Episode 1 – Introducing Dr. Bhatt
Dr. Ashish Bhatt ❘
Who is Dr. Ashish Bhatt? Learn about his story and his mission.
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HAYLEY: Hello, my name is Hayley, and you’re listening to Straight Talk with the Doc. A podcast that takes a real look at addiction, mental health, and treatment. I’m here with our content director Jeff and our medical director Dr. Bhatt. How are you guys doing?
DR. BHATT: I’m doing great, how are you guys doing?
JEFF: I’m doing pretty good, how are you doing Dr. Bhatt?
DR. BHATT: It’s been good. There’s been quite a bit of rain in south Florida, looking forward to it drying up a little bit
JEFF: I understand, we got quite a bit of rain in central Florida as well.
HAYLEY: So today we’re going to talk about a drug that pretty much everyone has heard of. It has a reputation for being very addictive and being one of those drugs that can totally take over and destroy someone’s life. And that drug is methamphetamine. But not everyone understands what’s really going on inside the brain of someone using meth. Can you break that down for us Dr. Bhatt and tell us more about the drug?
DR. BHATT: Sure, meth – methamphetamine goes by a variety of names. There’s a lot of slang terms for multiple drugs, but meth goes by crystal, ice, crank, glass, so many different terms that people use depending where you’re from. Methamphetamine is a powerful stimulant and it’s highly addictive due to the very, very potent high you get really quickly and the fact that it doesn’t last that long but compared to other stimulants it does last a little longer.
Just like many other mechanisms of addiction, it does attack the dopamine system in the brain. The dopamine system does provide that reward that works on providing us euphoria, that feel good feeling. The faster and more dopamine that can be put out into your brain and your blood stream creates that reward quicker. The thing with meth is that because it’s so potent in how it releases stored dopamine, it stops the re-uptake of dopamine. It’s kind of like a double mechanism.
The reason why. Meth compared to other stimulants, even compared to cocaine, is so much more potent or stronger and lasts longer is that dual mechanism. It not only releases dopamine, but stops re-uptake so that dopamine sticks around longer in that nervous system transmission.
HAYLEY: This is something I’ve heard, I don’t know if it’s true, but can you become addicted after trying meth one time.
DR. BHATT: Theoretically, people could become addicted after trying anything one time. Usually there is a process of addiction. There is an ongoing, repetitive type of – once you use, what type of reward somebody obtains from that usage, what type of feeling they get. Is it in the context of something else that requires them to get more motivated to pursue that reward again. How quickly it alters somebody’s brain’s neurochemistry, either up regulating or down regulating the normal homeostasis in the brain. And that relationship and how fast that happens.
Most often that doesn’t happen after one time with most drugs. Theoretically, something can make you feel great, but no I wouldn’t say after one hit somebody is going to become addicted by the pure definition of addiction. But it has a highly addictive potential.
JEFF: So, you would definitely say – it’s fair to say that meth is more addictive than many other substances that are out there that are commonly abused.
DR. BHATT: Yea if you look at the studies that are out there scientifically, methamphetamine ranks very high up there like nicotine, heroin, and opioids. Methamphetamine is a very highly addictive stimulant.
HAYLEY: Do you find that people typically abuse other substances before trying meth? It’s considered such a hard drug. Do people usually work their way up? If so, what would they use before?
DR. BHATT: Most people tend to have other drugs – excuse the phrasing, you know gateway drugs. Alcohol, nicotine, and cannabis are often drugs that are used more as the first line. Drugs that people tend to experiment with. And I think that holds true for those that use methamphetamine. They are going to be using alcohol or cannabis or nicotine beforehand. Studies do show that about 4% of the population, I think the latest study is in 2017, did show that 4% of the population 12 years or older have used it. I don’t think they’re saying that it’s the first drug they’ve used.
HAYLEY: Can you touch on the signs someone would show when they’re high on meth? How do they act, what are these effects?
DR. BHATT: Meth is a pretty erratic drug. Initially you might have some short-term effects and some longer-term effects, but in the short-term you might see someone who uses it and as a stimulant that increases the dopamine in that frontal lobe of the brain. It can increase your attention and your energy. So you might have a little bit more wakefulness, you might be more focused, feel less fatigued. As a stimulant it can reduce your appetite. At the same time with that increased energy and increased focus, you can become irritable, quicker to anger.
You can start having hallucinations, paranoia because dopamine is implicated in the process of how someone develops psychosis. When we have too much dopamine flowing in our brain, in certain areas, certain tracks of the dopamine system, it can cause us to have movement disorders, hallucinations, seeing or thinking that we’re seeing things that aren’t there. Hearing things that aren’t there. Feeling that people are out to get us or doing something.
So, you could have any one of those symptoms in that spectrum from attention – increased attention and focus, weight loss, decreased appetite, to agitation, paranoia, hallucination, and movement issues.
JEFF: I have a tangential question. I know that there are a lot of ways to use meth. People can smoke meth, people can shoot meth, and ingest meth. There seems to be some beliefs that different methods of using are more or less dangerous or get you more or less intoxicated or more or less addictive. The research I’ve seen from the medical community seems to indicate that that is not really the case. Can you speak to that Dr. Bhatt?
DR. BHATT: I think it speaks to the general sense of how a drug enters our bloodstream and how quickly it gets to the brain. Any method that gets to the bloodstream and gets to the brain the fastest tends to have the quickest potential for onset of action for that drug. So, injecting it and probably smoking it are the two fastest ways that methamphetamine can hit you.
Just for people who don’t know, meth comes – one of the reasons it’s called crystal is because it comes in rocks. When you cut it, shave it, or crush it, it chips away and looks like glass, like crystal. People can heat it and then smoke that and when you smoke something it goes into our lungs. Our lungs are extremely vascular due to the way that our blood vessels are set up. The exchange of oxygen to blood that occurs from when we inhale something, goes to our bloodstream very quickly due to the enormous amount of surface area that exists in our lungs.
Similarly, if you inject something in a liquid form directly into your bloodstream, it’s going to get to our brain that much faster than orally ingesting something. So for most drugs, including meth, smoking or injecting it are the fastest ways to get that feeling, the euphoria, the effects of the drug.
HAYLEY: You mentioned earlier that sometimes one of the effects is increased anger. Is violence something that you see in people that use meth?
DR. BHATT: Yeah, with drugs that can make you paranoid, you can have this duality. People can want to isolate because they’re afraid, they’re fearful, they’re hiding in a room in a hotel or in their houses and they don’t encounter many people. At the same time if you paranoid or afraid or perceive something as a threat, you can get more triggered to act out and feel that you need to retaliate if something is going to harm you.
Not only that, when you have anything that dysregulates dopamine to that extreme, you can create some sort of agitation. That paranoia mixed with that agitation can render somebody to be more impulsive or angry, labile in their mood. We do see people act out or get aggressive. It can be secondary to feeling a perceived threat or an excess amount of this stimulatory agent acting within their body
HAYLEY: Some of the physical health problem that meth causes seem pretty scary and pretty serious. For example, meth mouth. Can you explain why that happens and some of the other physically effects that can happen to the body?
DR. BHATT: Meth can cause a lot of things. You mention meth mouth. I think that’s kind of the common thing we hear – a lot of people, when they’re using drugs in general, especially methamphetamine, they’re not taking care of themselves. They go on binges often. When they go on these binges and they’re using drugs in this really excessive amount they’re not eating, they’re not drinking, they’re not brushing their teeth.
It can also increase cravings. It decreases their appetite, but then it has this almost obsessive craving for sweets. So this combination of downing sodas or candies or all of these different things and at the same time not taking care of this dental hygiene. Plus, smoking it can cause a lot of dry mouth and problems with your salivary glands. That combination is a breeding ground for bacteria and poor dental hygiene. The dental decay is very rapid amongst these individuals. It’s also a vasoconstrictor so less blood is going to this area. This whole combination can render somebody to have very poor dental hygiene.
Similarly, because of the mixing of foreign ingredients inside there’s this phenomenon that people can get this sensation that things are crawling on them. They start to itch and pick at their skin. So, if they start itching, picking, and scratching in this really overzealous, obsessive way they can cause a lot of wounds to occur. The wounds don’t heal, they don’t take care of them and you can see a lot of skin scarring amongst these individuals that then can be susceptible to increased infections.
On top of that, if you’re using IV stuff, sharing of needles, you’re susceptible to Hep B/C, HIV, these increased risks are there. There’s a plethora of things that can happen to somebody who’s using, not just meth, but any drug in this fashion where you start to neglect yourself.
HAYLEY: Yea, it’s really a combination of a lot of factors.
DR. BHATT: Yup, exactly.
JEFF: Obviously we just talked about some of the physical effects of meth use which I think are culturally what meth use is most associated with. If you are someone who suspects that one of your loved one’s is using meth or you know that one of your loved ones is using meth. What are some of the other concerns that you would have for them. What are some of the risks that that person is putting themselves and others at risk are?
DR. BHATT: It really depends on the degree. If someone is using meth, then of course we’re worried about them and their addiction. And with that addiction, how many of them are taking care of themselves on a basic level. Right there, people can suffer from neglect, they can suffer from legal consequences of trying to pursue the drugs. At the same time – as we mentioned in the previous question just the mechanism and route of how their using it and the behaviors that go along with it. There are a lot of risk-taking behaviors of someone whose using methamphetamines.
I failed to mention previously that a lot of the time because of the way meth works, there’s this increased propensity for people to use it to enhance sexual activity. When you’re using it to have sex, and sex in an unprotected way, that’s another way you’re rendering yourself susceptible to STDs. I failed to put that into context previously.
I think it’s the same for anybody who’s addicted to any substance, an illegal substance, illegal drug. You’re worried for the physical harm it causes them, the legal consequences that they can get into, and the fact that if they continue to use their life is in jeopardy. Are they ultimately going to stay alive or not? That’s the ultimate risk someone takes when they’re using these drugs, is death.
HAYLEY: So, what could family or friends do for someone who has a meth problem, someone they care about, but that person doesn’t want to stop? What can they do?
DR. BHATT: Just like any addiction – this is easier said than done what I’m about to say – is getting them into treatment. Treatment programs around the country, around the world are there that help people address substance use disorders. There are people who provide interventions. They’re trained individuals who are able to come and who use different methodologies to motivate somebody to get the assistance and take those steps to get them into treatment. That really is the best way to help somebody get off an illicit substance. Trying to talk to somebody when they’re in the thralls of addiction – intoxication and withdrawal cycles, logically trying to speak with them is very difficult. Nothing is going to get through. They’re not in their right state of mind. So having a trained professional come out and hopefully help out, that’s an options.
Some really difficult options are different states have court systems that are available to help the family member or loved one petition for an individual to get court mandated into a treatment center. Those are often difficult decisions that someone has to make, but those are also options. Those two are general modalities that people can use to help get somebody to the treatment that they need.
HAYLEY: You mentioned someone withdrawing from meth. Can you explain what’s happening in the brain when someone is withdrawing and what do they feel like?
DR. BHATT: They feel like crap, they feel terrible! When you’re using meth, I mentioned earlier that this dopamine which is this pleasure reward neurochemical in our brain, is surging and it’s there. Like anything the body has a balancing system, it has a naturally occurring balancing system. When you produce something in excess that’s artificially induced like introduction of meth creating this artificial high of dopamine making you feel happy, and euphoric, and focused, and concentrated. Your body tends to down regulate its own production or the receptors that would recognize it.
So when somebody comes off of this stuff, the exact opposite is going to happen. They no longer hae that energy, theyre no longer feeling happy. They’re irritable, depressed, or fatigued. They can become suicidal. They often want to just sleep for days, since it’s such a stimulant that it keeps people up for days binging on this drug. You see this catastrophic, lack of a better word, crash. In these individuals where they are just down and angry and apathetic, and they just want to hide. Trying to even talk with them they can get very angry and irritable and hostile. That’s the opposite of the high. In general, what the drug does for you in the high, the withdrawal is usually the opposite.
I always say that for every action a drug has, your body is going to produce that equal and opposite reaction. That’s the irony of addiction, that when someone’s using, we’re putting something so negative in the body that we’re now even worrying about the consequences at the time, even as dire and devastating as those consequences are. And that’s why we look at addiction as a disease. We continue to use despite all of those significant negative issues that come about in our lives. It’s very sad.
HAYLEY: When someone enters into treatment for meth, I assume the first step is detoxing from it?
DR. BHATT: We can call it – a lot of people interchange these words detoxing, withdrawing. Withdrawing is really the proper word when you’re coming off of a substance without any intervention there. There’s no traditional or FDA approved medications really that are out there, that are mainstream that the scientific has to help people come off.
There are medicines that we use, they’re really off label. They are medications that we can help with that provide comfort and support individuals that are coming off of methamphetamines. So yes, there is that initial withdrawal process that you see that they’re coming off of the let down from methamphetamines. That usually is the first process that we do see. After they come out of that, recover from that, is when the rehabilitative process starts. Where they’re able to with a clearer mind, focus on the different steps. I don’t want to get into those in detail because that would entail a whole rehabilitation process. They would be more able to engage in treatment.
HAYLEY: You don’t have to go into details, I know it’s different for every single person who enters into treatment. But is the type of treatment who is recovering from a meth addiction, is that different than say alcohol or something? Is that a different treatment process?
DR. BHATT: There are some fundamental modalities that I think different classes of drugs share. When we go as treatment providers to provide, to help, we do follow similar structures. It depends if you’re using 12-step model or motivational enhancement therapy, depends where that person’s at and what philosophy they want to go by. But, Initially treatment providers want to help that person physically feel comfortable first. Although I didn’t mention any FDA approved medications, there are medications that we use to help people try to feel comfortable first.
After that there are various forms of cognitive behavioral therapies, individual therapies, group therapies that are involved you know to help get someone’s life back on track. And that usually happens during the course of that treatment plan is developed with their therapist or treatment provider depending on where that person seeks help.
HAYLEY: I want to talk about relapse a little bit, because it’s very common when somebody is recovering from a substance use disorder. Is it more common for meth users to relapse compared to users of other drugs?
DR. BHATT: That’s a hard thing to say. There are numbers thrown out by different statisticians or agencies. I think meth is a drug that has a high rate of relapse due to the nature of its addiction and how potent it is as a chemical. It does have a high rate of relapse unfortunately. If we look at the statistics of people who go through treatment, we tend to see addiction being a disease of relapse and remission. People tend to correlate, once you develop that full-blown addiction, there are cycles. That’s kind of what’s expected, somebody’s going to go through a relapse. Does that mean somebody has to? No.
I think we don’t really have the best numbers of people who have gone sober or have achieved recovery who haven’t gone through treatment. The bottom line is going through treatment, learning the tools, and getting the help, you have a higher chance of attaining recovery as opposed to not. That has been demonstrated, that people who do go to treatment and stay longer in treatment and who work a program have correlated positive outcomes. Opposed to people who just try and stop. It’s a very difficult drug to just stop.
HAYLEY: If somebody is listening to this right now and they have a meth problem, what should they do? Do you have any advice for them?
DR. BHATT: Like a lot of times, many of us look to the internet. We do look online to seek help regardless of if it’s addictive illness or not. We go online to research about it you know. One good medium for those who suffer with addiction is to go to Addictioncenter.com and look at the resources that are available there. Both informational and access to treatment centers. That’s a good first step to seek the help that is potentially out there.
HAYLEY: Okay, awesome. Is there anything that we haven’t talked about that you think is important for people to know?
DR. BHATT: At the end of the day, it’s a dangerous, dangerous drug. We’re just touching the tip of the iceberg in these commentaries here. If in a brief period of clear-headedness someone can reach out and seek help from their family, loved ones, or even having access to a computer and going online. That’s really the most important thing they can do, is try to get help for themselves. Even if it’s not the person listening who’s the person addicted, but their family member or loved one, going online and reaching out to these resources we just mentioned. Addictioncenter.com those are great first steps you can take.
HAYLEY: There are so many resources available for people you just have to access them.
DR. BHATT: It’s hard, it’s really hard for people who are in the middle of suffering from an addiction to go out and seek help for themselves. That’s why when we’re speaking in this situation we’re also speaking to the family members and loved ones of those individuals suffering.
HAYLEY: Absolutely. I found this very interesting and I hope it gives people a better understanding of how meth actually affects a user’s brain. It’s not a simple process of just going cold turkey and quitting. So thank you for explaining that Dr. Bhatt. And thank you for everyone who listened today. If you have any questions on this topic or something we haven’t talked about yet, you can submit a question or message for Dr. Bhatt on Addictioncenter.com.
Thank you again for listening and we hope to have you next time on Straight Talk with the Doc.
Dr. Ashish Bhatt
Addiction Center’s Medical Content Director, Dr. Ashish Bhatt, MD, MRO is an accomplished physician, addiction medicine specialist, and psychiatrist with over 20 years of medical and administrative leadership.