Monica Avila is finally clean.
Bright-eyed, smiling with short blonde hair.
She's no longer the emaciated girl that was stuck in a 20-year rut of methamphetamine use starting when she was 13.
She has been sober since December 2005. She is working toward becoming a drug counselor. She is married. She has a dog, and a brand-new car.
But she has some reminders that will never go away.
She has hepatitis-C, contracted from injecting the drugs into her vein. She lost all her teeth, and now has a set of false ones.
"I wish I had a picture of what I looked like before," she said. "I had no teeth, I was just skinny and tore up."
Methamphetamine abuse can have long-lasting physical and psychological effects. It leads to paranoia, hallucinations and anxiety. It has physical consequences like rotting teeth, emaciation, and sometimes compulsive scratching because of "meth bugs."
Meth use can actually rewire the user's brain, making it difficult to think, to remember and to experience pleasure.
But despite meth's reputation for being more difficult than other drugs to kick, experts said it is possible to get clean, and that recovery rates are similar to other drugs.
Dr. Tim Cermak of the California Society of Addiction Medicine said short-term and long-term methamphetamine use can have lasting consequences.
"We always look at acute versus chronic," said Cermak. "Acute effects are probably the most dangerous in terms of immediate catastrophes. There is an exaggeration of normal fight or flight physiology, and people can have strokes and heart attacks," he said.
"With longer use, people become emaciated, using lots of energy with no appetite. They become malnourished and dental problems become massive," he said.
Known as "meth mouth," dental problems are caused by a combination of factors, including the acidity of the drug, lowered saliva production and heightened cravings for sugary soft drinks and foods, according to a 2007 report by the California Department of Alcohol and Drug Programs.
Long-term use also alters brain function, depleting the chemicals that induce pleasure, and decreasing attention- and memory-related abilities.
"On a brain-imaging scan we can show sufficient change in the brain that can take 12-18 months to correct, with a chance of permanent change," said Cermak. "A person literally has decreased capacity for pleasure, and even things that bring pleasure bring less pleasure for shorter periods of time."
Sue Weisenhaus-Braz, director of Champions Recovery Alternative Programs in Hanford, said she works with meth users between 14 and 25 years old.
"In younger users, it affects the immune system, so there's chronic flu and cold symptoms," she said. "When you're chronically sick, you're not motivated, and it starts to cross over into emotional well-being."
Weisenhaus-Braz, a former meth user herself, said many addicts are heavy tobacco smokers as well, "just adding insult to injury," she said.
It is hard to say whether or not a person will have irreversible damage caused by meth use. Certainly, higher quantities and longer use puts users at a greater risk, said Cermak.
Also, individuals who are vulnerable to mental illness, such as schizophrenia or psychosis are much more likely to have permanent damage, he said.
One side effect of chronic meth use causes addicts to believe that bugs are crawling under their skin. According to a report by the California Department of Alcohol and Drug Programs, this happens because meth causes the skin to feel tingly due to blood vessel constriction, combined with meth's hallucinatory properties.
Known as meth bugs or "formacation," derived from the scientific word (forma) for ants, this can be especially damaging when combined with meth user's inclination toward repetitive motions, or "tweaking."
"If this happens with scratching, it can be debilitating," said Cermak.
The way the drug enters the body can lead to other problems. According to the Drug and Alcohol Programs report, smoking meth can lead to serious cardiovascular problems. Injecting the drug often times results in serious infections. The rate of hepatitis-C among meth users in a recent study was almost 44 percent, according to the report.
"Snorting meth can lead to terrible sinusitis and scarring, even a loss of the nasal septum," said Cermak.
The use of unsanitary needles, along with the hypersexual nature of the drug puts users at much higher risk of contracting the HIV virus as well.
Avila said she lost a lot while she was on meth, including her health. But the one she lost out on that she can never get back is her identity.
"What I lost out on most was me. I had to grow up so fast, and the thing I missed out on the most was getting to know me without the meth."
Weisenhaus-Braz said she has been clean for 13-1/2 years, following a five-year relapse that started with a 40-ounce bottle of Coors and eventually progressed to snorting meth.
She said she would make deals with herself to cut back on her use, but it would never work.
It wasn't until she realized that she needed the help of others, and of a higher power, to stop the cycle of drugs.
"I had to surrender my life to God," she said. "I surrendered with both arms up, instead of one arm up and one on a straw."
It is possible for methamphetamine addicts to become sober, and treatment programs remarkably improve the likelihood of staying clean, said several drug experts.
"There are myths that less than 5 percent of methamphetamine addicts recover, but that's a made-up number that is somehow repeated around the country," said Dr. Richard Rawson, the associate director of the University of California, Los Angeles Integrated Substance Abuse Programs.
"In fact, recovery rates are comparable to other drugs, like cocaine and alcohol," he said.
Mary Ann Ford Sherman, Kings County Behavioral Health director, said a 12-month program is needed to combat meth addiction, and the idea that addicts cannot recover is not true.
"Meth is a beast, and it takes a longer time in treatment to address that addiction," said Ford Sherman. "But folks can recover, this is no longer the face of addiction we thought it was in the '80s."
Rawson helped create the Matrix Model, an outpatient, abstinence-based drug treatment program that combines therapy, education, urine monitoring and positive reinforcers.
The rate of methamphetamine-negative urine samples at six months was about 67 percent. One year after discharge, about 55 percent of meth users were still drug-free.
"That may sound like a number where we need to improve, but the fact remains that many methamphetamine addicts have gotten into a recovery lifestyle and can have fulfilling lives," he said.
Ford Sherman said for years Kings County has followed a social recovery model in drug treatment programs, where addicts talk in group sessions about the recovery process. However, "desperation" for a more effective plan has motivated the county to change to Rawson's Matrix Model.
"It's a recognition that what we're doing isn't enough, and we're willing to try something else," said Ford Sherman.
Rawson said the first six months are the most crucial, as the brain receptors that allow people to experience pleasure have been damaged. Called anhedonia, during this time users cannot experience pleasure, even when doing things that used to make them happy.
"Many recovering methamphetamine users say, 'If this is how it's going to feel to be sober for the rest of my life, I can't live like this,'" said Rawson.
That's why it's important to educate addicts that this feeling will pass, and to have that support system in place in case of relapse, he said.
Treating addiction as a chronic illness is a crucial step in the right direction, according to experts.
"People think you go into the box, you come out the other end and you're fixed," said Rawson.
"That's not how it works. Going into the box is the first step, then you need to figure out the recovery activities needed long-term for sustaining sobriety."
Rawson cited high-profile cases of celebrities going into short stints in rehab, only to continue using and return to rehab a short time after.
"If you have a heart attack, the hospital doesn't fix you, you still need to work at staying healthy for the rest of your life," said Rawson.
The same theory applies to meth addicts.
"They're not cured, they've simply found a way to deal with the illness," said Rawson.
Ford Sherman said that realizing addiction is a disease and not a crime is an important step toward getting more people into the programs they need.
"Sometimes behavior that follows addiction is illegal, but to be sick is not illegal," she said.
Health insurance rarely covers drug addiction, but Kings County funds treatment programs with minimal costs to those in recovery, she said.
"There are some client fees, but not full-blown treatment costs."
People who want to kick meth addiction are encouraged to call the county Mental Health office at 582-3211, ext. 2376 or Kings Connection at 1-877-864-9290.
The reporter can be reached at 582-0471, ext. 3043.
(Sept. 25, 2007)