methamphetamine and child welfare: trends, lessons and … · methamphetamine and child welfare:...
TRANSCRIPT
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Sharon Amatetti, MPHSAMHSA, Center for Substance Abuse Treatment
Nancy K. Young, Ph.D., DirectorNational Center on Substance Abuse and Child Welfare
Jay Wurscher, DirectorOregon Child Welfare Addiction Services
Methamphetamine and Child Welfare: Trends, Lessons and Practice
Implications
Presented at CWLA National ConferenceMarch 1, 2006
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Part IBackground and Context
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Scope of the Problem
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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
Scope of the Problem
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05
1015202530354045505560
Rat
e
1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003
Source: Treatment Episode Data Set (TEDS)
Meth/Amphetamine Treatment Admission RatePer 100,000 Population Aged 12 or Older - 1993-2003
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6Admissions per 100,000 population
Eastward Spread of Methamphetamine
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7Admissions per 100,000 population
Eastward Spread of Methamphetamine
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Alcohol 42% 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)
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Methamphetamine is affecting communities that have not experienced prior stimulant drug problems
Child welfare agencies are dealing with more cases involving methamphetamine
Impact of Increasing Methamphetamine Use
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35.0
65.07.1
22.2
3.2
55.3
5.30.920.72.30.9
0%10%20%30%40%50%60%70%80%90%
100%
Cocaine/Crack Meth/Amphetamine
White Hispanic African American Asian/PI Native Amer/AK Native OtherSource: Treatment Episode Data Set (TEDS)
Smoked Cocaine/Crack and Meth/AmphetamineTreatment Admissions by Race/Ethnicity
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Meth/Amphetamine & Cocaine Treatment AdmissionsAccording to Census Division 2003 RATE per 100,000
0102030405060708090
100110120130140150160170180190200210
NewEngland
MiddleAtlantic
East No.Central
West NoCentral
SouthAtlantic
East So.Central
West SoCentral
Mountain Pacific
Cocaine/Crack Meth/Amphetamine/Other Stimulants
Rat
e pe
r 100
,000
Source: Treatment Episode Data Set (TEDS)
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47% of admissions are womenThis is a higher percentage of women admissions than for any other drug except tranquilizers methamphetamine - ~ 1:1 cocaine - 1:2 heroin - 1:2+ marijuana & alcohol - 1:3
Since women are often caretakers of children, more children are likely affected
Gender Differences
Source: Vaughn, C. (2003)
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0%
5%
10%
15%
20%
25%
30%
35%
40%
To lose weight To relieve depression
*p< .001
Male Female
Richard Rawson, Ph.D., Presentation to SAMHSA, August 2005
Self-Reported Reasons for Starting Methamphetamine Use
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Treatment AdmissionsMeth/Amphetamine as Primary Substance by Gender
2.9%
6.1%
3.3%
6.8%
3.3%
6.9%
4.5%
8.8%
6.0%
11.0%
0%
2%
4%
6%
8%
10%
12%
1995 1997 1999 2001 2003
Male Female
Source: Treatment Episode Data Set (TEDS)
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Meth/Amphetamine AdmissionsBy Gender - 2003
55%
45%
30%
70%
44%
56%
0%
10%
20%
30%
40%
50%
60%
70%
All ages 12-14 year-olds 15-17 year-olds
Male Female
Source: Treatment Episode Data Set (TEDS)
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Female Treatment AdmissionsStates with Highest % of Meth/Amphetamine as Primary Substance
0%
5%
10%
15%
20%
25%
30%
35%
40%
45%
50%
Hawaii Nevada Idaho California Utah Nebraska
1997 1999 2001 2003
Source: Treatment Episode Data Set (TEDS)
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0%
5%
10%
15%
20%
25%
30%
35%
1995 1997 1999 2001 2003Cocaine Alcohol Heroin/Opiates Marijuana Meth/Amphet/Stimulants
Trends in Primary Substance UseTreatment 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)
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0
50
100
150
200
0 60 120 180Time (min)
% o
f Bas
al D
A O
utpu
t NAc shell
EmptyBoxFeeding
Source: Di Chiara et al.
FOOD
100
150
200
DA
Con
cent
ratio
n (%
Bas
elin
e)
MountsIntromissionsEjaculations
15
0
5
10
Copulation Frequency
SampleNumber
1 2 3 4 5 6 7 8 9 1011121314151617
ScrScrBasFemale 1 Present
ScrFemale 2 Present
Scr
Source: Fiorino and Phillips
SEX
Natural Rewards Elevate Dopamine Levels
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0100200300400500600700800900
10001100
0 1 2 3 4 5 hrTime After Amphetamine
% o
f Bas
al R
elea
seDADOPACHVA
Accumbens AMPHETAMINE
0
100
200
300
400
0 1 2 3 4 5 hrTime After Cocaine
% o
f Bas
al R
elea
se
DADOPACHVA
Accumbens COCAINE
0
100
150
200
250
0 1 2 3 4 5hrTime After Morphine
% o
f Bas
al R
elea
se Accumbens
0.51.02.510
Dose (mg/kg)MORPHINE
0
100
150
200
250
0 1 2 3 hrTime After Nicotine
% o
f Bas
al R
elea
se
AccumbensCaudate
NICOTINE
Source: Di Chiara and Imperato
Effects of Drugs on Dopamine Levels
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Effects of Methamphetamine Addiction
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Short-Term Effects of Methamphetamine
PSYCHOLOGICALConfidenceAlertnessMoodSex driveEnergyTalkativeness
BoredomLonelinessTimidity
PHYSICALHeart rateRespirationBlood pressurePupil sizeSensory acuityEnergy
AppetiteSleep Reaction time
Source: Judith Cohen, Ph.D., Presentation to NASADAD, June 2005
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MethamphetamineChronic Physical Effects
Tremors Weakness Headaches Sweating Coughing
Dry Mouth Oily skin/complextion Burned lips/sore nose Dental Weight Loss/Anorexia
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MethamphetamineChronic Psychological Effects
Confusion Concentration Hallucinations Fatigue Memory loss Insomnia
Irritability Paranoia Panic reactions Depression Anger Psychosis
Source: Richard Rawson, Ph.D., Presentation to SAMHSA, August 2005
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Decreased ability to: Recognize and recall words and picturesMake inferencesManipulate 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)
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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 functionMotor function
Cognitive Effects
Sources: Lundahl et al. (2004); Volkow et al. (2001)
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Risks to Children When Parents Use Methamphetamine
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Foster Care Population and Persons Who First Used Crack or Methamphetamine in Prior Year
0
100,000
200,000
300,000
400,000
500,000
600,000
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
0
100,000
200,000
300,000
400,000
500,000
600,000
Children in Foster Care** New Crack Users* New Methamphetamine Users*
New Female Crack* New Female Meth*
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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
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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
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
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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
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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
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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)
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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
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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
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Mother Uses While Pregnant
Shah, R. (2005, June). From NASADAD presentation
Home environment is the critical factor in the child’s outcome
Consequences can be mediated
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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 exposureToxic fumesRisk 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
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Environmental Methamphetamine Exposure and Risks
Toxic effects of manufacturing Children more at risk:
Higher metabolic ratesDeveloping bone and nervous systemsThinner skin than adults which absorbs
chemicals fasterChildren tend to put things in their mouth and
use touch to explore
Source: Mason (2004)
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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
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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
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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
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National Alliance of Drug Endangered Children (DEC)
Formed in October 2003
Provides multi-disciplinary training for communities interested in starting or expanding DEC programs
www.nationaldec.org
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Multidisciplinary DEC TEAMS
Medical and Mental Health Services trained in diagnosing and treating children exposed to neglect
and abuse, possible chemical hazards, and trauma
Child Protective Services determine the course of the child welfare investigation and share
information with law enforcement officers, district attorneys’ offices, and health care and mental health agencies.
Law Enforcement must act to ensure the immediate safety of the children present,
ensure that children are placed in a safe environment with a responsible caretaker.
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DEC Team (cont.)
Public Safety Fire department personnel and hazardous materials
professionals, play a key role in documenting conditions of child endangerment, including the potential for fire or explosion, presence of hazardous materials, improper storage of chemicals, and poor ventilation.
Prosecution Prosecutors are responsible for filing and supporting charges of
child endangerment. In cases in which one parent or caregiver is not charged with endangerment but lesser charges are levied, the prosecutor can play an important role in safeguarding the child’s welfare by influencing the terms of probation. These terms often include drug treatment, parenting classes, and other rehabilitative measures.
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Treatment for Methamphetamine
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CSAT’s Methamphetamine Treatment Project
Largest randomized clinical trial of treatment for meth dependence
• Intensive outpatient setting
• Three to five visits per week of comprehensive counseling for at least the first three months
• Cognitive behavioral approach
• Contingency management
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Matrix Model Treatment Outcomes Of 10 MA-abusing persons entering treatment (UA results):
6 still MA-abstinent12 months after treatment
After treatment: DC 6mo. 12mo.
Still MA-abstinent: 6.5 6.9 5.9
Source: Rick Rawson, Ph.D. Presentation to SAMHSA, August 2005
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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
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Gender Differences and Implications for Treatment
Co-occurring mental health problems
Trauma
Body image
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0.00
0.20
0.40
0.60
0.80
1.00
1.20
1.40
1.60
Somatiza
tion
Obsess
ive-C
ompuls
ive
Interp
erson
al Sen
sitivi
ty
Depres
sion
Anxiety
Hostility
Phobic
Anxiet
y
Parano
id Idea
tion
Psych
oticis
m
all significant at p< .001
Mea
n B
SI S
core
FemaleMale
Richard Rawson, Ph.D., Presentation to SAMHSA, August 2005
Behavior Symptom Inventory (BSI)Scores at Baseline
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Histories of Violence among Clients Treated for Methamphetamine
Persons in treatment for methamphetamine reported high rates of violence• 85% women• 69% men
The most common source of violence:• For women, was a partner (80%)• For men, was strangers (43%)
History of sexual abuse and violence:• 57% women• 16% men
Source: Cohen, J. (2003)
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Prevalence of Co-Occurring Problems, and Violence and Trauma
• Women in treatment 2 times more likely to have history of sexual and physical abuse than general population
• Women who are dependent on meth usually have more severe problems than their male counterparts in many areas of their life
• Speaks to the need for comprehensive, and trauma-related services
Source: CSAT TIP 36
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Gender Differences and Implications for Treatment
Sexual behavior linked to methamphetamine is a significant clinical issue that needs to be addressed in women-only groups
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
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Threats of violence and reduced cognitive capacity to manage activities of daily living suggest that a period of residential treatment orreferral to safe houses or supervised housing may be indicated.
Intensive outpatient treatment should be coupled with additional supports such as transportation, meals, child care.
Gender specific treatment is indicated given women’s histories of trauma and violence
Gender Differences and Implications for Treatment
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What Predicts Longer Abstinence?
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 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)
Longer abstinence following treatment for women with:
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Summary
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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
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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
Summary
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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
Summary
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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
Summary
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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
Summary
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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
Summary
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For Further Information
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SAMHSA Resources
Treatment Improvement Protocols (TIP 33)
Best Practice Guidelines for Treatment of Substance Abuse
Researched, Drafted, and Reviewed by Substance Use Disorder Professionals
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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
SAMHSA Resources
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SAMHSA Resources
SAMHSA’s Addiction Technology Transfer Centers (ATTC)
Pacific Southwest ATTChttp://www.psattc.org/events/cates/I/presentations/index.html
Methamphetamine 101: Etiology and Physiology of an Epidemic
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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
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A Program of the
Substance Abuse and Mental Health Services Administration
Center for Substance Abuse Treatmentand the
Administration on Children, Youth and FamiliesChildren’s Bureau
Office on Child Abuse and Neglect
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NCSACW Mission
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
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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)
NCSACW Consortium
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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 AvailableUnderstanding 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
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Contact NCSACW
www.ncsacw.samhsa.govProject Director:Nancy Young, Ph.D.714-505-3525
Government Project Officer:Sharon Amatetti, SAMHSA/[email protected]
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Part IIModel Programs
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Signs of Use and Warning Signs for Workers
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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
Signs of Methamphetamine Use and Use of Other Stimulants
Source: Crowell & Webber (2001)
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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 & Webber (2001)
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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
Other Severe Signs of Meth Use
Source: Crowell & Webber (2001)
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Methamphetamine: Implications for Workers
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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”.
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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.
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“Methamphetamine: Snapshot Phenomenon”Wurscher & Martin
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Oregon’s Response
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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
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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
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Current Oregon Issues
Meth Labs almost eliminated
Meth Addiction Higher than ever
2003 - 30% reduction in A&D TX
Foster Care Population Growing
Meth cases most CHAOTIC
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What Labs ARE NOT
Chernobyl– Meth Labs are not radioactive.
Fatal to CPS Workers– Meth Labs will not kill you.
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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
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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
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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.
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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
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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
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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
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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
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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
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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
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Oregon Resource People
Jay WurscherAlcohol & Drug Services CoordinatorOR Dept of Human ServicesSalem [email protected]
Samantha ByersFamily Involvement Team/Parent MentorsOR Dept of Human ServicesPortland, OR503-988-5464, [email protected]
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Sacramento County’s Response
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Program Context
Sacramento County population: 1.5 million
In 2004, there were approximately 7,000 substantiated child abuse/neglect referrals, in Sacramento1.
An estimated 70 to 80% of child welfare cases involve families affected by substance use
Source: Center for Social Services Research, University of California at Berkeley
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Sacramento County Prior to STARS and Dependency Drug Court
Reunification rate about 20-25%
Parents unable to access AOD treatment
Social workers, attorneys, courts often uninformed on parent progress
Drug testing not uniform and results often delayed
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Sacramento County After STARS and Dependency Drug Court
Reunification rates at 40–45 percent
Reunification is occurring faster
Parents truly have “treatment on demand”
All parties involved in the case are informed at every stage of treatment
All parents receive random observed “instant” drug testing
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1. Comprehensive cross-system joint training2. Substance Abuse Treatment System of Care3. Early Intervention Specialists4. Recovery Management Specialists (STARS)5. Dependency Drug Court
Reforms have been implemented over the past eleven years
Five Components of Sacramento County’s Comprehensive Reform
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Five Components of Sacramento County’s Comprehensive Reform
1. Comprehensive cross-system joint training
Three Levels of Training AOD basics for all staff – 4 days required AOD screening, brief intervention, motivational
enhancement and AOD treatment – 4 days required of all case carrying workers
Group intervention skills – 4 days required of all ADS staff and voluntary for any CPS division staff
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2. Substance abuse treatment system of care
Managed wait list
Immediate access to substance abuse services Group services expansion and implementation
of pre-treatment groups
Five Components of Sacramento County’s Comprehensive Reform
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3. Early Intervention Specialists
Review of every court petition to determine if substance use disorders may be present
Immediate access to intervention and assessment at court hearings
Immediate authorization of publicly-funded treatment services
Five Components of Sacramento County’s Comprehensive Reform
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4. Recovery Management Specialists (STARS) Motivational enhancement Gender-specific services Immediate access to recovery management and treatment services Provider orientation of providing hope and
accountability Compliance monitoring—twice monthlies
Five Components of Sacramento County’s Comprehensive Reform
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5. Dependency Drug Court
Parallel system to dependency petition 30, 60 and 90-day compliance hearings Structured incentives for compliance
and sanctions for non-compliance Voluntary participation in on-going
services
Five Components of Sacramento County’s Comprehensive Reform
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106
Sacramento CountyDependency Drug CourtEvaluation Findings
4940 Irvine Boulevard, Suite 202Irvine, CA 92620714.505.3525Fax 714.505.3626www.cffutures.org
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Parents and Children in Evaluation
111
173
324
432
249
429
274
485
050
100150200250300350400450500
Comparison CO YR 1 CO YR 2 CO YR 3
Parents = 847 Children = 1,346
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Total Mothers and Fathers in DDC Evaluation
0
100
200
300
400
500
600
Mothers Fathers
73.4%
26.6%
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109
Primary Drug Problem*
41.1
52.9
17.916.3
21.415.0
7.1 2.712.5 11.1
0.0 2.00
20
40
60
80
100
Per
cen
t
Meth Alcohol Marijuana Heroin Cocaine/crack Other
Comparison Court Ordered*p<.001
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112
50.5
86.4
0
20
40
60
80
100
Pe
rce
nt
Comparison Court Ordered*p<.001
Treatment Admission Rates*
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Percent of Mothers and Fathersby Treatment Completion
66.0%71.6%
34.0%28.4%
0
10
20
30
40
50
60
70
80
Completed Left & Unsatisfactory Progressn.s.
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114
27.2
42.1
31.8
22.9
13.3
5.41.7
14.118.5
5.17.5 10.4
0
10
20
30
40
50
60
70
80
Per
cent
Reunified Adoption Guardianship ContinuedFR/FC
Long-termPlacement
Other
Comparison CO YR 1*Significantly more Court Ordered Year 1 children reunified at 24 months than comparison children. Significantly more Year 1 children were in continued FR/FC at 12 months (with less in long term placement or guardianship) than the comparison groups.
24-Month Placement Outcomes*
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115
Time to Reunification
210.8187.1
266.1 266.6
300.7284.0
0
50
100
150
200
250
300
Days
12 Months 18 Months 24 Months
Comparison Court Ordered
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24-Month Cost Savings
27.2% - Reunification rate for comparison group children 42.1% - Reunification rate for court-ordered DDC group
children 63 Additional DDC children reunified 33.1 – Average months in out-of-home care for comparison
group children 8.6 - Average months to reunification for court-ordered
DDC children
$2,953,639 estimated savings in out-of-home care costs
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117
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 CenterFor Substance Abuse Treatment, State Systems Development Conference. August 13.
Cohen, Judith, Ph.D. Presentation to NASADAD, June 2005.Colorado DEC. Retrieved from
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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).
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