How Crystal Meth Affects the Brain

What is it and How is it Used?

Crystal meth, a form of methamphetamine that resembles glassy fragments or rocks, is a commonly abused stimulant drug. It is chemically similar to amphetamine, a drug used to treat attention-deficit hyperactivity disorder (ADHD). People abuse crystal meth for the feelings of euphoria and increased energy it produces. The initial high can be very intense but will subside quickly, which may cause people to repeatedly take the drug in a “binge and crash” pattern. In more extreme cases, users may binge on the stimulant for days, forgoing sleep and food. This is sometimes referred to as a “run.”¹ These patterns of crystal meth abuse can increase the risk of experiencing severe and dangerous side effects of use.

In its various forms, methamphetamine is used in a number of ways, such as:¹

• Orally (swallowing a pill).
• Intranasally (snorting the powder).
• Intravenously (dissolving the powder in water and injecting it).

Crystal meth specifically is usually heated and then smoked using a glass pipe. Occasionally people will crush the crystals to snort or inject. Common slang terms for the drug include speed, meth, ice, crank, chalk, and crystal.¹

According to the 2016 National Survey on Drug Use and Health, more than 1.3 million people over the age of 18 reported using methamphetamine in the previous year, with 658,000 people reporting use in the past month.²

Neurochemistry of Meth Abuse

Methamphetamine produces its short-term effects on the central nervous system (CNS) by increasing the activity of certain neurotransmitters, such as dopamine, norepinephrine, and serotonin.^3,4 These neurotransmitters are released by cells to relay information in the brain and signal specific physical and psychological functions. Information is transmitted from pre-synaptic neurons across a synapse (gap between neurons) to receptors located on post-synaptic neurons. Under normal circumstances, after a neurotransmitter has effectively communicated its message, it is either destroyed or it returns to the first neuron where it is recycled.³ When a person abuses crystal meth, this process is disrupted and large amounts of neurotransmitters are released into the synaptic space, eliciting a flood of effects, both desirable and undesirable.

Crystal meth’s action on the brain is largely due to its effect on dopamine levels. Dopamine is often referred to as the reward chemical—it is typically released in response to natural, pleasurable activities, such as eating or having sex, and it plays a large role in the development of addiction. Drugs like crystal meth dramatically increase the release of dopamine in your brain, causing an intense rush of euphoria.¹ This process reinforces crystal meth abuse, causing an individual who uses the stimulant to want to repeat the pleasurable experience.¹ The high dissipates as dopamine is gradually recycled back into the neuron, resulting in the crash that is often associated with crystal meth abuse.³

Other short-term effects of meth occur because of its action on different neurotransmitters in the brain, including serotonin, which regulates mood, appetite, memory, sleep, and social behavior, and norepinephrine, which also acts as a stress hormone and regulates your fight-or-flight response.

Meth’s action on serotonin causes a variety of effects, such as decreased appetite and increased libido.⁴

Long-Term Effects on the Brain

Chronic meth abuse can lead to a number of significant structural and functional changes in the brain. If you use meth on a regular basis, you run a great risk of developing tolerance. Tolerance develops over time as your brain and body become accustomed to the presence of the drug and no longer respond to the same amount of crystal meth. Once tolerance develops, you require higher doses of crystal meth to achieve previous results. Further, chronic use can lead to physiological dependence, which means that you need meth in order to function at an optimal level. Crystal meth withdrawal symptoms are likely to emerge when a dependent person abruptly quits or reduces use. Tolerance and dependence are both signs that neuroadaptations have occurred, or changes in the brain’s functioning.⁵

In the acute stages of meth addiction, methamphetamine abuse causes over-stimulation of the nucleus accumbens, or “pleasure center,” so it creates new pathways and receptors. Over time, this over-stimulation damages the serotonin and dopamine receptors on midbrain neurons. This damage results in the individual requiring higher and more frequent doses of crystal meth in order to experience a high. It also results in poorer neurotransmission, or the signaling between brain cells, which can result in anxiety, depression, mood swings, and irritability.⁷

Research has revealed that crucial neuronal pathways that control functions, such as goal-setting, motivation, and cognition, are depressed by long-term meth abuse. Surprisingly, research notes that this depression is reversed once a person resumes using meth, which may help to explain how patterns of addiction develop.⁸

Animal studies have also shown that chronic meth use leads to long-term brain changes that can persist even after drug abuse has ceased.

It may be distressing to learn about the chronic effects of meth abuse, but some of them can be reversed over time as a person maintains abstinence.

Can the Consequences Be Reversed?

A number of studies have examined whether the neurological consequences of chronic meth abuse can be reversed. Some brain changes may be reversible, while others may be permanent, although more research is needed to fully evaluate these changes. Whether the damages are reversible may depend on specific factors, such as how long a person has used meth, since some effects to the nucleus accumbens (part of the striatum and the key reward center of the brain) take a longer time to develop.⁷

Studies have shown that chronic meth users demonstrate deficits in the areas that involve dopaminergic neurons, even after they have achieved “sustained abstinence.” The areas with the most deficits mainly included working memory, but lowered capabilities were also found in the areas of executive function (which includes higher-level skills, such as decision-making) and motor function. These consequences were associated with a decreased production of dopamine. While the results of this study weren’t conclusive, the report supports the hypothesis that long-term meth abuse may lead to persistent and lasting brain changes. More research is needed to determine whether these changes can be reversed.¹⁰

A case report examined a 24-year old male who was dependent on meth for 4 years and found that he had developed visual hallucinations, anxiety, delusions, paranoia, apraxia (a disorder of learned or skilled movements resulting from brain damage or injury), and tachycardia (abnormally high resting pulse rate) due to structural cerebral alterations. These symptoms and the patient’s extensive white matter brain changes persisted for at least 7 months after the initial appointment. They didn’t follow up after the 7-month mark, so there’s no way of knowing whether the damage resolved over time or not, but this study gently implies the possibility of long-term and irreversible brain damage.¹¹

However, a clinical review that examined numerous studies on crystal meth and long-term brain damage reports that certain neurological changes may indeed be reversible after a period of abstinence. The changes that appear to be reversible include the damage to neurotransmitter receptors, which are replaced over a period of 12­–18 months after abstinence. Once these receptors are functioning normally again, symptoms related to neurotransmitter changes, such as anxiety, irritability, rage, apathy, depression, and insomnia, are also typically reversed.⁷ This happens as new receptors and transporters are produced, neurotransmitter levels are reestablished, and neurons grow back, a process known as neurogenesis.⁷

Professional detox and substance abuse treatment helps to promote abstinence and recovery, which will go a long way in preventing additional brain damage and potentially restoring brain functions.

Recovering from Addiction

Detox and addiction treatment are essential for recovering from a crystal meth addiction. However, formal detox is not a substitute for addiction treatment, but rather is the first step to recovery. Detox helps you withdraw from meth safely and comfortably by providing support, monitoring, and medical intervention, should it be needed. Although there are currently no medications approved by the Food and Drug Administration (FDA) to treat stimulant withdrawal, you may receive supportive medications to alleviate specific symptoms that can accompany withdrawal, such as insomnia or depression.¹³

Because severe depression and suicidal ideation can occur during crystal meth withdrawal, it is advisable to seek detox in an inpatient setting that will provide intensive monitoring and support. Inpatient programs provide you with 24/7 care and monitoring to ensure your safety during this distressing and trying time.

After detox, you should transition to an addiction treatment program to help build a solid foundation for recovery. Addiction treatment helps you address the underlying causes of your addiction and learn the skills you’ll need to stay clean and sober. You will participate in a variety of therapies, including individual and group counseling, as well as peer support groups.

Substance abuse treatment occurs in two main settings—inpatient and outpatient. Inpatient rehab requires that you reside at the facility for the duration of your treatment program. You receive around-the-clock care and are separated from your prior drug-using environment, which can help you focus solely on your recovery and avoid relapse. Outpatient treatment programs require that you commute to and from the facility for scheduled treatment sessions, ranging from a couple hours per week to several hours per day.

Regardless of the type of program you select, it’s crucial to engage in some type of rehab to help best prevent relapse and provide a solid foundation for sobriety. Once you complete your methamphetamine addiction treatment program, the work isn’t done. In order to prevent relapse and maintain abstinence in the long run, you’ll want to engage in an aftercare plan, which typically consists of varying types of ongoing support. Individual therapy, group counseling, 12-step meetings, non-12-step meetings, and sober living homes all qualify as types of aftercare.

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