Not that long ago, ice made drinks cold and polar bears happy. These days ‘ice’ suggests something a little more sinister. The word is often headlining media images of thrashing young people restrained by police and emergency medical staff.
Graphics like those and this type of coverage of ‘ice fuelled violence’ can be powerful influencers of public perception. This also includes the workers in health and welfare organisations, as they are not immune to these messages.
There is no disputing that some people who use ice experience significant problems, and in some cases the drug has contributed to explosive behaviours. But this is by no means the case for every person who uses it. In Australia, as elsewhere in the world, violence is much more frequently associated with alcohol consumption. For those who do experience problems with ice, research tells us that there are effective interventions available.
Speed, ice, meth, crystal meth are all different names for methamphetamine.
Below is an explainer article on ice, its history, use, and effects.
Ice is the street name for methamphetamine in its crystalline form. Methamphetamine belongs to a group of stimulant drugs called ‘amphetamines’. Together with ecstasy, they are sometimes referred to as ‘amphetamine type stimulants’ (ATS). Together with cocaine, ATS are referred to as ‘stimulants’.
(Levo) amphetamine and methamphetamine are the main illicit amphetamines available in Australia – amphetamine in the early and mid-1990s and methamphetamine since the late 1990s. Although similar in chemical structure to amphetamine, methamphetamine is more potent and toxic.
The larger group of amphetamines also includes pharmaceutical preparations such as dexamphetamine. Dexamphetamines are used to treat a number of medical conditions including attention-deficit hyperactivity disorder (ADHD) and narcolepsy. Occasionally these are diverted to the illicit market.
Amphetamines have a long history. Amphetamine was first synthesised in the late 1800s by an organic chemist looking for a new synthetic dye.
No medical use was found until the late 1920s when amphetamines became widely available as an over-the-counter inhalers. They were primarily marketed as decongestants and asthma treatments. The inhalers contained a strip of paper infused with amphetamine.
Learn more about the History of Amphetamines.
Methamphetamine comes in three main forms: powder (‘speed’), paste (‘base’) and crystal (‘ice’). These are all forms of the same drug with the same chemical structure and with the same range of physical effects. The forms vary in purity and potency, generally as a result of the manufacturing process. Ice is the purest form of methamphetamine and the most potent.
The difference between the three methamphetamine forms is like the difference between beer and a spirit. They are manufactured in a different way and they look and taste different and vary in strength. But the active ingredient (ethanol) is the same, and people experience differing degrees of intoxication depending on which they choose to drink.
The more potent the drug, the more likely it is that people using it will experience problems.
Speed is usually swallowed or snorted, but can be injected and smoked.
Ice can be smoked by heating it in a glass pipe or on a piece of aluminium to form a vapour. This method is sometimes referred to as ‘chasing the white dragon’. Ice can also be injected. Base is usually injected or swallowed.
Although many people who use methamphetamine believe that smoking is a safer way to use the drug, it can still result in dependence. People who smoke methamphetamine have similar rates of harms compared to people who inject. This includes mental and physical health problems, criminal involvement, and high levels of sexual risk-taking. Although there are additional harms from injecting as a result of equipment sharing and injection site problems.
Acute or short-term effects of methamphetamine vary widely from person to person. The effects depend on a range of factors such as; how much has been taken and how the person’s tolerance is to the drug. We should also consider the state of their physical and mental health. Effects of methamphetamine may fall along a continuum from pleasurable feelings and increased energy, through to toxicity or overdose.
Learn more about the effects of ice.
People who use methamphetamine can experience a range of mental health problems including depression, anxiety, and psychotic symptoms. Some effects are directly due to the drug and improve when the person stops using. However, there can also be long-term effects that last weeks or months or in some cases permanently.
It is likely that the drug acted as a trigger for a condition that may have occurred eventually even without drug use. Typically, this can be the case among people who have experienced permanent mental health problems after using methamphetamine.
Studies of mood disorders have associated dopamine and serotonin depletion with depression, while elevated dopamine levels have been implicated in psychotic illnesses and symptoms. The significant neurochemical changes resulting from methamphetamine suggest that many mental health symptoms may result from these changes.
Among people who are in treatment for methamphetamine related problems, the vast majority (72%) experienced mental health symptoms after they began using methamphetamine. Mental health symptoms coincided with ‘problem use’ and occurred an average of about a year after regular use began.
Below are some of the common mental health issues experienced by people who use ice and their treatment.
Methamphetamine is often referred to as ‘highly addictive’. However, the reality is that among people who have used recently (in the last 12 months), the percentage who are dependent is relatively low. At less than 15% it is relatively low compared to the dependence rate of other drugs.
The rate of dependence on crystal meth is higher because it is more potent. The probability of dependence is around 25% of people who have used at least once in the last year. These estimates are based on the percentage of people who use methamphetamine weekly. More than weekly use is associated with dependence.
Below provides an overview of treatment for ice dependence or ‘addiction’.
The value of a good assessment, even if the person using methamphetamine does not appear motivated for treatment, cannot be underestimated. Several studies have shown that assessment alone can result in a significant reduction in methamphetamine use, even among people who are not motivated for treatment.
Basic screening and assessment for methamphetamine use and harms is the same as a standard drug and alcohol assessment. Structured measures can provide consistency and an effective way to measure change. Some areas of additional or more detailed assessment may include:
Studies tell us that detoxification alone has no effect on long-term outcomes from methamphetamine use, and is therefore not a stand-alone treatment.
People who are dependent on ice do experience a withdrawal syndrome. Although many people withdraw from methamphetamine without any professional assistance, some may need support to get through it safely.
In 2014-2015, amphetamines accounted for approximately 17 percent of all withdrawal care cases delivered by AOD treatment providers across Australia.
Read more about Methamphetamine withdrawals
The wide-ranging symptoms associated with both withdrawal and dependence make the search for an effective medication difficult. Currently, no medicines have been approved for either of these purposes.
A systematic review of treatment trials of medicines for methamphetamine withdrawal and dependence found that, of approximately 40 medicines evaluated across a range of drug types including dopamine agonists, stimulants, and antidepressants, none showed enough benefit compared with controls (placebo or no treatment) to warrant widespread use in practice.
In Australia, two psychological interventions have been evaluated and shown to help people who use methamphetamine achieve abstinence. Both are specialised forms of cognitive behaviour therapy (CBT): Relapse prevention (RP) with motivational interviewing (MI) and Acceptance and Commitment Therapy (ACT).
The RP and MI intervention was either two or four sessions; the ACT intervention was 12 sessions. Both interventions have been shown to be effective in reducing methamphetamine use and improving abstinence. However, the dropout rate was also very high from the longer ACT intervention and the RP and MI intervention was more effective.
Approximately half of the people who participated in two or more sessions of the RP and MI intervention had achieved abstinence at six months. Compared to about one-quarter of the control group who received a self-help booklet only. People who participated in four sessions experienced a short-term reduction in depression.
In a study of treatment outcomes across Australia, people in treatment for methamphetamine related problems had the best outcomes of all people in treatment. Optimism about treatment success is an important predictor of outcomes. Keep in mind that people who use methamphetamine can successfully meet their treatment goals in all types of treatment.
From neurocognitive studies, people who are still using methamphetamine do better on cognitive tests than people who are newly abstinent. In the early stages of abstinence, cognitive functioning may continue to decline for several months.
So when people who use methamphetamine first come into drug treatment, their commitment can wax and wane, increasing the risk of dropout.
Without the brain stimulation by methamphetamine, the affected people have trouble concentrating and planning. They feel flat, have trouble sleeping, and may lose motivation for just about everything. During this period, cravings to use methamphetamine can be intense.
Insisting people who use methamphetamine initiate and maintain contact, as a demonstration of their motivation for drug treatment, is unhelpful. They may not have the capacity to generate internal motivation because of the very real changes that have occurred in their brains and neurotransmitter systems. Even if they are highly motivated for treatment, cognitive functioning can be so poor that it interferes with the ability to attend appointments and engage in treatment.
A critical part of treatment is to provide as much external motivation and cognitive scaffolding as possible, including:
After treatment, many people who use methamphetamine long-term relapse within the first three months. Most of them relapse within one to three years without ongoing support. Complete return to optimal cognitive function takes more than 12 months. Some degree of assistance may be required for an extended time as the body and brain readjusts to the absence of methamphetamine.
Long term treatment is not always necessary, but a lighter touch follow-up may be helpful. One large-scale Australian study found that people were less likely to relapse following treatment if they engaged in peer support groups, such as SMART Recovery.
As with all drugs of dependence, people who have had treatment for ice problems need to practice the skills learned in therapy in real life. They need to maintain vigilance for early warning signs of relapse for a long period of time – often years.
The euphoria people experience from methamphetamine is unrivaled by any natural experience, so for many people a life without methamphetamine may seem exceptionally bland. As the brain continues to recover in the longer term, mindfulness strategies have proven to be helpful. Mindfulness helps people recognise and savour the small pleasures in life, helping them see the positives.
Methamphetamine use can have significant adverse effects on friends and family of people who use the drug. Families of people who use methamphetamine experience long-term stress that can lead to physical and mental illness and even to domestic violence.
Family members may worry about the harmful effects of the person’s meth use and the overall welfare of the family and the home. They may also experience financial problems, feelings of helplessness and despair, and depression.
Relatives are often highly involved and active in reacting and responding to the person’s use. In bigger families, some individuals within the family, manage better than others.
Some of the ways that family members cope are more effective than others. For reducing their own risk of health problems and for influencing the person who uses methamphetamine to reduce or quit use. Think in a detailed nuanced way about families and family dynamics and to work out with families their best ways of coping.
An estimated 60 to 80 percent of people with any drug-related problem live with a parent, meaning families can have an important role in recovery.
Family pressure is a significant factor in when people choose to enter treatment. Help from significant others helps people adhere to treatment contracts and goals after treatment. Social support improves treatment compliance and reduces relapse.
Good treatment outcomes are positively correlated with the amount of money and time spent on care and support to reduce substance use. Poorer treatment outcomes were associated with stressful family interactions, family criticism, hostility, or overprotectiveness during or after episodes of drug taking. These findings suggest that teaching families coping strategies during lapse and relapse helps. This knowledge is likely to transfer to better outcomes for people who are in treatment for ice related problems.
Behaviour problems and poor motivation to undergo treatment are the major stressors reported by families of people who regularly use crystal meth.
Behaviour problems include irrational behaviour, deception, and family violence, which are associated with high arousal from continued and prolonged use. Families are also extremely distressed by – and often unable to understand – the person’s lack of motivation to deal with their problem. The disparity between their own strong motivation to arrange treatment and the person’s own low motivation causes feelings of frustration and hopelessness.
It is very hard for families to grasp the idea that the person has severe cognitive impairment because of their methamphetamine use. Without this understanding, they cannot see why the person will not think rationally and calmly about their behaviour. How they can not see the negative impact and consequences, and about the potential benefits of support and treatment.
The difference between these two stressors and their impacts is often blurred in family members’ minds. It can be helpful to separate them and talk separately about dealing with behavioural problems and dealing with motivation to treatment.
To help family members understand the reasons for each problem, the neurocognitive effects of methamphetamine on the brain can be explained in simple terms.
Read more about Effects on children and siblings
The Stress Strain Coping Support model was developed by Jim Orford, a psychologist from Birmingham, UK. The model was finalised after extensive research with families who use drug and alcohol services. The model applies to families irrespective of social, cultural, and economic differences, with different aspects taking prominence in different settings.
This model is useful for both practitioners and family members to think about a family’s functioning and wellbeing. Practitioners can use the Stress Strain Coping Support model to shift the conversation with families away from simply being a detailed report of the negatives. Instead of focussing on the behaviour of the person who uses methamphetamine, they can directly focus on how the whole family, as a unit, is functioning.
Read more about The Stress Strain Coping Support model
When working with family members and not the person using methamphetamine, clarity of purpose is crucial. There are a number of options of intervention, including:
Read more about Strategies for working with families
360Edge is a leading Australian health consultancy, specialising in the alcohol and other drug, and allied, sectors. We provide a full suite of advisory services to help health service organisations accelerate change. We work with leading international organisations, governments and not-for-profit agencies across Australia and internationally.
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Our team of experienced ‘pracademics’ take a 360 approach to viewing situations from multiple perspectives. We collaboratively and holistically work with our clients at every stage, wherever they are in the cycle of change, to achieve their goals.
As our additional services, we provide CBT training, Ice training, AOD courses, and other AOD services.