# Presentation: 570783

## Hope for RecoveryClient With Years of Alcohol, Cocaine, And Meth

- one year clean & sober

## Oregon Child Welfare 1997-99

- 60%  of CW families A&D involved
- 54%  of CW families DRUG involved
- 68%  of CW DRUG families METH
- #1 reason for termination –
- No recovery  - 46%  METH

## Oregon Child Welfare  2004

- 875,790 children  ages 0-18
- 46,524 reports of suspected abuse
- 10,622 FOUNDED abuse cases
-   9.6%  ^  over previous year
- 73.8%  ^  since 1994
-   9.4%  ^  in POPULATION since 1994
-   50%  of removals METH related

## Oregon METH Response

- Collaborate & Integrate
- Separation of issues – Labs & Addiction
- Governor’s METH Task Force
- Drug Endangered Child Response
- DEC Teams & OADEC
- Addiction Recovery Teams - ART
- Family Involvement Team - FIT

## Oregon Child Welfare & Treatment

- 2000 – 87.8% of child welfare parents with A&D problems entered treatment and 6,800 kids are in foster care.
- 2003 – Oregon legislature cuts TX.
- 2006 – 41.5% of child welfare parents with A&D problems enter TX and 8,600 kids are in foster care.

## DEC - Drug Endangered Child Team Partners

- DHS Child Welfare
- Local Law Enforcement
- Meth Lab Law Enforcement
- Criminal Prosecuting District Attorneys
- Child Welfare Attorneys
- Local Medical Staff - Hospitals

## DEC Collaboration Issues

- LEA will seek evidence for charges and arrest.
- DA’s will seek prosecution on both drug charges and child maltreatment.
- DEC Collaboration requires CPS to play active role in this process while advocating for the best outcomes for children.
- Can be conflicts in process.

## CPS Requirements – On Site

- Focus - on Your CPS Safety Assessment
- Gather Info from Site Safety Officer
- Determine De-Contamination Need/Plan
- Focus - Be the Social Worker, not the Police Officer.
- Stay Behind the Police Barriers
- Transport Children Safely

## Addiction Recovery Teams

- DHS & Contract Collaboration
- DHS staff person assigned to A&D
- Contracted A&D Counselor
- Contracted Outreach Worker
- Other Integrated Services
- Must be on site at child welfare

## Family Involvement Team 

- FIT Team
- Portland – Multnomah County
- A&D CW Services at the court
- On site DHS & A&D at all times
- On site transport & child visit
- Treatment Program Case Managers
- ASFA attentive & accountable

## ADVANTAGES – ART & FIT

- All providers believe in RECOVERY
- Immediate focus on A&D TX needs
- Tracking clients toward recovery
- Relapse response with Outreach
- FIT – services offered at court
- FIT – TX site case management

## ADVANTAGES – ART & FIT

- Parent focused service
- Caseworkers feel supported
- Treatment programs OK with CW
- Clients stick with TX
- Recovery modeled – Parent Mentors
***Reunited*** video    asfavideo.org

## ADVANTAGES ART - FIT

- Defense bar buys in
- Judges recommend & mandate services
- Negates punitive casework
- Promotes clinical approaches
- Drug testing seen as intervention
- Recovery is modeled to caseworkers

## Meth has changed over time:
1940’s pharmaceutical
L-methamphetamine
1970’s Street Chemist
d/l-methamphetamine
“Prop-dope” – peanut butter
Mid-1980’s
d-methamphetamine
Ephedrine reduction

- 1940’s pharmaceutical
- L-methamphetamine
- 1970’s Street Chemist
- d/l-methamphetamine
- “Prop-dope” – peanut butter
- Mid-1980’s
- d-methamphetamine
- Ephedrine reduction

- Levorotatory rotates to the left.
- Dextrorotatory rotates to the right.
- Drugs that are “right handed” have a greater affinity for receptors, and are therefore more potent.

- Some businesses contribute to the methamphetamine problem:
- Pseudoephedrine producers
- Paraphernalia manufacturers
- Mini Markets

## National Routes of Admin

- Source: SAMHSA, TEDS, 2002

## How do most use?How does this differ from other drugs?(Results: Frequency of Methamphetamine Use)

**25%**
**Occasional or Binge**

**75%**
**Daily or near daily**

## Oregon vs. National 8th Graders Since 9-11The next generation? 

**Alcohol**

**Drugs**

*Oregon Healthy Teens, 2004 & Monitoring the Future, 2004*

## Oregon 8th Graders Alcohol Past 30-day Use continues to rise above the national average (2003-2004)

**Oregon 8****th**** Graders consume alcohol ****54%**** **
**higher than the national average.**

## Double 

**Oregon**

**Oregon**

**National**

**National**

**Oregon 8****th**** Graders consume illicit drugs at nearly **
**Double**** **
**the national average.**

## Oregon ranks #7 nationally for recent illicit drug use in people 12+
Oregon ranks #2 in the U.S. for illicit drug use among adults 26+ and 4th in the U.S. for drug abuse/dependence among 18-25 year olds.
Oregon ranks 45th in U.S. for treatment access.
Oregon ranks 49th in U.S. for treatment access among 18-25 year olds.

- Oregon ranks #2 in the U.S. for illicit drug use among adults 26+ and 4th in the U.S. for drug abuse/dependence among 18-25 year olds.
- Oregon ranks 45th in U.S. for treatment access.
- Oregon ranks 49th in U.S. for treatment access among 18-25 year olds.

- Oregon is not  "treatment friendly"

*OMHAS, 12/2004*

## William White Researcher/Director: Lighthouse Research InstituteAuthor: Slaying the Dragon: The History of Addiction & Recovery in America, and Critical Incidents

- William White *Researcher/Director: Lighthouse Research Institute**Author: *_*Slaying the Dragon: The History of Addiction & Recovery in America*_*, and *_*Critical Incidents*_

| Addiction | Addiction + | Addiction ++ |
| --- | --- | --- |
| Oldest onset  16-18 | Younger onset  13-15 | Youngest onset   9-12 |
| Little/no trauma | Trauma | Early trauma |
| Believed
Immediate intervention 
 | Believed
Some intervention  | Not believed
And/or
No intervention |
| Little to no professional help | Some professional help | Lots of professional help |
| Low psychiatric
Symptomology
(older onset)
High “self-containment” | Moderate psychiatric
Symptomology
(earlier onset)
Moderate “self-containment” | Acute psychiatric
Symptomology
(earliest onset)
Little “self-containment” |
| “mature-out”
“many roads to recovery” | Single to multiple tx episodes
 | Chronic many tx episodes
 |

## 
Numerous addiction studies have shown a division at age 24:
Tx completion rates were lower for those 24 and under (TEDS, 2000).
Most adolescent substance abusers do not enter treatment until age 24 (NTIES, 1992).
Clients with poorer outcomes under 24 (Roffman).
Increasing belief that cigarettes are harmful at 24 (NIDA, 2002).
Increasing belief that cigarettes are addictive at age 24 (NIDA, 2002).

- 24

- _Numerous addiction studies have shown a division at age 24:_
- Tx completion rates were lower for those 24 and under (TEDS, 2000).
- Most adolescent substance abusers do not enter treatment until age 24 (NTIES, 1992).
- Clients with poorer outcomes under 24 (Roffman).
- Increasing belief that cigarettes are harmful at 24 (NIDA, 2002).
- Increasing belief that cigarettes are addictive at age 24 (NIDA, 2002).

- Many many studies have shown that adolescent treatment outcomes are lower than adult outcomes.  One of the largest studies showed that clients under 30 had greater susceptibility to drug using peer groups (DATOS, 1999).

## Age of Onset

## Oregon Child Welfare 1997-99

- 60%  of CW families A&D involved
- 54%  of CW families DRUG involved
- 68%  of CW DRUG families METH
- #1 reason for termination –
- No recovery  - 46%  METH

## Higher rates

- Large studies and
- small identical twin studies

- Significantly higher rates of anxiety and depression

**Up to 5x’s **
**greater**
**Substance **
**abuse/**
**dependence**

**Higher rates**
**Anxiety and**
**Depression**

## Adolescence is a period of profound brain maturation.

- It was previously believed that brain development was complete during early adolescence
- The maturation process is not complete until about age 24!!!

## Oregon 2001 Amphetamine Treatment Clients: Male to Female Ratios

- Males

- Females

## Psychoactive Substances and Sexual Behaviors

- My sexual drive is *increased* by the use of the following substance(s)

## Psychoactive Substances and Sexual Behaviors

- My use of the following substance(s) has made me become *obsessed* with sex and/or made my sex drive abnormally high.

## Psychoactive Substances and Sexual Behaviors

- I am *more likely* to have sex (e.g. intercourse, oral sex, masturbation, etc.) when using the following substance(s)

## Psychoactive Substances and Sexual Behaviors

- I am more likely to practice *“risky”* sex under the influence of the following substance(s) (e.g., not use condoms, be less careful about who you choose as a sex partner, etc.)

## Psychoactive Substances and Sexual Behaviors

- I have become involved in sex acts that are *unusual* for me when I am under the influence of the following substance(s) (e.g., marathon masturbation, go to “peep” shows, cross-dress, voyeurism, expose yourself, etc.)

## Follow-up of 114 MA Users Treated with Matrix Model – 1 year

- Follow-up of 114 MA Users Treated with Matrix Model – 1 year

## 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 information
- Ability to recall material

- Hippocampus?

- implications?

## “Methamphetamine: Snapshot Phenomenon” Wurscher & Martin

- Criminal

- Psycho-case

- Sad-case

- wants
- recovery

- Doesn't
- want
- recovery

## A 2002 study of 114 methamphetamine users, 2-5 years after completing treatment:
82% no meth past 30 days.
54% abstinent 24 months or longer.
Full time employment increased from 26% to 62%.

A 2004 controlled multi-site study of 978, six-month follow up after treatment completion:
66-69% of urinalysis were clean at discharge and follow up.

- 82% no meth past 30 days.
- 54% abstinent 24 months or longer.
- Full time employment increased from 26% to 62%.
- A 2004 controlled multi-site study of 978, six-month follow up after treatment completion:
- 66-69% of urinalysis were clean at discharge and follow up.

- Can People recover from meth addiction?

## Slide 37

## Nerve Cell

- Dendrites receive messages
- Cell Body (Soma) nourishes cell and keeps it alive
- Axon transmits messages
- Synaptic Gap – the space in between all cells

## Neuropharmacology

- Neurotransmitters are tiny electrical and chemical messengers.
- Axon (sender)
- Dendrite (receiver)
- Synaptic Gap (space in-between the cells)
- Lock & Key mechanism.

## Most drugs of abuse “mimic”

- Most psychoactive drugs of abuse look “similar” to neurotransmitters.  These drugs mimic the action and appearance of neurotransitters.
-  THC – Anandamide
-  Opiates – Endorphin Enkephalin
-  Alcohol, Benzo’s, Barb’s – GABA
-  Stimulants - catecholamines

## Drugs of Abuse are “Dopaminergic”

- Or, in other words, they increase dopamine activity.

- EXAMPLE:
- THC connects with receptors and causes the release of dopamine

## The one and only thing...

- Marijuana
- Alcohol
- Heroin
- Cocaine
- Crack
- Meth
- Nicotine
- Caffeine

- www.nida.nih.gov

## Natural Rewards Elevate Dopamine Levels

**Natural Rewards Elevate Dopamine Levels**

- 150

- 200

## 1050

- 340

- 225

- 200 Sustained

## Slide 45

## Receptor sites can increase and decrease over time, as the nerves assess the need to do so.

**Up & Down Regulation**

- Grow-shut

## Addiction Is A Brain Disease

**Addiction Is A Brain Disease**
**Expressed As Compulsive Behavior**

**Both Developing and **
**Recovering From It Depend on**
**Behavior and Social Context**

## Short Term

- Short Term:
- Delusions
- Memory Problems
- Hallucinations:
- Tactile
- Visual
- Auditory
- Gustatory
- Olfactory

- chronic meth user with significant reductions in brain activity

## Psychosis Stories

- Shadow People
- Meth Monsters
- Police
- Suspicious of Friends

## Meth & Aggression

- Animal Studies (rats, monkeys, etc.)
- Increases frequency of attack-behavior (# of incidents), decreases actual attack-time (actual minutes and seconds of attack behavior)
- Less awareness of submission-behavior of others, oblivious & unacknowledged (keeps attacking after the other has submitted)
- Low to higher doses increase aggression, really high doses produce less aggression (bell curve) becomes disabling.
- Hierarchy of Primates (on Meth)
- Increases in aggressive behavior seen most prominently in high ranking & low ranking monkeys, with lesser aggression effects on middle-rank monkeys (inverted bell curve).

- Low doses

- Super
- High doses

- Aggression

- Low class monkeys

- High class monkeys

- Aggression

- Aggression

## Twitch, Tic’s, Grimacing, Jerky muscle movements

- Twitch, Tic’s, Grimacing, Jerky muscle movements

*Dr. Darryl Inaba, Pharm.D.*
*Haight Ashbury Films*

## Dental Problems

- ADA rates meth worse illicit drug for your teeth.
- Constricts blood vessels in the mouth, reducing blood flow and immune protection.
- Tooth grinding, bruxism, adds to deterioration of teeth.
- Meth users drink a lot of pop.
- Meth users in treatment experience significant pain.

- Mike Shirtcliff, DMD

## Discomfort

- Meth users may experience physiologic discomfort from:
- sores
- tooth decay
- loss of REM sleep
- gastrointestinal ulceration's

## Increasing numbers of 

- _Increasing numbers of _
- _Meth injectors __(OD’s rank 9__th__)_
- _Needle Use Infections_
- abscesses
- septicemia
- cotton fever
- hepatitis B & C
- endocarditis
- embolism
- HIV & AIDS (IDU 37%)

**Notes:**
Slide 4-11   List of various needle use infections next to a picture of a severely infected arm that was ravaged by abscesses.

## Street Survey

- Meth is the same as Rx drugs.
- Rx drugs are “unnatural”.

## Route of Meth AdministrationADAM Adult Meth Users

- Route of Meth AdministrationADAM Adult Meth Users

**Snort****	****68%****	****43%****	****28%****	****46%****	****57%****	**
**Smoke****	****18%****	****27%****	****17%****	****39%****	****32%****	**
**Inject****	****11%****	****27%****	****49%****	****12%****	****5%****	**
**Other****	****2%****	****3%****	****5%****	****2%****	****6%**

- 	**Los****	****Phoenix****	****Portland****	****San****	****San****	**
**	****Angeles****	****	****	****Diego****	****Jose**

**Oregon OMHAS, CPMS**
**Meth primary treatment**
**Admits had 39% injection**
**Rate in 1999**

## Higher rates

- Large studies and
- small identical twin studies

- Significantly higher rates of anxiety and depression

**Up to 5x’s **
**greater**
**Substance **
**abuse/**
**dependence**

**Higher rates**
**Anxiety and**
**Depression**

## Hope for RecoveryClient With Years of Alcohol, Cocaine, And Meth

- one year clean & sober