Fries, lies and alibis: the impact of methamphetamine use on moral values and moral conduct

ABSTRACT

Despite the influence of the moral model of addiction, there remains a lack of knowledge about what methamphetamine users say about methamphetamine’s effects on morality. As part of a qualitative study on the life-course of users of methamphetamine in Aotearoa-New Zealand, this paper analyses the impact methamphetamine use exerted upon 42 former users’ moral values and and moral conduct—and how their ‘internal dialogue’ processed this intense experience. The initial motivation was to more closely adhere to societal norms, such as being a happier person, a more productive worker, or better parent or spouse. The negative impact methamphetamine use exerted upon interviewees’ moral values-and-conduct was minor for one-quarter, moderate for over a third, and major or severe for over a third. Freud’s id-ego-superego model and Marc Lewis’ neuroscience-based attraction-vs-willpower model was used to analyse the ‘internal dialogue’ between addictive desires and moral conscience. Methamphetamine activates addictive desires, which conflict with user’s moral conscience and results in guilt, shame, self-accusation and self-contempt. Frequent methamphetamine use may be partly understood as a normative failing, whereby users struggle to live up to their expectations and moral norms. Since interviewees believe methamphetamine “enhances the existing person,” individual and environmental factors strongly influence methamphetamine-related outcomes.

KEYWORDS:

• Aotearoa–New Zealand
• methamphetamine use
• moral values
• moral conduct
• id–ego–superego

Introduction

Research from Aotearoa–New Zealand (Carton 2016), Australia (Fredrickson et al. 2019; Cohn et al. 2020) and North America (Weidner 2009; Boyd and Carter 2010) show media narratives about methamphetamine use typically portray the user as an immoral and dangerous deviant, and the drug itself as a demon-like substance. Media reporting consistently employs ‘pharmacological determinism’ to make universalistic and fatalistic claims about methamphetamine’s supposed inherent addictiveness. Dramatic and alarming–but atypical–personal stories are selected to show how methamphetamine indiscriminately ruins the user’s health and undermines morality and the capacity for self-rule. Not only do such portrayals stigmatise people who use methamphetamine–thereby increasing the likelihood they will hide their use from others–but fear of stigmatisation is one of the most cited barriers to treatment-seeking for people who use methamphetamine (Deen et al. 2021). Since such narratives separate the person from their circumstances, the psychological, emotional, social and moral complexities of their lives are either downplayed or erased, leaving methamphetamine use as seemingly the only difficulty affecting their lives (Boyd and Carter 2010).

More broadly, the addiction discourse has been dominated by two opposed models; the medical model and the moral model (Morse 2004). According to the medical (or disease) model, addiction is conceptualised as a ‘brain disease’ characterised by ‘aberrant, impulsive, and compulsive behaviors’ (Volkow et al. 2016, p. 363). Excessive and compulsive drug use is said to cause desensitisation to the reward and emotional circuits of the brain, and seriously impair functioning of the prefrontal cortical regions involved in executive processes, such as decision making, judgment, inhibitory control and self-regulation. As a result, long-lasting brain changes erode a person’s voluntary ability to control the impulse to take addictive drugs, which leads to repeated relapse (Volkow et al. 2016). Since addiction is considered a chronic relapsing brain disease whose symptoms are mechanistic biophysical effects of an underlying pathology, theoretically it is difficult to claim the addicted person is morally responsible for having the underlying disease (Morse 2004). Consequently, the main concern is not attributing right- or wrong-doing to the addicted person, but rather treating the disease (Frank and Nagel 2017). By contrast, the moral model views drug seeking-and-using behaviour as intentional–but immoral–human action. Since sinful drug use is a matter of preference that violates morals and/or the law, it is considered an appropriate object of moral and legal evaluation. As a result, the addict can be held morally responsible for conduct motivated by one’s willful desire for the drug (Morse 2004; Frank and Nagel 2017). By attributing moral significance to a practice, the process of moralisation involves converting a preference into a value, which typically takes on a negative moral meaning. Moralisation then shifts focus onto the individual norm-violator as the problem (Frank and Nagel 2017). For example, methamphetamine use changed from a preference–to treat depression, weight loss and narcolepsy in the 1940s–50s in the U.S. and England–to a moral and legal violation after its adverse health effects became better known (Rasmussen 2008). The perceived moral wrongfulness of people who use methamphetamine, and the social threat and harm arising from such use, greatly influenced punitive laws against methamphetamine consumption and people’s attitudes towards the punishment of people who use methamphetamine (Durrant et al. 2011).

The moralistic view has generally focused upon public moral attitudes toward drug use and users. Despite the influence of this model, and the fact addiction is commonly viewed as an outcome of moral weakness (Morse 2004), we still know little about what people who use methamphetamine themselves say about the ways methamphetamine use affects their moral values and moral conduct. Moral values may be considered the principles or beliefs that guide an understanding of what is right or wrong, or good or bad, while moral conduct involves the behaviours that align with or depart from one’s moral values. In fact, the author is yet to read published research which analyses the subjective thought processes of the frequent methamphetamine user as they specifically pertain to moral values and moral conduct. This paper therefore helps to address this knowledge deficit by examining the impact methamphetamine use exerted upon users’ moral values and conduct–and how their ‘internal dialogue’ processed this intense experience.

Methamphetamine use and adverse outcomes

Whilst research has found a ‘significant number’ of people who frequently use methamphetamine experience ‘limited or no serious’ physical or psychological dysfunction (Sommers et al. 2006, p. 1476), frequent use can potentially affect weight loss, sleep deprivation, depression, paranoia, anxiety, hallucinations and psychosis (Sommers et al. 2006; Darke et al. 2008; Butler et al. 2010; McKetin et al. 2010; Degenhardt et al. 2017). Since methamphetamine reduces sensitivity to pain (Christian et al. 2007), it is commonly used to assist with emotional distress, especially depression (Boeri et al. 2009; Cheng et al. 2010). However, frequent use tends to exacerbate the emotional distress individuals initially sought to alleviate (Joe 1996; Boeri et al. 2009). Whilst methamphetamine is initially used to facilitate and enhance social interactions (Homer et al. 2008; Boshears et al. 2011), long-term high-dose use often erodes social connections and leads to social isolation and strained relationships with family and friends (Joe 1996; Homer et al. 2008; Boeri and Whalen 2009). Disconnection from social support systems can exacerbate moral issues and reduce the likelihood of adhering to societal norms pertaining to prosocial behaviour.

Methamphetamine initially provides a ‘feeling of mastery and power’ (Sommers et al. 2006, p. 1473), with use linked to increased aggression and violent behaviour (Brecht et al. 2004; Zweben et al. 2004; Sekine et al. 2006; McKetin et al. 2014, 2021). Although frequent use may be a risk factor for aggression (Homer et al. 2008), obviously not every person who uses methamphetamine becomes violent. Sommers et al. (2006, p. 1476) concluded ‘violence is not an inevitable outcome’ of even chronic use because two-thirds of respondents did not commit methamphetamine-related violence. A survey of people who frequently used methamphetamine in Aotearoa–New Zealand found 13% committed a violent crime in the past six months (Wilkins et al. 2015), while an analysis from Aotearoa–New Zealand longitudinal data found ‘most people’ who used methamphetamine ‘did not engage in violence’ (Foulds et al. 2020, p. 6). People in Aotearoa–New Zealand who frequently use methamphetamine may have a predisposition to violent behaviour (Policy Advisory Group 2009), because the same longitudinal data shows childhood conduct problems predict heavier substance use and involvement in adult crime (Lynskey and Fergusson 1995; Fergusson et al. 2005). Such research indicates a complex interaction between methamphetamine use and aggression, whereby methamphetamine’s outcomes are mediated by users’ circumstances, practices, norms and values (Sommers and Baskin 2006). Whilst there is uncertainty about the exact link between methamphetamine use and heightened aggression (Sexton et al. 2006), violent behaviour negatively impacts moral values and conduct because it violates or disregards the rights and well-being of others.

Studies examining the ‘drug-crime nexus’ have found a correlation between methamphetamine use and an increased likelihood of criminality. Compared to other drug users, Gizzi and Gerkin (2010) found regular users of methamphetamine tend to have a more extensive criminal history, often related to drug use, and engage in property crimes, including economic-compulsive crimes. However, they were not more prone to committing violent crimes. Different studies from Aotearoa–New Zealand (Wilkins et al. 2015, 2017) and Australia (McKetin et al. 2005, 2020) show varying rates of criminal involvement among people who use methamphetamine. But as Waldorf et al. (1991) concluded of people who use crack cocaine, crime is more likely among those who have no other means of supporting their use, have few bonds to conventional society, and have little to lose by violating norms.

Methamphetamine use has been associated with impaired moral decision-making (Homer et al. 2008). The drug's effects on the brain’s neural network responsible for making decisions may lead to altered perceptions of risk and reward, making people who use more likely to engage in risky, irrational or immoral behaviour (Fede et al. 2005; Sexton et al. 2006). Research indicates people who frequently use psychostimulants may experience difficulty with socio-affective processes important in moral decision-making, including identifying other’s emotions (Fox et al. 2007; Kim et al. 2011). However, one experiment (Fede et al. 2005, p. 3084) found people who regularly used stimulants did not differ from non-stimulant users in making moral judgments. Generally, people who use methamphetamine have said a key motivation to use the drug is to ‘induce changes in behavior’, including the desire to enter a ‘more carefree state’ whereby they feel ‘less inhibited and more outgoing’ (Halkitis et al. 2005, pp. 1337, 1339). Since methamphetamine lowers sexual inhibitions and engenders hyper-sexuality (Halkitis et al. 2005), such people may be more likely to engage in risky and ‘unusual’ sexual behaviour (Rawson et al. 2002; Semple et al. 2003; McKetin et al. 2021).

Research has shown methamphetamine use may impair cognitive functions related to moral reasoning. Specifically, methamphetamine’s ‘neurotoxic effects’ (O’Brien et al. 2008, p. 344) may cause deficits in neurocognitive functioning and impair cognitive abilities (Paulus et al. 2002; Homer et al. 2008). However, other psychopharmacological research (Johanson et al. 2006; Hart et al. 2012) found neurocognitive performance (e.g. motor function, attention, memory, executive function) was either slightly lower or within the normal range. Thus one study concluded ‘the magnitude of the differences was small and may not have major functional significance’ (Johanson et al. 2006, p. 336).

Whether violence, criminality or impaired moral decision-making, the above literature highlights the importance of social context in the development of adverse outcomes related to methamphetamine use (McKetin et al. 2021). Context shapes how and why methamphetamine is used and what its effects are taken to mean by the people who use it (Sommers and Baskin 2006). For example, exposure to adverse childhood experiences and mental illness increases the risk for methamphetamine onset and methamphetamine dependence (Messina et al. 2008; Wallace et al. 2009). Simply, people with strong relationships, good jobs and sound mental health rarely sacrifice investments in conventional life for powerful drugs (Szalavitz 2016, p. 133). For example, before and whilst attending school, interviewees 1–35 encountered five adverse childhood experiences (ACEs) on average (Bax 2021a). Specifically, physical neglect, physical abuse, parental mental illness, sexual abuse and early age of parental separation were especially detrimental to interviewees’ healthy development. The cumulative effect of ACEs typically contributed to lower attachment to parents, a weaker belief in conventional values, and lower commitment to conformity. Moreover, many exhibited weak commitment to school, low academic ambition and achievement, delinquency and/or delinquent peer involvement; all of which contributed to drug use (Bax 2021b). And one-third have been diagnosed with a mental illness, mostly depression, while almost two-thirds have consistently suffered mental and/or emotional distress over the life-course (Bax 2024).

Data and methods

The project from which this paper is derived uses the life-course method. The expanded framework of the life-course method allows researchers to account for the trajectories, transitions and turning points that characterise the life-course of methamphetamine users (Hser et al. 2007). Despite memory recall issues, a retrospective person-based life-history narrative approach is valuable for understanding the processes of frequent drug use over multiple phases and domains of the life-course (Boeri and Whalen 2009). Such an approach is invaluable for uncovering the distinct experiences and problems associated with drug use among hidden populations (Joe 1996). What gives the life-course approach its ‘life’ is the socially situated individual who, in their own words, integrates events and experiences and gives them meaning (Giele and Elder 1998; Carbone-Lopez et al. 2012). Table 1 shows the data acquired.

Table 1. Data source.

N	Primary Data (obtained via snowballing method)
35	In-depth semi-structured interviews with former-methamphetamine users (100 h of recorded data)
6	In-depth interviews with mother, partner, ex-partner of former-methamphetamine users (10 h of recorded data)
	Supplementary Data (obtained via online methamphetamine support group)
7	Transcribed testimonies of former-methamphetamine users (7 h of video data)
18	Transcribed live online chats with former-methamphetamine users (20 h of video data)
66	Approximately 1,000,000 words of transcribed empirical data

In this paper, data from the 35 interviews and seven testimonies are utilised;¹ a number analogous to qualitative studies of methamphetamine users by Joe (1996), Halkitis et al. (2005), Sexton et al. (2006), Lende et al. (2007), Boeri et al. (2009) and Carbone-Lopez et al. (2012), and twice as many as a comparative study in Aotearoa/New Zealand (Sheridan et al. 2009). The semi-structured interviews were divided into: (1) Life in Review and (2) Methamphetamine Use. Interviewees firstly reviewed their life-course, including family, school, friendship, work, romantic relationships, marriage, parenting, health and spirituality. They were also asked to detail their drug use history. Part two focused on methamphetamine use, including onset, progression, control, morality, impact, desistance and post-methamphetamine life. Interviewees also completed a ‘Life Satisfaction Chart’ (Clausen 1993).

To analyse interviewee’s moral values and moral conduct, each transcript was initially read to locate and select any relevant content. Then following Carbone-Lopez et al. (2012), the selected content was coded, sorted and tabulated by hand by the author for potentially relevant patterns and themes (e.g. moral/immoral values; moral/immoral conduct; violation of social norms; loss of self-control; exerting self-control; growing self-centeredness; narrowing of life; Dr. Jekyll and Mr. Hyde-like mindset). Further refinement led to the main thematic patterns presented here (e.g. initial increase in moral conduct; loss of existing moral values; level of impact on moral values and conduct; internal dialogue). Additionally, similarities and differences between interviewees regarding moral values and conduct were coded and sorted. Whilst such a grounded theory-based inductive analysis cannot make broad causal claims, the rich data does elucidate the key processes involved in methamphetamine use over time.

Interviewees were born between 1962 and 1995, with half born in the 1970s. They were 43-years-old on average, with 54% male, 46% female, 74% European/Pākehā and 26% Māori. Interviewees have lived in all of Aotearoa/New Zealand’s provinces in various villages, towns and cities. Contact with interviewees was initially made with five people known to the author. A snowballing method via referral from prior interviewees located 22 interviewees, while 14 were found through two online methamphetamine support groups. Each interview lasted, on average, approximately 3 h. In contrast to structured self-report questionnaires, the semi-structured technique allowed for deeper probing of interviewees’ self-reporting, especially if an answer lacked clarity or was inconsistent with a prior statement. To qualify as a ‘former frequent methamphetamine user’, participants had to have used methamphetamine for at least six consecutive months but had not used for at least 12-months (Boeri and Whalen 2009). Whilst interviewees were not asked to retrospectively evaluate their prior methamphetamine use using DSM-5 criterion for a substance use disorder (APA 2013), the interview data clearly indicates most–if not all–would have meet this criterion at some point during their methamphetamine using period. Even though many interviewees applied the concept addiction to describe their relationship to methamphetamine, and so believed they had become a meth addict, the author avoids applying such medicalised labels. If interviewees’ methamphetamine use is to be labelled, it may be conceptualised as psychosocially problematic methamphetamine use. In practice, participants used methamphetamine for eight-years on average, and desisted on average seven-years prior to the interview at age 36. Like other users of methamphetamine who are typically poly-drug users (Joe 1996; McKetin et al. 2006; Brecht et al. 2007; Sheridan et al. 2009), all interviewees have an extensive and varied history with numerous licit and illicit substances. All have used alcohol and cannabis (beginning around age 14 on average), approximately three-quarters have used nicotine, LSD and amphetamine, about half have used magic mushrooms and ecstasy, and one-third cocaine. On average, each has used six different substances over the past 14–43 years (Bax 2023).

Initial enhancement of social and moral functioning

Societal norms and moral values strongly influence use of stimulant drugs. Individuals can use stimulants to help conform to societal pressures and cultural expectations, such as hard work, outgoing behaviour and physical appearance (Rasmussen 2008). For interviewees, the initial motivation to use methamphetamine was typically to more closely adhere to social norms and moral values, such as being a happier person, a more productive worker, or better parent or spouse (Bax 2023). By ‘fitting in to’ or ‘keeping up with what was deemed to be the norm’ they were able to ‘act normal’, or keep up the appearance of a ‘normal’ person. For some, methamphetamine was a ‘tool’ used ‘in order to be functional’. For others, the stimulant was a ‘medicine’ to ‘make me feel better’. For those experiencing psychological distress, methamphetamine provided a ‘false sense of confidence’ where they felt ‘wonderful’ and ‘bulletproof’. Other interviewees initially used methamphetamine as a ‘performance enhancer’ to assist in becoming a ‘highly functioning’ worker. Within the home, methamphetamine initially helped some to ‘enhance’ normative social functioning, such as performing parenting and household duties. Likewise, methamphetamine initially made some a ‘more productive parent’; the powerful stimulant made them ‘motivated to do stuff’ with their children or made them feel ‘happy to be around our kids’.

Fries, lies and alibies

According to media narratives highlighted above, methamphetamine use extinguishes moral conduct and the capacity for self-rule; being ruled by an addictive drug they cannot control they are unable to act as a moral subject or operate in their own best interest. A few interviewees expressed views congruent with this narrative. Interviewee-20 believes methamphetamine brings out one’s ‘deviant nature’, while interviewee-11 thinks ‘meth comes with demons with it’. Likewise, interviewee-3 said ‘eventually you lose all your morals’, while interviewee-19 stated ‘99.9% of meth addicts rip people off’. In Aotearoa–New Zealand, the saying ‘fries, lies and alibis’ is commonly used amongst people who use methamphetamine to signify the impact use has on moral values and conduct–i.e. the user gets ‘fried’ or high and starts engaging in immoral behaviour.

The negative impact methamphetamine exerted upon interviewees’ moral values and conduct was placed into four categories: minor, moderate, major or severe. The impact was minor for about one-quarter, moderate for over a third, and major or severe for over a third. For the ten interviewees who saw methamphetamine exert a relatively minor impact, this included unethical or immoral acts of irrationality, lying, not doing work ‘to the best of your ability’ (or missing days off work), or treating a spouse, family member or friend poorly (including becoming distant). But for the most part, they ‘still kept a lot of my morals’. As interviewee-10 said, she ‘probably didn’t’ do things when using methamphetamine she wouldn’t have done before or after. Whilst interviewee-5 ‘secretly’ used methamphetamine twice when pregnant, she did not steal ‘to fund my habit’, she ‘always treated people with respect’, she tried to ‘protect’ her friends from exposure to methamphetamine, she ‘tried to do everything right’ with her young son, remained faithful to her husband and was ‘always good to his friends’. Likewise, interview-28 stayed morally ‘true to myself’ by consciously deciding not lose his core moral values. Despite ‘cooking’ and dealing methamphetamine, he made sure he ‘didn’t fuck people over’, so has ‘never stolen shit off anyone or ripped people off with deals’. Similarly, interviewee-16 ‘didn’t lie’, ‘didn’t do any crime’ and ‘didn’t think to root around on my wife’. On the contrary, he (like a few other interviewees) called methamphetamine a ‘truth serum’ because ‘it made me honest’.

For sixteen interviewees, methamphetamine use exerted a moderate impact on their moral values and conduct. As methamphetamine became a ‘priority’ in their life, their ‘morals weren’t terribly great’ because they became ‘selfish’ and ‘did things that I don’t think I would normally do’, which they now ‘regret’. Some ‘neglected’, ‘cut out’ or ‘pushed away’ family members and/or ‘older friendships’ because they only wanted to ‘hang out with my drug using friends’. To ‘conceal’ or ‘hide’ their use they engaged in ‘lying’ and ‘deceitful’ conduct. For five of the parents, being ‘focused’ on methamphetamine use ‘drew me away from parenting’. Knowing they had ‘neglected’ their parenting responsibilities could make them ‘feel really guilty’. Workwise, they were ‘making mistakes’, ‘missing’ work, ‘neglecting the business’, ‘losing jobs’ and the ‘trust of others’. The impact was considered ‘moderate’ because half did not have ‘terribly strong’ moral values prior to onset. They found ‘some attractiveness’ living and behaving ‘outside’ mainstream moral boundaries, or were ‘ambivalent’ about ‘criminality’, or even ‘idolized’ deviant conduct ‘to some extent’. As a result, they had a history of violating social and/or legal norms. The others managed to ‘maintain’ or ‘keep’ ‘some’ or ‘a lot’ of their moral values and mostly engage in moral conduct. This included not lying to or stealing from friends, treating employees and customers respectfully, not being ‘horrible’ to others, or not doing ‘bad things to people’.

For the remaining sixteen interviewees, methamphetamine use exerted a major or severe impact on their moral values and moral conduct. Since methamphetamine was ‘all I cared about’, they were ‘always worried about where my next hit was’ and so ‘didn’t care what you have got to do to get it’. As interviewee-34 said, ‘I just didn’t care about anything’. For example, interviewee-40 was bequeathed her mother’s beloved jewellery after she passed, but quickly ‘pawned off one of her rings’ because ‘my habit was more important’. As they started doing ‘horrible things’ or ‘illegal things I’m not proud off’, and started associating with ‘bad people’ or ‘really dangerous people’, existing moral values ‘went out the window’. Interviewee-11 believes methamphetamine ‘sucks your soul out of you’ because she fell into ‘darkness and depravity’ surrounded by ‘dark people’ who ‘believed in Satan and did satanic practices’. When coming down, interviewee-30 felt like methamphetamine ‘was bringing the evil out of me’ because she would physically ‘attack’ her partner (and supplier) if he didn’t give her the methamphetamine she ‘needed’. Since they would ‘focus on little things that are not important’, then ‘the things that are important get neglected’. They therefore neglected or avoided family, non-using friends, and work. For all but one parent, methamphetamine became ‘more important than my children’. For example, interviewee-8 became ‘a very bad parent’ because she would be in the ‘bedroom all week getting high’ while her children were left alone, hungry and angry. Likewise, interviewee-33 ‘sold my kids’ stuff’ after needing ‘quick cash’ to buy methamphetamine. Despite being someone who pre-use would ‘hate having to lie’ she told her sons, ‘Your PlayStation overheated, so mum got rid of it’. Like the others, she became a ‘really good liar’ or ‘master liar’. In addition to becoming dealers to ‘feed my habit’, a few started stealing to help ‘fund’ their use. Despite interviewee-9 ‘never taking anything in my life’, she became ‘one of the best shoplifters’ because she had no food after spending her salary on methamphetamine before her next payday. Likewise, interviewee-15 started stealing in the last six months of use: he stole a NZ$50,000 digger and sold it to his dealer for NZ$2,000, he secretly used his partner’s credit card, and was imprisoned after fraudulently using his employer’s credit card.

Nevertheless, methamphetamine use did not completely strip these interviewees of the ability to act in a moral way or possess a moral conscience. Interviewee-30’s partner was a criminal gang’s main ‘meth cook’, and he would regularly give her ‘$14,000’. Because her grandparents (and main caregivers) told her as a child, ‘You always have to look after your family’, she would give them ‘$10,000 at a time’. Giving this money made her ‘feel really good’ because she was ‘always trying to find a way to be accepted by them’. Interviewee-11 was in a constant battle trying to prioritise her children over methamphetamine. Since ‘being a good mother was the most important thing to me’, then despite daily intravenous use she mostly managed to ‘put my children first’; she got up early to make their lunches, got them to school and always cooked dinner. For the majority of the 16 years he used methamphetamine, interviewee-15 was ‘still moving up the ladder’ at work. Despite being a ‘functioning addict’, he made it to supervisor and ran a successful team who ‘always hit targets’ mostly because of ‘the respect I had from the workers under me’. However, he ‘hated myself’ for lying to and stealing from his partner. Despite interviewee-29 being a person who would ‘never steal off people’, an acquaintance ‘influenced me into stealing from shops’ to fund their use. However, she decided she ‘didn’t want to steal anymore’ because of the fear of the ‘repercussions’ and the realisation ‘you can only steal for so long until somebody gets caught’ (this acquaintance was caught shortly thereafter and imprisoned for 2-months).

Like longitudinal research in Aotearoa–New Zealand which found ‘most’ people who used methamphetamine ‘did not engage in violence’ (Foulds et al. 2020, p. 5), nine interviewees admitted to methamphetamine-associated physical violence (on either their partner or children). However, they disagree methamphetamine ‘causes’ violence; instead, they believe methamphetamine ‘heightens’ or ‘amplifies’ underlying ‘anger issues’. Thus interviewee-27 said, ‘if you are already a violent aggressive dude, it is just going to amplify you ten times what your normal state is’. For example, interviewee-17 was a violent gang member and chronic criminal offender–who experienced a lot of ‘bad shit’ as a child–and believes methamphetamine ‘enhanced bad things’ within him. By believing methamphetamine ‘enhances’ the ‘existing person’, interviewees indirectly support Sommers et al. (2006), who argue personality and environmental factors influence methamphetamine-related violent outcomes. For example, interviewee-2’s wife said ‘he was always so kind’ to her whilst using methamphetamine because he was the type of person who would never ‘purposely try to hurt me’. Likewise, interviewee-1–whose primary school teachers said he was a ‘kind’, ‘courteous’ and ‘polite’ boy–said ‘I could be on all the meth in the world and I wouldn’t think of robbing and thieving off somebody’. And interviewee-13 said he ‘would never hit’ his wife or ‘go out and start a fight’ because he has ‘strong morals and ethics’.

Regarding the relationship between the impact on moral values and conduct and the length, frequency and amount of use, unsurprisingly those for whom the impact was minor used for the shortest length of time (6.5 years on average), used substantially less per week (half a gram on average) and were unlikely to have become a daily user. But comparing the moderate to the major/severe group shows that while the latter group was more likely to have become a daily user, both used a similar amount per week (3 g vs. 3.5 g) while the moderate group actually used for significantly longer (14.5 years vs. 9.5 years). Interviewee-15 shows consuming a large quantity at high frequency is not required to greatly impact on moral values and conduct. Whilst he was ‘never a huge user compared to other people’, this moderate amount ‘was enough to turn my life to shit’. Conversely, for three-years interviewee-28 smoked ‘all day until I would crash and burn’ and would ‘then carry on for days on end’, but he always felt ‘in control’ of his use, stopped multiple times, and stayed morally ‘true to myself’.

The internal dialogue

Psychologically, many interviewees depicted an internal conflict or ‘mind game’ between a ‘Jekyll and Hyde’ character. Typically, an ‘alter-ego’ or ‘drug mind-set’ emerged to ‘fool’ and ‘deceive’ them, which over time created a ‘false reality’ and caused them to ‘lose touch’ with their ‘normal self’. Psychoanalytically, interviewees often described (either directly or more often indirectly) a Freudian-like ego-mediated tug-of-war between the id and superego. For Freud (1949), the id, ego, and superego form a complex interplay within the human mind, shaping an individual's thoughts, behaviours, and personality. The id is considered the amoral instinctual part of the psyche which operates on the pleasure principle and seeks immediate gratification of basic biological and psychological desires without considering the consequences or moral implications. While the id is unconscious by definition, some of its contents may become partially conscious via the ego, especially when the individual is in a state of heightened emotion (such as craving methamphetamine) or during dreams. The superego represents the internalised ethical and moral standards of society–learned from authority figures such as parents and teachers–and often imposes guilt, shame and feelings of moral obligation when the id or ego deviate from its standards. The ego is the rational and realistic trying-to-be-moral decision-making part of the psyche which operates on the reality principle and mediates between the demands of the id, the constraints of the external world, and the moral values of the superego. Simply, the id is a cauldron of passions seeking immediate gratification, the ego is the agent of reason navigating reality, and the superego is the personality’s conscience providing a moral compass based on internalised values (Lapsley and Stey 2011). Interviewee-39 labelled the id ‘the addict in me’ that lives inside the methamphetamine addict’s mind, and which seduces them to use. Whilst in recovery, ‘triggers’ can ‘spark the addict to come back’, thereby ‘regaining that power back’ over them. The pleasure-seeking or pain-relieving desire is so powerful because ‘you don’t even think about the choice you make’.

Neurobiologically, neuroscientist Marc Lewis (2015, p. 83) argues in a not too dissimilar way that ‘addicts’ are caught in a ‘tug-of-war between attraction and willpower’. Due to the forces of ‘now appeal’ and ‘delay discounting’, such people value immediate rewards over long-term benefits, and so discount or delay future gains in favour of immediate rewards. For Lewis (2017, p. 14), delay discounting ‘creates a narrowed beam of attention toward imminent rewards’. Lewis argues dopamine activated within the ventral striatum is the ‘villain’ in addiction, because as the ‘fuel for intentional action’ dopamine has a built-in bias toward immediate satisfaction (Lewis 2011, p. 64). As a result, so-called addicts are ‘excessively now oriented’ (Lewis 2015, p. 84). This does not mean their brain is ‘diseased’ or even working improperly; they have merely rearranged life around a single goal–obtaining and using methamphetamine (Lewis 2015). For example, interviewee-24 was ‘vulnerable’ and ‘lost’ when she initiated methamphetamine because her partner had just died by suicide. She constantly ‘wanted’ methamphetamine ‘to feel like me again’, and so couldn’t save any because she wanted ‘everything now’. Thus, ‘if we bought a big lot we would just sit there and smoke it all’. Lewis (2011) also emphasises the internal struggle and self-destructive thought patterns of long-term high-dose drug use, which are driven by ‘self-accusation and self-contempt’ (Lewis 2011, p. 274). This ‘internal dialogue’ (Lewis 2011, p. 304) is a complex interplay of self-rebuke and anger, originating from primitive brain circuits and leading to a self-reinforcing cycle of self-destruction and difficulties overcoming strong desires. For example, interviewee-21 would ‘feel guilty and ashamed’ for having ‘wasted’ his money, time and energy using methamphetamine when he ‘could have done something with the kids’. But he would slowly forget the guilt and shame–and more remember the ‘feeling great’ part–and then a social opportunity would appear and prompt him to use again.

For interviewee-15, the ‘craving addiction side’ of his mind was informing him methamphetamine ‘is great’ because ‘you are having a great time’. But ‘a split second later’ his ‘conscience’ was in his ‘other ear’ saying, ‘What the fuck are you doing?’ ‘The whole time’ his moral conscience was telling him ‘it is wrong’ to keep using, and reminding him he ‘shouldn’t be doing it’ because ‘it has turned your life to shit’. However, his strong desire was ‘justifying’ continued use by seducing him to think, ‘It’s all good, have another puff. Who gives a fuck? I haven’t good any issues’. Even though his reason or common sense was reminding him he was ‘already wasted’ and so ‘didn’t need any more’, ‘the addictive side’ was signifying, ‘I want some more. It is there, I might as well finish it’. Whilst he ‘knew what you were doing was wrong’, his ‘drug mind-set’ was signalling ‘It’s all good. You will get over it’. Fortunately, his reason would often mediate between his ‘addictive side’ and ‘conscience’ to prevent him from ‘carrying on’ using by reminding him he ‘can’t afford it’ or that he needed to work the following day.

When interviewee-24 was using methamphetamine she ‘wasn’t the real me’; instead, she was what she called ‘drug me’. ‘In the back’ of her mind she knew ‘it was a fake sense of self’, but because methamphetamine made her feel ‘good’ her strong desires would instruct her ‘real’ self to ‘fuck off’. From the beginning there was always a ‘superego’ in the back of her mind telling her, ‘Stop this. It is drugs. It’s not right. You weren’t brought up like this’. But she ‘would just ignore’ or ‘block that thought away and keep going’. Even though she ‘always knew it was wrong’, she was ‘trying to deny what I was going through’. Likewise, interviewee-30’s strict religious upbringing had instilled a strong moral conscience, which was ‘constantly in my head’ saying ‘this was wrong’. When she abandoned her young daughter whilst on bail to smoke methamphetamine with a man she had just met at a bar, she felt ‘so disappointed in myself’. As she was sitting in his car, ‘all I could think of was my daughter’s little face’. Meanwhile, ‘he kept passing me the pipe and I kept smoking it, hoping that that was going to take it all away’.

For interviewee-8, the ‘addict’ within her would indicate ‘I need it’, or ‘I have to have it’ or that she ‘can’t survive without it’. But ‘there was another voice in me’ which would say, ‘What about your fucking child?’ (who was left alone as she smoked methamphetamine in her bedroom for days on end). But this ‘addict’ side would respond with, ‘shut the fuck up’. Near the end, however, her moral conscience ‘got stronger’ and ‘pushed’ the ‘addict’ out. For interviewee-3, her conscience would say, ‘What the fuck have you done?’ or ‘Look at what you should be doing and what you actually are doing’. At the same time, she was ‘aware’ her children were getting fed ‘hours later than when they should be fed’. For her, this battle was ‘like you argue with yourself in your head. You can ask a question, but you are going to come up with an answer as to why it is still a good idea to use’.

Interviewee-11 ‘felt like every part of me that was good and kind and loving was slowly dying’. As she began ‘doing things I wasn’t proud of’, the ‘good angel’ on her ‘shoulder’ ‘got smaller and quieter’ while the ‘bad angel’ on her other shoulder became ‘louder and more leading’. Specifically, methamphetamine brought out the ‘worst’ sexual ‘depravities’ within her. While at the time she ‘liked it’, a part of her ‘didn’t like it’ because her conscience told her ‘it was wrong having sex with other partners’. She would also ‘feel really guilty’ and ‘beat myself up’ for being a ‘bad’ mother if she wasn’t being attentive and emotionally available for her children. As Flanagan (2013, p. 10) argued, ‘guilt is anger turned inward and normally involves blame.’ In response to her moral self-censure, her fellow users would respond, ‘Why do you feel so guilty? Just don’t worry about it’. But she would reply, ‘I am glad that I do, because that is going to keep me sane and lead me back to the right path one day’.

Interviewee-1 also experienced self-accusation and self-contempt after falling asleep when ‘babysitting’ his ailing elderly mother. He ‘felt terrible’ because he knew what he had done was ‘wrong’. Additionally, he ‘didn’t like not being successful at work’ because he was ‘not functioning that well’. These ‘personal failings’ helped him slowly realise, ‘I didn’t like me on it’. For him, it is very important ‘what you think of yourself and what other people think of you’. For Flanagan (2013, pp. 4–5), addiction is principally a problem of normative failing. On the one hand, they fail to execute normal powers of effective rational agency because they make a decision not to use, but use nonetheless. On the other hand, their frequent drug use results in them failing to live up to the hopes, expectations and standards they have for a good life. As they develop a narrative self-interpretation that perpetually evaluates how well they are doing in becoming who they aim to be, they have difficulty using their reason to control their actions and have trouble abiding by the moral norms upon which integrity and self-worth turns. The consequence of this ‘personal normative assessment’ is feelings of shame, guilt and embarrassment because they recognise their ‘behavioral failures with respect to norms’. But adjusting this self-interpretative narrative can lead to cognitive and behavioural change if they recognise their control failures and understand they are not living up to their own moral values or acting in their own best interests. Specifically, shame or disappointment can motivate a change in direction if they search for a way to overcome their destructive relation to their drug of choice.

For interviewee-19, an important part of her ‘owning’ her methamphetamine use was forcing herself to look in the mirror and say, ‘Look at you. You are a meth addict’. She would also force herself to put the ‘meth pipe’ in front of the mirror, which caused her to ‘hate it’ because she recognised ‘the pipe just killed everything’ good in her life. While it took her ‘years to get clean’, she eventually ‘self-talked’ her way out of methamphetamine use. Likewise, ‘right near the end’ of interviewee-33’s methamphetamine use she experienced a ‘reality check’ when she looked in the mirror and asked to herself, ‘Why are you doing this? You are doing this to be happy, but are you happy?’ And for interviewee-31, receiving drug treatment in jail ‘ruined’ her last two-years of use. Because treatment ‘worked on’ her moral conscience by telling her drug use is ‘wrong’, when she started using again the ‘conflict between the ego and the superego’ was ‘100 times worse’. Whilst her strong desire would signify, ‘Fucking give me some more!’ this revamped moral conscience would occasionally ‘push’ her to use ‘harder’ because she ‘just wanted it to shut up’. ‘Over time’, however, this moral conscience ‘just wore me down’.

Summary and implications

This paper qualitatively analysed the impact methamphetamine use exerted on interviewees’ moral values and moral conduct. Initially, methamphetamine was used to more closely adhere to societal norms, moral values and moral conduct, such as being a happier person, a more productive worker, a better parent or spouse, or just to function ‘normally.’ Over time, approximately one-quarter experienced only a minor impact as they were able to maintain or uphold many of their morals values while mostly engaging in moral conduct. A moderate impact affected over a third, leading to self-centeredness and regrettable immoral conduct, such as lying or neglecting family, friends or work responsibilities. For the remaining third or so the impact was major or severe as they came to prioritise methamphetamine over almost everything else in life, with some committing severe moral transgressions. Nevertheless, methamphetamine use did not entirely erase moral values and conduct, as they were still able to act in a moral way or possess a moral conscience. In regards to how duration, frequency, and quantity of methamphetamine use impacted on moral values and conduct, as expected those who experienced only a minimal impact used for a shorter time and consumed less. But comparing the moderate and major/severe impact groups, both groups used similar weekly amounts, yet the moderate impact group actually used for significantly longer. This suggests the impact of methamphetamine on moral values and moral conduct is influenced by factors solely beyond usage metrics. Since interviewees believe methamphetamine ‘enhances’ or ‘amplifies’ the ‘existing person’, then personality and environmental factors influence methamphetamine-related outcomes. As interviewee-32 said, ‘It is not the meth. It is the person using the meth’.

This paper also examined the psychological impact of frequent methamphetamine use by analysing the internal conflicts experienced by frequent methamphetamine users. The psychoanalytic conflict between the id (pleasure-seeking desires), the ego (reason and rationality), and the superego (moral conscience), as well as Lewis’ attraction-vs-willpower model, were used to explain this internal struggle. Since long-term high dose methamphetamine use changes the values that govern decision making in favour of getting high (Szalavitz 2016), the drug's powerful allure conflicts with users’ moral conscience, which may result in guilt, shame, self-accusation and self-contempt. Frequent methamphetamine use can therefore be partly understood as a normative failing whereby users struggle to live up to their own expectations and moral norms. This internal struggle, shaped by an interaction between pleasure-seeking desires, reason and rationality, and moral considerations and demands, can powerfully influence the decision to use–or abstain from use. Interviewees highlighted how frequent methamphetamine use distorts reality and self-image, which can lead to questioning the true nature of their actions. Confronting, understanding, adjusting and/or controlling this internal dialogue through self-reflection can alter one’s internal dialogue and lead to cognitive and behavioural change. For example, Dodes and Dodes (2014) argue pleasure-seeking or pain-relieving thoughts are not random; instead, they have triggers. Understanding when these thoughts arise is therefore crucial. Analysing what happened just before the powerful thought can reveal an underlying feeling or motivation driving the strong desire. Recognising these triggers allows individuals to gain perspective, anticipate urges, and develop strategies to manage them effectively. For example, interviewee-39 learned the ‘R.I.A.’ method whilst in recovery to ‘recognize, identify and acknowledge’ the triggering emotion whenever it arises.² When in ‘active addiction’, she would ‘pick up the pipe’ to ‘numb’ or ‘suppress’ the emotion. But being able to recognise, identify and acknowledge her feelings and emotions has been key in preventing her from ‘jumping back on the pipe’.

Despite the immoral conduct frequent methamphetamine users may engage in, blaming and stigmatising them is not a practical way to enable recovery (Frank and Nagel 2017; Deen et al. 2021). This is because experiencing intense–but unexamined–shame and guilt is more likely to thwart recovery than facilitate it (Lewis 2015). In the recovery literature, it is generally accepted frequent drug-taking negatively impacts an individual’s identity and that recovery should generate a more positive projection and sense of self (Neale et al. 2011). According to Marc Lewis (2017), the moral model of addiction advocates shame and punishment as the appropriate response to addiction. By contrast, the medical or disease model advocates medical intervention. But Lewis advocates a developmental-learning model, which suggests growth beyond addiction powered by individual effort. According to this model, addiction can be seen as a developmental stage that requires personal determination and progress based on an individual’s perspectives, goals and capacities. It emphasises that positive change originates from within the individual, aligning with the notion that overcoming addiction is part of personal development and growth. Similarly, Peele and Rhoads (2019, p. 22) argue a developmental model views addiction as ‘something that ebbs and flows in individuals over time, and that most of us are bound to outgrow’. Peele and Rhoads argue the best way to discourage addiction and engineer positive outcomes is by becoming oriented toward greater goals, developing new connections, and pursuing constructive paths that lead to greater satisfaction, self-confidence, self-respect and self-image. As Waldorf et al. (1991, p. 10) found for people who frequently used cocaine, a ‘stake in conventional life’ helps to prevent them ‘from falling into the abyss of abuse’, and ‘helps pull back those who do fall’. Thus, prosocially-oriented family, friends, jobs and purpose provide ‘the ballast’ that allows both control of and recovery from stimulant use (Waldorf et al. 1991).

Informed consent

All interviewees provided informed consent. This research received IRB approval by ‘Ewha Womans University Institutional Review Board’, at Ewha Womans University. IRB#: 158-6.

Acknowledgments

The author wishes to acknowledge all participants in this research

Disclosure statement

No potential conflict of interest was reported by the author(s).

Notes

1 For this analysis, the testimonies are also considered ‘interviewees’, despite the fact the author did not interview them (instead, a moderator working with an online support group moderated their testimony they provided during a live online session).

2 Similarly, ‘trauma adaptive recovery group education therapy’ is a self-reflection-based psychotherapeutic model which teaches clients how to prepare for and productively process internal and external triggers (see Ford and Russo 2006). Likewise, mindfulness-based relapse prevention methods have also been effective in dealing with triggers or addictive desires (see Witkiewitz et al. 2013).