Tuesday, January 15, 2008

Methamphetamine: What Child Welfare Workers Should Know

Vol. 10, No. 2
April 2005
Methamphetamine: What Child Welfare Workers Should Know
To protect and support families, child welfare workers need to know what methamphetamine is and how it affects users.
What Is Meth?
Meth is methamphetamine, a powerful central nervous system stimulant. A highly addictive drug, meth comes in different forms; most often it is a powder that dissolves easily in water, though it can also come in clear, chunky crystals called “ice.” Meth can be swallowed, snorted, injected, or smoked. It is known by many names, including speed, meth, crystal, crank, biker’s coffee, and chalk (ONDCP, 2003; Shaw, 2004).
Although known primarily as an illegal drug, methamphetamine does have legitimate medical uses. It is sometimes prescribed for the treatment of narcolepsy, attention deficit disorders, and obesity (NIDA, 2002). Medical methamphetamine is sold in the U.S. under the trade name Desoxyn (Narconon, 1998).
Yet the legal use of meth is almost entirely eclipsed by growing tide of illegal production and abuse. Nationally, four times as many people sought treatment for meth addiction in 1998 than in 1992 (NCPC, 2002). Meth is also showing up in the workplace. Between 1999 and 2003, the percentage of positive workplace drug tests containing amphetamines doubled, from 4.5% to 9.3% (CESAR, 2004). During 2000, 4% of the U.S. population reported trying meth at least once in their lifetime (NIDA, 2002).
Child welfare agencies may see a much higher incidence of meth use, just as they see more domestic violence and mental illness than are present in the general population. One western North Carolina county we spoke with said that the majority of CPS reports it has received so far in 2005 have involved meth.
Effects on Users
Users are drawn to meth because when they first take the drug they get an intense rush of pleasure followed by a sense of euphoria, energy, and elevated self-esteem lasting up to 8 hours (Swetlow, 2003).
Asked by a child welfare worker what taking meth was like, a user responded: “Imagine the most pleasurable experience you have ever had. Now multiply that times ten.”
Users also like meth because it helps with weight loss and acts as a sexual stimulant (Shaw, 2004). Another draw is meth’s relative affordability. Whereas $100 will hardly buy enough crack cocaine to get a user through the night, for the same amount a meth user can stay high for days (Shaw, 2004).
Because of severe depression and other negative effects that begin when the drug starts to wear off, users try to avoid sobering up. They may binge to stay high—and awake—for many days at a time and then use other drugs, such as alcohol or depressants, to help them sleep. Meth users who binge commonly crash and sleep for days afterwards. When chronic users stop taking meth they experience depression, anxiety, fatigue, paranoia, aggression, and an intense craving for the drug (NIDA, 2002).
According to the US Drug Enforcement Agency (2005), “methamphetamine has a phenomenal rate of addiction, with some experts saying users can get hooked after just one use.” Once a person becomes addicted, explains Agent Van Shaw of the North Carolina State Bureau of Investigations (SBI), “home maintenance, personal health and hygiene, and parenting all suffer” as the drug becomes the person’s only focus (Shaw, 2004).
Using meth can have many immediate physical side effects, as indicated in the table below.
Signs of Meth Use
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
Long-term negative physical effects of chronic use include lung and nerve damage, heart attack, kidney failure, extreme weight loss, tooth loss and cavities, stroke, seizures, and death (Mason, 2004; McFadden, 2003). Because they may engage in risky behaviors, there is also a higher rate of hepatitis, HIV, and STDs among meth users (NIDA, 2002).
The psychological side effects of meth use include hostility, impulsivity, irritability, insomnia, paranoia, and behaviors such as skin picking, pacing, chattering, and repetitive movements. Long-term psychological effects of chronic meth abuse can include delusions, hallucinations, homicide, suicide, psychosis, and bizarre and violent behaviors (Mason, 2004).
In addition to the physical and psychological effects, meth users are at risk for negative outcomes such as unemployment and criminal activity. Meth use and meth labs are linked to increases in crime, especially car thefts, forgeries, identity theft (NCDOJ, 2004), and domestic violence (Shaw, 2004).
User Profile
In North Carolina, most meth users are “young, white, small-town residents with limited education and a blue collar-career” (Lacour & Gregory, 2004). As with most drugs, the majority of users are men (McWhirter & Miller, 2004). Yet many women find the drug attractive. Today women account for 47% of all treatment admissions for meth—a much higher percentage than for most other drugs (Vaughn, 2003).
Anecdotal reports suggest that a significant percentage of the friends and family of parents arrested for cooking meth also use the drug. Though these reports do not have the weight of empirical evidence, they underscore the importance of thorough assessments before placing children.
Child Maltreatment
Compared to other children, children whose parents use drugs or alcohol are three times more likely to be abused and four times more likely to be neglected (Wells & Wright, 2004). This increased risk certainly seems to apply in the case of meth.
Pregnancy. Meth use during pregnancy can result in prenatal complications, low birth weight, birth defects, increased rates of premature delivery, and abnormal infant behavior (NIDA, 2002; Wells & Wright, 2004). Children born to meth-addicted mothers go through painful withdrawal for weeks or months (Lacour & Gregory, 2004). Long-term, most children prenatally exposed to meth function normally as they get older, though some may have “subtle impairments” that negatively affect regulation of emotions and ability to concentrate, which could put them at risk for behavioral and learning difficulties (Matthias, 2001).
Neglect. When parents use or make meth, their children often do not have necessities such as food, water, and shelter, and they frequently lack adequate supervision and medical care, including proper immunizations and dental care (NDIC, 2002). In addition, the cycle of meth abuse has a built-in phase when parents usually “crash” and are unable to look after their children (Wells & Wright, 2004). Children in meth-using families may also face hazards such as used hypodermic needles and razor blades (Swetlow, 2003).
Abuse. Exposure to parents intoxicated by meth may compromise child safety: when high, users often exhibit poor judgment, confusion, irritability, paranoia, and increased violence. Given the effects it has on libido, children of meth-using parents may be at greater risk for sexual abuse (Swetlow, 2003; Riverside DEC, 2005), either by parents themselves or by other adults coming in and out of the home (NCDOJ, 2004).
Brain changes brought on by chronic meth use can impair cognitive function long after a person stops using the drug. Experiments indicate that for up to six months after they stop using, addicts recovering from sustained, heavy meth use may have trouble processing information and may experience anhedonia (inability to experience even the simplest pleasures), depression, and anxiety.
On the bright side, research finds that meth users’ brains show signs of recovery after 12 to 14 months of abstinence (Wells & Wright, 2004).
Treatment for Meth
Although many people are pessimistic about the future of those addicted to meth, experts say that treatment for meth is just as effective as for other drugs, with 50% to 60% of patients recovering (Worth, 2005).
Predictions of low recovery rates, experts say, often arise in communities with little or no experience with crack, cocaine, or heroin abuse, where substance abuse professionals are unprepared for the challenges of meth addiction (Sommerfield, 2004). Thus, the problem is not that treatment doesn’t work with meth, but that the most effective treatment models can be hard to find (Szalavitz, 2005).
One approach that has been proven to work with meth is the Matrix model, which combines elements from relapse prevention, motivational interviewing, and other programs (Larimer County, 2004). One key difference between this model and others is its duration: whereas many programs last 30 or fewer days, Matrix lasts up to six months. This fits better with what we know about how long it takes the brain to shake off the effects of meth.
Thanks to a federal grant, the NC Division of Mental Health, Substance Abuse Services, and Developmental Disabilities is making the Matrix model more widely available in North Carolina. Through its Methamphetamine Treatment Initiative, North Carolina hired a Matrix consultant to train treatment clinicians from New River Behavioral Healthcare (Watauga and Ashe Counties), Western Highlands LME (Buncombe and Rutherford Counties), and Foothills LME (Caldwell and McDowell Counties).
If you are interested in bringing the Matrix model to the mental health LME in your area of North Carolina, contact Smith Worth, manager of the Methamphetamine Treatment Initiative, at smith.worth@ncmail.net.
Child Welfare Policy
In North Carolina, child welfare policy dictates that allegations of children exposed to meth labs must be investigated by DSS in cooperation with law enforcement. In Multiple Response System (MRS) counties, if the allegation concerns meth use (but no lab), the individual county DSS may respond to the report using either the family assessment or the investigative assessment approach