How ice affects behaviour: Aggression as a side effect of ice

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, are psychotic but not angry or aggressive, and are not psychotic but are angry and aggressive.

People intoxicated with methamphetamine are more likely to express hostility and aggression than people who are not, particularly in people who use it regularly and people who are already otherwise predisposed to violence. Drinking alcohol at the same time as using methamphetamine increases the risk of becoming aggressive. People with methamphetamine induced psychosis are at a higher risk of becoming hostile.

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

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

People who are most at risk of becoming aggressive 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 (eg, 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.

Signs that someone who has used methamphetamine may be becoming irritated or aggressive 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 (eg, speaking rapidly, sweating, having large pupils, restless and agitated)
  • Showing arousal (eg, breathing rapidly, showing muscle twitching, opening eyes wide)
  • Talking about fear, anger or loss of control
  • Vague or clear verbal threats or gestures

Strategies for diffusing situations

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

  • Reduce or remove stimulation from the immediate environment
  • Watch for signs of methamphetamine overdose (eg, 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 nervous
  • 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, eg, “I can do X”
  • Neither agree with nor 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

Looking to improve your skills in responding to methamphetamine? Our half day online workshop Breaking the Ice: Tailoring treatment for people who use methamphetamine is for you.

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