Ice Breaker

Ice use can make you feel agitated or distressedTrueFalse

What type of help is available?

COVID-19 Information

Since early 2020, Coronavirus (COVID-19) has impacted the availability of services in the Alcohol and Other Drugs (AOD) sector across Australia. Residential rehabilitation centres and face-to-face treatment options may be limited; however, innovative digital and telephone support options are available.

During this time, Cracks in the Ice will continue to provide evidence-based information and resources about crystal methamphetamine ('ice') including links to online support programs (e.g. Family and Friends Support Program, Crystal Clear). For more information about support options available in your state/territory call the National Alcohol and Other Drug Hotline on 1800 250 015.

Someone I care about has a problem with crystal methamphetamine ('ice'). What treatment options are available?

There are treatment and support options available to someone who is experiencing problems (including with crystal methamphetamine ('ice') or other drugs. The more intensive treatment options (such as residential rehabilitation clinics) are not always the best option. In fact, providing intensive rehabilitation too early can be harmful, as it can make someone feel overwhelmed and disengaged from treatment, thinking that it’s not relevant for them, and may prevent them from accessing support in the future.

Below you’ll find information on some treatment options and who they are best suited to. If you are unsure of which option is best for you or a loved one, your local doctor should be able to conduct an initial assessment and refer you to a service that fits your needs. For other support options, please refer to the When and where do I get help? page.

It’s also important to consider that people who are experiencing problems with ice often have a lot more going on in their life than just their ice use. For example, they may also be experiencing other physical and/or mental health issues such as dental problems, cognitive difficulties, and/or In addition, people who are experiencing problems with ice and other drugs also often face other difficulties due to lack of social support, stable housing and financial security. It’s important that everyone involved in the treatment and recovery process, including family and friends, consider the person’s use of ice within the context of the other challenges they may face in their recovery.

Some of the treatment options below may be available through Telehealth appointments. This involves delivering health services through online platforms such as video conferencing and phone calls. For more information on Telehealth, and how it can be utilised for Alcohol and Other Drug treatment, please refer to this factsheet.

Treatment options for crystal methamphetamine use

Cognitive Behavioural Therapy (CBT)
CBT involves understanding how particular patterns of thinking can affect our feelings, our behaviours, and the situations we encounter in the world. CBT assists a person to firstly identify those patterns of thinking that are working against them, and to develop strategies to make these thoughts work for them instead. This will have a flow-on effect to the person’s feeling and behaviour.

CBT and Motivational Interviewing (MI) have been used in combination with each other and may help people reduce their ice use. Adaptations that have been effective or utilise these techniques to reduce use are Crystal Clear, Alcohol, Smoking and Substance Involvement Screening TestASSIST and Ice: Training for Frontline Workers.

Motivational Interviewing (MI)
MI was originally developed to help people experiencing drug and alcohol issues consider how these choices affect their life. It centres on the individual having a conversation with a health professional about their use in a non-judgemental and collaborative way, with the person themselves setting the direction and tone of this conversation. MI can be used even with people who aren’t even contemplating making any changes to their drug use and can assist them in re-assessing the role of drugs in their lives. CBT and MI have been used in combination with each other and may help people reduce their ice use. Adaptations that have been effective or utilise these techniques to reduce use are Crystal Clear, Alcohol, Smoking and Substance Involvement Screening TestASSIST and Ice: Training for Frontline Workers.

Contingency Management (CM)
Although not widely used in Australia, contingency management (CM) is another effective approach to treatment for ice CM involves rewarding people in treatment for alcohol or other drug dependence with incentives (e.g. vouchers, activities) whenever they hit their treatment goals, such as attending a set number of treatment sessions or staying abstinent throughout the program. The idea is to make life without ice more attractive than continuing to use the drug.

Seeing a psychologist
Seeing a psychologist is a good way to learn the techniques involved in CBT and MI. Psychologists create a safe space for people to come and talk about things they might not feel comfortable talking about with their family and friends. They can assist people who are trying to understand their thoughts and feelings, and help them to learn skills and techniques to manage these thoughts and feelings. For people who are ready, a psychologist can help with setting goals to encourage changes in their life.

People presenting to their General Practitioner with mental health concerns may be eligible for up to 10 Medicare rebatable sessions each calendar year under a Better Access to Mental Health Care Plan. The Australian Government has also made available 10 additional Medicare subsidised psychological therapy sessions each calendar year until 30 June 2022 for people experiencing severe or enduring mental health impacts from the COVID-19 pandemic, and the measures needed to contain it.

Psychologists see people experiencing a range of mental health issues and can therefore assist with drug use concerns and any other difficulties you may be experiencing. This option is particularly suitable for people who do not need assistance with basic needs such as housing and food, as they have the means and motivation to attend regularly scheduled counselling appointments. Given that a limited number of subsidised sessions are available, this service is most appropriate for individuals who may only require a limited number of sessions or who don’t need to attend therapy very frequently.

Drug Counselling appointments
Drug Counselling appointments can also be booked with a trained counsellor at a drug and alcohol service. Some services may also be able to help with concurrent mental health issues such as disorders and Again, this option is suitable for those not needing assistance with basic needs but are able to attend regularly scheduled counselling appointments.

Outreach Support
Outreach Support can be provided by a trained health professional who visits a person’s home to help them complete daily activities and supports them in tasks such as securing safe housing and attending health check-ups. They may also be trained in providing counselling support for both drug and mental health issues. This option is particularly suitable for people who are severely on ice and unable to attend regular counselling appointments at a clinic due to housing or financial issues.

Online Treatment Programs
Online Treatment Programs can involve ‘chatting’ to a trained counsellor over the internet in real-time or by email, or a pre-programmed online “course” that is offered with or without support from a trained professional. For example, Counselling Online provides free drug and alcohol counselling over the internet 24 hours a day, 7 days a week to anyone in Australia. This site also offers a range of practical information, an SMS support program, an online peer support forum, and details about how to find a telephone or face-to-face treatment program in your state.

Online automated programs that have demonstrated benefits for people with drug use problems include the SHADE program (for and alcohol/other drug use) and OnTrack program (for alcohol use and . Other online automated programs include the MoodGym program (for , MindSpot program (for and , and ThisWayUp program (for and , which may assist people with additional concerns associated with their ice use. A number of online portals now exist, which can help people work out which is the best online program for them. These include the Head to Health portal, and the DigitalDog portal. Online services can help provide treatment at times when people most need them and are available 24-hours a day. They can offer support whilst people are waiting to access face-to-face treatment services, or in situations where specialist services are unavailable.

There is also an evidence-based online early intervention for ice use, based on CBT and MI, called Crystal Clear. The Crystal Clear program is designed to help individuals become more aware of how their use of ice affects their health and other areas of their life. Click here to access the Crystal Clear program.

Residential Rehabilitation
Residential Rehabilitation, such as ‘rehab’, ‘detox’ or centres are places where people can stay for a few days or up to several months at a time. Rehabilitation centres provide accommodation, food, and access to health professionals such as nurses and counsellors. These centres often run daily activities such as education classes, group therapy sessions, exercise classes, movie sessions and gardening. Nurses and doctors can provide support for individuals experiencing withdrawal symptoms, and psychologists, counsellors or support workers assist with emotional difficulties during this time. Residential rehabilitation allows the individual to devote a significant amount of time to their mental health and is an environment where people may be able to set goals and plan for their future. This option is suitable for people who are severely on ice, have limited family support and do not have commitments such as school or work, or who would not otherwise have access to a safe, drug-free environment to withdraw from ice.

The specific treatment options and length of stay offered by rehabilitation centres vary. Some centres also offer outpatient day programs where individuals attend treatment sessions and activities on a daily or weekly basis while still living at home. It’s recommended that individuals interested in residential rehabilitation seek advice from their GP and staff members from the different centres in their local area to decide on the best option for them.

Support Groups
Support groups, also known as mutual help groups or peer support groups, involve people meeting to discuss and support each other through various issues such as difficulties with alcohol or other drugs.

Support groups are often facilitated by group members or peer support workers. They are usually free, and people can attend as often as they like. They commonly follow an abstinence-first philosophy, meaning members are encouraged not to use alcohol or other drugs while they attend the groups.

Studies show that community or peer-based support groups can be an important part of someone’s recovery from alcohol or other drug use, especially when combined with treatment options such as Cognitive Behavioural Therapy (CBT) or Interviewing (MI). This type of support can be particularly helpful for people who cannot pay for formal treatment or have issues accessing it (such as those living in a rural or remote area). Support groups are unregulated and so each one can be run with different content and in different ways. This makes it difficult to measure how effective they are compared to other treatment and support options. However, for some people they are an important and effective part of their journey towards recovery.

SMART Recovery

SMART (Self Management and Recovery Training) Recovery is a free group program assisting people who are experiencing problems related to on drugs, alcohol, cigarettes, gambling, food, shopping and the Internet.

SMART has a stronger evidence base than other support groups, and it is facilitated by trained professionals. People who use crystal have also been shown to attend SMART recovery meetings more regularly than other support groups due to the meetings being more accessible.

Meetings include helpful information and support for people who use ice, but also cater to other group members and so may also include information about other substance use issues or problematic behaviours.

To view all meetings, visit: https://smartrecoveryaustralia.com.au/find-meetings/

To view meetings that support family and friends of people who use methamphetamine: https://smartrecoveryaustralia.com.au/support-for-family-friends-of-people-who-use-methamphetamine/

Narcotics Anonymous

Narcotics Anonymous provide regular meetings for people seeking peer support in their recovery from alcohol and/or other drug use.

Web: https://www.na.org.au/multi/

Crystal Methamphetamine Anonymous

Crystal Methamphetamine Anonymous provide regular meetings for people seeking peer support in their recovery from crystal (‘ice’) use specifically.

Web: https://cma-australia.org.au/

Emerging treatments for crystal methamphetamine use

Pharmacotherapy (medication)
There is currently no approved medication for treatment (including substitution therapy) of in Australia. Researchers in Australia and other countries are conducting clinical trials to test whether certain medications have the potential to help with treatment of methamphetamine dependence. So far, no medication has been consistently shown to be effective and safe enough to be routinely prescribed by health practitioners.

Multicomponent Treatment Programs
There is growing evidence supporting the use of multicomponent treatment programs for ice Multicomponent treatment programs combine multiple treatment approaches in a single program. The idea behind combining multiple approaches is that treatment will be more effective if it targets many of the processes driving ice dependence all at once.

The Matrix Model is a multicomponent treatment program that combines CBT, MI, CM, and other methods to treat ice dependence. This model has been trialled successfully in North America and is currently being trialled for the first time in Australia in several states and territories. If the program delivers promising results it may be offered in other states and territories. For more information about the program, please visit the Matrix Model website.

What to expect from the withdrawal, treatment & recovery process?

You should expect the treatment and the recovery process to be challenging, and to take time. People accessing treatment and support for the first time may have been using ice for long periods of time. It’s important to know that it’s never too late to start treatment. Also, it’s important to know that people don’t need to be on ice nor do they have to have used it for a long time in order to get help. If someone feels their use of ice or other drugs is getting out of control or they start noticing problems or unintended consequences arising, it’s never too early to seek support.

Adjusting to life without ice can be difficult, but it can also be rewarding, and open up many more opportunities in life.

Sometimes people recovering from ice dependence will have setbacks. Often people recovering from dependence and their family and friends can feel upset and want to give up. You should know that this is a normal step in the recovery process and that you are not alone. Health professionals will be there to provide support and guidance and can listen to any concerns you may have. As a family member or friend supporting someone in their recovery, it’s also important to seek support for yourself if you feel you need it. Click here to access a support program for families and friends.

Withdrawal
Withdrawal is the first stage to overcome when recovering from ice dependence. Withdrawal refers to the unpleasant bodily reactions people experience when they stop consuming a substance that their body has adjusted to having in its system. Withdrawal from methamphetamines such as ice generally takes longer than withdrawal from other drugs, making it more difficult for people who are dependent on methamphetamines to make it through treatment and recovery.

For example, withdrawal symptoms for heroin or alcohol typically start within 24 hours of stopping drug use, peak over the next couple of days and subside within a week. For methamphetamines, people typically experience a 2 to 3 day “comedown” or “crash” phase before withdrawal symptoms kick in. During the crash phase people typically feel exhausted and need to sleep to regain energy. After the crash, people then experience intense withdrawal symptoms such as strong cravings, sleeping difficulties, headaches and pain and stiffness in the body for up to 10 days. It’s around this point in time, 1 – 2 weeks into withdrawal, when people are at the greatest risk of starting to use methamphetamines again and when they need the most support. While withdrawal symptoms become less intense at this point, they can last for a further two weeks or more. Methamphetamine cravings persist throughout the entire withdrawal period and can carry on for up to three months.

Adapted from Beyond the tip of the iceberg: A practitioners' guide to ice. See the key source list below for more information.

The severity of ice withdrawal will depend on how long and how much people have been using, and the level of dependence a person has developed on ice (complete a screener for ice dependence). The longer an individual has been using a drug like ice and the greater the quantity they have been using, the more intense the withdrawal symptoms will be. The mental and physical health of the person using ice will also affect the severity of withdrawal, which is why we recommend seeking assistance to help build up mental and physical health in preparation for the withdrawal period. Although everyone’s withdrawal from ice will be different, there are common withdrawal symptoms that you should be aware of.

Treatment and Recovery
Working through withdrawal is a major achievement. Making it through this period does not, however guarantee that someone will stop using ice or treat the cause of dependence. Further treatment is needed to help people refrain from using ice and build a satisfying and meaningful life without it.

There are a number of treatment and support options available for someone experiencing problems (including dependence) with ice or other drugs outlined in the “Treatments that work for ice use” section above. If you are unsure of which option is best for you or a loved one, your local doctor should be able to conduct an initial assessment and refer you to a service that fits your needs.

Often issues other than a person’s ice use will be addressed in treatment. These might include other substance use, mental and physical health issues, or problems relating to social networks, housing, employment and financial security. These issues are often addressed as they have the potential to interrupt treatment and/or increase the likelihood of someone starting to use ice again once they have left the treatment environment.

Recovery from ice dependence is challenging and can take 12 to 18 months or longer due to the significant readjustments that are required in the person’s thinking and lifestyle. There can be times when people go in and out of treatment and continue using ice on and off. This is common and a normal part of the process. Health professionals will be there to support you and your loved ones along the way. They are there to provide support and guidance and will listen to any concerns you may have. Post treatment support (also known as aftercare) options are also available to provide further assistance to someone who has completed treatment but would like additional support to keep them on track over the longer term. Examples of post treatment supports include telephone or online counselling and ongoing involvement with a peer support group.

How important are family and friends to the recovery process?
Families and friends can play a critical role in the recovery of people who might be experiencing problems with ice or other drugs. Research has shown that people who are dependent on methamphetamines such as ice are more likely to recover if they report having social support.

Being around someone who is using or dependent on ice can be stressful though, especially if they are someone you love. As a friend or family member you may feel anxious at times because of the changes you see in your loved one when they are using ice. You may at times feel desperate or helpless if your loved one continues to use ice. It’s important that you look out for yourself as well as your loved one by seeking support when you need it, whether this be from a friend or health professional, and looking after yourself with a healthy diet, adequate sleep and regular exercise. If you require further support, Family Drug Support and the Family and Friends Support program are two free, nationally available support options specifically for families and friends. Other support information is also provided below.

Where to get support

If you’re worried about a loved one who may be using ice, you can get support for them and yourself. It can be difficult to seek help, but in most cases the sooner you reach out for support, the better. You may want to discuss your concerns with a friend that you can trust. Your General Practitioner or family doctor can also be a good starting point – they can confidentially discuss your concerns with you and refer you on to other services if you need additional support.

For more information on support services and how to get help for yourself or a loved one, visit the When and Where to Get Help section.

If you need emergency support, please call Lifeline (13 11 14) which is a 24-hour crisis helpline or dial '000' for the police or an ambulance.

KEY SOURCES

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de Andrade, D., Elphinston, R.A., Quinn, C., Allan, J., Hides, L. (2019). The effectiveness of residential treatment services for individuals with substance use disorders: A systematic review. Drug Alcohol Depend. doi: 10.1016/j.drugalcdep.2019.03.031

De Giorgi, R., Cassar, C., Loreto D’alò, G., Ciabattini, M., Minozzi, S., Economou, A., Tambelli, R., Lucchese, F., Saulle, R., Amato, L., Janiri, L. & De Crescenzo, F. (2018). Psychosocial interventions in stimulant use disorders: a systematic review and qualitative synthesis of randomized controlled trials.Rivista di Psichiatria 53(5), 233-255.

Gouzoulis-Mayfrank, E., Härtel-Petri, R., Hamdorf, W., Havemann-Reinecke, U., Mühlig, S. & Wodarz, N. (2017). Clinical practice guideline: Methamphetamine-related disorders. Dtsch Arztebl Int, 114, 455–61. DOI: 10.3238/arztebl.2017.0455

Grigg J., Manning V., Arunogiri S., Volpe I., Frei M., Phan V., Rubenis A., Dias S., Petrie M., Sharkey M. & Lubman D. I. (2018). Methamphetamine Treatment Guidelines: Practice Guidelines for Health Professionals (Second Edition). Retrieved from: Methamphetamine Treatment Guidelines: Practice Guidelines for Health Professionals (Second Edition)https://www.turningpoint.org.au/treatment/clinicians/methamphetamine-treatment-guidelines

Jenner, L. & Lee, N. (2008). Treatment Approaches for Users of Methamphetamine: A Practical Guide for Frontline Workers. Australian Government Department of Health and Ageing, Canberra. Retrieved from: Treatment Approaches for Users of Methamphetamine: A Practical Guide for Frontline Workershttp://nceta.flinders.edu.au/files/6514/3130/6042/Treatment_Approaches_for__Users_of_Methamphetamine_-_Practical_Guide_for_Frontline_Workers.pdf

Kamp, F., Proebstl, L., Hager, L., Schreiber, A., Riebschläger, M., Neumann, S., Straif, M., Schacht-Jablonowsky, M., Manz, K., Soyka, M., & Koller, G. (2019). Effectiveness of methamphetamine abuse treatment: Predictors of treatment completion and comparison of two residential treatment programs.Drug and Alcohol Dependence, 201, 8-15. Journal Article: Effectiveness of abuse treatmenthttps://doi.org/10.1016/j.drugalcdep.2019.04.010

Lanyon, C., Nambiar, D., Higgs, P., Dietze, P., & Quinn, B. (2019). Five-year Changes in Methamphetamine Use, Dependence, and Remission in a Community-recruited Cohort. Journal of Addiction Medicine, 13(2), 159-165. doi: 10.1097/ADM.0000000000000469

Lee, N., Jenner, L., & Ross, P. (2017). Beyond the tip of the iceberg: A practitioners' guide to ice. Retrieved from: Beyond the tip of the iceberg: A practitioners' guide to icehttps://www.360edge.com.au/resources/

Madden, E., et al. (2021). Best practice approaches for alcohol and other drug treatment in residential settings. Evidence check prepared for the Network of Alcohol and Other Drugs Agencies (NADA)

Paulus, M. P., & Stewart, J. L. (2020). Neurobiology, clinical presentation, and treatment of methamphetamine use disorder: a review. JAMA psychiatry, 77(9), 959-966.