METH ADDICTION DEFIES TREATMENTS; COUNSELORS ALTER THEIR APPROACH

The highly addictive drug so damages the brain that traditional treatment
methods often are ineffective.

Six months into drug rehab, and Kelly Arends still felt horrible.

She was keeping her promise to herself and God that she would kick her
methamphetamine addiction after 22 years. But her emotions were scrambled.

Arends confided to a counselor: If this is what sobriety feels like, maybe
it's not worth it.

"One minute you're just fine, the next minute you'd be way mad or you'd be
way depressed for no reason," Arends said. "It was just an emotional roller
coaster."

Researchers studying drug addiction are beginning to identify more
precisely what happens inside a meth-altered brain. Not only can meth cause
permanent damage - including memory loss and impaired cognitive function -
researchers have found that meth so damages nerve endings it can take
months for an addict's brain to recover normal function.

Dr. Dennis Weis, who studies addiction at the Powell Drug Dependency
Research Clinic in Des Moines, said meth triggers massive releases of
dopamine, a chemical messenger in the brain associated with feelings of
reward and pleasure.

The dopamine release causes the high that meth addicts crave. The problem
with meth is that some of the dopamine release occurs inside the nerve
cell, not at the nerve ending.

"It's like poison," Weis said. "If you use enough methamphetamine long
enough, it basically dissolves that nerve cell. It kills it. That's why
methamphetamine is much more toxic to brain cells than cocaine ever could be."

Drug counselors in meth-hungry states such as Iowa are finding they must
alter tried-and-true approaches to addiction treatment. What works for
alcohol, cocaine and prescription drugs won't necessarily work for meth.
Meth treatment takes longer, and complete recovery is not guaranteed.

Arends found out firsthand.

Kelly Arends, 42, grew up in Des Moines and grew up with drugs.

By age 12, she was taking uppers and smoking marijuana.

She started taking methamphetamine at age 20, back in the early 1980s when
it was better known as crystal. Over the next 22 years, she had two
children, earned her general equivalency diploma and briefly tried college.

But she spent most of her energy getting high or figuring out how she would
get high.

Early on, meth made her feel invincible. She stayed awake long hours, fit
into almost any social setting and felt sexy.

"It was magical," she said.

But the highs wore off. She was using half an ounce of meth a day, mostly
intravenously.

She would use and still fall asleep for 24 hours, her body too exhausted to
respond to the drug.

The crash came last year.

Arends was picked up in summer 2001 on charges of forgery, driving under
the influence and possession of ephedrine, a drug precursor.

She spent seven days in the Polk County Jail before she faced a judge, who
could have sentenced her to prison.

"I remember sitting in the courtroom and praying to God," Arends said. "One
little tear came down. I said, 'If you help me, I will change.' I was done."

If rehab were only so simple.

She had attempted to break meth's grip six times. This time, Arends first
spent time at the Mid-Eastern Council on Chemical Abuse, then went to
Beacon of Life shelter. Since Oct. 25, she's lived at Des Moines' House of
Mercy, transitional housing for women in substance abuse treatment.

Arends sits in a conference room. She has on jeans and a green shirt and
fidgets with a small silver ring she won at a House of Mercy raffle. She
pins her brownish-blond hair behind her ears and talks about her struggle.

"I recommend a long, extended treatment program for anybody," she said.
"Thirty days is not enough to get a person to know what's really going on.
Even to think.

"At six months clean, my brain was still fuzzy. I would have my highs and
my lows. I wasn't balancing. It's taken probably 10 months clean before it
started balancing out."

One minute she was crying. The next she was yelling at someone. Nothing in
particular set her off.

The wall stage - which addicts on some drugs scale in a matter of weeks -
lasted four to five months.

"A good four to five months," Arends repeated for emphasis.

Susan Haines, primary counselor at House of Mercy, said the staff there
tries to explain to residents exactly what drugs have done to their brains.

"We tell them, 'This is what your brain is going to go through," " Haines
said. " 'This is what your feelings will go through." "

Weis, medical director at Iowa Lutheran Hospital's Powell drug clinic, did
not treat Arends. But his research backs up meth's reputation as one of the
most addictive drugs on the street.

Longtime users are almost like adult sufferers of attention deficit
disorder, he said. Addicts have been mistakenly diagnosed with paranoid
schizophrenia and other brain disorders.

Other drugs leave other scars. Cocaine, for example, constricts arteries,
causing small strokes in the brain and damaging the heart.

"Meth acts in a different way," Weis said, drawing a quick sketch of a
nerve ending.

Small sacs inside brain cells store dopamine and other neurotransmitters -
the chemicals released from one nerve to another to tell the body to feel
pain, pleasure and other emotions.

Cocaine blocks the uptake of these neurotransmitters, producing a high.

Meth doesn't block the uptake, but instead causes a massive release of
dopamine. Some dopamine is released before the sacs reach the nerve ending.

This early dopamine release is toxic. The cells die, depleting the brain of
transmitters.

"If you're depleting these transmitters that are there to make you feel
good about life or experience a natural high, you're going to have the
opposite of that," Weis said. "You're going to feel bad about life, and
you're going to feel depressed."

When the brain begins to malfunction, the result can be paranoia or
hallucinations.

The brain becomes so impaired, Weis said, it no longer makes appropriate
associations from the messages coming in. The user may misinterpret reality.

One patient, Weis said, stood on a chair in his basement looking out a
small window while he smoked meth. He saw his wife cross the street to
their mailbox. She looked both ways for cars.

"In his mind, that was a signal to the SWAT team to come on in now because
he was in there," Weis said. "She went and opened up the door, and he
attacked her with a baseball bat. . . . Their emotions aren't attached to
anything that makes sense."

As a result, standard treatments often are ineffective.

Weis and his team say they often must retrain recovering addicts to perform
routine daily tasks. Instead of talking about whether patients feel sad or
mad or glad, the staff ask: Where do you plan to go when you leave the
clinic? When and where are you going to eat?

A study financed by the National Institute for Drug Abuse showed longtime
meth users still had reduced levels of dopamine transporters after two
months' abstinence. The damage appears to be linked to both slowed motor
skills and weakened memory.

After nine drug-free months, dopamine transporters showed substantial
recovery, but motor skill and memory damage remained.

Dr. Nora Volkow of the Brookhaven National Laboratory in Upton, N.Y.,
reported that the reduction of dopamine transporters occurs naturally at a
rate of 6 percent to 7 percent per decade.

The accelerated loss in meth users, Volkow said, "is roughly equivalent to
40 years of aging."

Arends struggles with memory loss.

Her children ask about events in their lives - a particularly scary fall, a
special event. She should remember, she said, but sometimes can't.

Short-term memory can be just as foggy. "It's not necessarily anything bad
or anything good," she said. "Sometimes, I'm like, 'Why didn't you tell me
that?' Well, they did."

These lingering problems aside, Arends is a success story.

She has been clean for 13 months. She is working as a saleswoman and taking
classes at Des Moines Area Community College, considering a career in
business or counseling.

It was hard to concentrate in class at first. But last semester, she
surprised herself and landed on the dean's list.

She's also reunited with her adult son. Her daughter will soon make her a
grandmother.

She's looking forward to getting her own place and starting a new life.

She can think clearly again. She's in control. The thought brings a smile
to her face.

"It's awesome," she said.