# Motivation and emotion/Book/2018/Methamphetamine and emotion

* Multimedia presentation (3 min)

## Overview

The focus points for this chapter include:
* What are emotions?
* What is methamphetamine?
* What impact methamphetamine abuse has on emotional functioning?
* How can methamphetamine abuse/addiction be treated?

## Emotion

Emotions, what are they? Emotions can be defined as a physical and mental reaction that is experienced subjectively as a strong feeling and it physiologically involves the body to change for immediate vigorous action (Koob, 2015). The term emotion can be applied to a diverse array of perceptions, behaviours and psychological states. Emotions are also a phenomenon$^{[elaborate]}$ and are able to reflect on the functions of neural circuits that allow an organism to survive, as the emotional circuits can trigger unconditioned stimuli (Murphy, Taylor & Elliott, 2012). The activation of these emotional neural circuits can trigger immense senses of pleasure, stress and/or withdrawal relief (Murphy et al., 2012).

## Methamphetamine
### What is methamphetamine?

Methamphetamine or amphetamine are a class of drugs that are highly addictive due to its stimulant properties (Vollm, Araujo, Cowen, Rolls, Kringelbach, Smith, Jezzard, Heal, & Matthews, 2004). Methamphetamine is classified as a stimulant that has an effect on the central nervous system with a high potential for dependence due to the euphoric properties$^{[whatarethese?]}$ of the drug (Wahlstrom, Scott, Tuliao, DiLillo & McChargue, 2015). Methamphetamine can also be defined as a neuro-toxic drug that causes deficits and alterations to the dopaminergic pathways$^{[why?]}$ in the brain (Ares-Santos, Granado & Moratalla, 2013).

### How does methamphetamine work?

Methamphetamine works by caused disruptions to the brain’s chemical messengers, which are known as neurotransmitters. It has an impact on dopamine, noradrenaline and serotonin; all of which have an important function. The neurotransmitter dopamine plays a role in everyday functions such as memory, attention, movement and behaviour. It is also the main chemical messenger involved with feelings of pleasure and euphoria. Dopamine encourages behaviours that pursue a feeling of euphoria or pleasure, linking it to the reward pathway, which leads to the dependence of the drug, as the individual requires the substance in order to feel pleasure. The methamphetamine raises the levels of the neurotransmitters and blocks the re-uptake, leaving the levels of these neurotransmitters high for a longer period of time than what normally occurs. Noradrenaline isn’t involved as much as dopamine but it is mainly involved in the fight/flight/freeze mechanism and stimulates the central nervous system. Serotonin is involved with the function of sleep, appetite and the regulation of mood (Jenner & Lee, 2008).

## History of methamphetamine

Methamphetamine and/or amphetamine was first synthesized in the 19thcentury in Japan but it gained more popularity during the Second World War, as it was more commonly used. It started to become more commonly used amongst soldiers in order for them to be able to stay awake and alert for prolonged periods of time (Evren & Bozkurt, 2018). The rise of methamphetamine abuse was seen during World War 2 and was slowly rising, as it was then being used to help with the treatment of psychological disorders such as depression, attention deficit hyperactivity disorder (ADHD), alcohol dependence and other disorders such as narcolepsy and obesity. The drug was used to help treat obesity due to the drug having a side effect of suppressing the appetite; it was promoted towards women for weight loss (Evren et al., 2018) .

## Theoretical framework
### Pavlovian conditioning

Pavlovian Conditioning can be used as a theoretical framework to understand some of the mechanisms involved with addiction and how an individual becomes motivated to abuse drugs (in this case methamphetamine). Learning occurs when emotional circuits are activated, as there is an association between innate triggers or biologically significant events (also known as the unconditioned stimulus) (Murphy et al., 2012). In this framework, the use of methamphetamine is used as a stimuli, as the individual is conditioned to feel that an intense euphoric feeling is caused by the use of methamphetamine. This in return causes the individual to become dependent on the substance in order to feel better or rewarded (Duka, Crombag & Stephens, 2011). The term reward can be defined as an incentive that causes neural representations to elicit motivation, pursue goals and target reinforced behavioural acts (Murphy et al., 2012).
* Motivation
* Motivation is a similar concept to emotion and can be defined as an inner psychological process or function that has a forcing drive element. It is found within the organism itself and has a plan or purpose (Koob, 2015).

### Drive reduction theory

Another theoretical framework that can be used to help with the understanding of substance addiction is Hull’s Drive-Reduction Theory (1943). The drive reduction theory focuses on providing an equilibrium within the organism (Koob, 2015). Based around addiction, the desire to seek drugs would be referred to as a ‘need’, meaning that the use of drugs is a biological requirement for the organism. The next step in the theory is the drive, which fulfils the need. The drive arises from behavioural arousal (Koob, 2015).

## Methamphetamine abuse

When abusing methamphetamine, the individual may experience an enhanced$^{[fixedgrammar]}$ sense of well-being, an increase in extroversion, increased activity, wakefulness and a sense of being more alert, a decreased appetite and the most common effect which is euphoria. These effects occur around 45 minutes after intoxication but the effects may occur at a faster rate depending on the method in which the drug was taken (National Institute of Drug Abuse, 2013). The effects that occur can also depend on other factors, such as the quality and purity of the drug, how much was used, or$^{[wordadded]}$ how it was used (crystalline, oily powder, coarse powder, tablet or oil) (Jenner & Lee, 2008).
The side effects of methamphetamine[spelling?] abuse can be divided into 3 subcategories: intoxication; in which occur a majority of the short term effects, higher doses and overdose or toxicity; in which occur majority, if not all of the long term effects of methamphetamine abuse. Methamphetamine abuse can also lead to death of the individual.

### Short Term Effects

* Increased attention
* Increased respiration
* Rapid/irregular heartbeat (arrhythmia)
* Decreased fatigue
* Hyperthermia
* Increased libido (sex drive)

### Long Term Effects

* Memory loss
* Violent and/or aggressive behaviour
* Psychosis, includingː
* Paranoia
* Hallucinations – auditory and/or visual
* Delusions
* Repetitive motor activity
* Mood disturbances such asː
* Depression
* Anxiety
* Changes in the brain and function
* Cerebral haemorrhage
* Renal failure
* Hypertension
* Weight loss
* Addiction
* Death may also occur

## Addiction

Addiction can be defined as a chronic, relapsing disorder that is motivated by a drug/substance withdrawal or when access to the drug is prevented. Addiction can be broken down into three stages: a) a compulsion to seek and take drugs, b) loss of control over drug intake, and c) the emergence of a negative emotional state such as anxiety and irritability. Addiction can be visualised as a three stage cycle: a) binge and/or intoxication, b) withdrawal and/or negative affect, and c) preoccupation and/or anticipation. These stages worsen overtime and impact the brain’s reward and stress system, due to the inability for the body to regain homeostasis (Koob, 2015).
An estimated 36% of people between the ages of 16 and 59 have experimented with illicit drug use, with the highest proportion being of individuals under the age of 25 (Murphy et al., 2012). Those individuals that develop substance dependence, which defined by the Diagnostic & Statistical Manual of Mental Disorders (DSM) as an excessive drug use with the inability to cut down on the abuse despite the knowledge of the negative outcomes and consequences. The dependence on the drug can be associated with changes to the brain structure along with neuro-psychological and emotional functioning (Murphy et al., 2012).

### Neurobiology of addiction

As stated, the cycle of addiction consists of a three-stage cycle. The concept of reinforcement can be seen throughout the stages and plays a large role in addiction or substance dependence. The key element to drug addiction is how the brain changes the reward system overtime due to the constant substance abuse (Koob & Simon, 2009). The neurotransmitter dopamine plays a large role in the reward system due its role in regulation the reward system (Volkow, 2013).
As time goes on and the substance dependence develops, the brain stress systems, which include CRF (Corticotropin-releasing factor), norepinephrine and more, produce stress like states. These stress like states in combination with the decrease in the dopamine function and ability can create a powerful motivational factor that can cause the individual to seek drugs (Koob, 2015).

## Cognitive deficits

The term or overall concept of cognition is used to describe a various amount of mental abilities such as memory, attention and the speed of which these processes occur (Potvin, Pelletier, Grot, Hébert, Barr & Lecomte, 2018). Chronic methamphetamine abuse can have implications on cognitive functioning and the chronic abuse can impact verbal and non-verbal fluency, working memory, verbal memory, abstract thinking, mental flexibility and psychomotor speed (Baicy & London, 2007).
Approximately 44 studies in relation to how methamphetamine abuse can cause cognitive dysfunction were researched and reviewed by Potvin et al., (2018). The studies wanted to review the following aspects of cognition: attention, executive functions, impulsivity/reward processing, social cognition, speed of processing, verbal fluency and/or language, verbal learning and memory, visual learning and memory, visuo-spatial abilities and working memory. Over the studies, it was found that there were approximately 1592 individuals that suffered from methamphetamine use disorder or chronic methamphetamine abuse, meanwhile the number of control individuals overall was approximately 1820. The results of all the studies reviewed concluded that the impairment of attention, executive functions, language and/or verbal fluency, verbal learning and memory, visual memory and working memory was found when an individual was chronically abusing methamphetamine.

## Emotions after abuse

The withdrawal of methamphetamine is considered to be a highly distressing time for the substance dependent individuals. Some of the most common symptoms that can occur during withdrawal include: depression and/or constant sadness, fatigue and/or hypersomnia, anxiety, irritability and aggression, an increased appetite and intense cravings for methamphetamine (Evren et al., 2018). Depression is an extremely common sign that is present during the withdrawal stage and it can last up to approximately 2 weeks or more, but it is dangerous as the depression can also lead to homicidal and/or suicidal thoughts. The initial craving of methamphetamine may last up to approximately 5 or so weeks but the individual may relapse within 7 to 14 days since the first day of the withdrawal.

## Management

Before the right management technique can be given, the individual must be willing to change their habits and must undergo a thorough assessment screening. This assessment screening is conducted in a safe, non-judgemental location in which the client is given the opportunity to answer some questions in regards to their substance dependence. The assessment screening consists of asking the client about the current and past use of methamphetamine (along with any other drugs which may have been abused e.g. cocaine), what type of methamphetamine (e.g. powder, oil), how much is abused in one sitting, how regularly it was abused and what effects were felt straight after abusing. Based on this information, and also if the client is willing to change, the specialist will then follow up with the most suitable and appropriate treatment plan which can include counselling, behavioural therapy or rehabilitation (Jenner et al., 2008).
A technique that is commonly used to help with the management of addiction is cognitive behavioural therapy. Cognitive behavioural therapy or CBT refers to a training activity and/or exercise that are conducted by a therapist, psychologist or psychiatrist and it is used to help individuals to recognise and understand emotional states within themselves (Baicy et al., 2007). The exercises conducted consist of how the individual can focus on their thoughts about drug abuse and how these thoughts can help with future coping skills about substance dependence. As methamphetamine abuse has an impact on cognitive functioning, cognitive behavioural therapy is recommended to help with the improvement of damaged functions, especially as those individuals that are substance dependent are unable to be in touch within one’s emotions, and also lack control over internal and external triggers for methamphetamine cravings (Baicy et al., 2007).

## Conclusion

* Emotions can be defined as a physical and mental reaction that is experienced on how the body physiologically interprets the context.
* Methamphetamine is a drug with stimulant and addictive properties, and when abused it can cause high euphoric feelings and extreme lows in emotions when the sensation begins and ends.
* Constant methamphetamine abuse can cause several health problems, both short term and long-term issues, and it can also result in death.
* When methamphetamine is first abused, it can cause immense sensations of euphoria, but overtime more methamphetamine is needed in order to provide the same euphoric sensations it once did at the beginning therefore resulting in addiction or substance dependence.
* Pavlovian Conditioning is a theoretical framework that can be used to understand how the cycle of addiction occurs.
* Chronic methamphetamine abuse can also cause cognitive deficits and impact memory, mental flexibility and abstract thinking.
* Methamphetamine addiction can be treated and/or managed with different approaches, depending on the individual itself and the state of their addiction. The most common treatment for methamphetamine dependence is cognitive behavioural therapy (CBT).

## Quiz

The following questions are based on the content of this book chapter and to help with the summary of the overall content.