As I was sitting with family and relatives around our kitchen table – aromas from sage-infused bread stuffing emanating throughout the warm, festive October air – I couldn’t help but think of all the people who were enjoying only a fraction of my good fortune; particularly, people with addiction. Dinner conversation turned to memorable movies of 2018 and upcoming 2019 – holiday season, after all, coincides with award season. While my family was enthusiastically discussing Black Panther, Green Book Spider-Man: Far From Home, my mind was tugged back to a father navigating his son’s difficult journey with methamphetamines and other drugs in Beautiful Boy.
While opioids like heroin and fentanyl are making daily headlines, stimulants such as methamphetamines – Nic Sheff’s drug of choice – rarely do, even though their use is on the rise. In this article, I will explore methamphetamine addiction, its impact on users and their families, and its portrayal in Beautiful Boy through gripping performances by Steve Carrell and Timothée Chalamet (who has been nominated for Screen Actors Guild, Critics Choice and Satellite Awards).
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Now, we are seeing a rise in the use of stimulants. From 2011 to 2016, the age-adjusted rate of drug overdose deaths involving methamphetamine more than tripled, according to a 2018 CDC Report. In addition, 50% of overdose deaths involving methamphetamine also included one or more other drugs. Just like Chalamet’s Sheff in Beautiful Boy.
Let me first address some common questions about stimulants including methamphetamine:
- What are stimulants?– They are substances that increase activity in the brain. Also known as psychostimulants, these drugs increase physical (e.g. walking, vacuuming) and mental (e.g. alertness) activities.- Common stimulants are caffeine, nicotine, methamphetamine, Ecstasy, cocaine and methylphenidate (a.k.a. Ritalin or Concerta)
- What are other names for methamphetamine?– Speed, meth, chalk, crank crystal, ice, crystal meth
- How does methamphetamine affect the brain?– It increases the amount of dopamine, a neurotransmitter involved in motivation and reinforcement of rewarding behaviors. This rapid release of high levels of dopamine in reward areas of the brain strongly reinforces drug-seeking behavior, making the user want to take more of the drug. Nic displayed this behavior time and again throughout the film.
- How is methamphetamine used?– Inhaling/smoking, swallowing, snorting or injecting the powder that is dissolved in water/alcohol
- What are some health effects of methamphetamines?– Short-Term Effects: faster breathing; increased blood pressure, wakefulness, body temperature and physical activity; decreased appetite; rapid and/or irregular heartbeat- Long-Term Effects: increased risk of contracting infectious diseases with injection of meth; impaired judgement and decision-making, leading to risky behaviors, e.g. unprotected sex or stealing (as seen in Beautiful Boy); worsened progression of HIV/AIDS including increased cognitive problems (learning, memory, understanding) through nerve cell damage
– Other Negative Consequences from Long-term Meth Use: anxiety, extreme weight loss, severe dental issues (“meth mouth”), intense itching, confusion, insomnia, paranoia, hallucinations and violent behavior
- Can methamphetamines be addictive?- Yes, they can be highly addictive. Stopping the drug can lead to uncomfortable withdrawal symptoms such as anxiety, meth sores, sweats, intense cravings, severe depression and psychosis.
- Can I overdose on methamphetamine?- Yes, too much of the drug can cause a toxic reaction resulting in overheating in the body which can lead to organ damage such as kidney failure, heart attack or stroke, and ultimately death.
- Can methamphetamine addiction be treated?- Yes. The standard of care is behavioral therapies including cognitive-behavioral therapy (CBT) and motivational incentives. Currently, no FDA-approved medications are effective in treating methamphetamine addiction.
If you haven’t seen Beautiful Boy, I highly recommend it. It’s one of very few films that explores methamphetamine use, and the ups and downs of addiction in general. A few of my observations:
- Supportive family. Steve Carell portrayed a very caring parent who went above and beyond, emotionally and financially, to better understand his son’s condition. He performed online searches and took exhaustive notes (not surprising for a writer). Family support is key in recovery.
- Relapse is expected. Carrell’s Sheff understands this. Addiction caused Nic to behave in ways he never would have otherwise (breaking into his parents’ home with his girlfriend, stealing from his family, etc.)
- Most people w/ SUD are polysubstance users. Nic might have started with marijuana and alcohol but he later used methamphetamines and opioids.
- Not all rehab programs offer evidence-based treatment. AND they mislead (i.e. lie) to families about outcomes. One rehab staff told David Sheff that success rates are over 80%. Later, an addiction expert (played by Oscar-winner, Timothy Hutton) shared true treatment outcomes (<10%)
- Most families aren’t so supportive. Nic Sheff was lucky to have parents that not only had means (financially, educationally), but they were present. Persistently. (Well, until the end when Carrell’s character said his son couldn’t come home.) But MANY people with SUD feel isolated. Many of my patients are disenfranchised from their families who often perceive addiction as a moral failing rather than a disease. Even those who know addiction impairs the brain just can’t take any more of the stealing, lying, manipulation, and all the other challenging behaviors that can be associated with addiction. In some cases, the family is the source of the pain and trauma.
- Offer medications when indicated. Medical therapy isn’t available for meth addiction – but it is for alcohol and opioids. Was Nic offered medications like methadone or bupe for his opioid use? Or naltrexone for alcohol use? Treating his other addictions may have given him a sense of normalcy and stability, and possibly decreased his cravings for stimulants.
- It’s good to be white. Important to be mindful of racial disparities in addiction and related issues. Not only were Nic Sheff’s parents loving and present, but they were privileged to have the ‘right’ skin color. According to a 2017 study in the Journal of Drug Issues, black Americans are more likely to be charged with drug possession and sales compared to their white counterparts, even though both groups reported the same degree of drug selling. In addition, a Human Rights Watch (HRW) report revealed that black Americans make up 13% of drug users but account for 62% of drug offenders sent to prison; and white Americans report using drugs at 5x the rate of black Americans, but the latter are imprisoned at 13x the rate versus the former.
The use of methamphetamines and other stimulants like cocaine is rising. Drug addiction itself is nothing new and will never go away. We need more films – Hollywood, independent, documentary – to tell these stories. Beautiful Boy, A Star is Born and the newly-released Julia Roberts’ project, Ben is Back, are leading by example. Please reach out to a loved one and let them know you’re here for them, and ask for help. It won’t be easy. Most things in life worth fighting for rarely are.
Wishing you all a mentally, spiritually, physically and emotionally healthy year!!
More information about methamphetamines and other stimulants can be found through the National Institute on Drug Abuse, CDC, Substance Abuse and Mental Health Services Administration and the World Health Organization.