Implications of Methamphetamine Abuse and Dependence for Child Welfare

1. 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

2. Topics for Presentation • NCSACW • Some Background and Data • Treatment Issues and Effectiveness • Issues for Children and Safety • Implications for Child Welfare

3. NCSACW

4. 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

5. 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

6. 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)

7. 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

8. Some Background and Data

9. 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.

10. Methamphetamine • 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.

11. Issues Specific to 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

12. 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

13. Confidence Alertness Mood Sex drive Energy Talkativeness Boredom Loneliness Timidity Heart rate Respiration Blood pressure Pupil size Sensory acuity Energy Appetite Sleep Reaction time Acute Effects of Methamphetamine Judith Cohen, Ph.D. Presentation to NASADAD June 2005

14. 52% Increase over 6 Years Foster Care Population ASFA Number of Children in Foster Care on Last Day of Federal Fiscal Year

15. Foster Care Population and Persons Who First Used Crack or Meth in Past Year *All persons age 12 and over

16. Illicit Drug Use in Lifetime, Past Year, and Past Month among Persons Aged 12 or Older: Numbers in Thousands, 2003 40331

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

18. Methamphetamine/Amphetamine Treatment Admission Rate Per 100,000 Population Aged 12 or Older: 1992-2002 Source: 2002 SAMHSA Treatment Episode Data Set (TEDS).

19. The Eastward Spread of Methamphetamine

20. The Eastward Spread of Methamphetamine

21. Methamphetamine/Amphetamine Treatment Admissions, by Route of Administration: 1992-2002 Source: 2002 SAMHSA Treatment Episode Data Set (TEDS).

22. Smoked Methamphetamine/Amphetamine Treatment Admissions, by Race/Ethnicity: 1992 and 2002 Source: 2002 SAMHSA Treatment Episode Data Set (TEDS).

23. Treatment Admissions: Percent Methamphetamine/Amphetamine as Primary Substance, By Gender Source: Treatment Episode Data Set (TEDS)

24. Methamphetamine/Amphetamine Admissions: Gender Breakdown, 2002 Source: Treatment Episode Data Set (TEDS), 2002

25. Female Treatment Admissions: States with Highest Percentages Meth/Amphetamine as Primary Substance Source: Treatment Episode Data Set (TEDS)

26. Treatment Admissions for Pregnant Females: by Primary Substance 51% Increase in Meth/Amphetamine Admissions for Women over 6 Years Source: Treatment Episode Data Set (TEDS)

27. Methamphetamine Lab Busts

28. Number of Children in Meth Labs

29. Number of Children in Meth Labs 4 years = 2,881; all children ~1,000,000

30. Treatment Issues

31. Past Year Need for and Receipt of Specialty Treatment for Any Illicit Drug or Alcohol Useamong Persons Aged 12 or Older: 2002 and 2003

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

33. 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

34. 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)

35. 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

36. Abuse During Lifetime *** significant difference between women and men p < .001 Judith Cohen, Ph.D. Presentation to NASADAD June 2005

37. Age That Physical Violence Began Judith Cohen, Ph.D. Presentation to NASADAD June 2005

38. Age That Sexual Abuse Began Judith Cohen, Ph.D. Presentation to NASADAD June 2005

39. Abuse During Past 30 Days *** significant difference between women and men p < .001 Judith Cohen, Ph.D. Presentation to NASADAD June 2005

40. 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

41. 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

42. 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

43. Short-Term Implications • Health Effects • Cardiovascular risks • HIV risks • Weight loss and malnutrition • Dental problems

44. Short-Term Implications • Psychological Effects • Chronic use can lead to paranoia • Confusion • Auditory and visual hallucinations • Violent behavior • During abstinence – depression and anxiety

45. Treatment Outcomes:Good News? Bad News? Of 10 MA-abusing women entering treatment: After treatment: 1mo. 12mo. 24mo. 48mo. Still MA-abstinent: 6 4 3 3 3 still MA-abstinent 48 months after treatment MethNH Lynn Brecht, Ph.D., UCLA Integrated Substance Abuse Program

46. 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) • Drug Court involvement • Family involvement MethNH

47. Risk of Relapse Higher: • Prior dealing • Partner not in treatment

48. Children’s Issues

49. 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

50. 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