Increase In Anxiety and Depression Linked to Increased Problem Drinking

Should we be concerned about an increase in alcohol use post-COVID?

In a letter published in the Journal of General Internal Medicine in late 2020, public health scientists Dawn Sugarman, PhD, and Shelly Greenfield, MD, of McLean Hospital at Harvard University warned that an increase in alcohol use in response to the stress caused by the coronavirus pandemic raised “significant public health concerns.”

The two doctors cited observed increases in alcohol consumption in the U.K. and Australia as potential indicators of similar increases here at home, and pointed out the disturbing fact of the treatment gap for people with alcohol use disorder (AUD): in the U.S. only 7.9% of people diagnosed with AUD receive the specialized treatment they need to address their disordered alcohol use.

They go on to point out that increased drinking – and substance use – is a common response to trauma, stress, and events involving large-scale suffering, injury, or death. A study published in 2009 analyzed the use of alcohol and drugs in response to one of the most infamous mass-trauma events in U.S. history – the 911 terrorist attacks – and concluded the following:

• 7.3% of a population can be expected to increase alcohol consumption in the first two years following a terrorist event
• There is a 20% probability that 14% of a population will increase alcohol consumption following a terrorist event
• An estimated 16.3% of a population can be expected to increase the use of both prescription and narcotic drugs following a terrorist event

Evidence from the aftermath of the 911 attacks is relevant because, although the coronavirus pandemic is not a terrorist attack, it is a mass casualty scenario. At the time they wrote the letter, we were still early in the pandemic. Sugarman and Greenfield made another critical point: unlike the 911 attack, the coronavirus pandemic was ongoing, and no one knew when it would stop.

Stay-at-Home Orders, Isolation, and Stress

In retrospect, the ongoing nature of the public, pandemic-related trauma was something mental health experts did not appreciate fully. Whereas single-incident events cause significant distress and trauma, their finite nature allows people who experience them to process the experience and move forward. That’s to say that their trauma does not persist. Rather, it means that the traumatic event can be contextualized and understood with the benefit of hindsight. This is not the case with the coronavirus pandemic.

Sugarman and Greenfield identified several layers of ongoing pandemic-related stressors that had the potential to lead to increased alcohol consumption:

1. Fear of contracting SARS-COV-2 itself

2. Psychological distress due to lack of social contact

3. Reduced participation in social support groups such as Alcoholic Anonymous (AA) due to public health guidelines

4. Reduced access to specialized treatment for Alcohol Use Disorder (AUD)

5. Job loss, income insecurity, and worry about finances

These five groups of potential stressors increased the risk of heavy and/or disordered drinking, which can lead to significant physical and emotional problems. Negative physical consequences of excess drinking include liver disease, cancer, high blood pressure, stroke, impaired immunity, and fatalities from drunk driving accidents. Negative emotional and psychological consequences of excess drinking include increased risk of depression, suicide, intimate partner violence, child abuse, and child neglect.

According to Sugarman and Greenfield, that was our current situation early in the pandemic: a perfect storm of stress that had the potential to lead to a nationwide alcohol consumption crisis, which, as noted above, itself had the potential to create a new public health emergency, in addition to the coronavirus pandemic.

And it turned out they were right. Studies published in 2020 and 2021 showed:

• Increases in anxiety disorders
• Increases in depressive symptoms
• A 60% increase in alcohol consumption
• An increase heavy drinking and binge drinking

That’s why it’s important for us to look back at the prescient insight Sugarman and Greenfield offered. The steps they recommended we take a year ago are just as important now as they were then. They may even be more important now.

Steps to Take: Awareness, Assessment, and Treatment

In light of the heightened risk of problem drinking related to coronavirus-related stressors, Sugarman and Greenfield recommended a series of proactive steps we, as a nation, can take to “moderate and reduce alcohol consumption in the face of this pandemic.” They reiterated that the full scope of the pandemic was not yet known and that it’s wise to look to the data provided by researchers in other countries in order to prepare for the potential collateral damage the pandemic may cause in the U.S.

Here’s what they recommended:

Step 1:

We should raise awareness about the fact that stress related to the coronavirus pandemic created and continues to create the risk of increased alcohol consumption, which may escalate to another nationwide health crisis in addition to the coronavirus pandemic.

Step 2:

We should realize our response to this risk needs to be nuanced, multi-faceted, and include everyone with any known risk factors for drinking or excess drinking.

Step 3:

We should advocate forward-thinking public health talking points. Public media outlets can counter the cultural messages (present in the form of social media posts and memes) that promote excess drinking. Public officials can prioritize messaging efforts that promote managing anxiety and stress without alcohol and substance use.

Step 4:

We should be ready for an increase in the need for treatment across a “continuum of severity” that includes “drinking-related exacerbation of other co-occurring medical conditions.”

Step 5:

In primary care settings, we should improve efforts to identify addiction and mental health issues early, by being aware of risk factors for increased drinking such as financial insecurity, and the presence of symptoms of anxiety and depression.

Step 6:

We should focus attention on targeted interventions for people with alcohol use disorder at risk of relapse, and expand access to telehealth, virtual therapy, and online social support communities for people in recovery. Increased access to these services and expanded insurance coverage for mental health/substance use treatment should last through the pandemic and beyond.

Integrated Effort with Full Collaboration

The open letter published by Sugarman and Greenfield – addressed to the medical community as a whole – is an important reminder that while we strive to manage our response to the primary health crisis, the coronavirus pandemic, the secondary effects of the pandemic, such as misuse of alcohol and an increase in alcohol use disorder (AUD), can create severe, chronic physical, emotional, and social consequences that may persist years after we get COVID-19 under control.

The sooner we can identify at-risk individuals, offer accurate diagnoses of AUD when necessary, and provide appropriate treatment and support, the more likely those individuals are to achieve and maintain sustained, long-term sobriety. Any steps we take in this direction will help to contain the scope of harm caused by the pandemic, and give people hope by offering a lifeline of support.

The Ridge in Cincinnati offers inpatient and outpatient rehab facilities. Besides, alcohol detox programs and other amenities help you identify the extent of the problem and get the right solution. Contact us today!

The statistics surrounding opioid addiction in the U.S. are staggering. In 2017, increasing rates of addiction and overdose deaths over more than two decades – beginning in the early 1990s – triggered an unprecedented response from the highest levels of government. That year, the Department of Health and Human Services (HHS), under the direction of the White House – with input from medical experts across the nation – declared the opioid crisis a nationwide health emergency.

A plan to address the crisis accompanied the declaration. The five-point nationwide strategy defined the following priorities:

1. Improve access to treatment, prevention, and recovery resources
2. Increase availability of and access to drugs that reverse overdose
3. Strengthen data reporting and collection processes
4. Invest in research on addiction treatment and pain management
5. Improve pain management practices

The statistics that led to this response were overwhelming and impossible to ignore. We’ll offer a quick look at the data from 2018, the year after the crisis declaration. These numbers show a small improvement over those from 2017:

• 47,600 opioid-related overdose deaths
  • That’s 130 deaths a day – a 200% increase from 1999
• 32,656 people overdosed on synthetic opioids
• 15,349 people overdosed on heroin
• 2,000,000 people diagnosed with opioid use disorder (OUD)
• 10,300,000 people reported misusing prescription opioids
  • 2,000,000 people reported misusing prescription opioids for the first time
• 808,000 people reported using heroin
  • 81,000 people reported using heroin for the first time

The areas of improvement from 2017 included overall overdose deaths, which decreased by two percent, prescription opioid-related deaths, which decreased by 13.5 percent, heroin-related deaths, which decreased by four percent, and synthetic opioid-related deaths, which decreased by 10 percent.

The Impact of the Pandemic on Opioid Overdose

Those decreases were a good sign. In comparison to 1999, however, the numbers make it clear we’re still a nation in crisis – and the preliminary numbers on overdose deaths during the coronavirus pandemic show that during 2020 and 2021, the opioid crisis did not go away.

The most recent statistics indicate that while our attention was on the pandemic, it got worse:

• Opioid-related deaths rose sharply in March 2020, the month most shelter-in-place orders began
• These opioid-related death levels remained high through August 2020 – the worst months on record for opioid-related deaths
• In 2021, over 93,000 people died of opioid overdose, our highest year on record, 20,000 more than our previous highest year.

That’s why it’s important for us all to understand that evidence-based treatment for opioid abuse or opioid use disorder works and can save lives, help families, and improve our communities.

Before we discuss treatment for OUD – a.k.a. opioid addiction – we’ll address a couple of topics to ensure we’re on the same page.

What Exactly Are Opioids?

First, we’ll address the question of vocabulary: what’s the difference between an opiate and an opioid?

An opiate is a narcotic pain reliever derived from the opium poppy plant, whereas an opioid is a narcotic pain reliever created in a laboratory with a chemical structure almost identical to opiates. Opium is the best example of an opiate, while prescription medications like fentanyl or oxycontin are the best examples of opioids. For the purposes of this article – and for general use by the public and medical professionals alike – it’s one hundred percent acceptable to use the two terms interchangeably.

Here’s a list of the most commonly abused opioids:

• Heroin
• Oxycodone (Oxycontin, Percocet, Percodan, Endocet)
• Hydrocodone (Vicodin, Norco, Lortab, Lorcet)
• Fentanyl
• Meperidine (Demerol)
• Hydromorphone (Dilaudid)
• Codeine
• Morphine
• Methadone

Of these drugs, heroin and morphine are the two most associated with illicit street use, while medications containing oxycodone and hydrocodone are the two most associated with prescription misuse.

Fentanyl, a synthetic drug that’s 50-100 times more powerful than morphine, is the most dangerous of all the drugs on the list. All the drugs listed are dangerous and can lead to addiction and accidental overdose. However, due to its potency, Fentanyl is the most dangerous. Fentanyl is a legitimate narcotic pain reliever used in limited clinical applications, but over the past five years, illicit Fentanyl of unknown potency has become widely available on the black market. In addition, street dealers add Fentanyl to other illicit drugs such as heroin, cocaine, methamphetamine, and MDMA, which increase risk of overdose and death.

Why Are Opioids So Addictive?

Opiate pain medications are intended to treat moderate to severe pain. When prescribed and used as directed following surgery or a medical procedure, they support the healing process by helping patients manage their pain.

Unfortunately, taking opiates can lead to disordered use because of the effect they have on the human brain. When opioids enter the body, they cause – directly and indirectly – the brain to release a flood of chemicals that trigger feelings of pleasure, satisfaction, and euphoria. Collectively, these sensations are what’s known as feeling or being high.

The human body has its own set of opioids – called endogenous opioids – that relieve pain naturally, and trigger similar sensations. External opioids – called exogenous opioids – interact with the same molecules as endogenous opioids, but the analgesic and euphoric effects are dramatically more powerful and intense than those triggered by endogenous opioids.

Another fact about opioids contributes to the risk of addiction: tolerance. Tolerance means that to achieve the same effect, more of the drug is needed with each repeated use. Through a process of several steps, prolonged opiate use can develop into an opiate addiction:

1. Tolerance: Larger doses of opiates are needed to create the same high.
2. Physical dependence: The body enters withdrawal in the absence of opiates.
3. Psychological dependence: Intense cravings for opiates drive repeated use, even when the user knows repeated use is unhealthy and dangerous.

Once physical and psychological dependence develop, a host of behaviors that cause physical, social, and emotional damage to the user manifest. Collectively, these behaviors are called opioid addiction or opioid use disorder (OUD).

Signs and Symptoms of Opioid Use Disorder (OUD)

While someone with OUD can experience harsh physical side effects, changes in behavior are often the more obvious signs of OUD. A severe OUD has negative consequences in almost every area of life: financial, professional, interpersonal, and legal – to name a few. That’s why it’s important to understand the primary symptoms, and how they may appear.

The behavioral symptoms of OUD vary from person to person. Here are some of the common behavioral signs to look out for:

• Inability to stop using opioids
• Isolating or withdrawing from family and friends
• Impaired work or school performance
• Inability to fulfill family obligations
• Stopping participation in/withdrawing from favorite activities
• Borrowing or stealing money
• Unexplained financial problems
• Ignoring or avoiding loved ones
• Drastic changes in behavior
• Lying about money
• Lying about drug use
• Faking pain-related injuries or hurting oneself to get a new prescription

The physical symptoms of OUD also vary from person to person, but there are common signs to look out for:

• Drowsiness
• Cravings
• Weight loss
• Changes in sleep patterns
• Changes in appearance: reduced care for personal hygiene
• Repeated flu-like symptoms
• Decreased libido

Like the behavioral and physical symptoms of OUD, the psychological symptoms can vary from person to person. Here’s what to look out for:

• Increased irritability
• Decreased cognitive function
• Defensiveness – especially around topics of addiction
• Increased symptoms of preexisting emotional disorders, such as depression, anxiety, or bipolar disorder

In isolation or when occurring occasionally, the signs and symptoms above may be related to any number of things other than OUD. Stress, anxiety, and challenging life circumstances can cause behavioral, physical, and psychological changes in anyone, independent of the presence of drug addiction. When these signs and symptoms persist over time or appear in clusters, they may indicate the presence of opioid addiction.

Signs and Symptoms of Opioid Withdrawal

Opioid withdrawal refers to the set of psychological, physical, and emotional responses that occur when someone addicted to opioids stops taking the drug. Withdrawal symptoms typically appear within 24 hours from the last dose. They’re divided into two categories: early and late.

Early symptoms of opioid withdrawal include, but are not limited to:

• Agitation/irritability
• Low energy
• Mood changes
• Anxiety
• Muscle aches
• Insomnia
• Runny nose
• Chills
• Profuse sweating
• Uncontrollable yawning

Late symptoms of opioid withdrawal include, but are not limited to:

• Stomach cramps
• Diarrhea
• Goosebumps
• Dilated pupils
• Increased heart rate
• Changes in blood pressure

Typically, the symptoms of opiate withdrawal – which can begin within 24 hours from stopping opiate use – are uncomfortable but not necessarily life-threatening, except in cases of extremely long-term use or in the presence of underlying health conditions. Additionally, if opioid use is combined with the use of other drugs, the chances for serious adverse complications during withdrawal increase dramatically. That’s why it’s vital that an individual be closely monitored by a physician during withdrawal.

Physical withdrawal symptoms can last anywhere from a week to a month. The psychological and emotional symptoms – low energy, insomnia, and anxiety – can last for several months, depending on the duration and level of use. Long-term users may experience post-acute withdrawal symptoms (PAWS). These symptoms occur because the brain takes time to achieve homeostasis – or equilibrium – in the absence of opioids. During this time, severe mood swings are common, and the various physical symptoms of withdrawal may come and go rapidly. Generally, post-acute withdrawal periods last only a few days but long-term opiate addicts report experiencing symptoms for up to two years after cessation of use.

After supervised withdrawal, it’s important to seek professional treatment for opioid use disorder. Professional treatment and support are vital to long-term abstinence and sobriety.

Evidence-Based Treatment for Opioid Addiction

The most effective treatment for opioid use disorder (OUD) follows an integrated treatment model. Integrated treatment is holistic, meaning it addresses the entire person, including all the biological, psychological, and social aspects of their life. If a co-occurring mental, behavioral, or mood disorder is present, then it’s essential to treat that disorder as well. An integrated treatment plan must be tailor-made and customized to the needs of each individual.

Evidence-based treatment plans for OUD include, but are not limited to:

• Individual counseling
  • Cognitive behavioral therapy
  • Motivational Interviewing
  • Dialectical behavioral therapy
• Group Counseling
• Family Counseling
• Medication (if needed)
  • Methadone, Suboxone, buprenorphine
• 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 OUD, find a treatment program that includes all the elements above. Each piece is important, and each contributes to long-term, sustained sobriety. The most highly regarded treatment programs, whether they’re residential, partial hospitalization, intensive outpatient, or outpatient, include the elements above, in varying degrees. Although the fundamental elements of effective treatment programs are universal, each treatment program or center has a unique identity and specific approach to treatment.

The best way to find an appropriate match is to gather all the information available on a given treatment program or detox center, then call or visit to get a feel for the clinical staff, support staff, and general atmosphere. Committing to treatment is a life-changing decision, and receiving the highest quality professional support in an environment that synchronizes with the specific needs of the person in treatment increases their chances of achieving sustained, lifelong sobriety.

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.