Maybe It's Not the Meth: Considering Biopsychosocial Contributors to Cognitive Impairment in Methamphetamine Polydrug Use.

James R Gooden,Catherine A Cox,Victoria Manning,Vanessa Petersen,Ashlee Curtis,Shalini Arunogiri,Georgia L Bolt,Dan I Lubman

doi:10.3389/fpsyt.2022.795400

Abstract

ObjectiveIn considering the cognitive harms of methamphetamine (MA) use, there is currently a limited appreciation of the profile of pre-existing, comorbid, or modifiable risk factors for cognitive impairment in individuals with MA-polydrug use who present to clinical services. This is in contrast to the well-recognized evidence in alcohol use groups. The aim of this study was to investigate the biopsychosocial and neuropsychological profiles of MA-polysubstance using individuals reporting cognitive impairment in comparison to an alcohol-using group.MethodsA retrospective file audit was undertaken of individuals who presented for assessment to a specialist addiction neuropsychology service and reported either more than 1 year of heavy MA use as part of a polydrug use history (n = 40) or having only used alcohol (n = 27). Clinical histories including demographic, medical, mental health, substance use, and neuropsychological assessment results were extracted from medical records. Between group comparisons were conducted to explore differences in the MA-polydrug vs. the alcohol group.ResultsIndividuals in the MA-polydrug group were significantly younger, commenced substance use at an earlier age, were more likely to have an offending history, and experienced an overdose than those in the alcohol group. No differences in comorbid neurodevelopmental, psychiatric or acquired brain injury diagnoses were observed between groups. For neuropsychological functioning, significant group differences were observed in overall IQ, semantic verbal fluency, and psychomotor tracking, where individuals in the alcohol group performed significantly worse.ConclusionsNeuropsychological profiles were largely equivalent between groups across cognitive domains, with minor differences in favor of the MA-polydrug group. Relative to the general population, cognitive functioning was reduced for both groups across a range of domains. High rates of comorbid mental health concerns were common across both groups, however, individuals in the MA-polydrug group presented with a higher risk of overall harm from substance use at a significantly younger age which is a unique concern for this group. These findings highlight the importance of considering the biopsychosocial factors, such as age of first use, emotional distress, indirect substance related harms including overdose and blood born virus infection that may be relevant to experiences of cognitive difficulty in MA-polydrug users.

Highlights

Methamphetamine (MA), often colloquially known as ice or crystal meth, is a highly addictive derivative of amphetamine and has been increasing in illicit use within Australia [1]
The Turning Point Addiction Neuropsychology Service is a government funded community-based service and is one of the specialist clinical services provided by Turning Point, a national addiction treatment and research center based in Melbourne, Australia
At the time of assessment, individuals in the MA-polydrug group were significantly younger than individuals in the alcohol group, with a mean of 34 years compared to a mean of 49 years, respectively

Summary

Introduction

Methamphetamine (MA), often colloquially known as ice or crystal meth, is a highly addictive derivative of amphetamine and has been increasing in illicit use within Australia [1]. Between 1999 and 2017 a 4-fold increase in MA deaths was observed [2], with an estimated $5 billion societal cost relating to MA use in 2013 to 2014 [3]. Effects include dysphoria, depression, irritability, anxiety, poor concentration, hypersomnia, fatigue, paranoia, and craving [4]. These symptoms can have significant implications for everyday functioning in those with recurrent or dependent use. It has been proposed that MA can have neurotoxic effects via interacting mechanisms relating to hyperthermia, oxidative stress, toxic metabolites, neuroinflammation, and high cortisol levels [6]. A particular concern regarding the increasing prevalence of MA use is the impact that this may have on neuropsychological functioning in heavy or dependent users

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