# Presentation: 207119

## Methamphetamine Use and the Impact on Child Welfare

**National Center on Substance Abuse and Child Welfare **
**Jay Wurscher, Director**
**Oregon Child Welfare Addiction Services**
**Presented at CWLA Methamphetamine Teleconference**
**September 22, 2005**

**Methamphetamine Use and the Impact on Child Welfare**

## Overview, Treatment and Risks to Children

## Overview, Treatment and Risks to Children

**    ****	****1.  NCSACW**
**	****2.  Scope of the Problem**
**    ****	****3.  Patterns of Use**
**    ****	****4.  Effects of Meth Addiction**
**	****5.  Risks to Children**
**    ****	****6.  Treatment for Meth**

## A Program of the 
Substance Abuse and Mental Health 
Services Administration
Center for Substance Abuse Treatment
and the
Administration on Children, Youth and Families
Children’s Bureau
Office on Child Abuse and Neglect

- Substance Abuse and Mental Health
- Services Administration
- Center for Substance Abuse Treatment
- and the
- Administration on Children, Youth and Families
- Children’s Bureau
- Office on Child Abuse and Neglect

**Notes:**
** I’d like to take just a moment to introduce to you the National Center on Substance Abuse and Child Welfare. We are coming up on our 2 year anniversary next month and we are quite pleased with the progress that is underway. 
Many of you may know that we are co-funded by the Substance Abuse and Mental Health Services Administration’s Center for Substance Abuse Treatment and the Administration for Children, Youth and Families’ Children’s Bureau, Office on Child Abuse and Neglect. 

## To improve outcomes for families by promoting effective practice, and organizational and system changes at the local, state, and national levels

Developing and implementing a comprehensive program of information gathering and dissemination

Providing technical assistance

- Developing and implementing a comprehensive program of information gathering and dissemination
- Providing technical assistance

**NCSACW Mission**

**Notes:**
You have a handout in your materials on our technical assistance program and how to reach us as well as an announcement of our first on-line curricula. 
This on-line training is directed to substance abuse counselors and explains child welfare services and the dependency court. It takes about 4 hours to complete, it is free of charge and comes with 4 hours of CEUs for those that are interested. Our second on-line curricula will be released in a few months and targets child welfare workers and explains addiction and recovery.
You can visit our website and leave us your email address if you are not currently on our distribution list to receive announcements of our products and activities and we look forward to hearing more from you.

## American Public Human Services Association (APHSA)
Child Welfare League of America (CWLA)
National Association of State Alcohol and Drug Abuse Directors (NASADAD)
National Council of Juvenile and Family Court Judges (NCJFCJ)
National Indian Child Welfare Association (NICWA)

- Child Welfare League of America (CWLA)
- National Association of State Alcohol and Drug Abuse Directors (NASADAD)
- National Council of Juvenile and Family Court Judges (NCJFCJ)
- National Indian Child Welfare Association (NICWA)

**NCSACW Consortium**

## Recent NCSACW Products

***Understanding Substance Abuse and Facilitating Recovery: A Guide for Child Welfare Workers***
**	****(A short monograph for front-line workers)**
**On-Line Training – ****Now Available**
**Understanding Child Welfare and the Dependency Court: A Guide for Substance Abuse Treatment Professionals**
**Understanding Substance Use Disorders, Treatment and Family Recovery: A Guide for Child Welfare Professionals**

**Notes:**
Publication and on-line training.  Free of charge.

## Scope of the Problem

## Meth use has increased
Use has spread from the West
Accounts for a small percentage of the total number of people affected by drug and alcohol problems
The impact of meth use on child welfare varies widely among States and among Counties

**Use has spread from the West**
**Accounts for a small percentage of the total number of people affected by drug and alcohol problems**
**The impact of meth use on child welfare varies widely among States and among Counties**

**Scope of the Problem**

## Meth/Amphetamine Treatment Admission Rate Per 100,000 Population Aged 12 or Older - 1993-2003

- Source: Treatment Episode Data Set (TEDS)

- Meth/Amphetamine Treatment Admission Rate **Per 100,000 Population Aged 12 or Older - 1993-2003**

## Eastward Spread of Methamphetamine

**Eastward Spread of Methamphetamine**

**Admissions per 100,000 population**

**Notes:**
Admissions per 100,000 people. For the United States as a whole, methamphetamine admission rates increased by 420 
percent between 1992 and 2002, from 10 per 100,000 population aged 12 and over
 to 52 per 100,000. Rates were generally highest in the West, 
particularly in the Pacific States, AND spreading east into the Midwest and South. 

## Eastward Spread of Methamphetamine

**Eastward Spread of Methamphetamine**

**Admissions per 100,000 population**

**Notes:**
Admissions per 10,000 people. By 2002, 19 States reported rates of 50 or more admissions per 100,000;
 in 13 of these, rates were 100 or more admissions per 100,000. 

## Alcohol 	     	  				42%

Heroin/Other Opiates			18%

Marijuana					15%

Cocaine						14%

Meth/Amphetamine and			  7%
	Other Stimulants				

**Heroin/Other Opiates****	****	****	****18%**
**Marijuana****	****	****	****	****	****15%**
**Cocaine****	****	****	****	****	****	****14%**
** **
**Meth/Amphetamine and****	****	****	****  7%**
**	****Other Stimulants****	****	****	****	**

**Treatment Admissions by Primary Substance - 2003**

- Source: Treatment Episode Data Set (TEDS)

**Notes:**
Heavy alcohol use is drinking five or more drinks on the same occasion in each of 5 or more days in the past 30 days.

## Methamphetamine is affecting communities that have not experienced prior stimulant drug problems

Child welfare agencies are dealing with more cases involving methamphetamine

**Child welfare agencies are dealing with more cases involving methamphetamine**

**Impact of Increasing ****Methamphetamine Use**

## Smoked Cocaine/Crack and Meth/Amphetamine Treatment Admissions by Race/Ethnicity

- Source: Treatment Episode Data Set (TEDS)

## Meth/Amphetamine & Cocaine Treatment Admissions According to Census Division 2003              RATE per 100,000 

**Rate per 100,000**

- Source: Treatment Episode Data Set (TEDS)

## 47% of admissions are women

Since women are often caretakers of children, more children are likely affected.

**Since women are often caretakers of children, more children are likely affected.**

**Gender Differences**

- Source: Vaughn, C. (2003)

## Treatment Admissions Meth/Amphetamine as Primary Substance by Gender

- Source: Treatment Episode Data Set (TEDS)

**Notes:**
Women are more likely than men to report meth/amphetamines as their primary substance at admission. This trend has remained constant over the years.  

## Meth/Amphetamine Admissions By Gender - 2003

- Source: Treatment Episode Data Set (TEDS)

**Notes:**
Unlike other drugs, the gender breakdown for meth/amphetamine admissions is nearly equal among men and women.  However, when you look at teens, the picture is much more disturbing, with females representing the majority of such admissions.

## Female Treatment Admissions States with Highest % of Meth/Amphetamine as Primary Substance

- Source: Treatment Episode Data Set (TEDS)

**Notes:**
This slide takes a closer look at the female treatment admissions.  It shows that the percentage for which meth/amphetamine is the primary substance at admission is strikingly higher in many western and midwestern States. The national average was 10% in 2002.  These States far exceed that number.  Next 4 highest States were: 7. Iowa, 8. Oregon, 9. Arkansas and 10. Oklahoma

## Trends in Primary Substance UseTreatment Admissions for Pregnant Females by Primary Substance 1995-2003 

**Trends in Primary Substance Use****Treatment Admissions for Pregnant Females by Primary Substance 1995-2003**

**Percent of Women’s Admissions for**** ****Meth/Amphetamine**** ****and**** ****Marijuana**** ****Nearly Doubled over 8 Years**

- Source: Treatment Episode Data Set (TEDS)

**Notes:**
Background/context: The percentage of females pregnant at admission has remained relatively constant at about 4%.  For 2003, the total number of females pregnant at admission was 19,179.
The graph shows an interesting trend:  from 1995 to 2003, alcohol and cocaine as primary substance for pregnant women at admission has gone down, while marijuana and methamphetamine have increased.  Heroin has remained relatively constant.
In addition (not reflected in any graph), if you look at all pregnant female admissions with meth/amphetamines/other stimulants as the primary substance, the percentage who are 18-24 years old has increased from 39% in 1995 to 46% in 2003 – so providers are dealing with more younger pregnant females who use meth.

## Foster Care Population and Persons Who First Used Crack or Methamphetamine in Prior Year 

## Effects of Methamphetamine Addiction

## Short-Term Effects of Methamphetamine

_**PSYCHOLOGICAL**_
**Confidence**
**Alertness**
**Mood**
**Sex drive**
**Energy**
**Talkativeness**
**Boredom**
**Loneliness**
**Timidity**

_**PHYSICAL**_**	**
**Heart rate**
**Respiration**
**Blood pressure**
**Pupil size**
**Sensory acuity**
**Energy**
**Appetite**
**Sleep **
**Reaction time**

- Source: Judith Cohen, Ph.D., Presentation to NASADAD, June 2005

**Notes:**
People like MA
Addictive—time varies, from immediate to years

Initially get a surge.  Accentuate the positive, eliminate the negative

## Methamphetamine Chronic Physical Effects

- Tremors
- Weakness
- Headaches
- Sweating
- Coughing

- Dry Mouth
- Oily skin/complextion
- Burned lips/sore nose
- Dental
- Weight Loss/Anorexia

**Notes:**
As time goes on, picture changes

Feel poorly, ingestion causes burns, hurts gums

Loose a lot of weight.  One of reasons women use initially.

## MethamphetamineChronic Psychological Effects

**-**  **Confusion                        -   Irritability**
**-  Concentration                 -   Paranoia**
**-  Hallucinations                 -   Panic reactions**
**-  Fatigue                             -   Depression**
**-  Memory loss                    -   Anger**
**-  Insomnia                          -   Psychosis**

- Source: Richard Rawson, Ph.D., Presentation to SAMHSA, August 2005

**Notes:**
Not only do you not feel well, your thinking and cognitive processes are impacted.

One of reasons women use, to help with depression, now is made worse.

## Decreased ability to:
Recognize and recall words and pictures
Make inferences
Manipulate information
Ignore irrelevant information
Learn from experience

Users and people in early recovery may find it difficult to:
Pay attention
Comprehend spoken and written information
Remember information

**Recognize and recall words and pictures**
**Make inferences**
**Manipulate information**
**Ignore irrelevant information**
**Learn from experience**
**Users and people in early recovery may find it difficult to:**
**Pay attention**
**Comprehend spoken and written information**
**Remember information**

**Cognitive Effects**

- Source: Simon (1999)

**Notes:**
Think about what you need from an individual to bring about change in behavior:

Need to pay attention
Understand you
Remember what you told them to do

All of these will be difficult.

## Abilities that improve after 12 weeks abstinence:

Manipulate information
Ignore irrelevant information

**Manipulate information**
**Ignore irrelevant information**

**Cognitive Effects**

**Abilities that do note improve after 12 weeks abstinence:**
**Recognize and recall words**
**Recognize and recall pictures (declines less than word recognition and recall)**

- Source: Obert et al. (2002)

**Notes:**
When stop using, things improve.

But they do not improve quickly, and certainly not as quickly as needed when the ASFA time clock is ticking.

## Rate of recovery is associated with severity of abuse and days of abstinence.

Study documented significant recovery with Meth abusers who were able to stay drug free for at least 9 months.

After 4 years of abstinence, no deficits in:

Memory
Learning
Attention
Executive function
Motor function

**Study documented significant recovery with Meth abusers who were able to stay drug free for at least ****9 months****.**
**After 4 years of abstinence, no deficits in:**
**Memory**
**Learning**
**Attention**
**Executive function**
**Motor function**

**Cognitive Effects**

- Sources: Lundahl et al. (2004); Volkow et al. (2001)

**Notes:**
But with time, person can regain their capacity to function and “have a life in the community.”

## Risks to Children When Parents Use Meth

## Six Different Situations for Children

**Parent uses or abuses methamphetamine**
**Parent is dependent on methamphetamine**
**Mother uses meth while pregnant**
**Parent “cooks” small quantities of meth**
**Parent involved in trafficking**
**Parent involved in super lab**

- Source: Nancy Young, Ph.D., Testimony before the U.S. House of Representatives Government Reform Subcommittee on Criminal Justice, Drug Policy, and Human Resources, July 26, 2005

## Each situation poses different risks and requires different responses
Child welfare workers need to know the different responses required
The greatest number of children are exposed through a parent who uses or is dependent on the drug 
Relatively few parents “cook” the drug

**Child welfare workers need to know the different responses required**
**The greatest number of children are exposed through a parent who uses or is dependent on the drug **
**Relatively few parents “cook” the drug**

- Source: Nancy Young, Ph.D., Testimony before the U.S. House of Representatives Government Reform Subcommittee on Criminal Justice, Drug Policy, and Human Resources, July 26, 2005

**Six Different Situations for Children**

## Parent Uses or Abuses Meth

**Risks to safety and well-being of children:**
**Parental behavior under the influence: poor judgment, confusion, irritability, paranoia, violence**
**Inadequate supervision**
**Inconsistent parenting**
**Chaotic home life**
**Exposure to second-hand smoke**
**Accidental ingestion of drug**
**Possibility of abuse**
**HIV exposure from needle use by parent**

- Source: Nancy Young, Ph.D., Testimony before the U.S. House of Representatives Government Reform Subcommittee on Criminal Justice, Drug Policy, and Human Resources, July 26, 2005

## Parent Is Dependent on Meth

**Risks to safety and well-being of children:**
**All the risks of parents who use or abuse, but the child may be exposed more often and for longer periods**
**Chronic neglect is more likely**
**Household may lack food, water, utilities**
**Chaotic home life**
**Children may lack medical care, dental care, immunizations**
**Greater risk of abuse**
**Greater risk of sexual abuse if parent has multiple partners**

- Source: Nancy Young, Ph.D., Testimony before the U.S. House of Representatives Government Reform Subcommittee on Criminal Justice, Drug Policy, and Human Resources, July 26, 2005

## Mother Uses Meth While Pregnant

**Risk to child depends on frequency and intensity of use, and the stage of pregnancy**
**Risks include birth defects, growth retardation, premature birth, low birth weight, brain lesions**
**Problems at birth may include difficulty sucking and swallowing, hypersensitivity to touch, excessive muscle tension (hypertonia)**
**Long term risks may include developmental disorders, cognitive deficits, learning disabilities, poor social adjustment, language deficits**

- Sources: Anglin et al.  (2000); Oro & Dixon, (1987); Rawson & Anglin (1999); Dixon & Bejar (1989); Smith et al. (2003); Shah (2002)

## Mother Uses Meth While Pregnant

**Observed effects may be due to other substances, or combination of substances, used by the mother**
**For example, if the mother also smokes, growth retardation may be significant**
**Observed effects may be complicated by other conditions, such as the health, environmental, or nutritional status of the mother**

- Source: Nancy Young, Ph.D., Testimony before the U.S. House of Representatives Government Reform Subcommittee on Criminal Justice, Drug Policy, and Human Resources, July 26, 2005

## Mother Uses While Pregnant

**Scope of the problem:**
**An estimated 10% to 11% of all newborns are prenatally exposed to drugs or alcohol; this amounts to 400,000 to 480,000 newborns per year**
**Only about 5% of prenatally exposed newborns are placed in out-of-home care; the rest go home without assessment and services**

- Sources: Vega; SAMHSA, OAS, National Survey of Alcohol and Drug Use During Pregnancy, 2002 and 2003

## Mother Uses While Pregnant

**	**
**Home environment is the critical factor in the child’s outcome**
**Consequences can be mediated**

- Shah, R.** **(2005, June). From NASADAD presentation

**Notes:**
The home environment depends on the parent’s engagement and success in treatment.  The home environment is the critical factor for the child.  In addition the child’s social, emotional, developmental and psychological needs must also be addressed.   Address the child’s need has an impact on the parent’s treatment as well because coping with the issues of recovery and the challenges of a child with unmet or undetected special needs can pose barriers for parents trying to maintain a safe and stable home for their child. 

## Parent “Cooks” Small Quantities of Meth

**All the risks of parents who use or are dependent on meth, with added risks of manufacturing the drug:**
**	****	**
**Chemical exposure**
**Toxic fumes**
**Risk of fire and explosion**

- Source: Nancy Young, Ph.D., Testimony before the U.S. House of Representatives Government Reform Subcommittee on Criminal Justice, Drug Policy, and Human Resources, July 26, 2005

**Notes:**
While the number of parent’s who cook is relatively small compared to the number that use, living in a meth lab is extremely dangerous, especially for children.

## Environmental Methamphetamine Exposure and Risks

**Toxic effects of manufacturing**
**Children more at risk:**
**Higher metabolic rates**
**Developing bone and nervous systems**
**Thinner skin than adults which absorbs chemicals faster**
**Children tend to put things in their mouth and use touch to explore**

- Source: Mason (2004)

## Parent Involved in Trafficking

**Presence of  weapons**
**Possibility of violence**
**Possibility of physical or sexual abuse by persons visiting the household**

- Source: Nancy Young, Ph.D., Testimony before the U.S. House of Representatives Government Reform Subcommittee on Criminal Justice, Drug Policy, and Human Resources, July 26, 2005

**Notes:**
The lifestyle that goes with trafficking is very dangerous.

## Parent Involved in Super Lab

**Lower likelihood of children on the site**

- Source: Nancy Young, Ph.D., Testimony before the U.S. House of Representatives Government Reform Subcommittee on Criminal Justice, Drug Policy, and Human Resources, July 26, 2005

## Number of Children in Meth Labs

|  | 2000  | 2001  | 2002  | 2003  |
| --- | --- | --- | --- | --- |
| Number of incidents 
 | 8,971  | 13,270  | 15,353  | 14,260  |
| Incidents with children present 
 | 1,803  | 2,191  | 2,077  | 1,442  |
| Percent with children present | 20%  | 16.5% | 13.5% | 10% |
|  |   |  |   |  |
|  |  |  |  |  |
| Children taken into protective custody  | 353 | 778  | 1,026  | 724  |
|  |  |  |  |  |
|  |  |  |  |  |
|  |  |  |  |  |

**Number of Children in Meth Labs**

- Source:  El Paso Intelligence Center

**4 years = 2,881; all children ~1,200,000**

**Notes:**
Labs include small home labs and large scale superlabs.

The data is trending down, but we don’t know if that is because of a shift in the resources to finding the labs, or something else.

May be more consolidation of super labs supplying more people.  Children less likely to be present at Super labs.

## Field medical assessment

Immediate care protocol

Baseline assessment protocol

Initial follow-up care protocol

Long-term follow-up care protocol

**Immediate care protocol**
**Baseline assessment protocol**
**Initial follow-up care protocol**
**Long-term follow-up care protocol**

- Source: Colorado DEC

**Medical Interventions for Children**

## Treatment for Methamphetamine

## CSAT’s Methamphetamine Treatment Project

**Largest randomized clinical trial of treatment for meth dependence**
**Compared the MATRIX manualized treatment model developed at UCLA to treatment as usual**
**8 study sites; site in HI was all women**

## Matrix Model

**Intensive outpatient setting**
** **
**Three to five visits per week of comprehensive counseling for at least the first three months **
**Cognitive behavioral approach**
**Contingency management **

## Urinalysis Results 

**Results of UA tests at discharge, 6 months**
**and 12 months post admission** *
- 	     _**Matrix Group**_**	****	****  **_**TAU Group**_
**D/C:**       **66%** **MA-free**	        **65%** **MA-free**
**6 mo:**     **69%** **MA-free**	        **67%** **MA-free**
**12 mo:**   **59%** **MA-free**	        **55%** **MA-free**
***Over 80% follow-up rate in both groups at all points**

- Source: Richard Rawson, Ph.D., Presentation to SAMHSA, August 2005

## Similar Outcomes

**Treatment outcomes do not differ from other drugs of abuse**
**Treatment outcomes have more to do with the quantity and quality of treatment than type of drug abused**

## Treatment Outcomes for Women

**Of 10 MA-abusing women entering treatment:**

**3 still MA-abstinent**
** ****48 months after treatment**** **

**After treatment:               1mo.          12mo.               24mo.                                  48mo.****   **

**Still MA-abstinent:            6                  4                       3                                         3  **

- Source: M.L. Brecht, Ph.D. (2004)

**Notes:**
Women’s outcomes were not as good as groups that were mixed.

40% vs. 55-60% at 12 months.

## Gender Differences and Implications for Treatment

**Co-occurring mental health problems**
**Trauma**
**Body image**

## Scores at Baseline 

**Behavior Symptom Inventory (BSI)**
**Scores at Baseline**** **

- Richard Rawson, Ph.D., Presentation to SAMHSA, August 2005

**Notes:**
Women have higher scores on mental health problems than men at time of entry to treatment for meth.

## Beck Depression Inventory (BDI) 

**Beck Depression Inventory (BDI) **
**Scores at Baseline**

- Richard Rawson, Ph.D., Presentation to SAMHSA, August 2005

**Notes:**
These are very significant differences.  Represent differences in depression at treatment admission.

## Self-Reported Reasons for Starting Methamphetamine Use 

**Self-Reported Reasons for Starting Methamphetamine Use**** **

- Richard Rawson, Ph.D., Presentation to SAMHSA, August 2005

**Notes:**
These differences explain why so many women use meth.

## Gender Differences and Implications for Treatment

**Co-occurring mental health issues complicate treatment and require longer duration for treatment**
**Violence linked to meth use is related to trauma and safety needs which must be addressed in treatment**
**Body image and nutrition need to be addressed**

## Gender Differences and Implications for Treatment 

**Threats of violence and reduced cognitive capacity to manage activities of daily living suggest that a period of ****residential treatment**** will most often be indicated for women with serious addiction to methamphetamine**
**When residential care is not available, IOT may be indicated, with ****additional supports**** such as transportation, meals, child care, referral to safe houses or supervised housing**

## What Predicts Longer Abstinence?

**Longer abstinence following treatment for women with:**
**Longer time in treatment (e.g. those with 4 or more mo. of treatment have more than double the rate of 24-48 mo. abstinence)**
**More sessions per month of individual counseling    (or sexual recovery groups)**
**Treatment, intervention and case planning need to account for short-term effects, especially cognitive deficits and verbal communication**
**Drug Court involvement**
**Family involvement**

- M.L. Brecht, Ph.D., et al. (2005)

## Sacramento, California Model of Effective Child Welfare and Substance Abuse Services 

**Comprehensive training—**to understand substance abuse and dependence and acquire skills to intervene with parents** **
**Early Intervention Specialists—**Social workers trained in motivational enhancement therapy are stationed at the family court to intervene and conduct preliminary assessments with *ALL* parents with substance abuse allegations at the first court hearing
**Improvements in Cross-System Information Systems**—to ensure that communication across systems and methods to monitor outcomes are in place as well as management of the county’s treatment capacity

## Prioritization of Families in Child Protective Services—County-wide policy to ensure priority access to substance abuse treatment services
Specialized Treatment and Recovery Services (STARS)—provides immediate access to substance abuse assessment and engagement strategies conducted by staff trained in motivational enhancement therapy. STARS provides intensive management of the recovery aspect of the child welfare case plan and routine monitoring and feedback to CPS and the court
Dependency Drug Court—provides more frequent court appearances for ALL parents with allegations of substance use.

**Specialized Treatment and Recovery Services (STARS)**—provides immediate access to substance abuse assessment and engagement strategies conducted by staff trained in motivational enhancement therapy. STARS provides intensive management of the recovery aspect of the child welfare case plan and routine monitoring and feedback to CPS and the court
**Dependency Drug Court**—provides more frequent court appearances for *ALL* parents with allegations of substance use.

**Sacramento, California Model of Effective Child Welfare and Substance Abuse Services **

## Treatment Discharge Status by Primary Drug Problem 

## 18-Month Child Placement Outcomesby Parent Primary Drug Problem

## Methamphetamine: Implications for Workers

## Methamphetamine:Implications for Workers

**Signs of Use and Warning Signs for Workers**
**Oregon’s Response**

## Signs of Use and Warning Signs for Workers

## Euphoria 
Grinding of teeth 
Rapid breathing 
Sweating
Hyperactivity 
Tremor - shaking hands 
Rapid or pressured speech 
Depression - when drug wears off 
Irritability, paranoia, suspiciousness 
Hallucinations 
Presence of drug paraphernalia 

**Grinding of teeth **
**Rapid breathing **
**Sweating**
**Hyperactivity **
**Tremor - shaking hands **
**Rapid or pressured speech **
**Depression - when drug wears off **
**Irritability, paranoia, suspiciousness **
**Hallucinations **
**Presence of drug paraphernalia **

**Signs of Methamphetamine Use ****and Use of Other Stimulants**

- Source: Crowell & Webber (2001)

## Warning Signs for Workers

**Client is extremely irritable, suspicious, or argumentative, or there is an escalation of irritability**
** **
**Regular client does not appear to know who worker is**
** **
**Evidence of paranoid thinking, delusions**
** **
**Client verbalizes implicit or explicit threat against worker**

- Source: Crowell and Webber (2001)

## Scratch marks or scabs, particularly on client’s hands and arms - may be evidence of tactile hallucinations and indicate a prior episode of stimulant psychosis
Severe damage to teeth and gums
Drawn face and underweight 
Strong chemical odor - may indicate manufacturing of meth

**Severe damage to teeth and gums**
**Drawn face and underweight**** **
**Strong chemical odor - may indicate manufacturing of meth**

**Other Severe Signs of Meth Use **

- Source: Crowell and Webber (2001)

**Notes:**
Severe signs.  Will not see these in all instances.

## Natural Rewards Elevate Dopamine Levels

**Natural Rewards Elevate Dopamine Levels**

## Effects of Drugs on Dopamine Levels

***Source: Di Chiara and Imperato***

**Effects of Drugs on Dopamine Levels**

## Denial = Super-memory Imprinting

- Memory imprinting increases in power as dopamine activity increases.
- Addicts remember the “good-times” and fail to remember the “bad-times”.

## Research on Cognitive Impairments of MA addicts

- Ability to manipulate information (multi-relational or “synthesis”).
- Ability to make inferences.
- Ability to ignore irrelevant information.
- Ability to learn new or recall information.

- Hippocampus?

- implications?

## “Methamphetamine: Snapshot Phenomenon” Wurscher & Martin

- Criminal

- Psycho-case

- Sad-case

- wants
- recovery

- Doesn't
- want
- recovery

## Oregon’s Response

## Oregon 2004

- 9,500 CW cases (kids)
- 50% connected to Meth
- Up to 75% in some counties
- Usually exaggerated because they are the most Chaotic Cases
- Major Media coverage
- Major Crime issue – Labs & ID theft

## Oregon CW Success

- CW - FIT – Family Involvement Team
- CW - ART – Addiction Recovery Teams

- CADC’s
- Outreach Workers
- DHS Staff
- ASFA Video

## Oregon Response

- Governor’s Meth Task Force
- Legislative Response – Labs Crushed & Drug Court TX increased
- Pseudo – RX Drug as of July-2006
- DHS Meth Response Team

## Summary

## Summary

**Methamphetamine is a dangerous drug with serious physical, cognitive, and health consequences**
**The effects of long-term use are reversible with prolonged abstinence **
**Treatment for methamphetamine is as effective as treatment for other drugs**

## A high percentage of methamphetamine users are women of child-bearing age

Meth accounts for 7% of treatment admissions nationally, but in some States 30- 44% of women admitted were admitted for methamphetamine 

**Meth accounts for 7% of treatment admissions nationally, but in some States 30- 44% of women admitted were admitted for methamphetamine **

**Summary**

## Scope of the problem:
The number of meth users is small compared to other drugs and alcohol 

Admissions increased through 2003

Communities that have not experienced prior drug problems may lack the resources to handle a meth problem

Meth use may be leveling off

**The number of meth users is small compared to other drugs and alcohol **
**Admissions increased through 2003**
**Communities that have not experienced prior drug problems may lack the resources to handle a meth problem**
**Meth use may be leveling off**

**Summary**

## Parents’ use of methamphetamine puts their children at risk

The best outcome for both child and parent is achieved when:

The parent receives immediate, effective treatment and comprehensive services

The child receives immediate assessment and services, as well as follow-up services

**The best outcome for both child and parent is achieved when:**
**	**
**The parent receives immediate, effective treatment and comprehensive services**
**The child receives immediate assessment and services, as well as follow-up services**

**Summary**

## Child welfare workers must distinguish between

  		Children whose parents use meth, and 
		Children whose parents manufacture 	meth

They must learn the established medical protocols for children present in meth labs

**  ****	****	****Children whose parents use meth, and **
**	****	****Children whose parents manufacture ****	****meth**
**They must learn the established medical protocols for children present in meth labs**

**Summary**

## We need early diagnosis and intervention for children affected by meth before and after birth

We need comprehensive, timely, and state-of-the-art treatment for parents referred to treatment as a condition of keeping or reunifying with their children

We need information systems that capture the necessary data to support effective approaches

**We need comprehensive, timely, and state-of-the-art treatment for parents referred to treatment as a condition of keeping or reunifying with their children**
**We need information systems that capture the necessary data to support effective approaches**

**Summary**

## For Further Information

## SAMHSA Resources

**Treatment Improvement Protocols (TIP 33)**
- Best Practice Guidelines for Treatment of Substance Abuse
- Researched, Drafted, and Reviewed by Substance Use Disorder Professionals

## KAP Keys & Quick Guide

Developed to accompany the TIP Series

Based entirely on TIP #33

Designed to meet the needs of busy clinicians for concise, easily accessed “how-to” information 

http://www.samhsa.gov 

**KAP Keys & Quick Guide**
- Developed to accompany the TIP Series
- Based entirely on TIP #33
- Designed to meet the needs of busy clinicians for concise, easily accessed “how-to” information
- _[http://www.samhsa.gov](http://www.samhsa.gov/)__ _

**SAMHSA Resources**

## SAMHSA’s Addiction Technology Transfer Centers (ATTC)

Pacific Southwest ATTC
	http://www.psattc.org/events/cates/I/presentations/index.html

Methamphetamine 101: Etiology and Physiology of an Epidemic

- Pacific Southwest ATTC
- 	_[http://](http://www.psattc.org/events/cates/I/presentations/index.html)__[www.psattc.org/events/cates/I/presentations/index.html](http://www.psattc.org/events/cates/I/presentations/index.html)_
- Methamphetamine 101: Etiology and Physiology of an Epidemic

**SAMHSA Resources**

## ATTC’s Introduction to Evidence-Based Treatments for Methamphetamine

- CD-ROM Learning Tools
- DVD Training Module
- Produced by: Applied Behavioral Health Policy at the University of Arizona for the Pacific Southwest ATTC
*web* _[www.psattc.org](http://www.psattc.org/)_

## Contact NCSACW

- _[www.ncsacw.samhsa.gov](http://www.ncsacw.samhsa.gov/)_
**	****Project Director:**
**	****Nancy Young, Ph.D.**
**	****714-505-3525**
**Government Project Officer:**
**	****Sharon Amatetti, SAMHSA/CSAT**
**	****240-276-1694**
**	**_[sharon.amatetti@samhsa.hhs.gov](mailto:sharon.amatetti@samhsa.hhs.gov)__ _

## References

**References**

- Anglin, M., Burke, C., Perrochet, B., Stamper, E. & Dawud-Noursi, S. (2000). History of the methamphetamine problem. *Journal of Psychoactive Drugs*, *32*(2), 137-141.
- Brecht, M.-L., M. D. Anglin, et al. (2005). "Coerced Treatment for Methamphetamine Abuse: Differential Patient Characteristics and Outcomes." The American Journal of Drug and Alcohol Abuse 31(2): 337.
- Brecht, M.L.(2004) Women and Methamphetamine: Characteristics, Treatment Outcomes. Presentation to the Center
-         For Substance Abuse Treatment, State Systems Development Conference. August 13.
- Cohen, Judith, Ph.D. Presentation to NASADAD, June 2005.
- Colorado DEC. Retrieved from  _[www.colodec.org/decpapers/Documents/DEC%20Medical%20Protocol.pdf](http://www.colodec.org/decpapers/Documents/DEC%20Medical%20Protocol.pdf)_
- Crowell and Webber, 2004. Retrieved from _[www.drugfreeinfo.org/PDFs/strengthensupervision.pdf](http://www.drugfreeinfo.org/PDFs/strengthensupervision.pdf)_.
- Dixon, S.D., & Bejar, R. (1989). Echoencephalographic findings in neonates associated with maternal cocaine and methamphetamine use: Incidence and clinical correlates. *Journal of Pediatrics, 115*(5 Pt 1), 770-778.
- Ferguson, T. (2001). *Overview of medical toxicology and potential exposures to clandestine drug laboratories in California*. Paper presented to the Minnesota Department of Health.
- Lundahl, L.H., Keenan, P., Schuster, C.R., & Johanson, C.E. (2004, June). *Neurocognitive function in chronic high dose methamphetamine abusers following long term abstinence*. Poster session presented at the 66th Annual Scientific Meeting of the College on Problems of Drug Dependence, San Juan, Puerto Rico.
- Mason, A. P. 2004. *Methamphetamine labs*. Presented at the annual conference of the North Carolina Family-Based, Services Association.
- Obert, J.L., London, E.D., & Rawson, R.A. (2002). Incorporating brain research findings into standard treatment: An example using the Matrix Model. *Journal of Substance Abuse Treatment*, *23*(2), 107-113.
- Office of Applied Studies, Substance Abuse and Mental Health Services Administration, Treatment Episode Data Set (TEDS).
- Office of Applied Studies, Substance Abuse and Mental Health Services Administration, National Survey of Alcohol and Drug Use During Pregnancy, 2002 and 2003.

- Oro, A.S., & Dixon, S.D. (1987). Perinatal cocaine and methamphetamine exposure: Maternal and neonatal correlates. *Journal of Pediatrics*, 571-578.
- Rawson, Richard, Ph.D., Presentation to SAMHSA, August 2005.
- Rawson, R., & Anglin, M.D. (1999, June). *Methamphetamine: New knowledge, new treatments*. Retrieved April 2004, from the UCLA Integrated Substance Abuse Programs Web site: http://www.uclaisap.org/slides/Index46/index.htm
- Simon, S. (1999). *Cognitive impairment in individuals currently using methamphetamine*. Retrieved April 2004, from the UCLA Integrated Substance Abuse Programs Web site: http://www.uclaisap.org/slides/Index46/sld034.htm
- Smith, L., Yonekura, M.L., Wallace, T., Berman, N., Kuo, J., & Berkowitz, C. (2003). Effects of prenatal methamphetamine exposure on fetal growth and drug withdrawal symptoms in infants born at term. *Journal of Developmental and Behavioral Pediatrics, 24*(1):17-23.
- Shah, R.** **(2005, June). From NASADAD presentation
- Thompson, P.M., Hayashi, K.M., Simon, S.L., Geaga, J.A., Hong, M.S., Sui, Y., et al. (2004). Structural abnormalities in the brains of human subjects who use methamphetamine. *Journal of Neuroscience, 24*(26), 6028-6036.
- Vaughn, C. (2003). Get up to speed on methamphetamine use. *NCADI Reporter*. Retrieved from _[http://www.health.org/newsroom/rep/215.aspx](http://www.health.org/newsroom/rep/215.aspx)_
- Vega et al (1993), Profile of Alcohol and Drug Use During Pregnancy in California, 1992.
- Volkow, N.D., Chang, L, Wang, G.J., Fowler, J.S., Leonido-Yee, M., Franceschi, D., et al. (2001b). Association of dopamine transporter reduction with psychomotor impairment in methamphetamine abusers. *American Journal of Psychiatry, 158*, 377-382.
- Young, Nancy K., Ph.D. Testimony before the U.S. House of Representatives Government Reform Subcommittee on Criminal Justice, Drug Policy, and Human Resources, July 26, 2005.
- Zickler, P. (2000). Brain imaging studies show long-term damage from methamphetamine abuse. *NIDA Notes, 15*(3).

**References**