Is there hope for me after meth abuse?

Dear HopingforHope,

Your comment about not being able to find a consensus on long-term effects of meth is right on the mark: the science behind the issue is mixed, and figuring out exactly how to study the long-term effects has proven to be tricky for researchers. This leaves scientists a bit uncertain and — you guessed it — in disagreement on the topic (more on that in a bit). You asked whether there’s hope for getting your brain back and being your old self again. The changes in your mood and personality might be due to one or more factors: the short-term effects of withdrawal, slightly longer-term damage to the brain cells, or even a reaction to unrelated stressors. The good news is that some research points to brain recovery after halting use of methamphetamines, and there may also be a few actions you can take to start feeling more like yourself again in the meantime.

The feelings that meth brings — euphoria, increased energy, and the feeling of everything being sped up — are the results of the drug triggering neurotransmitters in your brain, most notably serotonin and dopamine. It does this by tricking the receptors on the nerve cells to release more of these neurotransmitters. After repeated use, this can lead to addiction (a dependence on the drug) and withdrawal when not using it. Withdrawal symptoms can include drug cravings, depression, anxiety, and fatigue.

This explains the short-term, but how does this tie into any longer-term effects? Some scientists believe that repeated use may actually cause damage to the dopamine receptors in the brain due to a combination of excess dopamine, glutamate (another chemical that your brain releases), and increased body temperature (a side effect of meth use). This damage might make nerve cells less efficient at taking up and reacting to the dopamine that the body naturally produces, even when not currently high. In turn, this has led researchers to think that there could be long-term impacts of meth use on cognition, memory, or movement. Other potential long-term effects of meth use may include mood changes, confusion, paranoia, or anxiety. Some people may even experience hallucinations or delusions, especially when exposed to stress. 

Here’s where the research gets a bit tricky and less certain. At least a few studies have shown some long-term changes in these dopamine-receiving brain cells and decreased performance on tasks. Recent studies have confirmed that meth use does reduce areas of the brain containing gray matter, which handles self-control, decision making, and muscle movement. This could contribute to a decrease in information retention and analytical skills. However, it’s good to note that these studies were conducted on rats and primates, and it’s not totally clear how these findings translate to humans, if at all. It's also unclear if gray matter is impacted differently based on its location in the brain. Neuroimaging (CT scans and MRIs) in humans who use meth have also shown some changes in areas of the brain with lots of dopamine receptors. However, there are questions about whether neuroimaging is the best way to assess changes in cognition because there are still a lot of unknowns about brain imaging. In tests of long-term memory, attention, and quick thinking, former meth users tend to score lower than those who have never used meth. But, even though their scores are lower, it’s often not by a large degree, and the scores are still within a range that is considered normal. Additionally, a lot of these studies haven’t separated out the effects of methamphetamines from other recreational drugs (such as cocaine, marijuana, or alcohol), so there is some skepticism about whether meth is really the only culprit for cognitive changes.

More to your question, many of these studies, from rodents to humans, have shown at least some reversal of the damage to the brain cells given enough time. For humans, the damaged areas seem to start to bounce back after about 12 to 17 months of quitting meth, with nerve damage easing after about one year, which in turn improves motor and verbal function. Recent studies also show that two years without meth use may return brain activity to pre-use levels, and that greater improvements are generally seen the longer abstinence is maintained. This isn't a guarantee that all former users will be completely back to “normal” after a certain amount of time; some report still having psychotic episodes and feelings of stress and anxiety many years after stopping meth. But, the good news is that it does look like some of the damage to the brain may be reversed over time. 

Because using meth can have short and long-term health effects, abstaining may help keep your brain and body healthy. Obviously, this is easier said than done, especially once a dependency is developed. If you're struggling to stop using meth, know that you aren't alone. Unfortunately, it’s not uncommon to relapse after quitting, but there are several treatment options to help, if you need or want them. While there are no prescribed medications to treat meth addiction, there are several therapeutic options that have demonstrated success, such as cognitive behavioral therapy (CBT), where participants work to respond to negative thoughts with supportive coping mechanisms, or contingency management therapy, where meaningful incentives are provided throughout treatment. Some people also find support groups to be helpful in maintaining abstinence from meth use. If you're looking to try this, you may wish to check out Crystal Meth Anonymous, an organization that hosts online and in-person meetings to connect people in recovery.

Since you report no longer enjoying your usual activities, it may be helpful to take stock of stressors or circumstances in your life that might be making it hard to feel like your usual self. Your description of no longer finding certain activities enjoyable might be associated with depression, which could be a symptom of withdrawal or might be connected to the circumstances that led you to try meth in the first place. Even if you take the effects of meth out of the equation, have any other circumstances in your life changed lately that might be making you feel the way you do? Additionally, focusing on everyday healthy habits may also help. Have you thought about starting or changing an exercise regimen (sometimes seen as a natural high)? How about giving a new hobby a try, or finding a new social activity to join? You may also want to talk to a provider about your feelings of depression. For more on that, check out Q&A When do I need to get treatment for depression. Finally, eating well, getting adequate sleep, and finding people and activities that make you happy — even if they aren’t the same things that used to make you happy — may help set you on a path toward finding your way back to a something like “your old self,” or maybe even a new self you’ve yet to discover.