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Brainscans

Crystal meth addiction doesn't follow the rules of traditional rehabilitation. New Seasons clinic in California looks inside the brains of addicts to crack the code.

Skanda Miraglia started using crystal methamphetamine when his boyfriend promised, "We'll have the best mind-blowing sex if we do."

It was fun at first, but life under meth's influence wasn't. Miraglia lost his job, his boyfriend, and a group of friends. He lived in a state of total paranoia. With an embarrassed laugh, he says, "I thought people were always watching me and taking pictures."

Miraglia's remaining friends staged an intervention, which led to a series of rehabilitation programs, including a 10-day detox followed by six weeks of inpatient care at Banner Good Samaritan Behavioral Health Center in Phoenix, paid for through a state-funded program. Those efforts helped but only planted the seeds of recovery.

It wasn't until a few years later that Miraglia stopped using. That's when a fellow 12-stepper recommended that he pray. "I didn't know who I was praying to or what for--I just asked for help," he says. And slowly things started to change.

He found yoga, a guru (Ma Jaya Sati Bhagavati), and Crystal Meth Anonymous--a trifecta that has kept him clean for four years. But like a lot of other meth addicts, he had to take the initiative to find a treatment that worked. Traditional programs just didn't cut it.

Miraglia isn't the only one to find meth recovery programs lacking. Experts admit that what can work for other addictions often doesn't for meth. No drug approved by the Food and Drug Administration has been shown to reduce the craving for meth, though some are now being tested. Worse, recovering addicts can experience withdrawal symptoms for months. Traditional inpatient detox programs, though, last only 10 days. Even after meth is out of a person's system, the seductive memory of its influence remains alluring.

"There's a myth out there that meth users are essentially a lost cause," says Joel Ginsberg, executive director of the Gay and Lesbian Medical Association. "Our ['Breaking the Grip'] project identified many successful strategies for helping gay and bisexual men overcome meth addiction, though there are only a handful of programs around the country that are able to provide the kind of tailored treatments that work best for this population."

Psychotherapist Steven Orenstein opened the New Seasons clinic in Port Hueneme, Calif., as a tailor-made treatment center for meth addicts. He'd previously been the director of addiction programs at Cedars-Sinai Medical Center in Los Angeles. But he could see that treatment programs offered at these hospitals, even good ones, weren't as effective as they should be.

"In a hospital you have to get someone in and out," Orenstein says. "You can't do that with meth addiction."

He argues that understanding what triggers someone's meth use takes time. Giving someone the specific tools they need to avoid temptation isn't something you can do in a cookie-cutter program.

"People who come to us have tried three or four different programs. These programs keep trying the same things each time. But when they do, they get the same results," Orenstein says.

New Seasons isn't cheap, and insurance doesn't typically cover this kind of care. But Orenstein argues it is more affordable than most programs. The primary program, which lasts a month, is an all-inclusive $28,000. The cost goes down each month a person stays in the program. The 13-month aftercare program is another $15,000.

The real key to New Seasons' success, Orenstein says, is the work it does with a meth addict's brain, a step most programs skip. "All the drug and behavioral therapy in the world isn't going to change meth's physical impact," he says.

Fighting the addiction is the first step, naturally, but crystal meth physically harms the brain, hampering how a person functions, much like a stroke, epilepsy, or Alzheimer's disease does. Orenstein believes that a recovery program without neurocognitive rehab is incomplete.

At New Seasons, each patient is first administered a QEEG scan that assesses more than 293 dimensions of brain-wave activity to determine how meth has altered the function or structure of brain regions. These measurements are visually and quantitatively summarized in a brain map that serves as a guide to determine which areas need strengthening or balancing.

New Seasons then uses digital simulations, such as adaptations of computer games like Pac-Man, to stimulate regions of patients' brains. Subsequent scans are administered while patients perform tasks like playing a car-racing video game.

Clients view their scans so they can observe changes to their brain. "When you see those actual changes with the brain map, it's really exciting. It's had an incredible impact on my ability to focus," says Mike, a New Seasons outpatient client who asked that his last name not be used. Being able to see real, quantifiable progress, not just hear that he's doing better, was what he needed to stay focused on recovery. Mike has been in aftercare treatment three days a week since last October. In aftercare, clients are remapped every couple of months (depending on their progress) to monitor improvement.

While brain mapping may seem clinical, New Seasons feels more like a spa than a hospital. Addicts are called clients, not patients. They aren't locked in and are free to explore the nearby beach. The grounds have meditation spaces, an outdoor dining area, a fire pit, and a beach volleyball court. Counseling is supplemented with acupuncture, acupressure, massage, yoga, herbal therapy, spiritual guidance, and psychodrama, poetry, and music therapies.

As the program has been open just over a year, it's tough to determine its effectiveness. But Orenstein has measured improvements in clients' cognitive function ranging from 20% to 40%. That level of success has prompted the University of California, Los Angeles's Integrated Substance Abuse Program to launch a study of why the New Seasons methods appear to work.

The GLMA's study, "Breaking the Grip," didn't review New Seasons' program, but it did find that cognitive behavioral programs such as theirs can have success with meth users. The study, released last November, also concluded there aren't nearly enough recovery programs to meet the need.

Brian Dew, chair of the Atlanta Meth Task Force, agrees. Surveys he's conducted indicate treatment can still fall short, although some outpatient programs are being extended to deal with the long-term effects of meth withdrawal.

"I'm not surprised that there's a program with a more progressive approach out in California. They've been dealing with the epidemic a lot longer," Dew says. "I hope more comprehensive programs will be made available throughout the country."

Mike, who says he is eternally grateful to New Seasons, appreciates the tangible signs of his progress most of all--like when he plays Brain Builder, a New Seasons game that shows a series of disappearing dots he's then expected to remember. When he first came in, he could recall only five dots. He's up to 12 now, and he's excited about the progress. "It sounds like a minor thing," he says, "but I want to get even better. I want to remember 15."

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