Hope for Recovery
Client With Years of Alcohol, Cocaine, And Meth
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 –
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
Oregon Child Welfare & Treatment
• 2000 – 87.8% of child welfare parents
h bl d
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
• 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 Attorneysy
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
Addiction Recovery Teams
• DHS & Contract Collaboration
• DHS staff person assigned to A&D
• Contracted A&D Counselor
• Contracted Outreach Worker
• Other Integrated Servicesg
• 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 visitp
• Treatment Program Case Managers
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 Mentorsy
ADVANTAGES ART - FIT
• Defense bar buys in
• Judges recommend & mandate services
• Negates punitive casework
• Promotes clinical approaches
• Drug testing seen as interventiong g
• Recovery is modeled to caseworkers
• Meth has changed over time:
– 1940’s pharmaceutical • L-methamphetamine – 1970’s Street Chemist • d/l-methamphetamine • Levorotatory rotates to the left. • Dextrorotatory rotates to the right.
• Drugs that are “right handed” have a greater
• “Prop-dope” – peanut butter – Mid-1980’s
• d-methamphetamine
• Ephedrine reduction
affinity for receptors, and are therefore more potent.
• Some businesses contribute to the methamphetamine problem: the methamphetamine problem:
– Pseudoephedrine producers
– Paraphernalia manufacturers
12 15 17 18 22 27 31 34 9 0 % 10 0 % 39 42 42 42 38 35 30 25 21 18 17 31 34 39 44 50 4 0 % 5 0 % 6 0 % 7 0 % 8 0 % Smo ki ng I nsuf l at i o n I nj ect i o n O t her 17 14 12 12 11 10 11 13 13 12 10 32 29 28 28 29 28 28 28 27 26 23 0 % 10 % 2 0 % 3 0 % 1 9 9 2 1 9 9 3 1 9 9 4 ` 1 9 9 5 1 9 9 6 1 9 9 7 1 9 9 8 1 9 9 9 2 0 0 0 2 0 0 1 2 0 0 2 Source: SAMHSA, TEDS, 2002
How do most use?
How does this differ from other drugs?
(Results: Frequency of Methamphetamine Use) 6 2 3 4 5 75% Daily or near daily 0 1 DAIL Y 2-6X /WEE K 1X/W EEK 1X/2 WEE KS <1X/ MON TH 25% Occasional or Binge
Oregon vs. National 8thGraders Since 9-11 The next generation?
25.00% 30.00% Alcohol Alcohol 16 00% 18.00% 20.00% DrugsDrugs 10.00% 15.00% 20.00% 6.00% 8.00% 10.00% 12.00% 14.00% 16.00% 2001 2002 2003 2004 0.00% 5.00% 2001 2002 2003 2004 0.00% 2.00% 4.00%
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)
25.00% 30.00% e gon n Oregon 8th Graders 10 00% 15.00% 20.00% Or e Orego n National National Oregon 8 Graders consume alcohol
54%
higher than the national average.
2003 2004
0.00% 5.00% 10.00%
Oregon 8thGraders Illicit Drug Use
continues to rise above the national average (2003-2004)
14.00% 16.00%
Oregon
Oregon Oregon 8th Graders
6.00% 8.00% 10.00% 12.00% N ational National Oregon 8 Graders consume illicit drugs at nearly
Double
the national average. 2003 2004 0.00% 2.00% 4.00% N• 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.
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
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
• 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
• Numerous addiction studies have shown a division at age 24:
– Tx completion rates were lower for those 24 and under (TEDS, 2000). susceptibility to drug using peer groups (DATOS, 1999).
– 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).
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 –
• Early onset substance using kids had up to 5 times higher rates of substance
abuse/dependence
• 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
100% F l 562 1926 3387 3052 861 663 1519 2429 1869 443 0 500 1000 1500 2000 2500 3000 3500 4000 Male Female 0% 20% 40% 60% 80% 11 to 17 18 to 24 25 to 34 35 to 44 55 to 64 Males Females 0 11 to 17 18 to24 25 to34 35 to44 55 to64 0 200 400 600 800 1000 1200 1999 2000 2001 2002 2003 Youth Female Youth Male
Psychoactive Substances and Sexual
Behaviors
100%
• My sexual drive
is increased by the use of the following substance(s) 57% 16% 42% 73% 10% 20% 30% 40% 50% 60% 70% 80% 90% 0% 10% Alco hol Op iate Coca ine MA
Psychoactive Substances and Sexual
Behaviors
• My use of the • My use of the following substance(s) has made me becomeobsessed with sex
and/or made my sex 16%
40% 67% 20% 30% 40% 50% 60% 70% 80% 90% 100%
and/or made my sex drive abnormally high. 0% 0% 10% Alco hol Op iate Coc aine MA
Psychoactive Substances and Sexual
Behaviors
• I am more likely to
• I am more likely to
have sex (e.g. intercourse, oral sex, masturbation, etc.) when using the following 47% 4% 41% 71% 20% 30% 40% 50% 60% 70% 80% 90% 100% following substance(s) 0% 4% 10% Alco hol Opiat e Coc aine MA
Psychoactive Substances and Sexual
Behaviors
• I am more likely to
• I am more likely to
practice “risky” sex under the influence of the following substance(s) (e.g., not use condoms, be
45% 41% 55% 20% 30% 40% 50% 60% 70% 80% 90% 100%
not use condoms, be less careful about who you choose as a sex partner, etc.)
0% 0% 10% Alco hol Op iate Coc aine MA
Psychoactive Substances and Sexual
Behaviors
• I have become involved
• 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, 17% 4% 35% 58% 20% 30% 40% 50% 60% 70% 80% 90% 100% marathon masturbation, go to “peep” shows, cross-dress, voyeurism, expose yourself, etc.)
4% 0% 10% Alco hol Opiat e Coc aine MA
Medical/Psychiatric Symptoms
Follow-up of 114 MA Users
Treated with Matrix Model – 1 yearMedical/Psychiatric Symptoms Symptoms in Past 30 Days Baseline Follow-up Hallucinations P i 30% % 9% % Paranoia “Psychiatric Problems” Chest Pains Depression Headaches 24% 24% 23% 62% 44% 7% 5% 12% 59% 40%
Research on Cognitive Impairments
of MA addicts
• Ability to manipulate
• Ability to manipulate
information (multi-relational or “synthesis”)
• Ability to make inferences
• Ability to ignore irrelevant
information
• Ability to learn new
information
“Methamphetamine: Snapshot Phenomenon” Wurscher & Martin
• A 2002 study of 114 methamphetamine users
• 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-th f ll ft t t t l ti
month follow up after treatment completion:
– 66-69% of urinalysis were clean at discharge and follow up.
1. Rawson, R. et al. (2002). Status of Methamphetamine Users 2-5 years after Outpatient Treatment. Journal of Addictive Diseases, vol. 21, no.1, pp. 107 2. Rawson, R. (June 2004). A Multi-Site Comparison of Psychosocial Approaches for the Treatment of Methamphetamine Dependence. Addiction, volume 99, issue 6 3. DSHS Research and Data Analysis Division, Research and Data Analysis Division. Report Number 11.114fs
Nerve Cell
Dendrites receive messages messages Cell Body (Soma) nourishes cell and keeps it alive Axon transmits messages Synaptic Gap – the space in between all cellsNeuropharmacology
• Neurotransmitters ti l t i l are tiny electrical and chemical messengers. • Axon (sender) • Dendrite (receiver) • Synaptic Gap • 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
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 Nicotine Caffeine www.nida.nih.gov
200 200 NAc shell NAc shell FOOD FOOD 200 200 a seline) a seline) SEX SEX
Natural Rewards Elevate Dopamine Levels Natural Rewards Elevate Dopamine Levels
0 0 50 50 100 100 150 150 % of Basal DA Output % of Basal DA Output Empty Empty Box Box FeedingFeeding
100 100 150 150 DA Concentration (% B a DA Concentration (% B a 15 15 0 0 5 5 10 10 Copulation Frequen c Copulation Frequen c 0 0 0 0 6060 120120 180180 Time (min) Time (min)
Source: Di Chiara et al. Source: Di Chiara et al.
Mounts Mounts Intromissions Intromissions Ejaculations Ejaculations 0 0 cycy Sample Number Sample Number 1 1 22 33 44 55 66 77 88 9 10910 1111 1212 1313 1414 1515 1616 1717 Scr ScrScrScr Bas
BasFemale 1 PresentFemale 1 Present
Scr Scr Female 2 Present Female 2 Present Scr Scr
Source: Fiorino and Phillips Source: Fiorino and Phillips
600 600 700 700 800 800 900 900 1000 1000 1100 1100 s al R e lease s al R e lease DA DA DOPAC DOPAC HVA HVA Accumbens
Accumbens AMPHETAMINEAMPHETAMINE
300 300 400 400 a l Release a l Release DA DA DOPAC DOPAC HVA HVA Accumbens
Accumbens COCAINECOCAINE
Effects of Drugs on Dopamine Levels Effects of Drugs on Dopamine Levels
0 0 100 100 200 200 300 300 400 400 500 500 600 600 0 0 11 22 33 44 5 hr5 hr Time After Amphetamine Time After Amphetamine
% o f B a s % o f B a s HVAHVA 0 0 100 100 200 200 0 0 11 22 33 44 5 hr5 hr Time After Cocaine Time After Cocaine
% o f B a s a % o f B a s a 250 250 s e s
e AccumbensAccumbens MORPHINEMORPHINEDose (mg/kg)Dose (mg/kg)
250 250 s e s e NICOTINENICOTINE 0 0 100 100 150 150 200 200 0 0 11 22 33 44 5hr5hr Time After Morphine Time After Morphine
% of B asal R e lea s % of B asal R e lea s 0.5 0.5 1.0 1.0 2.5 2.5 10 10 Dose (mg/kg) Dose (mg/kg) 0 0 100 100 150 150 200 200 0 0 11 22 3 hr3 hr Time After Nicotine Time After Nicotine
% of B asal R e lea s % of B asal R e lea s Accumbens Accumbens Caudate Caudate
Source: Di Chiara and Imperato Source: Di Chiara and Imperato
R t it Up & Down Regulation • Receptor sites can increase and decrease over time, as the nerves assess the need assess the need to do so.
Addiction Is A Brain Disease
Expressed As Compulsive Behavior
Addiction Is A Brain Disease
Expressed As Compulsive Behavior
Expressed As Compulsive Behavior
Expressed As Compulsive Behavior
Both Developing and
Recovering From It Depend on
i
S
i
C
Both Developing and
Recovering From It Depend on
i
S
i
C
Behavior and Social Context
Behavior and Social Context
Short Term
• Short Term: Delusions chronic meth user with significant reductions in brain activity – Delusions – Memory Problems – Hallucinations: • Tactile • Visual • Auditory • Gustatory • OlfactoryPsychosis Stories
• Shadow People
• Meth MonstersMeth Monsters
• Police
• Suspicious of Friends
Meth & Aggression
• Animal Studies (rats, monkeys, etc.)– Increases frequency of
attack-Low doses Super High doses q y
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. Aggression A g Ag g
• 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 class monkeys High class monkeys g g ression g ression
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.
teeth.
• Meth users drink a lot of pop.
• Meth users in treatment experience significant pain.
Discomfort
• Meth users may experience physiologic discomfort from:
– sores
– tooth decay
– loss of REM sleep
– gastrointestinal ulceration's
Increasing numbers of Meth injectors (OD’s rank 9th)
N dl U I f i
Needle Use Infections abscesses septicemia cotton fever hepatitis B & Cp endocarditis embolism
Street Survey
• Meth is the sameMeth is the same as Rx drugs.
• Rx drugs are “unnatural”.
Route of Meth Administration
ADAM Adult Meth Users
Snort 68% 43% 28% 46% 57%
Los Phoenix Portland San San
Angeles Diego Jose
Smoke 18% 27% 17% 39% 32%
Inject 11% 27% 49% 12% 5%
Other 2% 3% 5% 2% 6%
Oregon OMHAS, CPMS Meth primary treatment Admits had 39% injection Rate in 1999 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% 1999 2001 2003 Smoking Injection Insuflation
• Early onset substance using kids had up to 5 times higher rates of substance
abuse/dependence
• Significantly higher rates of anxiety and depression Up to 5x’s greater Substance abuse/ dependence Higher rates Anxiety and Depression
Hope for Recovery