Motivation and emotion/Book/2020/Methamphetamine and emotion

Overview
Methamphetamine (MA) use disorder continues to be a major public health problem, with chronic abuse of methamphetamine associated with a myriad of problems, including difficulties in emotional perception, recognition and regulation (Zhang et al., 2018). Problems with emotional processing experienced by individuals who use MA have been associated with neural abnormalities (London et al., 2015; Payer, Lieberman & London, 2011), deficits in emotional attention (Zhang et al., 2018), sleep disruption (Lipinska, Timol & Thomas, 2015), psychosis (Arunogiri et al.,2019) and impaired social cognitive functioning, including deficits relating to emotion recognition and theory of mind (Kim, Kwon & Chang, 2011). It is thought that these emotional deficits are implicated in the maintenance of MA addiction and risk factors for drug cravings and relapse (Zhang et al., 2018). Consequently, greater understanding of the effect of methamphetamine on emotion is important for the development of interventions that target the emotional problems experienced by those with methamphetamine use disorder (MUD).

Personal accounts of emotional deficits experienced by those who use Methamphetamine:

“… I lose a sense of feeling and caring about everybody and it’s like I really don’t give a damn, I couldn’t care less if I chopped off your leg, I wouldn’t feel no remorse about it …” (Brecht & Herbeck, 2015)

“You know people weren’t important, family wasn’t important … I was out chasing my girlfriend in my brothers car somewhere and my daughter was in the car with me … I ran a red light and flipped the car upside down. My daughter went to the emergency room. And, you know, I couldn’t even think about what was going on with my daughter, all I could think about was chasing down my girlfriend …” (Brecht & Herbeck, 2015)



What is methamphetamine?

 * A description of the substance
 * Brief history and prevalence.

What is emotion?

 * The ability to regulate our emotions is inextricably linked to our well-being (Gross, 2002).
 * While emotions obviously elicit subjective feelings states, they are far more complex and multidimensional than first meets the eye, also existing as subjective, biological, purposive and expressive phenomena (Reeve, 2018).
 * Drugs such as MA elicit powerful emotions, ranging from euphoria to devastating negative emotional states, that in the extreme can lead to a break with homeostasis (Koob, 2015).
 * Methamphetamine use has been associated with a propensity for aggression, irritation, hostility, depression and problems with interpersonal relationships (Payer, Lieberman & London. 2011).

Relevant theories:
Deficits in serotonin/dopamine systems and cortical/sub-cortical brain circuits suggest a biological basis for emotional problems experienced by those who use MA, leading to problems with cognitive emotion regulation. Also too, the environment, social and cultural learning history of an individual can't be discounted. As such, I'm proposing that the following two theories are relevant ???
 * Biological perspective - discrete basic emotions linked to distinct patterns of brain activity (Vytal & Hamann, 2010)
 * Two-systems view of emotion - cognitive and biological systems working together

Methamphetamine and the Brain

 * Methamphetamine and the limbic system, the brains reward pathway.
 * Sensations include euphoria (caused by elevated levels of dopamine), increased energy, decreased anxiety, heightened attentiveness and hyper sexuality (Homer et al., 2008).
 * Methamphetamine (MA) is a cationic lipophilic molecule that has dramatic effects on both the sympathetic nervous system and central nervous system (Homer et al., 2008).
 * MA has been found to adversely effect both the dopaminergic and serotonergic transmitter systems (Homer et al., 2008)

Biological Aspects of Emotion and Methamphetamine

 * Deficits in cortical and sub-cortical brain circuits involved in emotion caused by MA


 * Deficits in serotonin and dopamine systems caused by MA and what that means for emotional processing.
 * Link between Amygdala hyperactivity, emotion dysregulation and MA dependence.
 * Lower activation in the ventral inferior frontal gyrus in those with MA dependence - linked to alexithymia (dysfunction in emotional awareness, social attachment and interpersonal relating) - as such, poor emotional insight thought to underlie aggression in those with MA dependence (Payer, Lieberman & London, 2011).
 * Abnormalities in the prefrontal cortex of MA users linked to impaired social cognitive functioning (Kim, Kwon & Chang, 2011).
 * Evidence for damage to the orbital frontal cortex and anterior cingulate in MA users - linked to higher level of response to negative stimuli (Chen et al., 2018).

Cognitive Aspects of Emotion and Methamphetamine

 * Problems with appraisal.


 * Impairment in social cognition and theory of mind.


 * Sleep disruption and affect processing - MA is known to produce insomnia - studies have shown that healthy sleep is important for emotion regulation (Lipinska et al., 2015).
 * Problems with emotional recognition - research suggests that people with MA dependence have an impaired ability to identify facial emotions (Hanegraaf et al., 2020).

Case study

Scarlett is a 25-year-old university student who has been using methamphetamine for 5 years. She first tried methamphetamine in the form of methamphetamine powder (‘speed’) when she was 18, developing the habit of snorting lines before going out to clubs with her university friends. This became something they did on a weekly basis and occasionally Scarlett would stay up all weekend without sleep. She would often get depressed after a big weekend, but this would usually pass. After finishing her degree, she obtained a job in a law firm and soon after tried crystal methamphetamine (‘crystal’ or ‘ice’) for the first time. Crystal is a potent form of methamphetamine that is usually smoked or injected. Smoking crystal and partying became a regular occurrence for Scarlett. When she was not intoxicated with methamphetamine her depression was impairing her functioning at work. Her work performance deteriorated noticeably as her binges on crystal necessitated days of recovery. Eventually she stopped work at the age of 23 and the next two years were spent using crystal methamphetamine for days at a time. Over this time, she became suspicious that people were following her, making her jumpy, agitated and aggressive towards others. While she no longer felt the euphoria experienced when she first started using the drug, she felt that she needed to keep using to take away the bad feelings she was having. After becoming aggressive towards shoppers at a local supermarket, Scarlett was taken into custody by police and eventually hospitalised and referred for drug treatment.

Interventions that target the emotional problems associated with Methamphetamine use disorder

 * The Matrix Program - is an education and cognitive intervention that helps to reduce the difficulty in cognitive emotion regulation and craving in methamphetamine dependant individuals (Amiri et al., 2019).


 * CBT
 * Acceptance and Commitment Therapy - has been shown to improve emotion regulation in methamphetamine dependant individuals (Khakbaz et al., 2016).


 * Transcranial direct current stimulation (tDCS) - there is growing interest in non-invasive brain stimulation techniques as treatments for addictive disorders.

Conclusion

 * 1) Individuals who use methamphetamine experience negative affect, such as anxiety, depression, aggression, hostility and irritability, while actively using the drug and during early abstinence.
 * 2) Individuals who use methamphetamine have been shown to have deficits in cortical and sub-cortical brain circuits, as well as deficits in serotonin and dopamine systems.
 * 3) It appears that the biological deficits caused by MA lead to problems with cognitive emotion regulation, experienced as problems with processes such as appraisal, attention, social cognition and theory of mind.
 * 4) Recognising the difficulties that MA users have with emotional regulation can help target more effective treatment interventions.