# Presentation: 675987

## Implications of Methamphetamine Abuse and Dependence for Child Welfare

Children’s Bureau
System of Care Grantees Teleconference
July 14, 2005

**Implications of Methamphetamine Abuse and Dependence for Child Welfare**
- Children’s Bureau
- System of Care Grantees Teleconference
- July 14, 2005

**Nancy K. Young, Ph.D., Director**
- 4940 Irvine Boulevard, Suite 202
- Irvine, CA  92620
- 714.505.3525
- www.ncsacw.samhsa.gov

## Topics for Presentation

- NCSACW
- Some Background and Data
- Treatment Issues and Effectiveness
- Issues for Children and Safety
- Implications for Child Welfare

## NCSACW

## 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.

## NCSACW Consortium

- 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)

## Recent Products

*Understanding Substance Abuse and Facilitating Recovery: A Guide for Child Welfare Workers* – A short monograph for front-line workers
- On-Line Training
- Understanding Child Welfare and the Dependency Court: A Guide for Substance Abuse Treatment Professionals
- Understanding Addiction and Recovery:         A Guide for Child Welfare Professionals

## Some Background and Data

## Methamphetamine

- Brief Description
- An addictive stimulant that is closely related to amphetamine, but has longer lasting and more toxic effects on the central nervous system. It has a high potential for abuse and addiction.
- Street Names
- Speed, meth, chalk, ice, crystal, glass.

## Effects
Increases wakefulness and physical activity and decreases appetite. Chronic, long-term use can lead to psychotic behavior, hallucinations, and stroke. 
Prevalence of Use
According to the 2002 National Survey on Drug Use and Health, about 12 million Americans (5.2% of population) have tried methamphetamine. 

- Increases wakefulness and physical activity and decreases appetite. Chronic, long-term use can lead to psychotic behavior, hallucinations, and stroke.
- Prevalence of Use
- According to the 2002 *National Survey on Drug Use and Health*, about 12 million Americans (5.2% of population) have tried methamphetamine.

**Methamphetamine**

## Meth users begin younger than other drugs

Differ from other users in their drug use pattern—they use more days

Differ in their cognition—particularly in early abstinence

Need alternative methods of imparting information

- Differ from other users in their drug use pattern—they use more days
- Differ in their cognition—particularly in early abstinence
- Need alternative methods of imparting information

**Issues Specific to Methamphetamine**

## Effects of Methamphetamine

- Remains active for longer periods
- Half life – the length of time for half of the substance to be eliminated from the body
- Cocaine half life is one hour
- Methamphetamine half life is twelve hours
- Length of active effect may be related to long-term structural changes in the parts of the brain that control memory and motor coordination

## Acute Effects of Methamphetamine

- Confidence
- Alertness
- Mood
- Sex drive
- Energy
- Talkativeness
- Boredom
- Loneliness
- Timidity

- Heart rate
- Respiration
- Blood pressure
- Pupil size
- Sensory acuity
- Energy
- Appetite
- Sleep
- Reaction time

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

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

## Foster Care Population

**Number of Children in Foster Care on Last Day of Federal Fiscal Year**

**ASFA**

**Notes:**
nearly doubling from 1980 to the current caseloads of over one-half million. 
Much has been said about the co-occurrence of the crack cocaine epidemic and the escalation of children in out of home during the six year period between 1986 and 1992. Let’s look at those numbers for a moment.

## Foster Care Population and Persons Who First Used Crack or Meth in Past Year

- *All persons age 12 and over

**Notes:**
** This is the same slide of the foster care population 
** with the number of new crack users overlaid by year. While we understand there are many explanations for the increase in the number of children in care, there does seem to be an interesting pattern of persons who initiated crack use and the increasing foster care population. 
** If we look at another drug epidemic that is currently influencing child welfare systems, particularly in the west and Midwest, this blue line represents the number of new methamphetamine users over the past decade. 

## Illicit Drug Use in Lifetime, Past Year, and Past Month among Persons Aged 12 or Older: Numbers in Thousands, 2003 

- 40331

**Illicit Drug Use in Lifetime, Past Year, and Past Month among Persons Aged 12 or Older: Numbers in Thousands, 2003**

| Drug | TIME PERIOD |  |  |  |  |  |
| --- | --- | --- | --- | --- | --- | --- |
|  | Lifetime |  | Past Year |  | Past Month |  |
|  |  |  |  |  |  |  |
| ANY ILLICIT DRUG1 |  | 110,205 |  | 34,993 |  | 19,470 |
|      Marijuana and Hashish |  | 96,611 |  | 25,231 |  | 14,638 |
|      Cocaine |  | 34,891 |  | 5,908 |  | 2,281 |
|           Crack |  | 7,949 |  | 1,406 |  | 604 |
|      Heroin |  | 3,744 |  | 314 |  | 119 |
|      Hallucinogens |  | 34,363 |  | 3,936 |  | 1,042 |
|           LSD |  | 24,424 |  | 558 |  | 133 |
|           PCP |  | 7,107 |  | 219 |  | 56 |
|           Ecstasy |  | 10,904 |  | 2,119 |  | 470 |
|      Inhalants |  | 22,995 |  | 2,075 |  | 570 |
|      Nonmedical Use of Any Psychotherapeutic2 |  | 47,882 |  | 14,986 |  | 6,336 |
|           Pain Relievers |  | 31,207 |  | 11,671 |  | 4,693 |
|           Tranquilizers |  | 20,220 |  | 5,051 |  | 1,830 |
|           Stimulants |  | 20,798 |  | 2,751 |  | 1,191 |
|                Methamphetamine |  | 12,303 |  | 1,315 |  | 607 |
|           Sedatives |  | 9,510 |  | 831 |  | 294 |
| ANY ILLICIT DRUG OTHER THAN MARIJUANA1 |  | 71,128 |  | 20,305 |  | 8,849 |
| 1 Any Illicit Drug includes marijuana/hashish, cocaine (including crack), heroin, hallucinogens, inhalants, or any prescription-type psychotherapeutic used nonmedically. Any Illicit Drug Other Than Marijuana includes cocaine (including crack), heroin, hallucinogens, inhalants, or any prescription-type psychotherapeutic used nonmedically.2 Nonmedical use of any prescription-type pain reliever, tranquilizer, stimulant, or sedative; does not include over-the-counter drugs.Source: SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2002 and 2003. |  |  |  |  |  |  |

## Illicit Drug Use in Lifetime, Past Year, and Past Month among Persons Aged 12 or Older: Numbers in Thousands, 2003 

**Illicit Drug Use in Lifetime, Past Year, and Past Month among Persons Aged 12 or Older: Numbers in Thousands, 2003**

| Drug | TIME PERIOD |  |  |  |  |  |
| --- | --- | --- | --- | --- | --- | --- |
|  | Lifetime |  | Past Year |  | Past Month |  |
|  |  |  |  |  |  |  |
| ANY ILLICIT DRUG1 |  | 110,205 |  | 34,993 |  | 19,470 |
|      Marijuana and Hashish |  | 96,611 |  | 25,231 |  | 14,638 |
|      Cocaine |  | 34,891 |  | 5,908 |  | 2,281 |
|           Crack |  | 7,949 |  | 1,406 |  | 604 |
|      Heroin |  | 3,744 |  | 314 |  | 119 |
|      Hallucinogens |  | 34,363 |  | 3,936 |  | 1,042 |
|           LSD |  | 24,424 |  | 558 |  | 133 |
|           PCP |  | 7,107 |  | 219 |  | 56 |
|           Ecstasy |  | 10,904 |  | 2,119 |  | 470 |
|      Inhalants |  | 22,995 |  | 2,075 |  | 570 |
|      Nonmedical Use of Any Psychotherapeutic2 |  | 47,882 |  | 14,986 |  | 6,336 |
|           Pain Relievers |  | 31,207 |  | 11,671 |  | 4,693 |
|           Tranquilizers |  | 20,220 |  | 5,051 |  | 1,830 |
|           Stimulants |  | 20,798 |  | 2,751 |  | 1,191 |
|                Methamphetamine |  | 12,303 |  | 1,315 |  | 607 |
|           Sedatives |  | 9,510 |  | 831 |  | 294 |
| ANY ILLICIT DRUG OTHER THAN MARIJUANA1 |  | 71,128 |  | 20,305 |  | 8,849 |
| 1 Any Illicit Drug includes marijuana/hashish, cocaine (including crack), heroin, hallucinogens, inhalants, or any prescription-type psychotherapeutic used nonmedically. Any Illicit Drug Other Than Marijuana includes cocaine (including crack), heroin, hallucinogens, inhalants, or any prescription-type psychotherapeutic used nonmedically.2 Nonmedical use of any prescription-type pain reliever, tranquilizer, stimulant, or sedative; does not include over-the-counter drugs.Source: SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2002 and 2003. |  |  |  |  |  |  |

## Methamphetamine/Amphetamine Treatment Admission Rate Per 100,000 Population Aged 12 or Older: 1992-2002 

- Source: 2002 SAMHSA Treatment Episode Data Set (TEDS).

## The Eastward Spread of Methamphetamine

**The Eastward Spread of Methamphetamine**

**Notes:**
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. 

## The Eastward Spread of Methamphetamine

**The Eastward Spread of Methamphetamine**

**Notes:**
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. 
The number of States reporting fewer than 25 admissions per 100,000 had decreased to 29 

## Methamphetamine/Amphetamine Treatment Admissions, by Route of Administration: 1992-2002 

**Methamphetamine/Amphetamine Treatment Admissions, by Route of Administration: 1992-2002**

- Source: 2002 SAMHSA Treatment Episode Data Set (TEDS).

## Smoked Methamphetamine/Amphetamine Treatment Admissions, by Race/Ethnicity: 1992 and 2002 

- Source: 2002 SAMHSA Treatment Episode Data Set (TEDS).

## Methamphetamine/Amphetamine Treatment Admissions, by Route of Administration: 1992-2002 

- Source: 2002 SAMHSA Treatment Episode Data Set (TEDS).

## Treatment Admissions: Percent Methamphetamine/Amphetamine as Primary Substance, By Gender

- Source: Treatment Episode Data Set (TEDS)

**Notes:**
More women than men report meth/amphetamines as their primary substance at admission.  This trend has remained constant over the years.  However, as the next slide shows, the percentage of female admissions in which meth/amphetamine is the primary substance is strikingly higher in many western and midwestern States.

## Methamphetamine/Amphetamine Admissions: Gender Breakdown, 2002

- Source: Treatment Episode Data Set (TEDS), 2002

**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 Percentages 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.  In looking at these States, keep in mind the last slide showing that the national average was 10% in 2002.  These States far exceed that number.  Next 5 highest States were: 6. Utah, 7. Iowa, 8. Oregon, 9. Arkansas and 10. Oklahoma

## Treatment Admissions for Pregnant Females: by Primary Substance

- Source: Treatment Episode Data Set (TEDS)

**51% Increase in Meth/Amphetamine**
**Admissions for Women over 6 Years**

**Notes:**
Background/context: The percentage of females pregnant at admission has remained relatively constant at about 4%.  For 2002, the total number of females pregnant at admission was 18,184.
The graph shows an interesting trend:  from 1996 to 2002, alcohol and cocaine as primary substance for pregnant women has gone down, while marijuana and methamphetamine have increased.  Heroin has remained rather constant.
In addition (not reflected in any graph), if you look at pregnant female admissions with meth/amphetamines as primary substance by age, the percentage who are 18-24 years old has increased from 35% in 1996 to 46% in 2002 – so providers are dealing with more younger pregnant females.

## Methamphetamine Lab Busts

**Methamphetamine Lab Busts**

## 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  |
| Children residing in labs  | 216  | 976  | 2,023  | 1,447  |
| Children affected**  | 1,803  | 2,191  | 3,167  | 3,419  |
| Children exposed to toxic chemicals  | 345  | 788  | 1,373  | 1,291  |
| Children taken into protective custody  | 353  | 778  | 1,026  | 724  |
| Children injured  | 12  | 14  | 26  | 44  |
| Children killed  | 3  | 0  | 2  | 3  |
| *The 2003 figure for the number of incidents is calendar year, while the remaining 
 data in the column are for fiscal year
**Data for 2000 and 2001 may not show all children affected  |  |  |  |  |

## 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  |
| Children residing in labs  | 216  | 976  | 2,023  | 1,447  |
| Children affected**  | 1,803  | 2,191  | 3,167  | 3,419  |
| Children exposed to toxic chemicals  | 345  | 788  | 1,373  | 1,291  |
| Children taken into protective custody  | 353  | 778  | 1,026  | 724  |
| Children injured  | 12  | 14  | 26  | 44  |
| Children killed  | 3  | 0  | 2  | 3  |
| *The 2003 figure for the number of incidents is calendar year, while the remaining 
 data in the column are for fiscal year
**Data for 2000 and 2001 may not show all children affected  |  |  |  |  |

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

**Number of Children in Meth Labs**

## Treatment Issues

## Past Year Need for and Receipt of Specialty Treatment for Any Illicit Drug or Alcohol Use among Persons Aged 12 or Older: 2002 and 2003 

## Past Year Perceived Need and Effort Made to Receive Specialty Treatment among Persons Aged 12 or Older Needing But Not Receiving Treatment for Illicit Drugs or Alcohol: 2003 

## Treatment Issues

- Outcomes have not differed from other drugs of abuse treatment studies
- Positive treatment outcomes were achieved using:
- Intensive outpatient setting
- Three to five visits per week of comprehensive counseling for at least the first three months
- Cognitive behavioral approach
- Contingency management
- Reducing consequences associated with drug use
- Motivational interviewing & brief intervention models
- Intervening earlier and reducing cumulative harm
- Attending to co-occurring mental disorders

## Women’s Issues

- Female methamphetamine (MA) users are more likely than male users to:
- Be introduced to MA by partner
- Initiate use to control weight and increase energy
- Live alone with their children
- Use MA more days
- Smoke MA rather than snort or inject the drug
- Progress to regular use more quickly
- Have worse medical, employment and psychiatric consequences than male users

- Sources: Brecht, M.L. & Brown, A.H. (2004); Reiber (2000)

## No Gender Differences:

- Number of years used meth
- Number of days of use in the last month
- Usual route of administration
- Number of prior treatment episodes
- Racial or ethnic background
- Level of education
- Number of chronic medical problems

## Abuse During Lifetime

***** significant difference between women and men p < .001**

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

## Age That Physical Violence Began

|  | Women | Men |
| --- | --- | --- |
| Total reports of violence |   365 | 324 |
|                 Percent of total N |   70% | 80% |
| Began between 1 and 10 yrs.  |   158 | 135 |
| Began between 11 and 18 yrs. |   207 | 189 |

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

## Age That Sexual Abuse Began

|  | Women | Men |
| --- | --- | --- |
| Total reports of sexual abuse |    307 | 58 |
|              Percent of total N |    56% | 14% |
| Began between 1 and 10 years |    134 | 34 |
| Began between 11 and 18 years |    173 | 24 |

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

## Abuse During Past 30 Days

***** significant difference between women and men p < .001**

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

## Implications For Treatment 

- Screen carefully for
- Psychological problems
- Abuse and violence
- Recognize pervasive gender differences
- Address substance abuse and psychological problems in an integrated treatment model

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

## Long-Term Effects

- Recent studies have found no deficits in motor function, memory, learning, attention or executive function in meth users after four years of abstinence

## Short-Term Implications

- Cognitive deficits
- To manipulate information
- To ignore irrelevant information
- To recognize and recall words
- To learn from experience
- Picture recognition is less impaired and is a strategy to use in early abstinence

## Short-Term Implications

- Health Effects
- Cardiovascular risks
- HIV risks
- Weight loss and malnutrition
- Dental problems

## Short-Term Implications

- Psychological Effects
- Chronic use can lead to paranoia
- Confusion
- Auditory and visual hallucinations
- Violent behavior
- During abstinence – depression and anxiety

## Treatment Outcomes:Good News? Bad News?

- 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  **

- MethNH

- Lynn Brecht, Ph.D., UCLA Integrated Substance Abuse Program

## What Predicts Longer Abstinence?

- MethNH

- 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)
- Drug Court involvement
- Family involvement

**Notes:**
Cox proportional hazards model
Considered background & personal char. (socio-demographic, family,
	vulnerabilities),  drug use history, treatment
Relationships hold for both residential and outpatient treatment
Relationships also hold for predicting 24-month abstinence

## Risk of Relapse Higher:

- Prior dealing
- Partner not in treatment

## Children’s Issues

## Risks to All Children of Parents with Substance Use Disorders

- Two primary ways in which children are affected by parental substance use disorders
- Prenatal exposure
- Post-natal living environment

## Children’s Issues

- Methamphetamine has effects on the developing fetus that continue into infancy and childhood, much like other drugs
- The environment where MA is used or manufactured is unsafe for children, posing some unique issues for child protection
- DEA reports that children were present at more than 20% of seized MA labs

**Notes:**
Effects:  
Poor fetal growth, elevated blood pressure, failure to thrive, birth defects, premature birth, developmental delays, learning disabilities, etc.

Environmental toxins, violence and traumatic exposures, drug and alcohol seeking behaviors, drug sales, dirty, impoverished homes, lack of proper heath care, nutrition, and severe neglect.  Sexual exploitation.  

## Best estimates are that a total of 10-11% of all newborns are prenatally exposed to alcohol or illicit drugs1,2

-  That means about 400,000-480,000
-         substance-exposed births nationwide
-         last year
-  An estimated 8 million of total of 77
-    million children 0-18

- 1. Vega et al (1993).  Profile of Alcohol and Drug Use During Pregnancy in California, 1992.
- 2. SAMHSA, OAS. (2003). Results from the 2002 National Survey on Drug Use and Health: National findings.

**Substance Exposed Infants: ****How Many?**

## Where do all the rest go?

- Total 2002 births: 			 	    4,093,000
- 10% estimated to be SEI: 			       **409,300**
- Total 2002 substantiated reports of abuse
- or neglect in children under age 1:        	       142,026
- Children under age 1 in out-of-home care        **22,957**
- in 2001:
**An estimated 5% of SEI are placed in OOHC.**

***Where do all the rest go?***

**Comparing Substance Exposed Infants and Child Welfare Cases**

## Many doctors and hospitals do not test or may have inconsistent implementation of state policies
Tests only detect very recent use

Inconsistent follow-up for women identified as AOD using or at-risk, but with no positive test at birth

CAPTA legislation raises issues of testing and reporting to CPS

- Many doctors and hospitals do not test or may have inconsistent implementation of state policies
- Tests only detect very recent use
- Inconsistent follow-up for women identified as AOD using or at-risk, but with no positive test at birth
- CAPTA legislation raises issues of testing and reporting to CPS

**Most go home . . .**

**Notes:**
The answer is of course that...
These issues are now being raised with changes to the Child Abuse Prevention and Treatment Act (CAPTA) within the Keeping Families Safe Act of 2003.  These changes include a requirement that states have policies and procedures requiring health care providers to notify CPS of “infants born and identified as being affected by illegal substance abuse or withdrawal symptoms resulting from prenatal drug exposure.”  States must also develop a “plan of safe care” for such infants.  The law does not require reporting of children prenatally exposed to legal substances such as alcohol and tobacco.  Nothing in the law, however, prevents states from requiring such reporting.
Whatever side of the debate you sit on regarding testing and reporting of substance exposed births, I would expect that we can agree on the need for a comprehensive response – whether the lead be taken by child welfare, public health or AOD services – because, even though these kids may go home and miss becoming part of the system at birth, we continue to find that these kids come back into one of several systems later.

## Effects of Prenatal Substance Exposure

- Physical health consequences
- Lack of secure attachment
- Psychopathology
- Behavioral problems
- Poor social relations/skills
- Deficits in motor skills
- Cognition and learning disabilities

- Research has shown that effects can manifest themselves in multiple developmental areas, including:

**Notes:**
While it is crucial that the parents are screened, assessed and engaged in treatment, it is also critical that the child’s social, emotional, developmental and psychological needs are addressed. Without intervention, the child’s unaddressed needs may impede a parent’s recovery or interfere with the timely resolution of the child’s permanent plan. 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. Identifying and addressing the needs of these children will support parents in this effort. In addition to the time limits on reunification under ASFA, the Federal legislation’s "fast track" provision gives States the option of bypassing efforts to reunify families in certain egregious situations. Depending on how a State views parental SUDs, there is a potential to fast track the termination of parental rights for these families, particularly those in which an infant has been prenatally exposed to illicit drugs.

## Pregnancy and Infant Outcome Study

- Population:  Substance-exposed infants evaluated at Blank Children’s Hospital
- Population Characteristics:
- 		Meth exposed				61
- 		Cocaine					36
- 		Meth/cocaine exposed			12

- From Dr. Rizwan Shah, presented at NASADAD Annual Meeting, June 2005

## Maternal Data

- _Substance Abuse Pattern_
- Women who use meth/cocaine in the first trimester are more likely to use during the third trimester
- Nicotine use is universal among drug-using pregnant women
- Marijuana and alcohol are secondary drugs,      used in 60% of the group

- From Dr. Rizwan Shah, presented at NASADAD Annual Meeting, June 2005

## Pregnancy Outcome

|  | Meth Group | Cocaine Group | Meth/
Cocaine |
| --- | --- | --- | --- |
|  No prenatal care | 40% | 22.2% | 40% |
|  Acute illness |  34.5% | 44.4% | 37.5% |
|  Nutritional    
  problems
 | 16.7% | 18.8% | 71.4% |
|  Pre-term birth | 25% | 24% | 30% |

- From Dr. Rizwan Shah, presented at NASADAD Annual Meeting, June 2005

## Infant Outcome

|    Growth | Meth Exposed | Cocaine Exposed | Meth/
Cocaine |
| --- | --- | --- | --- |
|  Weight <10% | 19% | 30% | 33% |
|  Head size   
  <10%
 | 10% | 20% | 40% |
|   Height value not affected in these groups |  |  |  |

- From Dr. Rizwan Shah, presented at NASADAD Annual Meeting, June 2005

## Indicators of Child Well Being

-                                   _Meth only_            _Cocaine_        _Meth/Cocaine_
- Accidents	       	   19.7%    	    8.3%	   25.0%
- Feeding problems   34.4%            9.4%            33.3%
- Sleep problems       39.3%           44.4%           50.0%
- Neuro problems      21.3%           19.4%           16.7%
- Behavior Problems  57.4%          63.9%           75.0%

- From Dr. Rizwan Shah, presented at NASADAD Annual Meeting, June 2005

## Indicators of Child Well Being

-                                   _Meth only_**            **_Cocaine_  **       **_Meth/Cocaine_
- Accidents	       	   19.7%    	    8.3%	   25.0%
- Feeding problems   34.4%            9.4%            33.3%
- Sleep problems       39.3%           44.4%           50.0%
- Neuro problems      21.3%           19.4%           16.7%
- Behavior Problems  57.4%          63.9%           75.0%

- From Dr. Rizwan Shah, presented at NASADAD Annual Meeting, June 2005

## Developmental Outcome

| Developmental Delays | Meth Exposed | Cocaine Exposed | Meth/
Cocaine |
| --- | --- | --- | --- |
|  Gross motor | 11.7% | 5.6% | 25.7% |
|  Fine motor | 9.6% | 9.4% | 16.7% |
|  Language | 6.7% | 14.3% | 16.7% |
|  Social | 4.9% | 4.5% | 11.1% |
|  Delay in any one domain | 41% | 41% | 66% |

- From Dr. Rizwan Shah, presented at NASADAD Annual Meeting, June 2005

## Developmental Outcome

| Developmental Delays | Meth Exposed | Cocaine Exposed | Meth/
Cocaine |
| --- | --- | --- | --- |
|  Gross motor | 11.7% | 5.6% | 25.7% |
|  Fine motor | 9.6% | 9.4% | 16.7% |
|  Language | 6.7% | 14.3% | 16.7% |
|  Social | 4.9% | 4.5% | 11.1% |
|  Delay in any  
   one domain | 41% | 41% | 66% |

- From Dr. Rizwan Shah, presented at NASADAD Annual Meeting, June 2005

## Post-Natal Environment

## Risks to All COSAs

- Chronic neglect
- Chaotic home life
- Violence associated with drug sales
- Inconsistent parenting
- Incarcerated parent(s)
- May be risk of HIV exposure if parent is a needle user

## Know What Kind of ParentalMeth Exposure

- Super labs
- Lower likelihood of children on site
- Traffickers
- Risks of violence and guns
- Mom and Pop Cookers
- Risks of chemical exposure
- Chemically Dependent
- Risks of chronic neglect and poor family/social environment
- Drug Abuser/Users
- Risks of episodic drug abuser and poor family/social environment

## 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

## 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

- http://www.colodec.org/decpapers/Documents/DEC%20Medical%20Protocol.pdf

**Medical Interventions for Children**

## Euphoria 
Grinding of teeth 
Light sensitivity due to pupil dilation 
Dry mouth 
Rapid heartbeat and breathing 
Sweating and increased temperature 
Hyperactivity 
Tremor (shaking hands) 
Rapid/pressured speech 
Depression (when drug wears off) 
Irritability, paranoia, suspiciousness 
Hallucinations 
Presence of drug paraphernalia 

- Grinding of teeth
- Light sensitivity due to pupil dilation
- Dry mouth
- Rapid heartbeat and breathing
- Sweating and increased temperature
- Hyperactivity
- Tremor (shaking hands)
- Rapid/pressured speech
- Depression (when drug wears off)
- Irritability, paranoia, suspiciousness
- Hallucinations
- Presence of drug paraphernalia

**Signs of Meth Use and Other Stimulants**

-  Source: Mason, 2004; Crowell & Webber, 2001

## Warning Signs for Workers

- Signs of methamphetamine use
- Client is extremely irritable 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
- Presence of knife, firearm, or other weapon in the immediate vicinity

- http://www.drugfreeinfo.org/PDFs/strengthensupervision.pdf

## Worker Safety – Components of a Safety Plan

- Inform supervisor/co-worker(s) that you will be visiting a client with a history of making/using methamphetamine
- Arrange for someone to check on you if you don’t call in by a pre-arranged time
- If you feel unsure of your safety, leave
- Do not let client get between you and an exit
- Park car so that you can not be boxed in
- Do not argue with or antagonize client
- Do not position yourself in the client’s peripheral vision area or where the client can not see you.
- Do not move suddenly
- Tell the client what you are doing and why
- Ask permission if you want to go to another area of the client’s dwelling or look in cabinets (e.g., to ensure food is in the house)

- 2001 Project Strengthen Supervision 5, Illinois State University/School of Social Work; Crowell and Weber
- www.drugfreeinfo.org/PDFs/strengthensupervision.PDF

## Signs to Watch for:

- Symptoms of stimulant use
- Methamphetamine paraphernalia
- Signs that client is becoming upset, angry or suspicious
- 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)
- Evidence of hallucinations
- Strong chemical odor (may indicate manufacturing of meth)

## Summary

## Summary

- Visit our website - ncsacw.samhsa.gov
- Meth specifics:
- Remains in body for longer than other stimulants
- Users tend to use for more days
- Users have cognitive impairments in early abstinence
- Users tend to smoke meth at higher rates
- Population is majority Caucasian

## Summary

- National survey data indicate meth use may be leveling
- Treatment admission data indicate continued increases through 2002
- Women are nearly half of meth admissions compared to one-third overall admissions
- Adolescent girls are 70% of admissions for methamphetamine

## About 2,800 children were removed from meth labs over 4 years – this compares to approximately 1,00,000 total children removed

**Summary**

## Women meth users in treatment have significant childhood physical and sexual abuse histories

Treatment needs to also screen for past trauma and provide trauma services and mental health treatment

- Treatment needs to also screen for past trauma and provide trauma services and mental health treatment

**Summary**

## Long-term effects tend to ameliorate with sustained abstinence

Treatment, intervention and case planning need to account for short-term effects, especially cognitive deficits and verbal communication

30% of women in treatment remained continuously abstinent for four years

Relapse risks include past drug sales and a partner who is not in treatment

- Treatment, intervention and case planning need to account for short-term effects, especially cognitive deficits and verbal communication
- 30% of women in treatment remained continuously abstinent for four years
- Relapse risks include past drug sales and a partner who is not in treatment

**Summary**

## Summary

- Most substance-exposed infants are not detected at birth although they are at high risk of poor developmental outcomes
- Methamphetamine prenatally-exposed children have high rates of feeding problems and in other aspects are similar to cocaine-exposed children

## Summary

- It is important for child welfare workers to know which children of meth users they are working with
- There are established medical protocols for children in meth labs
- There are safety concerns for workers that must be attended to