Download PsychoSocial Issues HIV Dr.DeWitt 2013

The Nexus of HIV: How Mental Illness,
Childhood Sexual Abuse, and Other Factors
Make Individuals Vulnerable to HIV and
Other Sexually Transmitted Infections
M. Jann DeWitt, PhD
Assistant Professor
Department of Family and Preventive Medicine
School of Medicine
University of Utah
Objectives

To understand the role of mental illness in creating
vulnerability to HIV/AIDS and other STD’s.

To understand the mental health issues impacting
individuals who have been diagnosed with HIV/AIDS.

To be able to discuss the integration of treatment for
HIV and mental illness.

To identify major issues in psychotherapy with HIV+
patients.
Risk Factors for
HIV Infection and Transmission




Mental Illness
Drug Abuse
Trauma
Sexual Abuse
Mental Health and HIV and STD’s

HIV elevates mental health risk

Mental health issues elevate HIV and STD risk
–
–
–

Increased risk for transmission
Increased risk for nonadherence
Possible increased risk for disease progression
Substance abuse goes with both
–
–
Mental health issues go with substance use
Substance use complicates HIV treatment
Reported Chlamydia Cases and
Rates**(Per 100,000) for State of Utah
2004
2005
2006
2007*
Cases
Rates
Cases
Rates
Cases
Rates
Cases
Rates
3,859
156.28
4,602
181.97
5,092
197.18
5,721
211.92
* Provisional data as of 07/10/08
Utah Department of Health, Bureau of Communicable Disease Control, HIV/AIDS and STD Surveillance Program
Reported Gonorrhea Cases and
Rates**(Per 100,000) for State of Utah
2004
2005
2006
2007*
Cases
Rates
Cases
Rates
Cases
Rates
Cases
Rates
603
24.42
727
28.75
888
34.38
821
30.41
* Provisional data as of 07/10/08
Utah Department of Health, Bureau of Communicable Disease Control, HIV/AIDS and STD Surveillance Program
Reported Primary and Secondary Syphilis Cases
and Rates**(Per 100,000) for State of Utah
2004
2005
2006
2007*
Cases
Rates
Cases
Rates
Cases
Rates
Cases
Rates
13
0.53
10
0.39
21
0.81
20
0.74
* Provisional data as of 07/10/08
Utah Department of Health, Bureau of Communicable Disease Control, HIV/AIDS and STD Surveillance Program
U.S. Trends in the HIV Epidemic

Growing and persistent health threat to women,
especially young women and women of color.

Persons of minority races and ethnicities are
disproportionately affected.

More young MSM (men who have sex with
men) are being impacted by HIV/AIDS.
U.S. HIV/AIDS Statistics
Transmission
Categories
AIDS
Cases
%
HIV
Positive
%
Men Having Sex with
Men (MSM)
422,769
45%
74,150
31%
Injection Drug Use
229,811
25%
33,434
14%
MSM/IDU
61,080
6%
9,483
4%
Hemophilia
5,737
1%
677
0%
117,063
12%
39,482
16%
Transfusion/Tissue
9,780
1%
1,306
1%
Other/Undetermined
94,042
10%
83,391
34%
Subtotal for Adults
940,282
100%
241,923
100%
9,446
100%
5,028
100%
Heterosexual Contact
Subtotal for Children
(under 13 years)
Total Adults and
Children
949,728
246,951
HIV/AIDS Reporting for Utah and United States February 29, 2008
U.S. HIV/AIDS Statistics
Total Deaths
AIDS
Cases
%
541,345
57%
HIV/AIDS Reporting for Utah and United States February 29, 2008
Utah HIV/AIDS Statistics
Transmission
Categories
AIDS
Cases
%
HIV
Positive
%
Men Having Sex with
Men (MSM)
1,484
62%
551
56%
Injection Drug Use
388
16%
106
11%
MSM/IDU
237
10%
126
12%
Hemophilia
48
2%
1
0%
Heterosexual Contact
146
6%
87
9%
Transfusion/Tissue
26
1%
2
0%
Other/Undetermined
80
3%
118
13%
2,409
100%
991
100%
20
100%
13
100%
Subtotal for Adults
Subtotal for Children
(under 13 years)
Total Adults and
Children
2,429
1,004
HIV/AIDS Reporting for Utah and United States February 29, 2008
Utah HIV/AIDS Statistics
Total Deaths
AIDS
Cases
%
1,168
48%
HIV/AIDS Reporting for Utah and United States February 29, 2008
July 2008 e
July 2008 e
July 2008 e
July 2008 e
July 2008 e
July 2008 e
July 2008 e
July 2008 e
Mental Illness and
Risk Factors for HIV/AIDS
McKinnon et al (2001) interviewed 195
patients with severe mental illness.

51% were sexually active
had a mean of 3.9 sexual partners in the
previous 6 months with


average of 27.5 sex episodes
Mental Illness and
Risk Factors for HIV/AIDS
49% had known high risk partners
 34% used alcohol or drugs during sex
 28% traded sex
 59% never used condoms

Mental Illness among HIV+
Individuals

Occurs at very high rates among HIV+ individuals
(Dr. Deborah Haller, Virginia Commonwealth
University, in a multi-site study)

Dual and Triple Diagnoses were common
–
–
–
–
94% of substance users had a co-occurring
psychiatric disorder
88% had at least one non-substance use psychiatric
disorder
43% of those with psychiatric diagnoses also had a
substance use disorder.
Mental Illness among HIV+
Individuals

HIV and Mental Illness Study (11 sites around the U.S.).
This CMHS study included 1,837 HIV+ male and female
subjects, minorities, heterosexuals and homosexuals.

Dr. Haller reported preliminary data for HIV+ men:
Mental Illness among HIV+
Individuals







Major Depression
Drug Dependence
Generalized Anxiety Disorder
Panic Disorder
Alcohol Dependence
Dysthymia
Agoraphobia
59%
48%
26%
25%
22%
22%
14%
Mental Illness among HIV+
Individuals

From Richmond Site, Dr. Haller reported
these other Axis I, DSM IV diagnoses in HIV+
Men (N=150) and Women (N=41) based on
the Millon-III:
–
–
–
–
–
–
Anxiety Disorder
Somatoform Disorder
Post Traumatic Stress Disorder
Thought Disorder
Bipolar Disorder
Delusional Disorder
82%
16%
19%
13%
11%
10%
Mental Illness among HIV+
Individuals

Dr. Haller also reported these Axis II, DSM IV
diagnoses for HIV+ Men and Women from the
Richmond Site based upon the Millon III:
–
–
–
–
–
–
–
–
Dependent
Passive Aggressive
Avoidant
Schizoid
Borderline
Paranoid
Antisocial
Schizotypal
45%
43%
39%
33%
32%
24%
22%
16%
How does HIV Infection Impact
Mental Health?



CSF Viral Load
Psychosocial manifestations of disease
Impact of diagnosis, etc.
With Asymptomatic Infection



HIV invades the brain at initial infection
Neither condition is rare and association may
be due to chance
Not known if HIV by itself increases biological
vulnerability to certain mental illnesses.
With Symptomatic Illness
-Concern is differential diagnosis
-Can be a complication of substance
use/withdrawal, medical illness, metabolic
disturbances, neuropsychiatric
manifestations of HIV (e.g.,HAD, MCMD),
side effects of HIV-related medications, etc.
-Can occur at the initial presentation of
symptomatic HIV illness.
Personality Traits/States Associated with
Sexual risk Behaviors for HIV exposure and
Transmission





Sensation seeking
Impulsivity
Conscientiousness (negatively associated)
Neuroticism (weakly associated)
Agreeableness ( negatively associated)
*Hoyle, Fejfar, and Miller, Personality and sexual risk taking: A
quantitative review. Journal of Personality,68;6: 1202-31
Common Treatment Dilemmas

Provider counter transference reactions to
“self- destructive” and “manipulative” patient
behaviors. These patients are the most
difficult to manage long term , the
paradoxical help seeking chronically help
rejecting patient.

Sensible limit-setting.
Personality Disorders Associated
with HIV Risk




Borderline
Antisocial
Histrionic
Dependent
Medical Management of Unstable
PD Patients



Reframe all consequence avoidance so this becomes a
reward
Appeal to the patients cognitive capacities in lieu of
mandate or ultimatums which typically result in non
productive power struggles and stalemates.
Treatment plans should be written down clearly and
agreed upon collaboratively setting firm limits and
realistic goals based on provider resources and
mandates .
Social Discrimination and Mental Health
Outcomes in Latino Gay Men
Rafael M. Díaz
Director, César Chávez Research Institute
College of Ethnic Studies
San Francisco State University
A Sociocultural Model of Mental
Health
Psychological Symptoms
Psychological Impact of Oppression
Discrimination and Social Oppression
Oppressive Sociocultural Factors
Machismo / Homophobia
Family Loyalty
& Sexual Silence
Poverty & Racism
Violence & Sexual Abuse
HIV/AIDS Stigma
Psychosocial Impact of Oppression
Loneliness / Social isolation
Self esteem / Self respect
Internalized homophobia
and sexual discomfort
Low perceptions of
sexual control
Hopelessness about
HIV infection
Psychological Symptoms
Anxiety
Depression
Suicidal Ideation
Sample Characteristics
• 912 men recruited
probabilistically in 35
Latino gay bars
• 50% under age 30
• New York:
n = 309
• Miami:
n = 302
• Los Angeles: n = 301
• 27% unemployed
• 84% self-identified
gay or homosexual
• 72% immigrant
(including Puerto Rico)
• 64% some college or more
• 41% mostly Spanishspeaking (with friends)
• 22% HIV-positive
Physical & Psychological Symptoms
last 6 months
Felt sick
54% (49-59)
Difficulty
sleeping
61% (56-66)
Scared for
no reason
44% (39-49)
Sad or
depressed
80% (76-84)
Suicidal ideation
17% (15-20)
Impact of HIV/AIDS Stigma on
HIV-Positive Men (N = 154)
Prevalence
Reported Impact
More difficult to trust people
64%
Harder to enjoy sex
66%
More difficult to find sex
46%
More difficult to find lover relationships
58%
Worried that any physical symptom is
a sign of AIDS
72%
Expects sexual rejection after disclosure
82%
Has to hide HIV status to find
acceptance from family and friends
45%
Treated unfairly for being HIV-positive
46%
Testing the Impact of HIV/AIDS Stigma
on the Mental Health of HIV-Positive Men
Basic Model
Resiliency
Poverty
Racism
Homophobia
Social
Isolation
Low SelfEsteem
Psychological
Symptoms
D R2 ?
Enhanced Model
Resiliency
Poverty
Racism
Homophobia
HIV/AIDS
Stigma
Social
Isolation
Low SelfEsteem
Psychological
Symptoms
Models of Oppression for Health
Outcomes of HIV-Positive Men
Predicted
Outcome
SCM + Stigma
Sociocultural “Enhanced”
Model
“Basic” Model
p
R2
R2
DR2
Loneliness
.30
.48
<.0001
Low Self-Esteem
.28
.31
<.05
Psychological Symptoms
.24
.35
<.001
Association Between Early Sexual Abuse and Adult
HIV-Risky Sexual Behaviors among CommunityRecruited Women
K. Parillo, R. Freeman, K. Collier, and P. Young
Journal of Child Abuse & Neglect
Volume 25, Issue 3, March 2001, Pages 335-346
Early Sexual Abuse & Adult HIV-Risky
Sexual Behaviors in Women

Methods
–
Recruitment in Boston, Los Angeles, & San Diego
–
Women recruited from neighborhoods
characterized by high HIV seroprevalence rates
–
Eligibility requirements:

Has not injected drugs in year prior to study

Has had sexual intercourse with male IDU at least once in
last 5 years
Early Sexual Abuse & Adult HIV-Risky
Sexual Behaviors in Women

Results
–
–
34% of women had experienced sexual abuse with
penetration

9% childhood only

17% adolescents only

7% both childhood & adolescents
49% had been raped in adulthood
Early Sexual Abuse & Adult HIV-Risky
Sexual Behaviors in Women

Results
–
Women penetrated in childhood (<12 yrs old) were 2.4 times
more likely to have traded sex for $ or drugs
–
Women penetrated in adolescence (12-18 yrs old) were 1.7 times
more likely
–
Women penetrated in both childhood and adolescence were 3.4
times more likely to have engaged in such behavior
–
Women who had been raped in adulthood were 2.9 times more
likely than women who had not been raped to have ever engaged
in sex trading
Early Sexual Abuse & Adult HIV-Risky
Sexual Behaviors in Women

Results
–
Sexual abuse in childhood was a predictor of # of
recent sex partners (p=0.03)
–
Other predictors include:



–
Adulthood rape (p<0.01)
Recent drug use (p<0.01)
Recent IDU Sex Partner (p<0.01)
Adulthood rape was a predictor of having
unprotected vaginal or anal sex (p=0.05)
Childhood Sexual Abuse and Risk
Behaviors Among Men at High Risk for
HIV Infection
C. Dilorio, T. Hartwell, & N. Hansen
American Journal of Public Health
Volume 92, Number 2, Feb 2002, Pages 214-219
Childhood Sexual Abuse & Risk
Behaviors Among Men

Methods
–
Recruitment from STD clinics in 7 US sites
–
Eligibility requirements:

Unprotected vaginal/anal intercourse in past 90 days

At least one of the following during the past 90 days
–
An STD
–
Sex with a new partner
–
More than 1 sex partner
–
Sex with a partner known to have multiple partners
–
Sex with an IDU
–
Sex with an HIV+ partner
Childhood Sexual Abuse & Risk
Behaviors Among Men

Results
–
25.2% of men reported unwanted childhood sexual activity

–
Average number of unprotected sex acts (in past 90 days)


–
This was more common among Hispanic men
31.9 for men with unwanted childhood sexual activity
26.5 for men without childhood sexual activity
Average number of sexual partners


6.4 for men with unwanted childhood sexual activity
5.0 for men without childhood sexual activity
Childhood Sexual Abuse & Risk
Behaviors Among Men

Results
–
Risky behavior higher among men with unwanted childhood
sexual activity
–
Men with childhood sexual abuse were 6.79 times more likely
to report unwanted sexual activity as an adult
–
Bartering sex was more common among men who had
unwanted sexual activity as a child
 OR 1.59 for buying sex
 OR 2.22 for selling sex
 OR 1.61 for bartering sex for food or a place to stay
Childhood Sexual Abuse & Risk
Behaviors Among Men

Results
–
Alcohol and drug use was more common among men with
unwanted childhood sexual activity
 OR 1.23 for alcohol use
 OR 1.64 for cocaine, heroine, injection drug use
Longitudinal Analysis From the HIV
Epidemiology Research Study
Mortality, CD4 Cell Count Decline, and Depressive
Symptoms Among HIV-Seropositive Women
Ickovics JR, Hamburger ME, Vlahov D, et al.
HIV Epidemiology Research Study Group (HERS)
JAMA. 2001;285:1466-1474
Study Objectives

To determine whether depressive symptoms were
associated with mortality among women with HIV.

To examine the association between depression and
decline in CD4+ lymphocyte count among women with
HIV.
Primary Study Hypotheses

Women with chronic depressive symptoms would have
the highest mortality rate and most rapid CD4+ cell
lymphocyte decline:
– followed by those with intermittent depressive
symptoms and limited/no depressive symptoms;
– even after controlling for relevant clinical, substance
use and demographic factors;
– effects strongest for those with most advanced
disease.
HIV Epidemiologic Research Study



Large, prospective cohort study of biological, social, and
psychological manifestations of HIV in women from 4 US
cities.
Broad measurement framework enables control for
confounding factors.
Repeated assessments of depression
– provide more reliable estimate
– proximal to changes associated with illness
Description of Study Cohort (N=765)




Age: 19-55 (M = 35.5, SD = 6.7).
Race/Ethnicity:
– 62% Black, 21% White, 17% Latina
Social Class:
– 45% did not complete high school
– 16% employed; 65% public assistance
– 74% household income of <$12,000
Drug Use (study period):
– 33% IDU; 41% non-injection crack/cocaine
Summary of Study Results


Compared to women with no/limited depressive
symptoms, those with intermittent and chronic depressive
symptoms:
– 2.0 times more likely to die, controlling for potential
confounding variables
– More rapid decline in CD4+ lymphocyte count
Those immunocompromised and with higher viral load
were most vulnerable to the adverse consequences of
depressive symptoms.
Additional Complications

Psychological
–
–
Coping with sexual trauma
Intimate partner violence (IPV) and domestic violence

–
Risky sexual behavior (RSB) (e.g., lower condom use, more
number of partners)


–
Influence of partner substance abuse and HIV status
Child sexual abuse and RSB
Chronic abuse and RSB
Possibly, partner HIV status  IPV  lower condom use
Additional Complications



Sexual/physical trauma  more risky sexual behavior
(more partners)  greater number of STD’s
Women experiencing both sexual and physical
violence more likely to attempt suicide, use drugs to
cope, and be threatened by their partner when asked
that condoms be used
Poor mental health tied to lower probability of use of
HAART. Receiving mental health services increased
HAART utilization
Additional Complications


Substance use
– 30 to 75% of women in drug treatment programs
have histories of child sexual abuse
– Women who had traumatic childhood histories
were five times more likely than those who did
not to abuse drugs, and over twice as likely to
abuse alcohol
Familial responsibilities
Therapeutic Model

Psychological
– Adaptive coping strategies in dealing with HIVrelated stressors
– Problems of sexual and physical trauma faced
by many women with HIV (e.g., PTSD,
depression, relationship difficulties)
– Maladaptive responses to abuse, including
risk-taking behaviors
– Substance abuse
– Issues related to death and dying
Therapeutic Model



Social
– Disclosure of status to family and children
Biomedical
– T-cell count, viral load, medication regimen, treatment
for other medical conditions, nutrition and physical
fitness
Spiritual
– Role of religion/spirituality: religion as a positive
influence (e.g., meaning, spiritual growth) and
religious struggles (e.g., feeling abandoned by the
church, feelings of being punished by God)
Coping & Secondary Prevention Research
for HIV+ Women


Remarkably limited # of evidence-based studies
Ongoing intervention outcome research with HIV+ women
–
–
–
–

Weiss
Wyatt
Sikkema
NIMH Collaborative: Kelly, Chesney, Erhardt and Rotheram-Borus
Primary focus
–
–
–
Stress management
Cognitive behavioral
Stress and coping
Coping Intervention Model
(Lazarus & Folkman, 1984)
ADAPTIVE COPING
Stress Appraisal
Coping
Outcome
Changeable
ProblemFocused
Psychological
Distress
Unchangeable
EmotionFocused
Psychological
Well-being
HIV/traum
astressors
Coping Intervention Model
(Lazarus & Folkman, 1984)
MALADAPTIVE COPING
Stress Appraisal
Coping
Changeable
ProblemFocused
Unchangeable
EmotionFocused
HIV/traum
a stressors
Outcome
Psychological
Distress
Psychological
Well-being
Preliminary Study of HIV & Sexual Abuse
(Kalichm an & Sikkema, 2002)

Results:
–
53% men, 76% women reported one lifetime unwanted
sexual experience
 86% reported repeat sexual victimization
–
Sexual abuse history among HIV+ men and women
associated with:
 Depression and anxiety
 Use of drugs, including injection drugs
 Unprotected sex and exchange of sex for money or
drugs
General Goals

Evaluate effectiveness of secondary prevention
intervention for HIV+ women & men with history
of sexual trauma to:
–
Reduce psychiatric distress, primarily trauma
symptoms, depression, & anxiety
–
Reduce substance use and sexual risk
behavior
–
Increase health protective behaviors, such as
treatment adherence & medical service
utilization
Intervention Overview

Trauma specific components
–
–
–
–

Cognitive-behavioral components
–
–
–
–

Exposure
Connecting memory with narrative
Connecting trauma with behavior
Mindfulness/relaxation training
Identifying and appraising specific stressors
Identifying specific coping strategies
Modeling/role-playing coping strategies
Learning meta-cognitive skills
Interpersonal components
–
–
Sharing personal experiences
Creating connections for support
Therapy Themes










“What gets me through? A good therapist!”
Sexual Abuse
Current abusive relationships
HIV and health
HIV and fears
Losses
Managing social services system
Social support networks
Family and child care
Financial problems
Substance Abuse
Mental Illness

Women with chronic depressive symptoms had the
highest mortality rate and most rapid CD4 decline even
after controlling for other variables (age, baseline CD4,
viral load, presence of symptoms, antiretroviral use,
and employment status).
Mental Illness

Women with chronic depressive symptoms were two
times more likely to die than women with limited or no
depressive symptoms.

Those immunocompromised and with higher viral loads
were most vulnerable to the adverse consequences of
depressive symptoms.
Additional Complications

High levels of depressive symptoms and poor
mental health quality of life is reportedly tied to
lower probability of use of HAART.

Receiving mental health services increased HAART
utilization (Cook et al, 2002).
Additional Complications

A recent study (Douglas, 2002) found that service
integration was an important mediating influence for all
HIV+ patients with moderate to severe mental illness.
University of Utah
University of Utah HIV Clinic has approximately 1300
patients, including

Patients who only speak Spanish,

A refugee population from Africa, and

Women as well as many MSM.
University of Utah
The Clinic Staff consists of:

Four HIV specialists plus fellows in ID,

A full-time clinical pharmacist (PharmD),

Two Physician Assistants,

A psychiatrist who spends 3 days a week in the clinic
managing HIV+ psychiatric inpatients,
University of Utah

Five full-time case managers including two Spanishspeaking case manager,

One nurse who work in the clinic, and

A psychologist and other psychotherapists in the
community.
University of Utah

The entire treatment team has a weekly 90 minute
management meeting to coordinate care.

Each team members can bring up cases to ask
questions or to share information about patients.
University of Utah

Case managers visit patients at home in the
community and routinely go looking for patients with
mental illness and substance use problems who fail to
appear for their appointments. They also help patients
with housing, medications, insurance and disability
applications.

One patient described the clinic as “one stop
shopping”.
University of Utah

In spite of these efforts at integration, more patients still
died from substance use and suicide than from HIV in
the past year in the clinic.
Psychotherapy Strategies and
Issues
Existential Issues:

What matters?

How should I spend my time?

How can I improve my relationships?
Psychotherapy Strategies and
Issues
Empowerment and Control:

Learning skills to deal with
– health care,
– insurance,
– disability, and
– social service systems.
Psychotherapy Strategies and
Issues
Gathering information about

Medical & alternative treatments,

Legal issues, and

Services.
Psychotherapy Strategies and
Issues
Working through grief and loss:

Loss of others,

Loss of one’s sense of self as a person without health
problems, and

Anticipatory loss.
Psychotherapy Strategies and
Issues
Managing pain and suffering and affective responses:

Learning pain management skills.

Learning cognitive strategies of managing depression,
anxiety and fear.
Psychotherapy Strategies and
Issues
Issues change across the course of the disease, but
common milestones are:

HIV testing, HIV diagnosis.

Psychosocial issues of early disease.

Accessing health care,

Wondering,
Psychotherapy Strategies and
Issues

Worrying and planning,

Coping with early symptoms,

Decline in T Cells, or Increase in Viral Load, and

Preparing to die if treatments fail.
Psychotherapy Strategies and
Issues
Problem-focused strategies for coping give a patient a
sense of control.
Emotion-focused strategies help to deal with situations
that are uncontrollable.
“METHAMPHETAMINE USE:
REASONS, RISKS, AND PRACTICAL
INTERVENTIONS”
presented by:
Neva Chauppette, Psy.D.
P.O. Box 6234, Woodland Hills, CA 91365-6234
CA Psychologist License # PSY14524
(818) 680-0234 (voicemail/pager)- (818) 439-7080 (cell) - (818) 703-1854 (fax)
[email protected] (E-Mail)
Routes of Administration
FIVE ROUTES LISTED IN DESCENDING ORDER:
1) Inhaling --
(7 to 10 seconds)
2) Injecting --
(15-30 secs.) intravenously (IV or slamming)
(3-5 mins.) intramuscular (IM or muscling)
(3-5 mins.) subcutaneously (skin popping)
3) Snorting --
(3-5 minutes) mucosal exposure
4) Contact --
(3-5 minutes) "dropping acid"
(10-15 minutes) morphine suppositories
5) Oral --
(20-30 minutes)
Ice
(aka crystal, meth, ice, JIB, glass, Tina, P, etc.)

Classification: Central Nervous System
stimulant type: Synthetic Illegal. It is a
freebase form of methamphetamine. It is
odorless, colorless, resembles rock salt or a
chip of ice or quartz rock.
Ice
(aka crystal, meth, ice, JIB, glass, Tina, P, etc.)

Method of use: Inhaled by smoking

Duration of action: 8 – 24 hours

Detection in urine screening: 48-72 hours 2-3 days
Ice
(aka crystal, meth, ice, JIB, glass, Tina, P, etc.)

At a low dose:
–
Increased alertness, wakefulness, elevation of
mood, mild euphoria, increase in athletic
performance, decrease in fatigue, increased
energy, or may cause increased irritability,
restlessness, insomnia, anxiety, panic
Ice
(aka crystal, meth, ice, JIB, glass, Tina, P, etc.)

At a high dose:
–

Euphoria, can induce a pattern of psychosis
marked by confused, disorganized behaviors,
irritability, fear, paranoia, hallucinations, increased
aggressiveness and antisocial behaviors.
Note: Violence and hostility are more severe.
Ice
(aka crystal, meth, ice, JIB, glass, Tina, P, etc.)

Physical symptoms: Puts body in
“overdrive”, increased pulse, blood pressure,
respiration, and temperature, and dilate
pupils. Can cause a stroke, heart attack, or
kidney failure.
Ice
(aka crystal, meth, ice, JIB, glass, Tina, P, etc.)

Withdrawal symptoms: Disorientation,
confusion, apathy, irritability, itching,
depression that may be so severe that
suicide occurs. Long periods of sleep and
increased appetite occurs because while the
user was on a “run” taking drugs for one or
more days they did not sleep or eat.
Ice
(aka crystal, meth, ice, JIB, glass, Tina, P, etc.)

In some cases more severe with hallucinations,
paranoid ideation and toxic psychosis. Recovery
from psychosis may be complete; for some,
however, there has been no improvement after 2
years with medications.

Overdose: Agitation, hostility, hallucinations,
convulsions, high temperature, possible death.
Powder
(aka crank, speed, glass, hot ice, among other slang terms)

Classification: Central Nervous System
Stimulant

Type: Synthetic Illegal - Methamphetamine is
amphetamine to which 1 methyl group has
been added thus it is more potent and can
cross the blood brain barrier more rapidly
than amphetamine. May be cut with toxic
substances like cyanide or strychnine
Powder
(aka crank, speed, glass, hot ice, among other slang terms)

Method of use: Intravenous, snorting

Duration of Action: 4-6 hours

Detection in Urine Screening: 48-72 hours
after use (2-3 days)
Powder
(aka crank, speed, glass, hot ice, among other slang terms)

At a low dose:
–
Increased alertness, wakefulness, elevation of
mood, mild euphoria, increase in athletic
performance, decrease in fatigue, increased
energy, or may cause increased irritability,
restlessness, insomnia, anxiety, panic.
Powder
(aka crank, speed, glass, hot ice, among other slang terms)

At a high dose:
–
Euphoria, can induce a pattern of psychosis
marked by confused, disorganized behaviors,
irritability, fear, paranoia, hallucinations,
increased aggressiveness and antisocial
behaviors.
Powder
(aka crank, speed, glass, hot ice, among other slang terms)

Physical symptoms: Puts body in
“overdrive”, increased pulse, blood pressure,
respiration, and temperature, and dilate
pupils. Can cause a stroke, heart attack, or
kidney failure.
Powder
(aka crank, speed, glass, hot ice, among other slang terms)

Withdrawal symptoms: Disorientation, confusion,
apathy, irritability, itching, depression that may be so
severe that suicide occurs. Long periods of sleep
and increased appetite occurs because while the
user was on a “run” taking drugs for one or more
days they did not sleep or eat.

Overdose: Agitation, hostility, hallucinations,
convulsions, high temperature, possible death.
Powder
(aka crank, speed, glass, hot ice, among other slang terms)

Chronic methamphetamine abusers exhibit
symptoms that can include violent behavior, anxiety,
confusion, and insomnia.

They also can display a number of psychotic
features, including paranoia, auditory hallucinations,
mood disturbances, and delusions (for example, the
sensation of insects crawling/running on the skin –
also known as formication).

The paranoia can result in suicidal and homicidal
thoughts.
Three Neurotransmitters Play A Big Part In How
Crystal Meth Affects The Mind & Body
Dopamine
Gives a sense of reward and pleasure
Associated with body movement
Too little dopamine causes paralysis or
Parkinson’s-like tremors and rigidity.
Too much dopamine and a person can become
paranoid, hear voices, and have irrational, bizarre
thinking
Three Neurotransmitters Play A Big Part In How Crystal Meth
Affects The Mind & Body
Serotonin
Plays a role in depression, sex, and regulating
body temperature
Involved with many emotional disorders like
schizophrenia, phobias, super-aggressive states,
and obsessive-compulsive behavior
It is involved in sleep and sensory perception.
Too much serotonin can make it difficult (or
impossible) to have an orgasm
Three Neurotransmitters Play A Big Part In How Crystal Meth
Affects The Mind & Body
Norepinephrine
Increases alertness and concentration
Helps kill pain and regulate blood
pressure
Basic instincts like hunger, thirst, and sex
can be triggered by norepinephrine
Too much contributes to “crystal dick”
SEX ADDICTION
Core Elements of
Addiction
Defined
How Each if Manifested
Obsession
intrusive, ruminating
thoughts, "preoccupation
with"
preoccupation with obtaining the
drug/sex, using the drug/sex,
and getting over withdrawal from
drug/sex.
Compulsion
strong urge or drive to have
to do something (i.e., use)
"I have to do this, if for no other
reason than to stop obsessing.”
no ownership of a problem; at
minimum the existence of
(e.g., "I'm still functional") any
problem is minimized or
rationalized (e.g., "everyone
is doing it")
"My use is not a problem everyone gets STDs/uses drugs
and/or uses something to
change their mood."
"I have done bad things
during my use" (e.g., sex
addict)
"I'm engaging in types of sex that
I consider against my morals."
"As a result of doing bad
things during my use, I am
bad."
"Because I'm engaging in types
of sex that are morally wrong to
me, I must be immoral or
innately bad, evil, or defective."
Denial
Guilt
Shame
Ten Signs of Sexual Addiction
1. Out of control behavior
a) escalating frequency
b) escalating dangerousness
Ten Signs of Sexual Addiction
2. Consequences - escalating and
compounding consequences
a) impaired or decreased job performance due
to preoccupation, absenteeism
b) STD, unwanted pregnancies
c) possible arrests - lewd/lascivious conduct
d) marital/monogamous relationships are
jeopardized/lost
Ten Signs of Sexual Addiction
3. Inability to stop - self perpetuation of behavior
once guilt and shame are fused
4. Self-destructive or high risk - as frequency of
"using" goes up, so too does the need for
drama; danger to add to the "rush“
5. Effort/desire to limit the sexual behavior - limit
sexual behavior to only certain types, with
certain partners, etc.
Ten Signs of Sexual Addiction
6.
Sexual obsession/fantasy - when things are
uncomfortable or problematic, this is the mental place
sex addicts go to
7.
Increased amounts - it is equivalent to physiological
need (tolerance) and the desire to achieve the same
effect can only be reached with increasing frequency,
intensity, etc. of acts
8.
Mood swings - sex is used as a fix to alter "bad" mood
states but ultimately is bad itself due to the guilt/shame
Ten Signs of Sexual Addiction
9. Increased time - preoccupation with obtaining,
using and recovering from sexual fix
10. Neglect - as disease progresses, so does the
pervasiveness of the neglect