Pubdate: Tue, 08 Nov 2005
Source: Washington Post (DC)
Copyright: 2005 The Washington Post Company
Author: George Kolodner, Board-Certified Addiction Psychiatrist and 
Medical Director of the Kolmac Clinic


Comments On Drug Use And Treatment

George Kolodner, a board-certified addiction psychiatrist and medical 
director of the Kolmac Clinic in Silver Spring, Md., was online 
Tuesday, Nov. 8, at 4:30 p.m. ET to answer your questions about 
Crystal Methamphetamine use and the treatment for addiction. From The 
Post: Meth Comes Out of the Closet (Post, Nov. 8)

Kolodner was quoted in today's article:

"George Kolodner, a board-certified addiction psychiatrist and 
medical director of the Kolmac Clinic in Silver Spring, said his 
clinic saw an increase in crystal meth users beginning about two 
years ago, but the trend has not accelerated since then. He said meth 
users are the most difficult patients to treat because there is no 
medication to prevent craving or treat the protracted post-use 
symptoms, such as dysphoria, or depressed mood.

"'With other substances,' said Kolodner, 'we can help people get off 
and keep off by decreasing their cravings. With meth and cocaine, we 
don't have that.'"

The Transcript follows.

Harrisburg, Pa.: What are the differences in how chrystal meth 
affects the body from cocaine, and, from a medical perspective, is it 
more damaging than cocaine? I ask because there are discussions on 
whether there should be legal differences in how courts handle those 
caught selling and using each, and I wish to understand if there 
should be a legal difference due to their being a medical difference.

George Kolodner: Meth and cocaine affect the body in very similar 
ways. in lab studies, people can not usually tell the difference. 
except that the effect of meth usually lasts longer than does 
cocaine. Medical effects and legal consequences are very separate issues.

Washington, D.C.: I am wondering about how friends of addicts (from 
before they were addicts, not drug buddies) are supposed to react 
when for the millionth time the addict says "THIS time the program 
I'm doing is really helping and I'm doing really well and I'm not 
going to use anymore." I want to be supportive, but if I only had a 
nickle... And the truth is that I've resigned myself to going to my 
friend's funeral in the next three years, because I don't see where 
else this addiction is gong to go. I guess what I'm asking is if 
there's any light at the end of the tunnel and how do we know if it's close?

George Kolodner: Support groups such as Naranon and Alanon were 
established specifically to address the dilemma that friends and 
family face when people close to them are struggling with addiction. 
Both have websites and phone numbers and I would recommend that you 
seek out some meetings near you.

Washington, D.C.: The article mentions that crystal meth abuse is 
well-established in the heartland.

What factors besides sexual orientation, such as harsh religious 
upbringing or social isolation, might factor into an individual's 
vulnerability to crystal meth abuse? Does sexual orientation alone 
cause increased risk?

George Kolodner: Genetics has been documented as a significant factor 
contributing to vulnerability to alcohol and nicotine dependence. I 
am not aware of specific studies looking at the genetics of stimulant 
dependence, but I expect that this is the case and will probably be 
documented in the future. I do not think that sexual orientation has 
been documented as a factor contributing to vulnerability.

Washington, D.C.: I have been clean for over 4 years now. My question 
is regarding whether there are any medical tests to determine if any 
permanent damage (physically that is, mentally I know I'm scarred and 
I have been dealing with this aspect) has occurred and whether it has 
healed up, I ask because of a number of articles and studies 
regarding the long term health effects that has me a little worried 
about my future health.

George Kolodner: Congratulations on being clean for 4 years! People's 
bodies are remarkably resilient. If you do not have any residual 
symptoms by now, I think that you do not need to do anything more 
than get routine medical monitoring.

Washington, D.C.: In your experiences at the clinic, how many meth 
users do you work with? Do you see this as a growing problem in the 
area? In the country -- in your opinion? And what happens to meth 
users physically speaking while they're on the drug? Thank you.

George Kolodner: We have worked with about 40 crystal meth users and 
our numbers of new patients has not been increasing. I cannot speak 
for the nation, but these numbers are being well tracked by different 
organizations. One good source for youth is The federal agency, NIDA, is also a good 
source as is the National Clearing House on Alcohol and Drugs. 
Crystal meth is a stimulant which intensely activates a person's body 
and mind. Usually this is so intense that it does not help people 
function. The one exception to this is people with ADD. If used for a 
prolonged time, it can lead to paranoid symptoms as well as seizures 
and heart and stroke problems.

Minnesota: My sister has become addicted to meth. It's a difficult 
situation, as she has a schizoaffective disorder as well as substance 
addiction. There really isn't a lot to do if she doesn't want to be 
treated; involuntary commitment is merely a very temporary 
palliative. We've had her parental rights terminated and have tried 
so hard to get treatment for her.

We live in a small town, and it's so easy to know where she and other 
addicts are getting their drugs. But local law enforcement is 
ill-equipped and ill-trained to deal with drug issues -- they're 
completely overwhelmed and behind the times.

How can people in rural areas advocate for a public-health response 
to the growth of meth use in our communities? It just seems that each 
family is on its own.

George Kolodner: Some national organizations exist that may provide 
some assistance. I would suggest that you contact Partnership for a 
Drug Free America and Mothers Against Drunk Driving.

Arlington, Va.: Do you provide treatment differently for Meth than 
you would for other drugs? How addictive of a substance is it, and 
compared with other illegal drugs? How difficult is it for someone to 
get clean once they're on Meth?

George Kolodner: Like most other programs, we treat all of the drugs 
similarly. The only difference with meth is that there are currently 
no medications to assist us, as there are with alcohol, opioids, and nicotine.

Meth is highly "addictive" in that it is very reinforcing -- once 
someone starts to use it, they tend to keep using it until it is 
gone, especially because it keeps people awake rather than puts them 
to sleep. On the other hand, there is no significant physical 
withdrawal syndrome when one stops so that medical detoxification is 
not necessary.

Right now, it is one of the most difficult substances from which to 
get clean. We are all looking for ways to improve our success and 
hoping for new medications to help us in this pursuit.

Anonymous: Is there a particular population of people that is taking 
Meth more than other populations - are there myths out there about 
this question?

George Kolodner: The meth problem has been most widespread in Hawaii 
and the western part of the U.S. and has slowly spread eastward. It 
has especially been a problem in rural areas. As it has become more 
popular in cities in the East, it has been especially concentrated in 
the gay male population

George Kolodner: I would be glad to answer any other questions 
through our website,

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