Nausea
• Sweats
• Dilated pupils
• Loss of appetite
• Weight loss
• Intense cravings
• Rotting teeth
• Skin lesions/sores

3. Emotional symptoms of meth addiction may include:

• Paranoia
• Mood swings
• Anger
• Irritability
• Hallucinations
• Delusions
• Anxiety
• Depression
• Panic

In addition to these common signs of meth addiction, long-term use of methamphetamine can lead to rhabdomyolysis, a condition that causes a breakdown of skeletal muscle tissue and leads to a release of muscle fiber – called myoglobin – into the bloodstream. Rhabdomyolysis can lead to permanent kidney damage. Finally, long-term methamphetamine users often fail to eat regularly, resulting in malnutrition. In combination, these consequences of meh use lead to general malaise, illness, and a chronic inability to heal from illness or injury.

Methamphetamine Withdrawal

In most cases, it’s not difficult to deduce someone is addicted to meth. The behavioral and emotional signs are often clear to friends and loved ones of the person misusing the drug, while the physical signs make it clear to others familiar with the condition.

Methamphetamine withdrawal – while uncomfortable – is more challenging psychologically than it is physically. When a person with a methamphetamine use disorder stops taking the drug, the levels of dopamine in the brain drop quickly. Because long-term methamphetamine use compromises the dopamine reuptake process, anhedonia – the inability to feel pleasure – sets in quickly. In some cases, it can take up to two years for the dopamine system in the brain to normalize.

The severity of methamphetamine withdrawal varies according to many different factors, including:

• The duration and amount of use
• Age: the older the user, the more difficult the withdrawal
• Overall mental and physical health before methamphetamine misuse began
• The potency/purity of the drug used

Methamphetamine withdrawal typically occurs in two phases:

Phase One

Known as the acute phase, this typically lasts a week to ten days, and begins about 24 hours after last use.

Phase Two

Known as the subacute phase, this typically lasts another two weeks, but may continue for as long as five weeks after last use.

Withdrawal symptoms are similar in both phases. The difference between the phases lies in the intensity and the severity of the subjective experience. In Phase One, symptoms are intense and difficult to endure. After about a week, Phase Two begins, and symptom intensity and severity gradually decline. In cases of mild methamphetamine addiction, withdrawal symptoms may disappear completely by the end of the second, subacute phase. In cases of severe addiction, withdrawal symptoms may last longer than the typical three-week withdrawal period described above.

Methamphetamine withdrawal symptoms include:

• Cravings
• Depression
• Anxiety
• Psychosis
• Paranoia
• Phobia
• Hostility
• Reactivity
• Body aches and pains
• Lethargy

The intensity of the symptoms – especially psychosis, depression, and paranoia – is more severe the longer the individual has been addicted to the drug. This makes abstinence challenging for long-term users, and that’s why relapse is common. However, research shows the best way to achieve sustained sobriety after methamphetamine addiction is through professional treatment at and specialized addiction treatment center.

Evidence-Based Treatment for Methamphetamine Addiction

The Substance Abuse and Health Services Administration (SAMHSA) indicates an integrated, holistic, medical treatment model is the most effective approach to methamphetamine addiction treatment. This approach addresses the entire person. This approach accounts for and supports all areas of life, including biological, psychological, and social factors that may be at play. If a co-occurring mental, behavioral, or mood disorder is present, then it’s essential to treat that as well. An integrated treatment plan must be customized to the needs of each individual.

Holistic treatment plans for methamphetamine use disorder include, but are not limited to:

• Individual counseling
  • Cognitive behavioral therapy
  • Motivational Interviewing
  • Dialectical behavioral therapy
• Group Counseling
• Family Counseling
• Medication (if needed)
• Community/peer support
  • 12 Step groups such as Narcotics Anonymous (NA)
• Lifestyle Modifications
  • Mindfulness
  • Experiential activities
  • Exercise
  • Expressive therapies (art, music, journaling)
• Relapse Prevention
  • Aftercare plans
  • Ongoing community support

When seeking treatment for methamphetamine addiction, it’s important to find a treatment program that includes all the elements above. Each element matters, and each contributes to long-term, sustained sobriety.

For methamphetamine users, the damage to the dopamine system means it may take a long time to feel healthy again. This makes the lifestyle and community support elements of recovery critical. The lifestyle changes give a person in recovery from methamphetamine use disorder a framework within which to live life without drug use, and community support gives them the human contact, compassion, and wisdom to help them make those lifestyle changes last.

Finding the Right Addiction Treatment Program

High-quality treatment programs, whether they’re residential, partial hospitalization, intensive outpatient, or outpatient, will include most, if not all, of the elements listed above. While different treatment programs around the country will have many common components and similar approaches to addiction treatment, each program has its own identity and vision of how to support its patient.

To find a high-quality treatment program, we recommend taking the following three steps:

1. Gather all the information you can about any center/program that may be a good fit
2. Call or visit the treatment center to get a feel for the clinical staff, support staff, and general atmosphere.
3. Confirm they offer the elements listed above. Tip: the best treatment programs also have the best people answering the phones. If the person on the phone is vague, uniformed, or can’t answer questions to your satisfaction, check that center off the list, and move on to the next one.

Committing to an addiction rehab program is a big, life-changing decision. That’s why it’s critical to find the highest quality professional support at a program that’s not only high-quality but also has a treatment philosophy and treatment environment that resonates with the specific needs of the individual in need of support. When an individual with methamphetamine addiction finds the right program for them, their chances of achieving lifelong recovery increase dramatically.

When someone you love experiences problems with alcohol, it’s not easy to know exactly what you should do about it. You love them and you want what’s best for them. You want to see them live a healthy, fulfilling life. But you’re not sure how you can help. You’re not even sure if it’s your place to say anything or try to stage an alcohol intervention.

First, we want to tell you that if you love someone and you’re concerned about them, it’s important to tell them how you feel. Therefore, your first step – when you’re concerned about a loved one’s drinking – is understanding that yes, it is your place to say something. You can’t control how they react to what you say, but you can control you – and there’s never anything wrong with telling a loved one you’re worried about them, you’re there for them, and you want to help them.

Now that we’re clear on that, let’s talk about the drinking. More specifically, about things you already think, feel, or do that are related to your loved one’s alcohol consumption. Have a look at this list and ask yourself if any of these statements apply to you:

• You spend time and energy thinking about their drinking
• You make excuses for the amount and frequency they drink
• When they drink, you feel unsafe
• When they fail to fulfill their work, school, or family responsibilities, you cover for them
• You offer support that goes unrecognized or unappreciated – this may be money, or it may be other types of practical support
• You fear how they may react if you bring up their drinking

If any of those statements are true for you, then it’s time to consider having a serious conversation with your loved one about drinking.

How to Talk to Them/Stage an Alcohol Intervention

The hardest part of this might be gathering the courage to initiate the alcohol intervention conversation. Remember: this comes from a place of love and concern. You owe it to yourself and to them to express your feelings and offer to help in any way you can. You may be nervous, and that’s okay. Marshal your emotions, coax the butterflies in your belly to fly in formation, and take solace in the fact you’re doing the right thing – even if it’s incredibly hard.

Here’s a step-by-step approach that has a good chance of success:

1. Schedule a time to talk. Avoid bringing up the subject when they’re intoxicated or when you’re emotional. Tell them you have something important you need to discuss with them and prepare yourself to have the talk in a calm, rational manner.
2. Lead with empathy and love. Make sure the first thing they hear from you is that you love and support them. That’s why you’re having the conversation.
3. Tell them what you see. Describe – with concrete examples – the aspects of their alcohol-related behavior that concern you.
4. Listen to what they say. Let them talk. Listen without interrupting. As you lead with empathy and love, also listen with empathy and love.
5. Tell them what you would like to see. Offer ideas for specific behavioral changes that you think will improve both your relationship and their overall health and wellbeing.
6. Come up with an action plan. This depends on how the conversation went, of course. If it went well – meaning they heard and understood your concerns and are ready to make changes – then you can help them start their recovery journey to detox.

The most important thing to remember about alcohol interventions is that it’s not a conflict. If things get heated, take a step back. Take a break, maybe take a walk, and pick back up when you’ve had a moment to cool down.

The Next Step: Beginning Recovery

Your goal is to help.

If you see someone you love engaging in a dangerous pattern of alcohol use that damages their physical health, their mental and emotional wellbeing, their work and school responsibilities, and their personal relationships, then the way you help them is by playing a part in initiating behavioral change.

To do that, they need to see the need to change for themselves. That’s why, in your conversation, you offered specific examples of the behaviors that worry you. Whether the alcohol intervention goes well or goes south, there’s one more step you can take: offer access to recovery resources. The best way to handle problem drinking is by seeking professional help at an addiction treatment center or an inpatient rehab facility that offers integrated, evidence-based, data-driven treatment for people with an alcohol use disorder.

You can help your loved one get treatment by arranging an appointment with a therapist, a drug and alcohol counselor, or the admissions staff at a treatment center. If they’re not ready to take that step, then encourage them to seek social support in the community. Programs such as Alcoholics Anonymous (AA) are a good place to start: you can find daily meetings in just about every city and town in the country.

Make a list of meeting dates, times, and locations. Try to get them to commit to going to at least one meeting. Remind them that all AA meetings are anonymous, it’s okay to go to a meeting just to sit and listen, and that everyone is there for the same reason: they want to move past their problem drinking and live a productive, fulfilling, and sober life.

Alcohol use disorder (AUD) – formerly known as alcohol dependence or alcoholism – is a matter of urgent concern in this country. Consider the statistics. The 2020 National Survey on Drug Use and Health (NSDUH) categorizes 17.7 million Americans – slightly more men than women – as heavy drinkers. That’s nearly 7% of the population. And they’re all at significant risk of developing AUD.

The social and economic costs of alcohol use disorder are considerable. Each year, an estimated 88,000 Americans die from alcohol-related causes. From job loss to accidents and injuries, to healthcare costs from associated medical problems, the burden on society from alcohol misuse is a significant one. This makes the prevalence of alcohol use disorder something that matters to us all.

It’s not surprising, then, that research into new treatments for alcohol abuse is ongoing. Researchers and clinicians seek and test new approaches constantly. Evidence shows many of these new approaches help people quit drinking, rebuild their lives, and move toward a healthy and productive future. Yet a recent study found that the rate of alcohol use disorder among adults in the United States increased dramatically over the past two decades.

If effective, evidence-based treatments are available, why does the problem persist?

A significant part of the answer lies in what addiction professionals call the treatment gap.

What is the Treatment Gap?

Simply put, the phrase means that not everyone diagnosed with alcohol use disorder receives care or intervention. Statistics show that in the United States, of the people diagnosed with AUD, only about 8.0 % of men and 7.7 % of women sought treatment.

This problem has multiple underlying causes. Stigma is one of the most powerful and pervasive. In recent history, particularly in the U.S., alcoholism was viewed as a personal weakness or failure. The idea that the disordered use of alcohol is a moral failing, rather than a medical issue, is tied to early cultural values of abstention, cleanliness, and discipline. Despite research suggesting otherwise, the notion that a person can and should give up drinking by relying on willpower alone persists today.

The Problem of Stigma

Though the roots of this attitude are rooted in our social and cultural norms, it’s perpetuated not only in society at large, but sometimes within the medical profession itself. That’s a place where people who seek treatment should be able to expect to find evidence-based support, sound scientific information, and compassionate care. Unfortunately, that’s not always the case. There’s a persistent stigma surrounding people with alcohol use disorder. There’s also a persistent stigma surrounding treatment for alcoholism.

Meanwhile, drinking alcohol has become increasingly less stigmatized in recent years. This has happened for demographics that were once strongly discouraged by social taboos from consuming alcohol at all, such as mothers and older women.

These attitudes are hard to pin down. Many people don’t realize they have them. Therefore, they don’t know they perpetuate them. Nevertheless, this embedded stigma has real and detrimental effects on people with alcohol use disorder and want to quit. In many cases, stigma prevents them from seeking life-changing and life-saving treatment.

For those looking to change their habits around drinking, stigma and misinformation also make it difficult to find reliable information. People want to quit, but stigma prevents them from finding safe and healthy methods for seeking sobriety. In addition, some may fear withdrawal symptoms, hold misconceptions about alcohol use disorder and sobriety, or simply lack knowledge of the various evidence-based and effective treatment options available to them.

Many will seek treatment only when forced by some extreme circumstance, such as a court order, a severe accident or injury, loss of employment, or family intervention.

Awareness and Access

The stigma surrounding alcohol use disorder (AUD) and seeking treatment might be less problematic if everyone diagnosed with AUD had equal access to all available treatments. However, this is not the case. The availability of support groups varies by geographic location. In some poor or rural areas, there may be little to no access to treatment at all. Although these geographic disparities in access are gradually being remedied by the increased use of virtual care and online community support meetings, not everyone in rural areas has reliable internet access. Also, many insurance programs don’t cover treatment. This makes cost a significant barrier to care even in well-served areas.

There’s also a lack of awareness about the latest advances in treatment. For example, some medications show promise for reducing the severity of withdrawal symptoms. There are also medications that reduce the craving for alcohol. These medications can facilitate behavioral change. They help break patterns of craving in the reward circuit in the brain. In the absence of intense cravings, a person in recovery has an increased chance of developing and reinforcing new, life-affirming skills and behaviors.

How Can We Close the Treatment Gap?

Though it won’t change overnight, increased knowledge and awareness of the medical model of addiction is a crucial piece of the puzzle. This awareness can help reduce the stigma surrounding the misuse of alcohol. The medical model prioritizes the perspective that addiction is a chronic medical condition that responds well to evidence-based treatment. It allows people to seek treatment without the fear they’ll be demonized or shamed for having a medical condition that’s analogous to other chronic conditions such as hypertension or diabetes.

Data also indicates that, when routine screening for problem alcohol use becomes part of a regular annual checkup, patients can begin to see alcohol use disorder as a medical problem. They understand AUD – like high blood pressure or diabetes – must be treated. And the best way to treat AUD is with professional treatment and support.

Evidence shows that the most effective treatment for alcohol use disorder follows a multi-modal, integrated model. High-quality residential programs for people with AUD typically include:

• Group therapy
• Individual therapy, which may include:
  • Cognitive behavioral therapy
  • Dialectical Behavior therapy
  • Motivational interviewing
• Exercise
• Nutrition
• Yoga and meditation
• Music and art

These approaches help people develop the practical skills they need to achieve sobriety and abstinence. The best treatment programs are progressive, stepwise, and tailored to the individual. We can trust them because decades of clinical data prove they’re safe and effective.

Professional support and care can help people move past the painful, damaging cycles of addiction and create a sustained life in recovery. Committing to treatment is a big step. The work can be challenging. However, we know from experience that for those willing to take the step and do the work, treatment works – and can change their lives for the better.

The Ridge offers a complete detox program and an inpatient rehab center to help people fight addiction.

What is the link between insomnia and binge drinking?

When you ask people about the challenges associated with quitting alcohol, one thing you hear often is “I can’t get to sleep without drinking.” When you ask people who begin drinking again after they try to stop – known as relapse – they often cite insomnia as one of the factors. In fact, research shows that around half the individuals diagnosed with alcohol use disorder (AUD) – formerly known as alcoholism – also have insomnia. Depending on what study you read, the number may be as low as 36 percent or as high as 72 percent.

Whether it’s 36 percent, 72 percent, or somewhere in between, experts agree that insomnia, alcohol use disorder, and relapse are related phenomena. Over the past twenty years, researchers have conducted experiments to try to unravel this relationship, and solve the problem of insomnia-related relapse. Several studies indicate that therapeutic interventions such as cognitive behavioral therapy (CBT), classes on sleep hygiene, and medication can reduce insomnia and help prevent relapse.

A recent study conducted at the University of Missouri-Columbia took a different approach. Rather than analyzing the effect of therapeutic intervention on the behavior of people with insomnia in recovery from AUD, they analyzed the effect of a specific therapeutic intervention – cognitive behavioral therapy (CBT) – on young, active binge-drinkers with a high risk of experiencing alcohol-related harm.

Finding a Path Around Stigma – Insomnia and Binge Drinking

The National Institute on Alcohol Abuse and Alcoholism (NIAA) defines binge drinking as “drinking more than four alcoholic beverages (women) and five alcoholic beverages (men) on one occasion.” This Missouri study focused on people aged 18-30 who reported binge drinking at least once in the month before the study began. The goal of the study was to find a way to reduce the harm associated with excess drinking by targeting the related phenomenon of insomnia without addressing the binge drinking directly.

In an interview with Science Daily, study author Mary Beth Miller, Ph.D., explained the approach:

The potential for insomnia treatment to influence alcohol-related consequences has significant implications for the prevention and treatment of alcohol use among young adults. Given the stigma associated with mental health issues and addiction, it’s crucial to identify other forms of treatment that either influence alcohol outcomes or open the door to alcohol-related treatment.”

The reasoning is rock-solid. Despite decades of awareness efforts and public advocacy campaigns to reduce stigma around alcohol use disorder and the treatment of alcohol use disorder, stigma around addiction and treatment still prevent people with drinking problems from seeking treatment. While we don’t have detailed information about why every person who needs treatment does not seek treatment, we know that a significant treatment gap exists. We also know stigma around treatment contributes to the treatment gap.

To learn more about the treatment gap and stigma, please read our article Alcohol Use Disorder in Adults: The Treatment Gap.

With regards to the effect of CBT on insomnia, and the knock-on effect on alcohol related harms, this Missouri study yielded important results. They indicate Dr. Miller and her team may be onto something important.

The Effect of Improving Sleep on Young Binge Drinkers

The study involved 56 participants who were divided into two groups. One group received five sessions of cognitive behavioral therapy (CBT) for insomnia. The other group received a single session on sleep hygiene. The CBT group received instruction on subjects such as sleep diaries and relaxation techniques. In contrast, the sleep hygiene group received instruction on how to create a consistent bedtime routine and arrange their sleeping space to improve their sleep environment.

Here’s what the researchers found:

• CBT group:
  • 56% decrease in the severity of insomnia symptoms
  • Moderate improvement in sleep efficiency: more hours asleep in bed
  • Moderate reduction in drinks per week
  • Reduction in negative consequences of drinking
• Sleep hygiene group:
  • 32% decrease in the severity of insomnia symptoms
  • No reported improvement in sleep efficiency
  • Moderate reduction in drinks per week
  • Moderate reduction in negative consequences of drinking

These results are modest, we admit. However, they contain an easter egg of sorts. The 56 percent reduction in the severity of insomnia symptoms for the CBT group is an important finding. We’ll return to that in a moment. The big picture takeaway is that the idea behind the study – discover a way to reduce alcohol harm that doesn’t involve stigma – showed itself as valid and worthy of further pursuit. Both groups reduced drinks per week and negative consequences of drinking. That’s a positive finding. But here’s where it gets interesting. They did it by addressing their sleeping patterns. They didn’t address their alcohol consumption directly. That’s a new development in the treatment of alcohol use disorder.

Cognitive Behavioral Therapy, Sleep, and Alcohol-Related Harm

Now we’ll talk about the specific data around insomnia. The cognitive behavioral therapy (CBT) group showed a 56 percent reduction in the severity of insomnia symptoms. We see this as an important data point for two reasons. The first is related to relapse. If insomnia is a significant driver of relapse, and CBT for insomnia reduces the severity of insomnia symptoms, it follows that CBT for insomnia for people in recovery from AUD may help them prevent relapse.

Let’s be clear.  The study authors do not say that. But we see that potential in the data.

The second reason is that CBT had a positive effect on the sleeping and drinking patterns of people who are neither in recovery nor receiving treatment for alcohol use disorder. This is another piece of evidence in support of the holistic, integrated model of AUD treatment.

The integrated model advocates treating the whole person. It doesn’t focus solely on the disorder. In the case of these 56 people between the age of 18 and 30 who reported binge drinking at least once in the month before the study, this means that treating an aspect of their overall wellbeing – sleep – had a positive effect on their drinking. It also led to an overall reduction in the number of drinks per week. Finally, it led to a reduction in the negative consequences of drinking.

This is good news and offers a novel entrée to the treatment of problem drinking in young adults. By sidestepping any question of stigma or fear of treatment, it offers young binge drinkers a potential pathway to reducing alcohol consumption. In addition, it may, in the long run, point them in the direction of seeking support for problem drinking, and help them take their first steps toward recovery.

If you need help with the detox process, The Ridge offers an inpatient rehab facility in Cincinnati and the outpatient and partial hospitalization treatments you can enroll in.