A blended approach to methamphetamine treatment: the major deficits impeding recovery can be addressed concurrently.

For the person in the grip of methamphetamine addiction, the psychological, behavioral, cognitive, and spiritual elements required for a comfortable existence all have been knocked out of balance. As is stated in the Basic Text of Narcotics Anonymous, "We could no longer continue because of physical, mental, and spiritual pain." Federally supported research has clearly shown the long-term damage to brain cells that methamphetamine abuse can yield, including reduced concentrations of N-acetyl-aspartate, a chemical marker that in low levels has been associated with conditions such as Alzheimer's disease.

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People who have been impaired by methamphetamine cannot change negative behaviors, twisted thinking, or warped spiritual ideas on their own. A blended model of treatment that I have used in a 12-Step context, based on a variety of research findings I have studied, incorporates treatment exercises used concurrently to provide a strong antidote. They are identified using the letters "A,B,C,S," standing for "affirmation," "behavioral change," "cognitive restructuring," and "spirituality education."

Need for affirmation

Simply removing the substance and the discomfort accompanied by an intense sensation of being invalidated does not suffice. While the brain in crisis seems to be spinning sideways, the invalidation must be immediately replaced with validation. Use of affirmation constitutes a powerful tool, because it establishes a sensation of humanity and validates the sufferer with a level of comfort. Mass doses of affirmation are the antidote for intense psychic pain.

Affirmation techniques include statements read aloud daily and a verbal commitment from clients to affirm self and others. All persons allowed on-site are required to attend a lecture on these essentials.

Early in treatment, when Step 1 is completed, counselors assign an affirmation exercise known as the "lifeline collage." Meaningful photographs and words from magazines that represent clients' life events are placed on a poster board and presented to staff and peers in a group, followed only by positive peer and counselor feedback (i.e., what I hear, see, and feel). The comments serve as restorative, validating, and easing of pain. Because of the danger of excessive psychic strain on presenters, we generally never allow more than a 90-minute group session for these presentations.

Staff, peers, and visitors in a residential or inpatient program facilitate four hours a day of positive affirmation. Clients write in a journal daily, writing specifically on which affirmations helped.

Practicing behavioral change

In order to disguise thinking and speech impairments caused by meth use, many clients compensate by conducting pressured, brief conversation. This becomes habitual. The natural change with which to assist clients is to teach them to talk in a less pressured way. The counselor educates formally and informally on assertive speech, honesty in all communication, appropriate social skills, and practice of language change (such as no swearing). Counselors are role models and are to practice the same behaviors.

Behavioral change also requires daily assignments for improvement that include focus on room cleaning and personal hygiene. The staff encourages positive peer influence and elicits repeated behaviors through motivational statements such as, "Way to go; you went a mile. I'll help you go another mile." The techniques for behavioral changes are delivered concurrently with affirmations--a unified application of this model is essential.

Like affirmations, behaviors are put to the test when practiced during interaction. "Big Book Pursuit" exercises help improve behavioral functioning since they require interaction with others. They also assist in cognitive improvement as they are designed to heighten knowledge of recovery. They enhance the practice of affirmations and validation through relying on self and others to achieve goals. These exercises are done weekly in a 90-minute group.

Improving cognitive functioning 

In an effort to improve cognitive functioning, clients are given short reading assignments at least twice a day (if given both tasks at once, meth clients tend to accomplish them in one sitting and become bored later on). The counselor will read for 20 to 30 minutes twice a week from books such as The Greatest Miracle in the World by Og Mandino.

To prepare to write their own tales, clients are taught how to utilize time as a coordinate dimension (the fourth dimension). Clients are educated about being "rocketed into the fourth dimension of existence that leads to happiness," as described by NA. This assists in cognitive restructuring. Clients gather in an educational setting and are instructed to draw a straight line across the middle of a piece of paper and divide the line evenly into five-year intervals. Clients then mark dots above and below the line, representing positive and negative experiences over their lifetime. For example, playing T-ball as a young child could be represented by a dot above the line, while being injured in an accident as an infant could be represented as a dot below the line.

On a separate sheet the clients list what the dots represent and describe what worked for them in positive times and what failed in negative times, adding the length of time each experience lasted. For example, clients may write, "Six months in college; got straight As by studying hard" or, "Six years in prison for DUI manslaughter; got into arguments when first in prison."

Clients present the work to a peer group and are to receive feedback. Peers are reminded that NA's text states, "It is a privilege to respond to a cry for help." Clients gain perspective on their own and others' journey.

This fourth dimension exercise is used to put clients in touch with AA's statement that "great events will come to pass." NA's text describes it as "an end to loneliness and a sense of direction in our lives." Clients are able to understand the far-reaching consequences of meth use and achieve an improved clarity in thinking. Cognitive restructuring exercises are conducted concurrently with affirmations and behavioral changes.

Sense of spirituality

To help with spirituality, clients are educated about the "wonders" of life through discussion groups, stories, reminiscing about childhood, reading, prayer, and meditation. When clients improve as a result of the "A,B,C" segments, they have a glimpse at a power greater than themselves and often refer to a faintly felt serenity, with many stating that they "wonder" how this works.

The spiritual idea of "wonder" is explained as synonymous with a miracle--a phenomenon resulting from recovering that sense of validation. This fact is openly discussed at every opportunity. Observable improvements in functioning will occur in the clients--counselors will begin to recognize a new sense of ease in working with clients. With serenity, clients gain the impetus needed to explore spirituality further.

The qualitative experiences produce awe that is difficult to describe objectively. Charting on these improvements requires writing accurate quotes from clients' statements and recording observed facial expressions (such as: "Client stated, 'I am amazed; I feel human again'").

Clients must be educated that when induced feelings of energy, happiness, and serenity are attained through use of meth, these qualities are not lasting, for when the substance leaves the body there is excruciating discomfort. When even a small amount of restored spirituality replaces the damage, clients begin to recover.

Deliberate use of the combined elements of affirmative, behavioral, cognitive, and spiritual approaches in meth treatment forms a strengthened foundation upon which a life of true recovery can be constructed. We endanger clients' prospects for success whenever any one of these areas is left unaddressed. When these areas are addressed concurrently, a greater likelihood of full recovery ensues, as these concepts now lie within clients' grasp for use in any circumstance.

Mimi Robidoux, PhD, is a member of NAADAC, The Association for Addiction Professionals, and CEO of the Institute of Methods That Work for Recovery. She has worked for 20 years as a counselor, lecturer, and creator of recovery exercises. To send comments to the author and editors, e-mail [e-mail].

by Mimi Robidoux, PhD