‘Crystal Meth’ Use in an Addiction Outpatient Clinic in Italy: A Multifaceted Challenge

Abstract

Shaboo is a street name commonly used in parts of Asia, particularly the Philippines and Thailand, to refer to methamphetamine, a powerful and highly addictive stimulant. Its long-term effects are related to chronic exposure to the drug effects, primarily neurotoxicity phenomena, which could lead to cognitive impairment, or psychiatric symptoms. We aim to present one case of problematic shaboo use in a patient referring to an addiction outpatient clinic in Northern Italy. This case highlights that the treatment of these patients involves careful multidisciplinary management. An accurate knowledge of the physical and psychological effects of New Psychoactive Substances is essential, as well as the implementation of a tailored psychological and social support program.

1. Introduction

Shaboo is a street name commonly used in parts of Asia, particularly the Philippines and Thailand, to refer to methamphetamine, a powerful and highly addictive stimulant. Methamphetamine is also known by various other names around the world, including “crystal meth,” “ice,” and “glass” [1]. Methamphetamine effects are mainly directed to the central nervous system (CNS), due to its action on several neurotransmitters that are part of the reward pathway, such as dopamine, norepinephrine, and serotonin [2]. Particularly, Methamphetamines inhibit the transport of dopamine into the storage vesicles, leading to an increase in synaptic dopamine concentration [3,4]. The immediate effects of drug use are as follows: euphoria and increased energy, due to the rapid release of dopamine in the brain, increased heart rate and blood pressure, and decreased appetite, which can contribute to a rapid weight loss [5]. The long-term effects are related to chronic exposure to the drug effects, primarily neurotoxicity phenomena, which could lead to cognitive impairment, or psychiatric symptoms. Other long-term effects could be intestinal mucosal dysfunctions, severe dental issues (the “meth mouth”), and skin sores [6].

There are also multiple functional and structural neuroimaging changes in people using methamphetamine. The majority of these changes involve cortical and striatal pathways [7], which contribute to cognitive and behavioral changes promoting compulsive drug use.

Effects on cognition and memory are another common adverse effect [8]. Specifically, chronic use leads to oxidative stress, mitochondrial dysfunction, and neuroinflammation, contributing to cognitive deficits and increased risk of neurodegenerative diseases such as Parkinson’s and Alzheimer’s [9].

Many students may believe that the use of prescription stimulants may improve their academic performance. However, a recent narrative review highlighted that stimulant misuse among students does not actually improve academic performance, as shown by grade point averages, and may even lead to a decline in executive function compared to students who do not misuse these medications [5]. Clinical and psychological effects of crystal meth use are summarized in

Table 1. Physical and psychological effects of methamphetamine (shaboo) use.

Effect Domain	Acute Effects	Chronic Effects	References
Neurological/CNS	Euphoria, increased alertness, reduced fatigue, agitation, insomnia	Neurotoxicity, cognitive impairment, memory loss, psychosis, paranoia, anxiety, depression	[5,6,7,8]
Cardiovascular	Tachycardia, hypertension, vasoconstriction	Cardiomyopathy, arrhythmias, increased risk of stroke and myocardial infarction	[6,10]
Psychiatric	Increased confidence, hyperactivity, talkativeness	Hallucinations, delusions, mood disturbances, increased risk of suicidality	[5,8,11]
Oral Health	Dry mouth, teeth grinding	Severe dental decay (“meth mouth”), tooth loss	[6,12]
Dermatological	Increased sweating, dilated pupils	Skin picking, sores, infections due to poor hygiene or hallucinations (formication)	[6,11]
Gastrointestinal	Decreased appetite	Malnutrition, intestinal mucosal dysfunction	[6,13]
Respiratory (if smoked)	Bronchospasm, cough	Chronic lung disease, respiratory tract infections	[14]
Behavioral/Social	Risk-taking behaviors, increased sociability	Social withdrawal, occupational/relationship dysfunction, legal issues	[11,15]
Reproductive/Sexual	Increased libido	Sexual dysfunction, increased risk of sexually transmitted infections due to risky behavior	[6,11]

.

Epidemiological Context

Methamphetamine use remains a significant global public health challenge, with notable regional variations. According to the European Drug Agency (EUDA) 2025 report, while methamphetamine prevalence is relatively low in much of Western Europe, there has been an observable increase in use and seizures of the drug in Central and Eastern Europe, particularly in countries such as the Czech Republic, Slovakia, and Poland [16]. During the last years, Europe is emerging as a new global producer and market for these kind of psychostimulants, as highlighted by the ever increasing frequencies of drug seizures reported (more than doubled) and quantities of drugs seized from 2010 to 2020 (more than four times the mount), These trends underscore a shifting drug landscape and the need for continued monitoring.

In Asia, methamphetamine use is widespread and escalating. The United Nations Office on Drugs and Crime [17] highlights methamphetamine as the most commonly used illicit stimulant in Southeast Asia, with countries like the Philippines and Thailand reporting high prevalence rates. In the Philippines, the Dangerous Drugs Board estimates that approximately 1.8% of the population aged 10–69 has used methamphetamine in the past year, making it the most widely used illicit drug nationally [18]. Similarly, Thailand reports significant methamphetamine production and trafficking, fueling regional consumption [17].

In the United States, methamphetamine is the second most commonly used illicit drug after marijuana, with the National Survey on Drug Use and Health (NSDUH) estimating about 1.5 million past-year users in 2022. Methamphetamine-related overdose deaths have also increased sharply over the last decade [19].

Methamphetamine use is highly prevalent in countries like the Philippines and Thailand. In the Philippines, methamphetamine use has been a significant public health issue, leading to government crackdowns and anti-drug campaigns [18]. In countries like China and Japan, methamphetamine use has been a concern, with notable trafficking and production activities. In USA, methamphetamines are one of the most commonly used illicit drugs after marijuana [20].

Methamphetamines are relatively affordable and widely accessible in the Philippines, making it popular among individuals from lower socioeconomic backgrounds. Economic hardship and lack of employment opportunities drive some to use methamphetamines as a coping mechanism for stress and fatigue.

One key sociocultural dimension of methamphetamine use in the Philippines is the notion of “methamphetamine exceptionalism”—the perception of methamphetamines as uniquely dangerous, morally corrosive, and socially destructive [15]. This view is often shaped by political rhetoric and media portrayals, which frame users as criminals rather than individuals in need of care. Consequently, individuals who use methamphetamines are often highly stigmatized and marginalized [21].

This cultural background profoundly shaped the experience of D., a Filipino man living in Italy and seeking treatment for methamphetamine use. Despite living abroad for over two decades, D. expressed feelings of shame, guilt, and internalized stigma associated with his drug use—feelings likely rooted in the dominant cultural discourse from his country of origin. These perceptions appeared to influence his initial hesitation in seeking help and contributed to low self-worth and ambivalence about treatment.

Within the Italian healthcare system, while providers did not express overt stigma, D. initially perceived himself as being judged—a reflection stemming more from internalized beliefs than actual provider attitudes. As treatment progressed, building therapeutic trust was crucial to overcoming these barriers. Psychoeducation played a key role in reframing drug use from a moral failure to a treatable health condition, helping to reduce self-stigma and improve engagement. The multidisciplinary team also took into account the patient’s cultural background when discussing coping strategies, motivations for use, and identity-related stressors.

Based on these premises, we aim to present one case of problematic methamphetamine use in a patient referring to the drug as ‘shaboo’. The patient is attending clinical visits in an addiction outpatient clinic in Northern Italy. The patient provided his informed consent in the realization of this paper.

2. Case Discussion

D. is a 40-year-old male originally from the Philippines, living in Italy for the past 22 years. He currently resides with his aunt after being asked to leave the family home by his partner following a domestic dispute. The patient has been in a long-term relationship since he was 18 and has a 15-year-old son. His two younger brothers live in the Philippines and are unemployed. His father died 13 years ago due to a stroke, while his mother remains in relatively good health. D. previously worked as a cleaner at a car dealership but left due to job dissatisfaction and is currently employed by a cleaning company. He has no significant medical history and is not on any medications.

The patient reported occasional use of ‘shaboo’ (methamphetamine) starting in 2014, with a four-year period of particularly intense use. During this time, he reported daily or near-daily consumption, particularly during periods of emotional distress, financial strain, and job instability. After this period, he significantly reduced intake to approximately 2–3 times per month. He uses methamphetamines primarily to “have more energy” and to cope with feelings of fatigue and illness. He described a cycle in which fatigue and low self-worth were followed by methamphetamine use, which temporarily relieved symptoms but eventually worsened his emotional state. Additionally, D. has a history of gambling, mainly on slot machines. He reported gambling as an emotional escape, especially after arguments with his partner or setbacks at work. Although less frequent now, he still gambles occasionally, especially following conflicts with his partner. He acknowledged that gambling had at times led to financial hardship, borrowing money from friends or skipping bill payments. The exact amount spent varies according to his financial situation.

At the initial clinical assessment, standardized diagnostic tools were employed to evaluate substance use and behavioral issues. The Problem Gambling Severity Index (PGSI) [22] indicated a moderate-risk gambling behavior with a total score of 4. Alcohol use was screened using the Alcohol Use Disorders Identification Test (AUDIT) [23], which was negative for alcohol abuse.

To confirm the diagnosis of methamphetamine use disorder and to monitor ongoing substance use, toxicological testing was systematically performed. Biweekly urine toxicology screens and hair analyses every three months were instituted. The initial hair test revealed methamphetamine levels of 32.47 ng/mg (normal value < 0.2 ng/mg) and amphetamine levels of 1.13 ng/mg (normal value < 0.2 ng/mg), confirming recent and sustained methamphetamine use. Subsequent urine toxicology screenings over the last several months of treatment were consistently negative, indicating abstinence.

Other substances of abuse were ruled out by comprehensive toxicology screening panels, which tested for common drugs including opioids, cocaine, benzodiazepines, cannabinoids, and others, all of which were negative. This comprehensive approach ensured specificity in diagnosing methamphetamine use disorder.

Given the known neuropsychiatric effects of methamphetamine—including risks of psychosis, mood disorders, anxiety, and cognitive impairment—D. underwent thorough psychiatric evaluation as part of the clinical assessment. Mental status examinations and clinical interviews assessed for active psychotic symptoms (e.g., hallucinations, delusions), mood disturbances (e.g., depression, mania), and anxiety symptoms. At presentation, D. reported psychological distress characterized by low mood, irritability, and anxiety, but no current hallucinations or delusions. There was no evidence of active psychosis or bipolar features. Formal screening using validated scales for depression and anxiety (PHQ-9) [24], and the Generalized Anxiety Disorder-7 (GAD-7) [25] supported mild to moderate symptoms of depressive and anxiety spectrum disorders, likely related to psychosocial stressors and substance use.

The initial phase of treatment presented several challenges. First, the patient’s living instability and lack of family support significantly affected his emotional regulation and adherence to appointments. Although he recognized the negative consequences of methamphetamine use, he expressed doubts about maintaining abstinence due to fatigue and low motivation. The co-occurrence of gambling behavior complicated treatment planning, as it served as both a trigger for methamphetamine use and a maladaptive coping mechanism.

Throughout treatment, ongoing psychiatric monitoring was maintained to detect any emergence of neuropsychiatric symptoms potentially related to methamphetamine use or withdrawal. A multidisciplinary team approach—consisting of medical staff, a psychologist, and a social worker—helped establish a structured care plan. Psychological interventions focused on developing coping strategies to maintain abstinence, which the patient reported as beneficial.

The personalized psychological and social support program offered to D. was structured as a weekly, 60 min outpatient intervention over a six-month period, with flexible scheduling depending on patient availability and clinical status. The therapeutic program consisted of the following:

• Cognitive Behavioral Therapy (CBT), targeting methamphetamine cravings, relapse prevention, and dysfunctional thoughts associated with substance use and gambling. Core components included trigger identification, coping skills training, and cognitive restructuring.
• Motivational Interviewing (MI), particularly in the early stages, to enhance engagement, strengthen internal motivation for change, and address ambivalence toward abstinence.
• Psychoeducation sessions, which included education on the neurobiological effects of methamphetamine, the cycle of addiction, and the interaction between stimulant use and emotional dysregulation. These sessions also involved family education where possible.
• Social work support aimed at addressing broader determinants of health, including assistance with housing stability, employment support, and immigration regularization processes. The patient received practical help in completing bureaucratic tasks and referrals to legal aid services when appropriate.
• Regular case conferences ensured that all professionals involved were updated on the patient’s progress, goals, and any required adjustments to the treatment plan.

The main goals of the program were to: (1) achieve and maintain abstinence from methamphetamine and gambling; (2) improve psychosocial functioning and coping strategies; (3) promote emotional regulation; (4) support social reintegration through legal and employment pathways.

No pharmacological treatment was necessary during his care, though options such as bupropion, which has shown promise in reducing methamphetamine cravings [26,27], were discussed and reserved for potential future needs.

Following sustained abstinence, the patient acknowledged the negative consequences of his methamphetamine use from familial, economic, and occupational perspectives. He reported improved relationships with his child and successfully integrated alternative coping mechanisms into his daily routine, moving away from their previous reliance on methamphetamine to manage fatigue and energy levels.

Currently, D. remains engaged with the clinic through regular follow-up calls and ongoing toxicological monitoring, with both urine and hair tests confirming continued abstinence.

3. Discussion

This case highlights a complex interaction between substance use (methamphetamine) and compulsive behaviors (gambling) in the context of significant personal and family stressors. The patient’s use of methamphetamines appears to be motivated by a need to cope with daily fatigue, while his gambling may serve as a coping mechanism for interpersonal conflict. The case underscores the importance of considering the impact of psychosocial factors and family dynamics in the therapeutic approach and management of the patient.

This case also highlights the need for more knowledge regarding the effects of Novel Psychoactive Substances (NPS), which are often almost unknown to health professionals, mainly due to the lack of evidence-based sources of information [28]. Indeed, the spread of NPS represents an unprecedented challenge in the field of drug addiction, as well as a multifaceted and growing problem from social, cultural, legal and political points of view. In this light, it is key to raise awareness and skills through addiction professionals regarding this topic, as well as to implement tailored research and international networks [28].

Particularly, there is a need for more comprehensive research on the epidemiology of methamphetamine use, the effectiveness of current interventions, and the social determinants of drug use. In our clinical experience, we treated several cases of patients with methamphetamine use disorder, particularly from Asian countries. This represents an important clinical challenge, and could be also due to the high burden of migration, which has been acknowledged as a risk factor for substance use disorder [29,30]. Indeed, in a recent study conducted in two refugees centers in Serbia, it was highlighted that more than a half of the participants (53.3%) displayed significant symptoms of PTSD. Out of these participants, 50% consume energy drinks, 13% use alcohol, 4.6% use marijuana, and 1.7% use LSD and amphetamines [30]. It is important to consider that, as in the case described, the irregular migrant status significantly contributed to the overall well-being of the client and the substance abuse. The patient identified the regularization of his immigrant status, implemented through effective social support, as a strong abstinence-promoting factor. In this light, it is acknowledged that the irregular immigrant status is one of the main risk factors for the severity of substance use [31].

While non pharmacological strategies—such as motivational interviewing, cognitive behavioral therapy (CBT), and structured psychosocial support—were central to this patient’s care and proved successful, it is also important to acknowledge available pharmacological options for the management of methamphetamine cravings or comorbid symptoms, particularly when nonpharmacologic approaches are insufficient.

Although no medications are currently approved specifically for methamphetamine use disorder, several off-label options have demonstrated potential in reducing methamphetamine cravings or addressing comorbid psychiatric conditions. Bupropion, a norepinephrine–dopamine reuptake inhibitor, has shown efficacy in individuals with moderate methamphetamine use, particularly when combined with contingency management [26]. Similarly, mirtazapine, a noradrenergic and specific serotonergic antidepressant, has been associated with reduced methamphetamine use and improved sleep and mood symptoms in some populations [32]. Other agents explored in the literature include modafinil, naltrexone, and combination therapies, although more robust, large-scale trials are needed to confirm their efficacy [27]. While pharmacotherapy was not indicated in this case due to the patient’s good response to psychological and social interventions, awareness of these emerging options may broaden clinical decision-making in more resistant cases.

Furthermore, improved epidemiological surveillance is necessary to monitor trends in methamphetamine use and assess the effectiveness of policy and intervention strategies. In this view, the role of national early detection programs is fundamental, such as the SNAP (Sistema Nazionale di Allerta Precoce), the Italian national psychoactive substances identification system [33].

4. Conclusions

This case highlights that the treatment of these patients involves careful multidisciplinary management. An accurate knowledge of the physical and psychological effects of New Psychoactive Substances is essential, as well as the implementation of a tailored psychological and social support program, as the association with work-related difficulties and legal problems is frequent. Clinicians should also consider the role of cultural background and legal status in both the etiology and maintenance of these conditions, as these factors may significantly influence treatment engagement and outcomes. Coordination between addiction services, mental health professionals, and social care systems is crucial to optimizing long-term recovery and social reintegration.