How Ice Affects Mental Health – Aggression As a Side-effect of Ice.

People intoxicated with methamphetamine are about five times more likely to be hostile and express aggression than people who are not. Drinking alcohol at the same time as using methamphetamine increases the risk of becoming aggressive. Psychosis adds to the risk of becoming aggressive, but only by a small factor. About one in four people with methamphetamine-induced psychosis become hostile. 

People who use methamphetamine often show a heightened sensitivity to threat. They may appear constantly on guard, and show high levels of aggression and in some cases may become violent. This is related to both the increase in noradrenaline (in the short term) and disruptions to the dopamine system, which affects ability to regulate emotions (in people who use regularly).

While the general public conflate methamphetamine use with violence, aggression and psychosis, in reality we deal every day with clients who use methamphetamine and are not aggressive at all; use methamphetamine and are psychotic but not angry or aggressive; and with those who are not psychotic but are angry and aggressive.

Aggression in people who use methamphetamine can be triggered by intoxication or withdrawal; an exaggerated response to a frustrating situation; (e.g. perceived or actual long wait for service); fear or paranoia; psychosis; or other environmental factors.

People who are most at risk of becoming aggressive or being involved in a challenging situation include those who:

• have been aggressive or violent in the past (even when not using alcohol or other drugs)
• are using multiple drugs with methamphetamine
• are intoxicated with methamphetamine or another drug
• are withdrawing or ‘coming down’ from methamphetamine
• have multiple difficulties in their life (e.g. financial, legal, health, housing, relationships)
• also have a serious mental illness such as schizophrenia.

Young men who use methamphetamine are more likely to be involved in challenging situations than other people who use methamphetamine.

Be aware of the signs that someone is about to become aggressive. Services should have a plan for managing these types of situations based on national guidelines and the organisation’s protocols.

Some signs that someone who has used methamphetamine may be becoming irritated or express aggression include:

• Being loud, demanding or argumentative
• Restlessness, erratic behaviour, being unable to sit or stand still
• Pacing, clenching fists, drumming fingers, repeatedly running hands through hair, tapping or banging on walls or furniture
• Rapidly shifting mood
• Showing tense, frustrated or angry facial expressions
• Making extended eye contact that appears challenging
• Being intoxicated (speaking rapidly, sweating, having large pupils, restless and agitated)
• Showing arousal (e.g. breathing rapidly, showing muscle twitching, opening eyes wide)
• Talking about fear, anger or loss of control
• Vague or clear verbal threats or gestures

At a minimum, the aim in a challenging situation is to avoid escalation, but there are many simple strategies to diffuse a situation in which someone appears irritable or aggressive. Strategies include:

• Reduce or remove stimulation from the immediate environment
• Watch for signs of methamphetamine overdose (hot, flushed sweaty, unsteady walking, muscle rigidity, difficulty breathing, panic. confusion)
• Listen carefully to what is said
• Use the person’s name if you know it
• Act confidently and in control, even if you are anxious
• Speak calmly
• Ask, simple open-ended questions to find out why the person is acting this way
• Keep an even tone of voice, even if the person is shouting or they become aggressive
• Avoid saying ‘no’ and don’t argue; if you must deny the person something, offer an alternative e.g. I can do X
• Neither agree with, or argue against, a person’s delusions
• Allow the person as much personal space as possible
• Don’t let them block your exit from the room
• Avoid too much eye contact, if possible – this can increase fear and might prompt an aggressive response