PREVALENCE AND TREATMENT OF METHAMPHETAMINE DEPENDENCE: IMPLICATIONS FOR WOMEN AND CHILDREN

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A S E R V I C E O F T H E
CHILDREN’S BUREAU The Source
Newsletter of
The National
Abandoned Infants NOTE FROM THE EDITOR
Assistance
Resource Center
V O L U M E 1 5 , N O . 1 Over the past several years, treatment programs and child welfare agencies
S P R I N G 2 0 0 6 throughout the country have seen a shift in the drugs of choice of many
pregnant and parenting women. Specifically, methamphetamine, once used
primarily in rural areas of western states, has been gaining widespread
popularity throughout the country. Also, an increase in pregnant women’s
IN THIS ISSUE abuse of prescription drugs, most notably OxyContin© and other opiates,
presents unique challenges to providers in certain parts of the country—
2 Prevalence and Treatment of
Methamphetamine Dependence: primarily Kentucky, Virginia, Ohio, West Virginia and the Northeast. In
Implications for Women and Children fact, some experts claim that more Americans are addicted to prescription
painkillers than illicit drugs. Although marijuana and alcohol remain the most
7 What do we know about the impact
of methamphetamine on infants commonly abused drugs, the “newer” drugs require a fresh look at how we
and young children?
An interview with Dr. Rizwan Shah identify them in pregnant and parenting women and in newborns, how we
treat them, and how we work with children and families affected by them.
11 OxyContin® Abuse in Women:
A growing body of literature is beginning to address some of these challenges.
Implications For Pregnancy
This issue of The Source attempts to further the discussion; synthesize some
15 OxyContin®: What Do We Know
of the information about effective treatment strategies and the impact of these
About Its Impact on Infants?
“contemporary” drugs on infants and children; and dispel some of the
20 Moms Off Meth Support Group
myths and misconceptions that have arisen about methamphetamines. Many
22 Meth Science Not Stigma: thanks to the authors who are pioneers in this field, and who took time out
Open Letter to the Media of their busy schedules to share their expertise and knowledge with us.
23 Methamphetamine and HIV: The Good Bets section of the newsletter on p. 24 includes additional sources
What’s the Connection for Women?
of information on this and other related issues.
24 Good Bets Amy Price, Editor
28 Conference Listings
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T H E S O U R C E , V O L U M E 1 5 , N O . 1 T H E N A T I O N A L A B A N D O N E D I N F A N T S A S S I S T A N C E R E S O U R C E C E N T E R
PREVALENCE AND TREATMENT OF
METHAMPHETAMINE DEPENDENCE:
IMPLICATIONS FOR WOMEN AND CHILDREN
What is one to conclude about admission rates for methamphetamine for crack cocaine, the majority (49%)
the headlines concerning methamphet- increased 300% to 56 persons per was Black, 39% were White, and 10%
amine use and dependence? Is it 100,000 (TEDS, 1993-2003). were Hispanic (SAMHSA, 2005b).
spreading to “epidemic” proportions?
To what extent are children of
methamphetamine users at risk com-
pared to users of other drugs? Is DEMOGRAPHIC GENDER DIFFERENCES
methamphetamine dependence treat- CHARACTERISTICS OF USERS
able? The data and recent community Of all persons treated for methamphet-
experiences with methamphetamine The demographic characteristics of amine in the United States in 2003,
addiction and treatment provide some people seeking treatment for metham- 45% were women. This is higher than
answers. phetamine abuse is significantly differ- the percentage of females associated
ent from that of persons needing treat- with any other drug except tranquiliz-
ment for crack cocaine abuse. As a ers. For instance, women represent
result, the communities now respond- only 25% of those treated for alcohol
Patterns of Use ing to the rapid growth in metham- and marijuana, 34% for heroin, and
phetamine related problems may not 39% for cocaine (SAMHSA, 2005b).
Nationally, methamphetamine is used have the experience and benefit of the In addition, a disproportionate share of
by fewer people than other illicit drugs. treatment infrastructure that was adolescent girls sought treatment for
According to the 2004 National Survey created to respond to crack use. methamphetamine addiction—56%
on Drug Use and Health (NSDUH), Methamphetamine use has been con- compared to 44% of boys (TEDS
of the approximately 19.5 million peo- centrated primarily in western states analysis, 2005).
ple who used illicit drugs in the prior and rural communities; whereas crack Women and men often initiate
month, only 583,000 (3%) of them cocaine use was, and still is, typically and maintain drug use for different
reported past month use of metham- associated with urban areas. For reasons. For instance, women more
phetamine. This compares with 14.6 instance, in five states, over 40% of all often first use drugs with a male part-
million reporting marijuana use and women admitted for drug treatment ner, and continue to use in order to
2.8 million reporting cocaine or crack identified methamphetamine as their maintain connections with other users
use (SAMHSA, 2005a). This relatively primary substance (Idaho 48%, Hawaii (Covington, 2002). In addition, a
lower number of people using 46%, California 45%, Utah 44%, and study by Dr. Richard Rawson of
methamphetamine has raised some Nevada 40%.) In comparison, UCLA’s Integrated Substance Abuse
questions about the recent media and methamphetamine/amphetamine treat- Programs (ISAP) showed that women
legislative attention to methampheta- ment accounts for only 11% of female were more likely than men (37% vs.
mine use. The lower numbers, howev- admissions nationally (TEDS analysis, 25%) to report using methampheta-
er, do not tell the complete story. 2005). mine to relieve depression (El Paso
Treatment admissions data paint the The racial demographics also dif- Intelligence Center, 2004). Metham-
picture of a dramatically increasing fer dramatically: of those treated for phetamine’s appetite suppressing and
trend in methamphetamine related methamphetamines in 2003, 75% were energy enhancing properties also are
problems, particularly in western and White, 16% were Hispanic, 3% were especially appealing to women. In the
rural regions of the country. From Black, and 3% were Asian/Pacific UCLA study, 37% of women reported
1993 to 2003, national treatment Islanders. In contrast, of those treated using methamphetamine to lose
weight, compared to 9% of men.
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T H E S O U R C E , V O L U M E 1 5 , N O . 1 T H E N A T I O N A L A B A N D O N E D I N F A N T S A S S I S T A N C E R E S O U R C E C E N T E R
Women who are dependent on and have worse medical, employment
methamphetamine usually have more and psychiatric consequences than
severe problems than their male coun- male users (Brecht et al., 2004 as Risk to Children
terparts in many areas of their life. A reported in Rawson, 2005)
study by Hser, Evan and Huang (2005) Because of the higher rates of women
that examined treatment outcomes
seeking treatment for meth-related
among methamphetamine-abusing problems, and the aforementioned cir-
patients confirmed this observation. WOMEN WHO ARE cumstances often related to their use,
The authors note that the women in
more children are likely to be affected.
the sample, most of whom were child- DEPENDENT ON In fact, some children have been placed
bearing age or had children, reported METHAMPHETAMINE in alarmingly dangerous situations as a
more psychiatric symptoms; were more result of their parents’ methampheta-
likely to have been physically or sexual- USUALLY HAVE MORE mine use, particularly when they live
ly abused; and had greater incidence of or spend time where the drug is being
serious employment, legal/criminal, SEVERE PROBLEMS THAN manufactured. According to the El
parenting, and psychological problems THEIR MALE Paso Intelligence Center (EPIC), in
than did men. This finding speaks to approximately 10% of the 14,250 lab
the need to provide methamphetamine COUNTERPARTS IN MANY incidents recorded nationwide in 2003,
dependent women with adequate serv- AREAS OF THEIR LIFE. children were present during the dan-
ices to meet their myriad needs. gerous manufacturing of methamphet-
In addition, interpersonal violence amine and placed at risk for exposure
is characteristic of the majority of per- to toxic chemicals and the possible
sons entering treatment for metham- dangers of chemical contamination,
phetamine dependence, and this is fires and explosions (EPIC, 2004).
especially true for women. In a study Hazardous living conditions and filth
conducted by Cohen et al. (2003), over are common in meth lab homes, and
85% of women and 69% of men in living conditions are unsuitable for
treatment for methamphetamine PREGNANT WOMEN anyone, especially young children.
dependence reported experiencing vio- While much attention has been
lence. The most common source of Data concerning pregnant women also focused on the risk to children living in
violence for women was from a “part- is worrisome. Preliminary estimates homes where methamphetamine is
ner” (80%), whereas the most common from the recent Infant Development, being manufactured, most parents do
source for men were “strangers” (43%). Environment, and Lifestyle (IDEAL) not manufacture methamphetamine.
The study also found that 57% of Study indicate that 5.2% of women However, children whose parents use
women and 16% of men in the study used methamphetamine at some point methamphetamine are at risk even
reported a history of sexual abuse and during their pregnancy (Arria et al., when their parents are not manufactur-
violence. An exhaustive literature 2006). In the same study, 25% report- ing the drug, and the risks are similar
review found that women with sub- ed smoking, and 22.8% reported con- to those associated with other drugs of
stance abuse disorders were nearly two suming alcohol during pregnancy. abuse. They include chronic neglect;
times more likely than women in the While the relative prevalence of physical and sexual abuse; living in
general population to report childhood methamphetamine using during preg- chaotic, disruptive living situations;
sexual abuse (SAMHSA, 2000). nancy is much smaller, it is increasing. and exposure to violence that is so
A qualitative study by Brecht et al. Between 1995 and 2003, admissions often associated with methampheta-
(2004), noted some additional gender for methamphetamine dependence mine use, and may involve meth-using
differences pertaining to meth use. nearly doubled for pregnant women, associates frequenting the home.
This study found that female users while the number of pregnant women Further, mothers who use metham-
were more likely to use meth on more seeking treatment for both alcohol and phetamine during their pregnancies
days; smoke rather than snort or inject cocaine problems decreased significant-
the drug; progress to regular use more ly (TEDS, 2005). Continued on page 4 . . .
quickly; live alone with their children;
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T H E S O U R C E , V O L U M E 1 5 , N O . 1 T H E N A T I O N A L A B A N D O N E D I N F A N T S A S S I S T A N C E R E S O U R C E C E N T E R
Continued from page 3. . . National Institute on Drug Abuse and decreased drug use as measured objec-
SAMHSA as an evidence-based prac- tively by urinalysis. The resulting pack-
may increase the risk of poor birth out- tice. Currently available therapist man- age of treatment elements was organ-
comes and long term risks for their uals, along with patient and family ized into a standardized treatment
children (Shah, 2005; see article on workbooks, make the program more model.
p. 7 of this newsletter). However, as easily transferable to community based Services are delivered in an inten-
noted in the Open Letter to the Media organizations than other known treat- sive outpatient setting. Clients attend
on p. 22 of this newsletter, “research ment strategies for methamphetamine 16 weeks of cognitive behavior therapy
on the medical and developmental dependence. groups (36 Sessions), family education
effects of prenatal methamphetamine groups (12 sessions), individual coun-
exposure is still in its early stages,” and seling (4 sessions), and social support
the results remain inconclusive.
groups (4 sessions), combined with
weekly, random breath alcohol testing
OUTCOMES FOR and urine testing for cocaine, metham-
phetamine, opiates, cannabis and ben-
Treatment for METHAMPHETAMINE zodiazepines. Participation in 12-step
Methamphetamine TREATMENT HAVE NOT meetings at least once a week is
encouraged.
Recognizing the growing problem of DIFFERED FROM STUDIES OF Several evaluations of the Matrix
methamphetamine abuse and depend- TREATMENT FOR OTHER Model support its usefulness and effi-
ence, in 1998, the Substance Abuse cacy with methamphetamine users, as
and Mental Health Administration DRUGS OF ABUSE. well as other substances. For example,
(SAMHSA) and The Center for in one Southern California site, a
WE KNOW THAT TREATMENT
Substance Abuse Treatment (CSAT) group of 500 methamphetamine users
published a Treatment Improvement OUTCOMES HAVE MORE TO and a group of 224 cocaine users were
Protocol (TIP) entitled Treatment for treated using the Matrix Model in the
Stimulant Use Disorders, TIP #33. DO WITH THE QUANTITY AND same office with the same staff during
These best practice guidelines were QUALITY OF TREATMENT the same time period. The two groups
researched, drafted, and reviewed by a had demographic and drug use differ-
panel of substance use disorder profes- RECEIVED THAN THE TYPE OF ences but had virtually identical
sionals chaired by Dr. Richard Rawson. responses to the Matrix outpatient
DRUG ABUSED.
The TIP provides vital information on treatment. The methamphetamine
the effects of stimulant abuse and users had higher ratings of depression,
dependence, discusses the relevance of hallucinations, and several other symp-
these effects to treating stimulant users, toms, and required a longer time peri-
describes treatment approaches that are od for symptom remission. However,
appropriate and effective for treating the data collected during treatment and
these clients, and makes specific rec- MATRIX MODEL at follow-up suggested comparable
ommendations on the practical appli- response to treatment using the Matrix
cations of these treatment strategies, The Matrix Model, originally devel- Model for both cocaine and metham-
which include: Cognitive Behavioral oped for cocaine users, is a directive, phetamine use (Rawson, Huber,
Therapy/Relapse Prevention; Contin- non-confrontational treatment Brethern, & Ling, 1998; Huber et al.,
gency Management; Community approach that focuses on current issues 1997).
Reinforcement Approach + Voucher; and behavior change. This multi-com- To further test the effectiveness of
Motivational Interviewing; and the ponent model was constructed using treatment for methamphetamine use
Matrix Model of Intensive Outpatient empirically supported interventions disorders, SAMHSA/CSAT also issued
Treatment for Stimulant Users. and treatment elements, and guided by a Request for Applications for a knowl-
Of these strategies, the Matrix a process of pilot-testing diverse strate- edge development program entitled
Model has been identified by both the gies and incorporating those that “Replication of Effective Treatment for
enhanced treatment attendance and Methamphetamine Dependence and
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T H E S O U R C E , V O L U M E 1 5 , N O . 1 T H E N A T I O N A L A B A N D O N E D I N F A N T S A S S I S T A N C E R E S O U R C E C E N T E R
Improvement of Cost-Effectiveness of Clinical supervisors conducted addi- quality treatment. The measures of
Treatment.” The short title for the pro- tional training at each site with the drug use and functioning collected at
gram is Methamphetamine Treatment help of the clinical director at the coor- treatment discharge and at 6 month
Project (MTP). This cooperative agree- dinating center. The Matrix Institute post admission follow up indicated sig-
ment was the largest randomized clini- clinicians also monitored clinician per- nificant improvement by clients in all
cal trial of treatment for methampheta- formance via a weekly activity check sites and all conditions when compared
mine dependence to date. UCLA ISAP list and reviewed a sample of tape to baseline levels. This is not surprising
served as the coordinating center for recorded sessions to provide feedback given that the other treatment models
the program and, with the Matrix and ensure that the Matrix Model was most commonly used in the TAU
Institute on Addictions, implemented implemented as designed. group shared elements with the Matrix
and evaluated the adaptation of the Results of the study, published in Model, including cognitive behavioral
Matrix Model in community drug June 2004, indicated that in the overall approaches, contingency management,
treatment programs in eight communi- sample and in the majority of sites, the and psychodynamic approaches.
ty out-patient settings in the western clients assigned to the Matrix Model It is important to note that out-
United States. treatment attended more clinical ses- comes for methamphetamine treatment
Seven sites that had been provid- sions, stayed in treatment longer, and have not differed from studies of treat-
ing treatment for methamphetamine provided more methamphetamine free ment for other drugs of abuse. We
dependence for at least two years par- urine samples during the treatment know that treatment outcomes have
ticipated in the study, which compared period. The Matrix clients also had more to do with the quantity and qual-
their treatment as usual (TAU) to the longer abstinence periods while in ity of treatment received than the type
Matrix Model.** Over an eighteen treatment than the clients assigned to of drug abused. Treatment providers,
month period between 1999 and 2001, TAU. clients, families, and communities can
978 clients seeking treatment for be reassured that persons with
methamphetamine dependence were TABLE 1: methamphetamine disorders can and
randomly assigned to receive either do recover from addiction.
TAU or the manualized Matrix Model
Follow-up Urinalysis Results*
at the study locations.
To ensure fidelity to the Matrix
Matrix Group TAU Group
Model, training for staff at the study ADDRESSING TRAUMA
sites consisted of an initial 40 hours of Discharge: 66% MA-free 65% MA-free
didactic and experiential training. 6 mo: 69% MA-free 67% MA-free In 1999, recognizing the need to assess
for and address issues of violence and
12 mo: 59% MA-free 55% MA-free
victimization in treatment for metham-
phetamine dependence, SAMHSA
*There was a follow-up response rate of
** The seven sites were: The Journey Recovery funded a study to investigate promising
over 80% in both groups at all points.
Chemical Dependency Treatment Program, models for treating women with these
South Central Montana Regional Mental complex problems. The premise of the
Health Center in Billings, Montana; New “Women with Co-Occurring Disorders
Leaf Treatment Center in Lafayette, and Violence Study (WCDVS)” was
California; The Matrix Institute, Orange However, as illustrated by the that substance abuse treatment with
County in Costa Mesa, California; East Bay
Community Recovery Project in Hayward, comparative urinalysis test results in women who have histories of past trau-
California; The Women’s Addiction Treatment Table 1, the superiority of the Matrix matic events involves both “trauma-
Center of Hawaii in Honolulu, Hawaii; The Model approach did not continue into informed” and “trauma-specific”
Family Recovery Center, Eye Counseling and the discharge and 6 month post admis- approaches. Trauma-informed systems
Crisis Services in San Diego, California and; sion time periods as clients receiving and services take into account
San Mateo County Alcohol and Drug Services TAU did equally as well. The good knowledge about trauma—its impact,
in Belmont, California. San Mateo County
collaborated with two providers and compared news from the study is that positive interpersonal dynamics, and paths to
Matrix to the TAU at two locations. They treatment outcomes were achieved
were Pyramid Alternatives and Outpatient using both Matrix and other good Continued on page 6 . . .
Drug and Alcohol Services for Asians.
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T H E S O U R C E , V O L U M E 1 5 , N O . 1 T H E N A T I O N A L A B A N D O N E D I N F A N T S A S S I S T A N C E R E S O U R C E C E N T E R
Continued from page 5 . . .
Addiction Technology Transfer Centers documents/IntegratedTrauma.pdf.
recovery—and incorporate this knowl- (ATTC). The Pacific Southwest ATTC Hser, Y.I., Evans, E., & Huang, Y.C.,
(2005). Treatment outcomes among women
edge thoroughly in all aspects of service (www.psattc.org) offers two training and men methamphetamine abusers in
delivery. The primary goals of trauma- modules: Methamphetamine 101— California. Journal of Substance Abuse Treatment ,
specific services are more focused to Etiology and Physiology of an Epidemic 28(1): 77-85.
address directly, through the delivery of and Methamphetamine, and 102— Huber, A., Ling, W., Shoptaw, S., Guiati,
V., Brethern, P., Rawson, R. (1997). Integrating
Introduction to Evidence Based
clinical treatment services, the impact Treatments for Methamphetamine Abuse: A
of trauma on people’s lives, and to Treatments. Psychosocial Perspective. Journal of Addictive
Diseases, 16(4): 41-50.
facilitate trauma recovery and healing Rawson, R. (2005) Clinical Phenomena in
(Finkelstein et al., 2004). This study Sharon Amatetti, MPH, Methamphetamine Treatment: Treatment Response,
went a long way to advance models of Senior Public Health Analyst, and Sexual Behavior, and Route of Administration.
treatment that integrate an understand- Cheryl Gallagher, MA, Presentation to SAMHSA, August 2005.
ing of trauma and substance abuse. Public Health Advisor, Rawson, R., Huber, A, Brethern, P., and
Ling, W. (1998). Treatment Response and
Programs that view trauma as a defin- Substance Abuse and Mental Health Treatment Outcome of Methamphetamine and
ing experience are relevant for women Services Administration, Cocaine Users. Presented at American Society of
dependent on methamphetamine given Center for Substance Abuse Treatment; and Addiction Medicine. New Orleans, Louisiana.
the high rates of violence and trauma Nancy Young, PhD, Shah, R. (2005). Implications of
Methamphetamine Abuse and Dependence for
experienced by them. Project Director, National Center on Child Welfare, ACYF Children’s Bureau, System
Substance Abuse and Child Welfare of Care Grantees Teleconference, July 14, 2005.
http://www.ncsacw.samhsa.gov/files/508/Meth
CaliberTeleconference.htm.
Substance Abuse and Mental Health
Conclusion Services Administration. (2005a). Results from the
REFERENCES 2004 National Survey on Drug Use and Health:
Arria, A.M., Derauf, C., LaGasse, L.L., National Findings (Office of Applied Studies,
The escalation of methamphetamine Grant, P., Shah, R., Smith, L., Haning, W., NSDUH Series H-28, DHHS Publication No.
use has taken many communities by Huestis, M., Strauss, A., Della Grotta, S., Liu, J., SMA 05-4062). Rockville, MD. Accessed online
storm. Fortunately, we are prepared & Lester, B. (2006). Methamphetamine and other January 18, 2006 at http://www.oas.samhsa.gov/
with knowledge about effective treat- substance use during pregnancy: Preliminary esti- NSDUH/2k4nsduh/2k4Results/2k4Results.pdf.
mates from the Infant Development, Environment Substance Abuse and Mental Health
ment for methamphetamine dependent and Lifestyles (IDEAL) Study. Maternal and Child Services Administration, Office of Applied
individuals, and methamphetamine Health Journal. Studies (2005b). Treatment Episode Data Set
dependent women in particular. Brecht, M.L. (2004). Women and (TEDS). Highlights - 2003. National Admissions
Methamphetamine: Characteristics, Treatment to Substance Abuse Treatment Services, DASIS
Studies suggest that treatment models, Outcomes. Presentation to the Center for Substance Series: S-27, DHHS Publication No. (SMA)
like the Matrix Model and other evi- Abuse Treatment, State Systems Development 05-4043, Rockville, MD.
dence based practices, developed for Conference, August 13, 2004. Substance Abuse and Mental Health
cocaine and other substances, can be Cohen, J., Dickow, A., Horner, K., Zweben, Services Administration (2000). Substance Abuse
J., Balabis, J., Vandersloot, D., and Reiber, C. Treatment for Persons with Child Abuse and
effective in treating methamphetamine (2003). Abuse and Violence History of Men and Neglect Issues, TIP 36.
users. Treatment outcomes for Women in Treatment for Methamphetamine Treatment Episode Data Set (TEDS)
methamphetamine users appear to be Dependence, The American Journal on Addictions, 1993-2003, Substance Abuse and Mental Health
similar to those for users of other 12:377-385. Services Administration, Office of Applied
Covington, S. (2002). Helping women Studies.
drugs, and successful treatment and recover: Creating gender-responsive treatment. TEDS (2003). Online analysis using
long term recovery for a parent may In L. Straussner and S. Brown, eds., Handbook of Treatment Episode Data Set (TEDS) 2003
lead to life long benefits for both the Women’s Addictions Treatment. San Francisco: public use file, available through the Substance
child and the parent. Jossey-Bass. Abuse and Mental Health Data Archive at
El Paso Intelligence Center (2004). Accessed http://www.icpsr.umich.edu/SAMHDA/
online August, 2005, at http://www.dea.gov/ das.html. Analysis conducted August 2005.
For more information about treat- programs/epic.htm.
ment for methamphetamine, and Finkelstein, N., VandeMark, N., Fallot, R.,
treatment for women with children, visit Brown, V., Cadiz, S. and Heckman, J. (2004).
Enhancing Substance Abuse Recovery Through
the SAMHSA website at www.ncsacw.
Integrated Trauma Treatment, National Trauma
samhsa.gov. Additional information and Consortium. Accessed online January 18, 2006
resources regarding methamphetamine http://www.nationaltraumaconsortium.org/
also are available through the CSAT
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T H E S O U R C E , V O L U M E 1 5 , N O . 1 T H E N A T I O N A L A B A N D O N E D I N F A N T S A S S I S T A N C E R E S O U R C E C E N T E R
WHAT DO WE KNOW ABOUT THE IMPACT OF
METHAMPHETAMINE ON INFANTS AND YOUNG CHILDREN?
AN INTERVIEW WITH DR. RIZWAN SHAH
On April 3, 2006, Amy Price and The data from our clinic are based
Jeanne Pietrzak of the AIA Resource upon 109 kids that we extrapolated
Center had the opportunity to interview from a population of more than 500
children that we have seen since 1993.
Rizwan Shah, MD, Medical Director of the
Our oldest child in the study will turn
Child Abuse Program at Blank Children’s
13 this year. Of the 109 children, 61
Hospital in Des Moines, IA. Following are
were meth exposed, 36 crack cocaine
the questions we asked along with her
exposed, and 12 kids were exposed to
responses. To hear more from Dr. Shah, both crack cocaine and methampheta-
you can listen to a 90 minute presenta- mine.
tion that she gave on February 21, 2006, I think it’s important to note that
as part of the AIA Resource Center’s 2006 even though methamphetamine has
Teleconference Series. To hear that entire been a major drug of abuse in most of
the western and mid-western states for
presentation and view accompanying
the last ten plus years, there are very
written materials, go to http://aia.
few prevalence or clinical outcome Dr. Rizwan Shah
berkeley.edu/ training/teleconference/
studies on meth-exposed children. We
teleconference_series.html.
have a few earlier studies by Dr.
using illegal drugs, including metham-
Suzanne Dixon from UCLA, looking
phetamine, they do not take care of
at data on the babies born exposed to
themselves and they do not go for pre-
methamphetamine, and one study
AIA: You have conducted research natal care. Many previous studies of
on outcomes for infants who have been based in Sweden by Billing and crack cocaine and heroin users have
Erikson who have followed children for
prenatally exposed to methamphetamine. about 10 plus years. Our studies pro- clearly shown that if a pregnant
Can you briefly describe your research? vide us with an insight into what these woman who uses substances continues
to go for prenatal care, the pregnancy
children look like in the first few
DR. SHAH: The Blank Children’s and child outcomes will be better.
months of life and over a period of
Hospital Clinic for Drug Exposed time. Also, because of the weight loss
Babies started seeing drug affected seen in meth using populations, and
babies in 1989. In 1993, we started the perception that these individuals
seeing methamphetamine exposed AIA: What are the most critical findings do not take good care of themselves,
babies. In 1998, I received a small we were expecting to see a lot of
of the studies?
grant from NIDA to look at the out- women with nutritional problems.
comes of this clinical population, pri- DR. SHAH: First, we looked at charac- However, the actual numbers were
marily to see what these children look teristics of the moms. In our clinic lower than our expectations. Only
like. In addition, I am part of a four- about 16% of the meth using group
population, about 40% of the mothers
site national study through Brown who are using methamphetamine do had nutritional problems like anemia
University. Dr. Barry Lester is the prin- and poor weight gain during pregnan-
not get any prenatal care, compared to
cipal investigator of this study, which is 22% of the moms using crack cocaine. cy. About 34% of the meth using
in its fourth year. We are just starting This illustrates that when moms are
to get preliminary data. Continued on page 8 . . .
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Continued from page 7 . . . and swallowing. Even the full-term at birth, these children are hard to
meth exposed babies had a poor quali- detect beyond the infancy period. An
pregnant women had acute illnesses ty of suck, compared to the crack important message, therefore, is for
and were sick enough to see a physi- cocaine exposed babies. professionals and caregivers to carefully
cian. Current research also identifies evaluate problems in drug exposed
Another important finding in this differences in meth exposed infants’ cry children, because a lot of the behaviors
clinical outcome study is that 25% of patterns, which may indicate neurotox- that they show in the preschool age are
the meth exposed babies were born ic effects of meth exposure. Further, going to be well within the normal
premature, i.e., earlier than 36 weeks some meth exposed babies have shown range.
of gestation. This is similar to the symptoms of muscle tone problems.
groups we have for cocaine exposure. About 20% of them displayed poor,
So, there obviously are complications disorganized quality of movement, AIA: Have you been able to isolate the
during pregnancy related to poor pre- which was comparable to what we saw effects of methamphetamine from those
natal care and pre-term birth that in the crack cocaine exposed group in caused by other substances (e.g., tobacco,
our clinic. alcohol)?
necessitate a close follow-up of the
pregnancies complicated by metham-
phetamine use. DR. SHAH: The meth using population
AIA: How do other outcomes for meth does not exclusively use methampheta-
exposed children compare to outcomes mine during pregnancy. About 60% of
AIA: What about the key findings for for children exposed to cocaine? the women in our clinic population
children? who use methamphetamine also use
DR. SHAH: Overall, the developmental marijuana and alcohol, and nicotine is
DR. SHAH: In our population, 19% of screening outcomes for meth exposed used about 80% of the time. So, a
the children born to meth using moms babies were comparable to crack baby exposed to meth is also likely to
were small for gestational age, and their cocaine exposed babies. Both groups, be exposed to alcohol, nicotine, and
head size was also small. This is also in the first 5 years of life, had an marijuana. And this is an important
noted in the prospective, four-site abnormality or delay in one of the four finding, because when we are seeing
Infant Development, Environment and main domains—gross motor, fine signs and symptoms in these children,
Lifestyles (IDEAL) Study. It is impor- motor, language, and social skills—at how sure are we that these symptoms
tant to remember that a baby exposed any given time. In the speech and lan- are related to methamphetamine rather
to methamphetamine may be born guage domain, meth exposed children than other drugs of exposure? We hope
without any symptoms, and no two did better than cocaine exposed chil- that our current prospective study,
children exposed to methamphetamine dren; 57% of the caregivers were con- which has seen and documented these
may look alike. However, there are cerned about behaviors in children trends of substance use, is going to be
noticeable subtle neuro-behavioral who were meth exposed, compared to able to comment on that.
about 64% in the case of children that
symptoms in early infancy. The two
areas that stood out among meth were crack cocaine exposed. Yet, a
exposed babies in our clinic were feed- majority of those behavior concerns fell AIA: How does the timing and pattern
ing difficulties and sleep regulation well within the normal range of the age of maternal methamphetamine use
problems. appropriate behaviors. affect the fetus?
Both meth exposed and cocaine Thus, it is important to note that
exposed infants were prone to sleep the majority of the children exposed to DR. SHAH: In our clinical outcome
problems. However, thirty-four percent either substance achieved their devel- study, we did not quantify the moms’
of the newborns exposed to meth had opmental milestones well within the methamphetamine use. However, we
feeding problems, compared to 9% of normal range. Further, beyond six-to- do know on a case-by-case basis, that if
crack cocaine exposed babies. The eight months of age, meth exposed a mother uses methamphetamine
feeding difficulties were related to children were indistinguishable from throughout pregnancy, it has a greater
coordination problems with sucking the non-drug exposed children. So, impact on the pregnancy outcome.
without a history of substance exposure Having said that, among twin ges-
tations, though both twins were
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T H E S O U R C E , V O L U M E 1 5 , N O . 1 T H E N A T I O N A L A B A N D O N E D I N F A N T S A S S I S T A N C E R E S O U R C E C E N T E R
exposed to the same amount of Among children removed from many parents who are manufacturing
methamphetamine for the same period homes due to parents’ meth use, we see methamphetamine have increasingly
of time, the symptoms were different a large number of delays in social inter- gone out of the home to do so, rather
for each of the twins. Even the level of action and/or language skills. We than making it at home, so the number
methamphetamine tested in the twins’ believe this is related to poor parenting of children living in a home with an
meconium was different, indicating and is similar to earlier studies, in active meth lab has been small in our
that, along with maternal factors, there which other drugs of abuse (including area.
are also fetal factors that determine alcohol) affect a parent’s child rearing In our clinic, other than a few case
how much of the drug is going to pass ability. For instance, a number of meth reports of children who accidentally
through the placenta and how the exposed children in our practice have got into methamphetamine, we haven’t
fetus’s body is going to metabolize the been diagnosed with attention deficit seen symptomatic children from resid-
drug. The history of exposure to all disorder, depression, reactive attach- ing in a home where meth is or was
drugs, not just methamphetamine, also ment disorders, disobedient-defiant being produced. However, we have
is relevant, because it will have an disorder, or obsessive-compulsive disor- seen about 220 children from homes
impact on infant outcome, especially der. School absenteeism also is signifi- where parents were meth users. The
on fetal growth. cant in this population. Basically, these medical effects of this passive exposure
children have lived in an environment still need to be analyzed statistically,
without adult supervision or structure, and The National Drug Endangered
AIA: Has a positive home environment and with a lack of boundaries. They Children’s medical group is collecting
been found to mediate the effect of have been functioning as independent the information for consensus recom-
prenatal methamphetamine exposure on adults and caregivers, at the cost of mendations. But our clinic has not
the child? foregoing important developmental seen acute toxicity in children living in
tasks of childhood. These difficulties the home where parents are smoking
DR. SHAH: By far, the most devastating persist even after children are placed in meth.
effects in our clinical experience have foster or adoptive homes. In spite of As previously mentioned, the pri-
been on children who are continuously normal cognitive ability, environmental mary effect that we’re seeing is neglect.
in an environment complicated by exposure to drugs, violence and abuse These children depend upon their own
ongoing substance abuse. The majority will effect the child’s academic and resources to take care of themselves.
of these children experience neglect social functioning. We see five, six, seven, and eight-year-
because of poor home environment The IDEAL prospective research is old children who have not only to take
conditions, poor quality of parenting, looking more closely at the home envi- care of themselves and their younger
and lack of supervision. Many suffer ronment. Although the data are not yet siblings, but also act as primary care-
from nutritional neglect. In the state of compiled, we hope to learn more about giver for their parents who are not able
Iowa, 12% of child maltreatment its impact from this study. to take care of themselves under the
reports are a direct result of mom’s influence of drugs. Also, many children
methamphetamine use. Whereas most are exposed to inappropriate material
of the physical abuse cases involve a AIA: What are the principal medical in these homes. Almost universally,
father’s methamphetamine use, the vast effects on young children who have some exposure to pornography has
majority of the founded cases are due resided in homes where meth is being been experienced by these children.
to neglect, primarily from maternal produced? So, sexual exploitation issues are more
meth use. In our clinic population, common than the traumatic sexual
78% of the children will be placed in DR. SHAH: Since Iowa enacted a pseu- abuse of children.
out-of-home care—with family mem- doephedrine control law in May 2005,
bers or foster care—by the time they we have seen a significant (80%)
are two years of age. This has created a decrease in the number of metham- AIA: What kinds of interventions have
strain on the foster care system and an phetamine labs. But, for the 10 years you found effective in treating infants
increase in “children in need of assis- before that, the state of Iowa was in the who were prenatally exposed to
tance” proceedings in the Juvenile top three in the nation for the number methamphetamine?
Court system. of meth labs discovered. However,
Continued on page 10 . . .
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Continued from page 9 . . .
Starting at 12 months, we also
DR. SHAH: The primary interventions have all parents include sign language AIA: What do you believe are the most
that we are utilizing in our clinic are for enhancing communication between compelling research and policy questions
directed towards education of care- the child and the parent. This works that should be addressed regarding
givers in understanding and managing wonders for temper tantrums when the infants exposed to methamphetamine?
subtle behavioral symptoms in meth child is two and three years of age, par-
exposed infants. These include calming ticularly when they do not have ade- DR. SHAH: Substance abuse is a com-
interventions, such as infant massage to quate language to express their emo- plex health and social issue. In the
help calm the infant and enhance tions. This intervention is not specific public policy arena, a need to find a
bonding, and caregiver education to: for drugs exposed infants; all children quick fix often undermines treatment
(1) understand infants’ need for social can benefit from early sign language and rehabilitative efforts. Funding for
interaction without over stimulation; implementation. treatment programs for women falls
(2) recognize signs of stress in infants For older children, if there is a short of the need for extended residen-
and implement soothing interventions; diagnosis of hyperactivity and/or other tial treatment programs for women and
(3) help the infant achieve sleep regula- underlying mental health disorders, of children. Lack of available treatment
tion by providing consistency in daily course, I refer to the appropriate psy- facilities, coupled with the eagerness to
routines; and (4) address feeding diffi- chologist for neuropsychological evalu- protect the child from harm, often
culties, which may include special ations and then to the psychiatrist for results in placement of the child in out
feeding practices and/or referral to an medical management of the disorder. of home placement. Children with
occupational therapist or feeding spe- behavioral issues often experience mul-
cialist. Additionally, a speech therapist tiple placements, leading to multiple
is often needed to help with oral motor AIA: To what degree do you believe that co-morbidities for the vulnerable child.
function difficulties. The most impor- pediatricians and other medical profes- Substance abuse in pregnant
tant intervention is to reassure the sionals are getting information that is women has, at times, caused criminal
caregiver that the infant will achieve being published now regarding the pre- proceedings against the mother. Such
normal development and that symp- vention, identification and treatment of actions cause more harm than benefit
toms noted in infancy do resolve with- meth exposed infants and children? to the woman and her child. On the
out long lasting effects. research front, we obviously need
Sometimes parents who are still DR. SHAH: Adequate experience in prospective research on long term out-
struggling with their own substance issues related to substance abuse is not comes of both prenatal and environ-
abuse can be very abrupt, and they are addressed in physicians’ training. For mental exposure to methamphetamine.
hyper themselves, so they do not read issues related to meth abuse by preg- We also must address medication needs
the children’s cues very well. So, work- nant women and its impact on child for children with behavioral disorders,
ing with the parent to understand the health, there are limited research data who have been prenatally exposed to
nonverbal cues that the infant is giving available to clinicians. Statistically meth. None of the drugs currently
is very important, along with providing sound, well controlled prospective used for this purpose have ever been
consistency in the daily routine so that research takes a long time to produce studied in this population.
we have a schedule for feeding, bed data, and we are always lagging behind In conclusion, I would like to add
time, nap time and daily infant mas- the urgent need on the clinical side. that we do not need to reinvent the
sage. Preliminary data from the IDEAL wheel in providing for the needs of
For children who have muscle research group was presented at the pregnant women and their children
tone issues—most commonly increased Pediatric Research meeting in 2004, in who are affected by methamphetamine
muscle tone—significant enough that multiple poster presentations. use. As a group, meth exposed children
we are worried about the child achiev- Maternal and Child Health Journal and are similar to children exposed to other
ing developmental milestones, we will Pediatrics Journal also have accepted drugs. Their problems are fixable and
refer them to early intervention services articles for publication by Dr. Arria short lived. Overall, environmental fac-
for effective range of movements, phys- and Dr. Smith. We hope to see an tors contribute much more than prena-
ical therapy, and occupational therapy. interest in many more publications on tal drug exposure to the child’s devel-
However, the number of infants requir- this important subject. opmental outcomes.
ing such interventions is small.
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T H E S O U R C E , V O L U M E 1 5 , N O . 1 T H E N A T I O N A L A B A N D O N E D I N F A N T S A S S I S T A N C E R E S O U R C E C E N T E R
OXYCONTIN® ABUSE IN WOMEN:
IMPLICATIONS FOR PREGNANCY
Individuals can develop dependence (2.5 to 10 mgs) and in combination Blue. OxyContin® can be expensive
on many substances ranging from licit with other analgesics (e.g., acetamino- when purchased illegally ($20-$40 per
drugs (e.g., alcohol and tobacco), to phen) (www.justfacts.org). tablet). Like heroin and other opiate
prescription drugs, to illicit drugs such When OxyContin® was first narcotics, OxyContin® can cause phys-
as opiates. While opiate dependence approved by the Food and Drug ical and mental impairment. Side
traditionally has been equated with Administration in 1995, many saw it effects may include respiratory depres-
heroin addiction, it also includes abuse as a “miracle drug” and sales skyrocket- sion, headaches, dizziness, seizures,
of prescription opiates. In particular, ed. By 2001, OxyContin® was the low blood pressure and nausea
OxyContin®, a widely-prescribed most frequently prescribed, brand (Rischitelli & Karbowicz, 2002). With
opiate analgesic, has received intensive name narcotic medication for treating overdose comes the risk of death, as
media attention in recent years. The moderate-to-severe pain. Subsequent OxyContin® can produce cardiac arrest
purpose of this article is to: a) describe experience has found that OxyContin® or slowed breathing, especially if the
what we currently know about is a controlled substance with high individual ingested crushed tablets.
OxyContin® abuse; b) describe the abuse potential. This is because oxy-
epidemiology of OxyContin® use, codone has pharmacological properties
abuse and dependence, with a particu- similar to those of heroin, and individ-
lar focus on women; and c) discuss the uals prone to addiction found ways to Epidemiology
unique challenges presented by defeat the slow time-release mechanism
OxyContin® use during pregnancy and in OxyContin® tablets. Those who In recent years, considerable attention
the implications for treatment of this misuse OxyContin® typically do so in has been paid to the non-medical use
new form of opiate dependence. one of three ways: (1) chewing the of OxyContin® and other oxycodone-
tablets; (2) crushing pills into a fine containing analgesic medications (e.g.,
power, which they snort; or (3) dissolv- Miller and Greenfield, 2004).
ing the tablets in water and then inject- According to the National Survey on
What is OxyContin®? ing the solution. All three methods Drug Use and Health (NSDUH), life-
lead to rapid, rather than slow, release time prevalence of nonmedical use of
OxyContin® is a high potency, con- of oxycodone, delivering the full 12 oxycodone increased significantly from
trolled release pain reliever. The active hour dose almost immediately after 11.8 million users (5%) in 2002 to
ingredient in OxyContin® is oxy- ingestion (GAO, 2003). 13.7 million users (5.8%) in 2003.
codone, a semi-synthetic morphine Why do people abuse Oxy- During this same time period, the
derivative that is also the active ingredi- Contin®? First, as a physically addic- prevalence of lifetime heroin use
ent in a variety of prescription pain tive drug, it has abuse potential in its remained relatively unchanged (1.6%).
relief medications (e.g., Tylox®, own right. Second, those who alter To examine the epidemiology of
Percocet®). Medically, OxyContin® is how it is administered do so to achieve non-medical opiate use, NSDUH
used to treat moderate to severe pain, a euphoric high similar to that of hero- compared Americans who had used
chronic pain syndromes, and terminal in. Third, some people, particularly only oxycodone to those who had used
cancers (Inciardi & Goode, 2003), and those who are already opiate depend- only heroin and those who had used
is marketed in a 12-hour time-release ent, use it to control withdrawal symp- both oxycodone and heroin in their
toms when heroin or other alternative
formula at doses ranging from 10 to 80 lifetime. Oxycodone-only users were
mg. Other pain medications (e.g., drugs are unavailable. significantly younger than members of
Percocet®, Percodan®) also contain OxyContin® is known by a num- the other two groups. There were more
oxycodone, but at much lower doses ber of street names including Oxy,
OC, Kickers, Hillbilly Heroin, and Continued on page 12 . . .
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T H E S O U R C E , V O L U M E 1 5 , N O . 1 T H E N A T I O N A L A B A N D O N E D I N F A N T S A S S I S T A N C E R E S O U R C E C E N T E R
Continued from page 11 . . . distributed across the country. Rather, to be prescribed narcotic analgesics
it seems to be particularly acute in (Simony-Wastila, Ritter, and Strickler,
female oxycodone-only users (43.7%) more rural areas of such states as 2004). This information aligns with
than female heroin and oxycodone and Maine, West Virginia, Virginia, and clinical experiences of many addiction
female heroin-only users (31.1 % and Eastern Kentucky (Davis, et al, 2003; medicine physicians who find pain
30.7%, respectively). Oxycodone only Hayes, 2004; Inciardi & Goode, medications are most commonly
(91.3%) and heroin and oxycodone 2003). The nature and extent of the abused by women, with benzodi-
(90.6%) users were predominantly problem can be illustrated by the fol- azepines a close second (Martha
Caucasian, while heroin only users lowing example where, in the first six Wunsch, personal communication,
were more diverse (65.7% Caucasian,
months of 2001, one Eastern Kentucky 2006).
26.8% African American, and 7.5%
drug treatment program reported
other race/ethnicity). Finally, lifetime over 40% of its admissions to be
heroin-only users were more likely than OxyContin®-related. Inciardi and
members of the other two groups to Goode (2003) found that Kentucky Women and Opiate
report a past year family income of less had some of the highest rates of Dependence
than $20,000. ®
OxyContin related crimes in the
The NSDUH report also exam- United States, and that the number of
ined the extent to which lifetime users Women of childbearing age make up a
of these substances met diagnostic cri- patients statewide who sought treat- large proportion of the opioid depend-
teria for abuse or dependence in the ment for oxycodone addiction ent population. Approximately five-to-
past 12 months. Rates of drug depend- increased 163% between 1998 and ten thousand infants are born to opioid
ence were highest among those who 2000. dependent women each year (NIDA,
1996). However, these numbers are
used both oxycodone and heroin
(16.1%), followed by those who used likely gross underestimates, due to bias-
oxycodone alone (7.2%) and finally es in both maternal reporting of drug
heroin only (4.0%) in their lifetime. Women and Prescription Drug use, and drug screening practices
The impact of prescription opiate Use and Abuse employed by health care professionals
(Robins & Mills, 1993; Norton-Hawk,
use on opiate abuse and dependence is
evident in the tracking of drug-related Several factors make abuse of prescrip- 1997). Further, perinatal opioid use
emergency room visits. Drug Abuse tion drugs a particular concern among may go undetected in many women
Warning Network (DAWN) data women. While studies report similar who chose to forego treatment.
found that from 1995 (when rates of non-medical use of prescrip-
OxyContin® was first introduced to tion drugs in men and women, women
the market) to 2002, oxycodone- are more likely than men to abuse psy-
related emergency department visits chotherapeutic drugs (e.g., pain killers, OxyContin® and Pregnancy
increased by 560% (SAMHSA, 2003). tranquilizers, sedatives, stimulants)
The implications can also be seen (Cafferata & Meyers, 1990; Simoni- To date, no systematic studies of
within the alcohol and drug abuse Wastila, Ritter, and Strickler, 2004). In OxyContin® use during pregnancy
treatment community. SAMHSA’s fact, a recent study by Simoni-Wastila have been reported in the research lit-
Drug and Alcohol Services Information and colleagues (2004) found that, even erature. Instead, practitioners must rely
System (DASIS) found that treatment after controlling for a number of fac- upon anecdotal impressions and case
admission rates for controlled narcotics tors, women were at increased risk for reports as well as what is known about
more than doubled between 1992 non-medical tranquilizer and narcotic opiate dependence in pregnancy.
and 2000. (SAMHSA, 2004). This rise analgesic use. This may be due partial- Pregnancies of opioid-dependent
in narcotic abuse has been attributed ly to the fact that women are more women are often associated with a host
specifically to the development of likely than men to be prescribed drugs of medical problems, including an ele-
powerful new painkillers, such as with higher abuse potential, such as vated risk for obstetric complications
OxyContin® (CSAT, 2001). narcotics (e.g., oxycodone) and anti- such as toxemia, maternal syphilis,
OxyContin’s slang name (e.g., anxiety medications (e.g., benzodi- hepatitis, premature labor, intrauterine
“hillbilly heroin”) speaks to the fact azepines). It has been estimated that death, eclampsia, pre-eclampsia, gesta-
that abuse of the drug is not evenly women are 33% more likely than men tional diabetes, and anemia (Hans,
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T H E S O U R C E , V O L U M E 1 5 , N O . 1 T H E N A T I O N A L A B A N D O N E D I N F A N T S A S S I S T A N C E R E S O U R C E C E N T E R
1989, Finnegan 1991, Finnegan, many such programs are no longer in methadone treatment generally appear
1982). Many of these medical prob- operation, and fewer services currently to fare better than heroin exposed
lems appear to be an indirect effect of are available for this high-risk popula- infants, demonstrating superior birth
the lifestyle associated with illicit drug tion of women (Jansson et al., in outcomes (e.g., birth weight, head cir-
use, including poor nutrition, lack of press). cumference, estimated gestational age
medical/prenatal care, needle use, and (EGA) at delivery), and reduced mor-
domestic violence/victimization. tality (Kaltenbach & Finnegan, 1987;
Few heroin dependent women Olofsson et al., 1983).
receive adequate medical and prenatal PHARMACOTHERAPY (OPIOID A cause for concern with regard
care for a number of reasons, including SUBSTITUTION) to maternal methadone maintenance is
lack of pregnancy recognition, limited the increased incidence and severity of
access to services, no medical coverage, Since it was first introduced in 1965, neonatal withdrawal/abstinence syn-
and preoccupation with drug use methadone has been the preferred drome (NAS) in methadone exposed
(Hans, 1989; Wilbourne, Wallerstedt, treatment alternative for medical man- infants. Results of a recent literature
Dorato, & Curet 2001). Thus, these agement of opioid dependence, and it review indicate that between 60%-87%
women often present for care either is the only pharmacotherapy approved of methadone exposed infants require
very late in pregnancy, or unregistered for use in treatment of perinatal opioid treatment for NAS, and up to 30% are
with the health care system at the time addiction in the United States. admitted to the Neonatal Intensive
of delivery. This inadequate attention Methadone is a long-acting (approxi- Care Unit (Johnson, Jones, and
to prenatal health may ultimately result mately 20-30 hours) synthetic opiate Fischer, 2003). Further, methadone
in obstetrical, delivery, and/or medical agonist (Dole & Nyswander, 1965). exposed infants often demonstrate
complications for both the mother and When properly prescribed, methadone higher rates of individual withdrawal
infant. While less is known about effectively prevents the symptoms of symptoms, increased severity, and
OxyContin®, anecdotal reports suggest opiate withdrawal without producing delayed onset, longer duration of
similar factors may be operating for intoxication (Kaltenbach and symptoms, and longer need for treat-
women who abuse this drug. Finnegan, 1992). Advocates of ment in comparison with other opioid
methadone therapy have long touted exposed infants (Stimmel &
the advantage of methadone over drug- Adamsons, 1976; Luty, Nikolaou, and
free abstinence based treatment in its Bearn, 2003; Johnson, Greenough, &
Treatment of opiate utility as a tool to allow treatment Gerada, 2003). While methadone
abuse/dependence providers ongoing contact with indi- treatment has been provided to
viduals in recovery, as participants OxyContin® dependent non-pregnant
While no systematic studies have been must come to clinics daily to receive individuals in a variety of settings (e.g.,
their medication (Svikis et al., 1997). Times Argus, March 22, 2006), little is
conducted in relation to perinatal
OxyContin® dependence, it is likely Additional benefits of properly man- known about the relative risks and
that pregnant and parenting women aged methadone treatment include the benefits of methadone treatment for
dependent upon OxyContin® would elimination of drug cravings and signs perinatal OxyContin® dependence.
benefit from the same types of services of withdrawal, removing individuals Buprenorphine, a partial opioid
as other opiate dependent women. from the dangers associated with illicit agonist, appears to be a promising
This includes gender specific treatment drug use (e.g., crime, violence, prosti- alternative to methadone treatment for
programs that meet the special needs of tution, etc.), and providing links to opioid dependence. While a relative
medical and social services within their newcomer in the United States, over
women (e.g., childcare, mental health
care, housing, transportation, medical community. 55,000 individuals have been treated
and prenatal care, psychosocial and While not without controversy, with buprenorphine in France since
behavioral issues, socioeconomic con- many believe methadone maintenance 1996. Initial studies have indicated
cerns, legal and custody issues, and is the treatment of choice for pregnant that buprenorphine effectively elimi-
short-term and long-term planning for opiate dependent women as well. In nates drug cravings, and allows individ-
the care of the mother and her studies conducted within the context uals to experience little or no signs of
child(ren)) (Puentes, 2000). With the of clinical care, infants born to opioid withdrawal upon cessation of treatment
advent of managed care, however, dependent women participating in
Continued on page 14 . . .
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Continued from page 13 . . . REFERENCES dependence on Hydrocodone and Oxycodone.
American Journal of Therapeutics, 11, 26-32.
(Johnson, Jones & Fischer, 2003). Cafferata, G.L, & Meyers, S.M. (1990). Myers, B., Britt, G. C., Lodder, D. E.,
However, buprenorphine has only Pathways to psychotropic drugs. Understanding the Kendall, K.A., Williams-Peterson, M.G. (1992).
basis of gender differences. Medical Care, 28(4), Effects of Cocaine Exposure on Infant
recently received FDA approval for gen- 285-300. Development: A Review. Journal of Child and
eral treatment of opiate dependence, and Center for Substance Abuse Treatment. Family Studies, 1(4), 393-415.
has only recently been approved as an (2001). OxyContin: Prescription drug abuse National Institute on Drug Abuse (1996).
(DHHS Publication No. SMA 02-3636), Rockville, National Pregnancy and Health Survey, (NIH
investigational drug to treat opiate MD: CSAT. Publication No. 96-3819). Rockville, MD:
dependence in pregnant women. For Davis, MP., Varga, J., Dickerson, D., Walsh, National Institutes of Health.
now, methadone continues to be the D., LeGrand, S.B., & Lagman, R. (2003). Normal- Norton-Hawk, M. (1997). Frequency of pre-
pharmacotherapy of choice in treating release and controlled-release oxycodone: pharmaco- natal drug abuse: Assessment, obstacles, and policy
kinetics, pharmacodynamics, and controversy. implications. Journal of Drug Issues, 27(3), 447-462.
pregnant opioid dependent women. Supportive Care in Cancer, 11(2), 84-92. Olofsson, M., Buckley, W., Andersen, G.E.,
Dole, V. P. & Nyswander, M. (1965). & Friis-Hansen, B. (1983). Investigation of 89
Rehabilitation of patients on methadone programs. children born by drug-dependent mothers. Acta
Proceedings of the National Conference on Methadone Paediatrica Scandinavica, 72, 403-406.
Treatment, 1, 1-7. Puentes, A.J. (2000). System responses to
Summary Finnegan, L.P. (1982). Outcome of children perinatal addiction. Pregnancy and Exposure to
born to women dependent upon narcotics. Advances Alcohol and Other Drugs (DHHS Publication No.
OxyContin® is a high-potency, con- in Alcohol & Substance Abuse, 1(3), 55-101. SMA 93-2040, pp. 7-45). Rockville, MD: US
Finnegan, L.P. (1991). Treatment issues for Department of Health and Human Services.
trolled-release pain reliever. Once touted opioid-dependent women during the perinatal peri- Rischitelli, D.G., Karbowicz, S.H. (2002).
as a “wonder drug” for chronic pain od. Journal of Psychoactive Drugs, 23(2) , 191-201. Safety and efficacy of controlled-release oxycodone:
patients, OxyContin® is now viewed by Government Accounting Office (GAO) a systematic literature review. Pharmacotherapy 22,
(2003). Report to Congressional Requesters: 898-904.
many as a medication with high poten- Prescription Drugs: OxyContin abuse and diversion Robins, L.& Mills, J. L. (1993). Effects of in-
tial for abuse, particularly among indi- and efforts to address the problem, Washington, DC. utero exposure to street drugs. American Journal of
viduals with a history of alcohol or other Hans, S. (1989). Developmental consequences Public Health, 82(12), 247-261.
drug problems. This is of particular con- of prenatal exposure to methadone. Annals of the Simoni-Wastila, L., Ritter, G., & Strickler, G.
New York Academy of Sciences, 562, 195-207. (2004). Gender and other factors associated with
cern for women, who are much more
Hays, LR. (2004). A profile of OxyContin the nonmedical use of abusable prescription drugs.
likely than men to be prescribed narcotic addiction. Journal of Addictive Diseases, 23(4), 1-9. Substance Use and Misuse, 39(1), 1-23.
analgesics. OxyContin® use among Inciardi, J.A. & Goode, J.L. (2003). Stimmel, B., & Adamsons, K. (1976).
women of childbearing age adds the OxyContin and prescription drug diversion. Narcotic dependency in pregnancy: Methadone
Consumer Research, July, 22-25. maintenance compared to use of street drugs.
additional concern of pregnancy com- Jannson, L., Svikis, D., Jones, H., & Velez, M. JAMA, 235(11), 1121-1124.
plications. While little is known about (in press). Impact of managed care on treatement for Substance Abuse and Mental Health Services
the maternal and fetal impact of drug dependent women and their children. Administration (2004). Results from the 2002
OxyContin® use during pregnancy, Substance Use and Misuse. National Survey on Drug Use and Health: National
Johnson, K., Greenough, A., & Gerada, C. Findings (DHHS Publication No. SMA 03-3836),
there are certainly many adverse conse- (2003). Maternal drug use and length of neonatal Rockville, MD: US Department of Health and
quences associated with the use of other stay. Addiction, 98, 785-789. Human Services.
opiate analgesics during the perinatal Johnson, R. E., Jones, H. E., & Fischer, G. Substance Abuse and Mental Health Services
period. Until more is known about (2003) Use of buprenorphine in pregnancy: patient Administration Drug Abuse Warning Network.
management and effects on the neonate. Drug and (2003). Emergency Department Data from the Drug
OxyContin® use during pregnancy, Alcohol Dependence, 70, S87-S101. Abuse Warning Network Final Estimates 1995-2002.
physicians and other health care Kaltenbach, K., & Finnegan, L.P. (1987). (DHHS Publication No. SMA 03-3780). Rockville,
providers are encouraged to use caution Perinatal and developmental outcome of infants MD: US Department of Health and Human
when prescribing the medication to a exposed to methadone in-utero. Neurotoxicology and Services.
Teratology, 9, 311-313. Svikis, D. S., Lee, J. H., Haug, N. A., &
pregnant woman. Kaltenbach, K. A., & Finnegan, L. (1992). Stitzer, M. L. (1997). Attendance incentives for out-
Prenatal opiate exposure: Physical, neurobehavioral, patient treatment: Effects in methadone and non-
Dace S Svikis, Ph.D., and developmental effects. In M. W. Miller (Ed.), methadone-maintained pregnant drug dependent
Development of the Central Nervous System: Effects of women. Drug & Alcohol Dependence. Vol 48(1),
Lori Keyser-Marcus, Ph.D.,
Alcohol and Opiates (pp 37-46). Iowa City, Iowa: 33-41.
Benita Panigrahi, John Wiley and Sons. Wilbourne, P., Wallerstedt, C., Dorato, V., &
Virginia Commonwealth University, Luty, J., Nikolaou, V., & Bearn, J., (2003). Is Curet, L. B. (2001). Clinical management of
Richmond VA; and opiate detoxification unsafe in pregnancy. Journal of methadone dependence during pregnancy. Journal
Substance Abuse Treatment, 24, 363-367. of Perinatology Neonatal Nursing, 14(4), 26-45.
Martha J Wunsch, MD FAAP,
Miller, N.S. & Greenfield, A. (2004). Patient
Virginia College of Osteopathic Medicine, characteristics and risk factors for development of
Charlottesville VA
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T H E S O U R C E , V O L U M E 1 5 , N O . 1 T H E N A T I O N A L A B A N D O N E D I N F A N T S A S S I S T A N C E R E S O U R C E C E N T E R
OXYCONTIN® : WHAT DO WE KNOW ABOUT
ITS IMPACT ON INFANTS?
Nationally, non-medical use of effects on the human fetus or neonate illicit substance abuse during pregnan-
OxyContin® and other prescription without causing malformations. These cy. However, neonatal urine specimen
pain relievers has steadily increased effects may be reversible (Micromedex, is indicative of only a short duration of
over the last decade. Although the 2006). intrauterine exposure and maternal
overall number of users remains very Use of oxycodone during or prior drug use. Meconium, the initial stools
small compared to many illicit drugs, to labor can result in longer duration passed by newborn infants, can detect
particularly among pregnant women, of labor by decreasing the strength, exposure as long as 20 weeks prior and
hospitals in certain parts of the country duration and frequency of uterine con- should, therefore, be used in addition
have seen an increase in the number of tractions. Additionally, oxycodone to urine specimens (Beauman, 2005;
newborns experiencing withdrawal crosses the placenta and, like other opi- Baldacci et al., 2004).
from prenatal exposure to it. This arti- ates, can cause adverse fetal affects that We have found that OxyContin®
cle provides information about the include physical dependence and with- is not detected by routine tests (Rao &
potential impact of prenatal exposure drawal, growth retardation and respira- Desai, 2002), which can result in
to OxyContin® on infants; and strate- tory depression in the newborn infant under diagnosis. Therefore, confirma-
gies for diagnosing, monitoring and (Micromedex, 2006). Therefore, tory tests like gas chromatography-
treating infants who have been prena- although no causal link has been estab- mass spectroscopy (GC-MS) are rou-
tally exposed. lished with its use and teratogenicity tinely required to confirm the presence
(i.e., developmental malformations) in of oxycodone and its metabolites,
animal experiments, it, like other opi- noroxycodone and noroxymorphone
ates is still not recommended for use in (Le et al., 2005; Meatherall, 2005).
Use of OxyContin® in pregnancy. Other confirmatory tests include high
pregnancy, labor, and lactation Additionally, the oxycodone performance liquid chromatography
metabolite, noroxycodone, has been (HPLC) and capillary electrophoresis
detected in breast milk in low concen- (CE) (Cheremina et al., 2005; Baldacci
Oxycodone has been labeled as a cate-
trations. Because of the possibility of et al., 2004). However, these latter tests
gory B drug by the United States
sedation and respiratory depression in are not routinely available and are also
Federal Drug Administration and as
the nursing infant, caution should be expensive.
category C by the Australian Drug
exercised in administration of oxy- Additional methods have been
Evaluation Committee’s. Category B
codone to the mother. There have also developed more recently for detection
means that either (1) animal-reproduc-
tion studies have not demonstrated a been rare reports of excessive sleepi- of oxycodone and its metabolites in
ness, lethargy, and withdrawal symp- urine, blood and meconium. The
fetal risk, but there are no controlled
toms in breast-feeding infants when Oxycodone Direct Immunoassay Kit
studies in pregnant women, or (2) ani-
maternal administration is discontin- (Pomona, CA) can detect oxycodone
mal-reproduction studies have shown
ued (Micromedex, 2006). but has 30-35% cross reactivity to oxy-
adverse effects (other than a decrease in
morphone, codeine and hydrocodone.
fertility) that was not confirmed in
controlled studies in women in the first A modification of this assay for use on
meconium specimens (with additional
trimester, and there is no evidence of a
risk in later trimesters. Category C Diagnosis pretreatment to decrease cross reactivi-
ty) has allowed the detection of oxy-
includes drugs that, owing to their
pharmacological effects, have caused or Most hospitals utilize maternal and codone at concentrations of 100ng/g of
may be suspected of causing harmful neonatal urine specimens to detect
Continued on page 16 . . .
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T H E S O U R C E , V O L U M E 1 5 , N O . 1 T H E N A T I O N A L A B A N D O N E D I N F A N T S A S S I S T A N C E R E S O U R C E C E N T E R
Continued from page 15 . . . 2006). Importantly, the timing and neonatal mortality, sudden infant death
severity of the withdrawal symptoms syndrome (SIDS), and abnormal long
meconium (Le et al., 2005). Recently, depends on the dosing and duration of term developmental outcomes
another immunoassay (DRI® opiate exposure in pregnancy. For (Osborn, Jeffery, & Cole, 2005a;
Oxycodone Assay) has been developed example, withdrawal from methadone Beauman, 2005).
that detects oxycodone in urine with (an opiate used to treat mothers addict-
97.7% sensitivity and 100% specificity ed to drugs like OxyContin®) occurs
at cutoff concentrations of 300ng/ml later than that from heroin and is usu-
with no significant cross reactivity with ally more severe. However, while most Monitoring of withdrawal
other opiates (Abadie et al., 2005). women cut back on alcohol, tobacco
symptoms
Another sophisticated method called and drug abuse when they find out
capillary electrophoresis-multiple stage they are pregnant, there is very little
ion-trap massspectrometry (CE-MS) data on patterns of OxyContin® use Objective scoring systems have been
and computer simulation has been during pregnancy (Ebrahim & developed to monitor infants suffering
developed to detect oxycodone and its Gfroerer, 2003). from withdrawal symptoms. These
metabolites and has even resulted in scoring systems provide an objective
Commonly seen clinical signs fol- assessment of the infant’s condition
detection of a previously unidentified lowing withdrawal from opiates in the
metabolite of oxycodone (Baldacci et newborn infant include increased irri- and are helpful in monitoring and
al., 2004). tability or lethargy, poor feeding, diar- directing therapy. The most commonly
used is the Finnegan Scoring system
rhea, vomiting, excoriating rashes and
that scores (from 0-2) signs and symp-
friction burns secondary to scratching, toms based on observation of the
and fever. There may be poor feeding,
Clinical features in the sleep-wake abnormalities, dehydration, infant over a 2 to 4 hour time period
(Finnegan et al., 1975). These symp-
prenatally exposed poor weight gain and seizures. Seizures
toms include excessive crying, sleeping
newborn infant are usually seen with severe and
difficulties, tremors, skin breakdown,
untreated withdrawal in neonates.
seizures, excessive sweating, poor feed-
Very little data is available to evaluate Seizures also can be precipitated by the ing, vomiting, diarrhea, frequent sneez-
the effect of OxyContin® on pregnan- use of Naltrexone (naloxone) in infants ing or yawning, nasal congestion and
cy or long-term infant development. who have been exposed to opiates dur- fever. A score of 8 or more over an 8
With increasing polydrug abuse, as ing pregnancy. hour period of observation is common-
well as concomitant use of tobacco, Other signs of opiate withdrawal ly used as an indicator for more fre-
alcohol, and psychoactive substances include irritability, yawning, sneezing, quent monitoring and intervention.
prescribed to pregnant women, it is excessive high-pitched crying, increased Other scoring systems include the
becoming increasingly difficult to dif- tone, sensitivity to sound, excessive Lipsitz tool or the Neonatal Drug
ferentiate the effect of any single drug sweating, excessive sucking, poor feed- Withdrawal Scoring System (Lipsitz,
on the newborn infant. However, new- ing, increased tearing, diarrhea and 1975) and the Neonatal Withdrawal
born infants who have intrauterine tremulousness. Typically, neonatal Inventory (NWI) (Zahorodny, 1998).
exposure to OxyContin® are likely to withdrawal occurs within 2 weeks of The Lipsitz tool scores for the follow-
suffer from withdrawal symptoms. birth. Acute symptoms generally last ing symptoms from 0-3: tremors, irri-
First recognized more than 30 from days to weeks, but may persist for tability, stools, muscle tone, skin break-
months.
years ago, neonatal abstinence syn- down, respiratory rate and reflexes.
drome (NAS) is a clinical constellation In the preterm infant, symptoms However, this tool is not as widely
of signs and symptoms in the newborn are generally milder, with alternating used as the Finnegan Scoring system.
infant following intrauterine exposure periods of hyperactivity and lethargy. The NWI tool is similar and has an
to opiates. Up to 90% of infants Tremors are seen less frequently, and infant distress scale in addition.
exposed to opiates during pregnancy sweating, which is common in normal
experience clinical signs of withdrawal term infants with NAS, is not seen in
(Johnson, Gerada & Greenough, 2003; the preterm neonate. In addition,
Beauman, 2005; Sarkar & Donn, infants may be at increased risk of
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T H E S O U R C E , V O L U M E 1 5 , N O . 1 T H E N A T I O N A L A B A N D O N E D I N F A N T S A S S I S T A N C E R E S O U R C E C E N T E R
to use the Finnegan scoring system for
monitoring these infants. Tincture of
Treatment opium or morphine sulfate solution is
IN OUR EXPERIENCE, the most commonly used drugs for
treatment of opiate or polydrug with-
Treatment consists mainly of support- WITHDRAWAL SYMPTOMS drawal. Methadone and Phenobar-
ive care and close monitoring. WITH OXYCONTIN ® bitone were the second most common
Supportive care for these infants should
medications used for opiate or poly-
consist of swaddling, minimal han- ARE SIMILAR TO THAT SEEN
drug withdrawal, respectively (Sarkar
dling, placement in a quiet, low light
IN OTHER INFANTS WITH & Donn, 2006).
environment, and close observation.
Attention should be paid to weight loss OPIATE WITHDRAWAL
by providing small volume, high calo-
rie formula feedings. Many infants WITH NO SPECIFIC
Our experience
have difficulty coordinating sucking DISTINGUISHING
and swallowing and may require gavage
In our experience (unpublished data),
feedings to provide adequate nutrition. FEATURES.
Skin breakdown should be treated with withdrawal symptoms with Oxy-
Contin® are similar to that seen in
barrier creams and clear transparent
other infants with opiate withdrawal
dressings. Knees, elbows, tip of the
nose, and the area around the anal with no specific distinguishing features.
unclear. In general, the use of opiates In the last 3 years at the Kentucky
opening are the most likely areas sub-
or phenobarbitone to treat withdrawal Children’s Hospital in Lexington, KY,
jected to breakdown. Prone sleeping
symptoms, as compared to supportive we have admitted over 70 infants in
should be avoided due to the increased
risk of SIDS. care only, appears to reduce the time to our NICU with withdrawal symptoms
regain birth weight and reduce the following drug abuse during pregnan-
Pharmacologic treatment is usually
indicated for more severe withdrawal. duration of supportive care, but may cy. Eleven (11) mothers admitted to
increase the duration of hospital stay using OxyContin® in addition to other
The American Academy of Pediatrics (Osborn et al., 2005a; Osborn et al., drugs, most commonly other prescrip-
(AAP, 1998) recommends that for
2005b). They also reduce the incidence tion opiates, and 5 of these mothers
infants with confirmed drug exposure,
of seizures compared to phenobarbi- were enrolled in methadone treatment
the indications for drug therapy should tone (Osborn et al., 2005a). There is programs. None of the mothers used
be seizures, poor feeding, diarrhea and
no significant difference in treatment OxyContin® alone. One infant was
vomiting resulting in excessive weight
failure between opiates and phenobar- born to a mother using both metham-
loss and dehydration, inability to
bitone when used alone, yet some stud- phetamine and OxyContin®. Despite
sleep and fever unrelated to infection.
ies have reported the combination of our awareness of the false negative
However, in practice, therapy is usually
tincture of opium and phenobarbitone results of screening, only 3 of the 11
initiated when the Finnegan scores are
to be more efficacious (Beauman, were confirmed to have OxyContin®
over 8 and include symptoms not lim-
2005, Coyle et al., 2002). When com- metabolites in neonatal urine or
ited to those listed above.
pared to diazepam (benzodiazepines), meconium specimens.
There is no optimal drug treat-
opiates reduce the incidence of treat- In our observations, neonatal
ment for withdrawal symptoms. ment failure (Osborn et al., 2005a). withdrawal symptoms from Oxy-
Commonly used medications include
However, use of phenobarbitone and Contin® have occurred in the first
sedatives (e.g., phenobarbital and ben-
other sedatives may impair infants’ 2-3 days and have lasted for as long as
zodiazepines) or other opiates (e.g.,
sucking. There also is long term devel- 30 days. We have used medications in
morphine, tincture of morphine, pare-
opmental concerns associated with pro- only 4 of the 11 infants with history of
goric, or methadone). Table One on
longed use of phenobarbitone OxyContin® exposure. Oral morphine
p. 18 compares the advantages and dis-
(Langenfeld, et al., 2005). sulfate, phenobarbitone and chloral
advantages of the commonly used
medications in the treatment of NAS. In a recent review of practices hydrate were used in our infants for
across the country, most Neonatal
The optimal frequency of drug Intensive Care Units have been shown Continued on page 18 . . .
dosing for symptomatic NAS remains
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T H E S O U R C E , V O L U M E 1 5 , N O . 1 T H E N A T I O N A L A B A N D O N E D I N F A N T S A S S I S T A N C E R E S O U R C E C E N T E R
Continued from page 17 . . .
TABLE 1
Commonly used drugs in the treatment of withdrawal symptoms in newborn infants
ADVANTAGES DISADVANTAGES
PHENOBARBITONE Sedative • No effect on diarrhea
Effective in controlling • Potential for affect on long term development
neurological symptoms • Can depress suck reflex and cause lethargy
and sedation with higher levels
DIAZEPAM Sedative • Can result in respiratory depression if used
with phenobarbitone
• Not effective when used alone
• Risk of seizures due to benzoic acid preservative
• Increased risk of jaundice
• Decreased tone, decreased feeding
METHADONE Effective control of symptoms • Increased hospital stay due to long half life
• Risk of abuse if discharged home on it
TINCTURE OF OPIUM Effective in controlling symptoms • Concentrated solution, may result in overdose
• Contains alcohol
• No effect on diarrhea
ORAL MORPHINE SULPHATE Effective in controlling symptoms • Safer than tincture of opium or paregoric
• Less dosing errors
PAREGORIC Most effective • Has benzoic acid- can result in elevated
Effective in controlling diarrhea bilirubin levels and risk of kernicterus
• Risk of hepatic damage and hypoglycemia due to
45% alcohol content
CHLORPROMAZINE Effective in treating diarrhea and • Long half life
central nervous system symptoms • Increased risk of seizures and blood abnormalities
CHLORAL HYDRATE Sedative • Gastrointestinal irritation
Non specific action
Adapted from Beauman et al., 2005; Johnson, et al., 2003; Osborn et al., 2005a, 2005b; and Langenfeld et al., 2005.
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T H E S O U R C E , V O L U M E 1 5 , N O . 1 T H E N A T I O N A L A B A N D O N E D I N F A N T S A S S I S T A N C E R E S O U R C E C E N T E R
1-5 days. Only one infant was treated increase of more than 40% in the last Neonatal opiate withdrawal in term infants. J
with phenobarbitone alone for 30 days three years, and 5 times higher than Pediatrics 140:561-564.
Ebrahim, S.H. & Gfroerer, J. (2003).
while all others required more than one that reported with methamphetamine Pregnancy-Related Substance Use in the United
medication. We currently have no data (Arnold, 2005). States During 1996–1998. Obstet Gynecol
on the long term affects of These data suggest that Oxy- 101:374–9.
OxyContin® on these infants following Contin® abuse will continue to be a Finnegan, L.P., Kron, R.E., Connaughton,
J.F., Emich, J.P. (1975). Neonatal abstinence syn-
discharge from the hospital. significant health problem and one can drome: assessment and management. Addict Dis Int
anticipate seeing more OxyContin® J 2(1):141-158.
exposed newborn infants. However, it Holstege, C.P., Kell, S., Baer, A.B., Fatovitch,
is important to remember that specific T. (2002). Prevalence of OxyContin Abuse in high
school students. J Toxicol: Clin Tox 40(5):656.
The future testing is required to detect Oxy- Johnson, K., Gerada, C. and Greenough, A.
Contin® and its metabolites. Studies (2003). Treatment of neonatal abstinence syndrome.
OxyContin® use has become increas- are currently ongoing to evaluate the Arch Dis Child Fetal Neonatal Ed 88:F2–F5.
Katz, D.A. and Hays, L.R. (2004). Adolescent
ingly widespread with abuse identified long term effects on infants exposed to OxyContin Abuse. J Am Acad Child Adolesc
in more than 23 states (Rosenberg, OxyContin® during pregnancy. Psychiatry 43(2):231-4.
2004). Non-medical abusers of Langenfeld, S., Birkenfeld, L., Herkenrath, P.,
Rakesh Rao, MD, Muller, C., Hellmich, M. and Theisohn, M. (2005).
OxyContin® have been shown to have Therapy of the neonatal abstinence syndrome with
a severe pattern of abuse characterized Assistant Professor of Pediatrics, and tincture of opium or morphine drops. Drug and
by polydrug use, use of injections and Nirmala S. Desai, MD, Alcohol Dependence 77:31–36.
needles, and high rates of dependence Professor of Pediatrics, Le, N.L., Reiter, A., Tomlinson, K., Jones, J.,
and abuse. In fact, 83% of non-med- Division of Neonatology, University of Moore, C. (2005). The detection of oxycodone in
meconium specimens. J Anal Toxicol 29(1):54-7.
ical OxyContin® users use other drugs Kentucky, Lexington, KY Lipsitz, P.J. (1975). A proposed narcotic with-
or have abused other non-medical pre- drawal score for use with newborn infants. Clinical
scription drugs use prior to using REFERENCES Pediatrics, 14: 592-594.
Abadie, J.M., Allison, K.H., Black, D.A., Micromedex Health Care Systems, Volume
OxyContin®, suggesting that these Garbin, J., Saxon, A.J. and Bankson, D.D. (2005). 127, 2006.
users are “graduating to” using Can an Immunoassay Become a Standard Meatherall, R. (2005). GC–MS Quantitation
OxyContin® (Sees et al., 2005). Technique in Detecting Oxycodone and Its of Codeine, Morphine, 6-Acetylmorphine,
Metabolites? J of Anal Toxicol 29: 825-829. Hydrocodone, Hydromorphone, Oxycodone, and
OxyContin is also the single most Arnold, C. (December 19, 2005). Teen Oxymorphone in Blood. J Anal Toxicol 29:301-308.
commonly abused opioid analgesic Abuse of Painkiller OxyContin on the Rise. All Osborn, D.A., Jeffery, H.E., Cole, M.
among street and recreational drug Things Considered, National Public radio at (2005a). Opiate treatment for opiate withdrawal in
users (Cicero, Inciardi, & Munoz, www.npr.org. newborn infants. The Cochrane Database of
2005). Further, due to its high cost of American Academy of Pediatrics (1998). Systematic Reviews, Issue 3. Art. No.: CD002059.
Neonatal Drug Withdrawal: Committee on Drugs. DOI: 10.1002/14651858.CD002059.pub2.
nearly one dollar per mg or more, Pediatrics 101:1079-1088. http://www.pediatrics. Osborn, D.A., Jeffery, H.E., Cole, M.J.
OxyContin® users are increasingly orgcgi/content/full/101/6/1079 (2005b). Sedatives for opiate withdrawal in newborn
turning to theft and other means to Baldacci, A., Caslavska, J., Wey, A.B., infants. The Cochrane Database of Systematic Reviews,
Thormann, W. (2004). Identification of new oxy- Issue 3. Art. No.: CD002053. DOI:
pay for this addiction resulting in codone metabolites in human urine by capillary 10.1002/14651858.CD002053.pub2.
social and economic downfall (Arnold, electrophoresis-multiple-stage ion-trap mass spec- Rao, R. and Desai, N.S. (2002). OxyContin
2005). trometry. J Chromatogr A 1051(1-2):273-82. and Neonatal Abstinence Syndrome. J Perinatol
OxyContin® abuse and addiction Beauman, S.S. (2005). Identification and 22:324–325.
Management of Neonatal Abstinence Syndrome. Rosenberg, D. (2004). Kentucky’s pain.
has also been increasingly identified in J Infus Nurs 28:159-167. Newsweek, 144(12):44-5.
adolescents and teenagers (Katz and Cicero, T.J., Inciardi, J.A., Munoz, A. Sarkar, S. and Donn, S.M. (2006).
Hays, 2004). More than 9.5% of high (2005). Trends in Abuse of OxyContin and other Management of neonatal abstinence syndrome in
school children reported using opioid analgesics in the United States: 2002-2004. neonatal intensive care units: a national survey. J
® J Pain 6(10):662-72. Perinatol 26:15-17.
OxyContin in a survey in Virginia, Cheremina, O., Bachmakov, I., Neubert, A., Sees, K.L., Di Marino, M.E., Ruediger, N.K.,
and most of these students reported Brune, K., Fromm, M.F., Hinz, B. (2005). Sweeney, C.T., Shiffman, S. (2005). Non-medical
that “it was not at all difficult” to get Simultaneous determination of oxycodone and its use of OxyContin Tablets in the United States. J
OxyContin® (Holstege et al., 2002). major metabolite, noroxycodone, in human plasma Pain & Palliat Care Pharmaco19(2):13-23.
by high-performance liquid chromatography. Bio Zahorodny, W., Rom, C., Whitney, W. et al.
In fact, a recent report on National Chromat 26;19(10):777-782. (1998). The neonatal withdrawal inventory: A sim-
Public Radio highlighted that, in 2005, Coyle, M.G., Ferguson, A., Lagasse, L., Oh, plified score of newborn withdrawal. Dev Behav
5.5% of 12th grade students nation W., Lester, B. (2002). Diluted tincture of opium Pediatr, 19: 89-93.
wide reported using OxyContin®, an (DTO) and Phenobarbital verus DTO alone for
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T H E S O U R C E , V O L U M E 1 5 , N O . 1 T H E N A T I O N A L A B A N D O N E D I N F A N T S A S S I S T A N C E R E S O U R C E C E N T E R
MOMS OFF METH SUPPORT GROUP
Recognizing the importance of gender-specific recovery support for women, the
Moms Off Meth is a self- Moms Off Meth support groups focus on the following 7 issues:
1. Empowerment
help group specifically designed 2. Victimization—helping moms move from victim to survivor by:
• Providing information about domestic violence and sexual assault
to help mothers recover from
• Providing information about addiction and recovery
their addiction to methampheta- • Providing information about effective coping skills
• Helping women to form bonds with other women
mines. Located in Ottumwa, Iowa, 3. Helping women become accountable and responsible for their own actions by:
• Educating about the importance of accountability and responsibility for
it is the first of at least 16 similar
their actions
groups statewide. The group was • Educating about the importance of not taking on others’ responsibilities
• Allowing women to claim the dignity and respect that they deserve
started in 1999 by Ottumwa’s 4. Problem solving techniques
5. Ways to advocate for themselves and other women in the group by:
Crisis Center and Women’s
• Writing their own court reports to supplement the social worker’s report
Shelter to address the pervasive • Guiding them through the court process
• Modeling behavior that is consistent with caring for themselves and other
trauma and victimization issues women
• Using their experiences to help others; pooling their collective wisdom
among these women, particularly
6. Ways to move past the guilt and shame that they feel over their life choices and
issues related to past and/or the things that their children have witnessed
7. Education on how to survive in a sober world
current sexual abuse.
The group, which meets weekly, is co-facilitated by a staff person who is a
domestic violence advocate and, when available, a volunteer who is an experi-
enced member of the group. The lead facilitator receives at least 40 hours of
domestic violence training, which includes group facilitation; 20 hours of sexual
assault training; and a one-to-two day facilitator training. The role of the facili-
tator(s) is to maintain the focus of the group, which is driven by the partici-
pants with no specific curriculum.
The group is ongoing and open-ended. That is, women can start at any
time and stay for as long as they want. Some mothers come to the group volun-
tarily and others are ordered by the courts to attend. As long as they are not
disruptive, women are not required to be clean and sober to attend a meeting.
However, through use of a “group conscience,” participants encourage women
who show up high to seek treatment and come back when they are better able
to participate.
Formal child care is not provided during the group, however, some of the
chapters have volunteers that provide child care. In addition to the weekly
For more information about the group, Crisis Center staff also provides individual counseling, as well as court
Moms Off Meth Group, contact accompaniment for those involved in the child welfare system, and various
the director, Cheryl Brown, at other services.
641-683-1750. Following is the story of one woman who is in recovery from poly-substance
abuse, and currently co-facilitates the Moms Off Meth group in Ottumwa.
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T H E S O U R C E , V O L U M E 1 5 , N O . 1 T H E N A T I O N A L A B A N D O N E D I N F A N T S A S S I S T A N C E R E S O U R C E C E N T E R
ONE WOMAN’S STORY
My name is Leigh Bakker. I am 37 years I went through periods of sobriety over the encouraged to go to a place called The Bridge of
old and have 2 children, Leslie 15 and Tyler 4. I next 6-8 years and then got back into it all over Hope. It was a new treatment facility for women
work for the Crisis Center and Women’s Shelter again. I ended up losing my daughter to my par- and their children. It was long term (4-6 months).
in Ottumwa, Iowa. I have lived in Ottumwa for ents, and then my ex-husband got custody of her. I decided that my children were much more
the majority of my life. I guess you could say After that I went all out again drinking and using. important to me than using drugs, so I voluntary
that I grew up in a traditional, upper middle class I had always held jobs and supported myself. I checked myself in to the Bridge. I cannot say that
family. had several good jobs and ended up screwing I loved every minute of the 5 months and 2 days
I began using alcohol at the age of 15— them up for one reason or another, which I now that I was there, but I do love being clean and
drinking on weekends. My use then progressed know was due to my using. sober today.
to drinking through the week, and I started smok- In 2000, I found out I was pregnant. I was As for making this time different… Well, I
ing pot and cigarettes when I was about 16. I using pretty heavily at the time and quit doing did have 3 years clean, and I know the program
finished high school and went to our area com- everything during my pregnancy but smoking pot. and how it works. I had the opportunity to receive
munity college the summer after graduation and Pot is my drug of choice and, as far as I’m con- those tools when I was 19 years old in my 1st
then in the fall I attended UNI in Cedar Falls. I cerned, it is probably one of the harder drugs to treatment. I relied on those a great deal over the
was there about 2 years when I decided that par- quit. Also, I didn’t really see that smoking pot years, and that is what probably made quitting so
tying was much more fun, so I dropped out and would hurt my child. easy when I did decide to do so. Also, as much
moved back to Ottumwa. I got a job (actually 3 My son tested positive for THC when he as I really hated going into a long-term treatment
jobs) and went back to community college. was born, and we were then involved with what facility, it was the best thing that could have hap-
I began getting involved with cocaine when DHS terms as a CINA (Child In Need Of pened. The 30 day centers barely give you time to
I was about 18 or 19 years old. I was a little Assistance). I had to complete another outpatient get your body rid of the drugs and through the
scared of Meth because I had seen several friends treatment and worked with DHS with their in- majority of after-effects (coming down). I had the
using it, and they were going down hill at a high home providers that came to teach parenting opportunity to basically disappear from the drug
rate of speed. So I just stuck with the cocaine. My skills and other child development tools. I had to world I was living in. People forgot about me, so I
parents were very concerned about my behaviors submit to random UA’s and, after about 18 didn’t have to worry about running into using
and, since we have a history of substance abuse months, the Juvenile Court closed my case. I was friends or just having to distance myself from the
in our family on both sides, they called my uncle doing really well and almost had 3 years clean lifestyle. I had already gotten into a routine, and I
and a recovery friend of his to come down and when I decided to go back out, which brings me was completely substance free. I had a chance to
get me on a planned intervention. They took me to a little over a year ago. My significant other take a good long look at how my life was and
to Forest City Iowa to a treatment facility. This was still using, and I finally just gave up the fight how it had changed, and I was reminded of how
would be the 1st of several treatments I would go with him and with myself and relied on the old much better it was when I wasn’t using. If I had
through in my life. When I left that treatment, I saying, “If you can’t beat them join them!” I got not had the chance to do treatment at the Bridge,
did stay clean for a while. But at 19 years of age, really caught up in the drug scene, and my whole my children would not be with me today, I would
I wasn’t convinced that I had an alcohol or drug life fell apart piece by piece. not be living like I am, I would not have the job
problem. For God’s sakes, I am only 19 years old! DHS showed up at the place I was staying that I do and Love. I get the chance to give back
I was running to bars again, smoking pot, and and said they had a child abuse report for my what has so freely been given to me by all the
doing lots of coke and now meth. son. They would need to remove him from my persons I have met in the recovery program. It
Meth was cheaper and a lot longer buzz for care and place him in foster care until we could has truly saved my life and the lives of my children
the money. I ended up getting pregnant at 20 determine what we would be doing next. I and family. I am very proud to be where I am
years old. I was married and my husband was a ended up working it out with my mother that she today. I am comfortable living in my own skin
severe alcoholic. Things progressively got worse would keep my son and I would go stay with her these days, and I don’t have the total chaos that
during my pregnancy because he refused to quit until his tests came back and we could proceed. came from the drug world I was living before. I
using and drinking. I did the minute I found out I Through a hair analysis, he tested positive for also get to practice my program every day with
was pregnant because I was afraid that I would marijuana, amphetamines and methampheta- the work that I do. It makes a big difference when
hurt my baby. She was born happy and healthy in mines. So he was again placed under a you decide to LIVE THE PROGRAM!!!!!!
July of 1990. I stayed clean for about a year after CINA.They also found out that my daughter was I have been through 5 treatment centers and
I had her. I was working, my husband was rarely living with her father and asked that he bring her have used drugs for over 22 years. I am a survivor
around, and I was busy trying to raise a child on in for a test, which he did, but refused testing of domestic violence and sexual assault. I enjoy
my own. We ended up getting a divorce and, himself. He made no further contact with DHS my job now and none of it would be possible if I
shortly after that, I started using again. I ended and they called me one day to let me know that hadn’t made the choice of LIFE instead of DRUGS!
up at the bars just so I would have adult they were returning her to my custody. I was
companionship. — Leigh
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T H E S O U R C E , V O L U M E 1 5 , N O . 1 T H E N A T I O N A L A B A N D O N E D I N F A N T S A S S I S T A N C E R E S O U R C E C E N T E R
METH SCIENCE NOT STIGMA:
OPEN LETTER TO THE MEDIA
The following was excerpted Despite the lack of a medical or re-incarceration rates and other meas-
from a letter that appeared on the Join scientific basis for the use of such terms ures of outcome, in several recent stud-
Together website on July 25, 2005. as “ice” and “meth” babies, these pejora- ies indicate that methamphetamine
The original letter, along with a complete tive and stigmatizing labels are increas- users respond in an equivalent manner
list of the nearly 100 professionals who ingly being used in the popular media, as individuals admitted for other drug
signed it, can be found on-line at in a wide variety of contexts across the abuse problems. Research also suggests
http://www.jointogether.org/news/ country. Even when articles themselves the need to improve and expand treat-
yourturn/commentary/2005/meth- acknowledge that the effects of prenatal ment offered to methamphetamine
science-not-stigma-open.html. exposure to methamphetamine are still users.
unknown, headlines across the country Too often, media and policymak-
are using alarmist and unjustified labels ers rely on people who lack any scien-
To Whom It May Concern: such as “meth babies.” tific experience or expertise for their
Although research on the medical information about the effects of prena-
As medical and psychological
and developmental effects of prenatal tal exposure to methamphetamine and
researchers, with many years of experi-
methamphetamine exposure is still in its about the efficacy of treatment. For
ence studying prenatal exposure to psy-
choactive substances, and as medical early stages, our experience with almost example, a New York Times story about
20 years of research on the chemically methamphetamine labs and children
researchers, treatment providers and
related drug, cocaine, has not identified relies on a law enforcement official
specialists with many years of experi-
a recognizable condition, syndrome or rather than a medical expert to describe
ence studying addictions and addiction
disorder that should be termed “crack the effects of methamphetamine expo-
treatment, we are writing to request
baby” nor found the degree of harm sure on children. A police captain is
that policies addressing prenatal expo-
reported in the media and then used to quoted stating: ‘’Meth makes crack
sure to methamphetamines and media
justify numerous punitive legislative look like child’s play, both in terms of
coverage of this issue be based on sci-
proposals. what it does to the body and how hard
ence, not presumption or prejudice.
The term “meth addicted baby” is it is to get off.” (Fox Butterfield, Home
The use of stigmatizing terms,
such as “ice babies” and “meth babies,” no less defensible. Addiction is a Drug-Making Laboratories Expose
technical term that refers to compulsive Children to Toxic Fallout, Feb 23,
lack scientific validity and should not
behavior that continues in spite of 2004 A1)
be used. Experience with similar labels
adverse consequences. By definition, We are deeply disappointed that
applied to children exposed parentally
babies cannot be “addicted” to metham- American and international media as
to cocaine demonstrates that such
phetamines or anything else. The news well as some policy makers continue to
labels harm the children to which they
media continues to ignore this fact. use stigmatizing terms and unfounded
are applied, lowering expectations for
their academic and life achievements, In utero physiologic dependence assumptions that not only lack any sci-
on opiates (not addiction), known as entific basis but also endanger and dis-
discouraging investigation into other
Neonatal Narcotic Abstinence enfranchise the children to whom these
causes for physical and social problems
Syndrome, is readily diagnosable and labels and claims are applied. Similarly,
the child might encounter, and leading
treatable, but no such symptoms have we are concerned that policies based on
to policies that ignore factors, includ-
been found to occur following prenatal false assumptions will result in punitive
ing poverty, that may play a much
cocaine or methamphetamine exposure. civil and child welfare interventions
more significant role in their lives. The
Similarly, claims that methamphet- that are harmful to women, children
suggestion that treatment will not work
amine users are virtually untreatable and families rather than in the ongoing
for people dependant upon metham-
with small recovery rates lack founda- research and improvement and provi-
phetamines, particularly mothers, also
tion in medical research. Analysis of sion of treatment services that are so
lacks any scientific basis.
dropout, retention in treatment and clearly needed.
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T H E S O U R C E , V O L U M E 1 5 , N O . 1 T H E N A T I O N A L A B A N D O N E D I N F A N T S A S S I S T A N C E R E S O U R C E C E N T E R
METHAMPHETAMINE AND HIV:
WHAT’S THE CONNECTION FOR WOMEN?
The increase in methamphetamine the type of intercourse (Semple, Grant rapid and increased brain HIV viral
use among women over the last several & Patterson, 2004; Molitor et al., load which may accelerate HIV-related
years brings new challenges to the pre- 1998). Molitor and colleagues (1998) dementia (Volkow, 2005; Urbine &
vention and treatment of HIV. also found that methamphetamine Jones, 2004). Similarly, preliminary
Although most of the literature on the users were more likely to have an STD. studies suggest that meth using, HIV-
relationship between methampheta- In addition to increasing their positive patients may experience greater
mine and HIV is based on men who chances for contracting HIV through neuronal damage and neuropsychologi-
have sex with men (MSM), several risky sexual behavior, a relatively small cal impairment, resulting in impaired
studies have looked at the impact on proportion of female meth users inject motor functioning and verbal learning
women as well. In sum, the literature the drug intravenously, potentially (Volkow, 2005; Urbina & Jones, 2004;
suggests that methamphetamine use increasing their risk of using contami- Jernigan et al., 2005). Further, because
increases the risk of HIV transmission nated equipment. For example, in depression is often associated with both
and can cause complications in people Semple et al.’s study (2004), 25% of HIV and meth separately, the com-
with HIV. the women reported injecting meth, pound effect may result in more com-
and 13% indicated that injection was plex psychological problems (Berger,
their primary method of consumption. 2004). Finally, meth use has been
Finally, meth users are at increased risk found to have serious acute cardiovas-
Increased Risk for HIV of contracting HIV because the drug cular effects and may interact with
itself “suppresses a part of your HIV medications to cause increased
Methamphetamine (meth) lowers inhi- immune system that’s important in toxicity or death. Medical complica-
bitions, increases libido, and impairs fighting off HIV” (Press release, 2004). tions can include hypertension, hyper-
judgment, often leading to an increase thermia, rhabdoymyolysis (break down
in risky sexual behaviors (Urbina & of skeletal muscle cells), and stroke
Jones, 2004; Semple, Patterson & (Urbina & Jones, 2004).
Grant, 2004; NYC Department of Meth-related complications
Health & Mental Hygiene, 2004). for people with HIV
Thus, its use is often associated with
high-risk sexual behaviors and HIV infected individuals who use Conclusion
increased risk of HIV among gay men. methamphetamines may have trouble
However, several studies have found adhering to their anti-retroviral med- More research is needed to fully under-
that women, like men, also experience ication plan, which can speed up the stand the many possible interactions
increased sexual desire and sex drive, progression of the disease and increase between methamphetamine use and
heightened sexual pleasure, and pro- their chance of transmitting the virus HIV, particularly among women. In
longed sexual activity associated with during unsafe sex (Berger, 2004). the meantime, sufficient evidence exists
methamphetamine use (Klee, 1992; Preliminary studies also suggest that to justify increased HIV education and
Rawson et al., 2002). meth suppresses one’s immune system, prevention efforts among meth users,
At least two studies have found allowing the virus to replicate more as well as increased education on the
that, compared to non-users, female rapidly in the body (Heathology, potential impact of meth use among
meth users report significantly more 2006). Even if one is adhering to his or HIV-infected individuals.
sexual partners, are more likely to have her medications, meth can accelerate
sex with an intravenous drug user and replication of the virus in the brain. Amy Price, MPA,
trade sex for drugs, are significantly For example, animal studies suggest National AIA Resource Center,
more likely to have anal sex, and are that meth use may result in a more University of California at Berkeley
less likely to use a condom regardless of
Continued on page 27 . . .
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T H E S O U R C E , V O L U M E 1 5 , N O . 1 T H E N A T I O N A L A B A N D O N E D I N F A N T S A S S I S T A N C E R E S O U R C E C E N T E R
GOOD BETS
J. Fish (2005). Rowman & Littlefield Living with FASD (3rd Edition)
Publishers, Inc., 4501 Forbes Blvd., Suite 200,
BOOKS, GUIDES, AND REPORTS This resource for parents and professionals
Lanham, MD 20706. Ph: 301-459-3366.
who care for individuals with Fetal Alcohol
Fax: 301-429-5748. www.rowmanlittlefield.com.
Spectrum Disorder includes the latest Institute
Behind the Eight Ball: Sex for Crack for Medicine diagnostic criteria and terms, spe-
Cocaine Exchange and Poor Black Drugs in Pregnancy and Lactation: cial considerations for infants, adolescents and
Women A Reference Guide to Fetal and adults, and an expanded resource list.
Neonatal Risk (7th Edition) Cost: $24.95.
This book places crack addiction, crack-
This reference provides practical informa- S. Graefe (2004). Groundwork Press, 2780 E
related prostitution and its consequences—
tion on more than 1,000 drugs that may be Broadway, Ste 101, Vancouver, BC, Canada V5M
STDs, HIV, and pregnancy—into the context used by pregnant and lactating women. New 1Y8. Ph: 604-687-3114. Fax: 604-687-3364.
of the larger social issues of inner-city poverty,
to the 7th edition are 132 new drug entries, www.groundworkpress.com.
race, gender, and class. In their own words,
and highlighted recommendations in each
poor black women—nameless, faceless, and
drug entry that indicate the level of risk to the Living with Prenatal Drug Exposure:
marginalized by poverty—share the details of
their lives before and after crack cocaine fetus and nursing infant. The recommenda- A Guide for Parents
tions help readers interpret animal and human
invaded their communities, each recalling the This guide for parents and professionals
pregnancy data to assess potential human risk
circumstances of her introduction to the drug when there are human data or the human introduces caregivers to the challenges of caring
and her first experience using sex to support data are limited or not available. FDA Risk for a child prenatally exposed to drugs. It offers
her addiction. Cost: $49.95. practical techniques and strategies, debunks well-
Factor ratings for each drug are also included.
T. Telfair Sharpe (2005). Haworth Press, Inc., Cost: $99.00. known myths, explores social issues, and includes
10 Alice St., Binghamton, NY 13904-1580. a workbook section for parents and other care-
G. Briggs, R. Freeman, S. Yaffe (2005).
Ph: 800-429-6784. Fax: 800-895-0582. givers. Cost: $24.95.
Lippincott Williams & Wilkins, 530 Walnut St,
www.haworthpress.com. L. Cowan & J. Lee (2003). Groundwork Press,
Philadelphia, PA 19106-3621. Ph: 215-521-
2780 E Broadway, Ste 101, Vancouver, BC, Canada
8300. Fax: 215-521-8902. http://www.lww.com.
Drugs and Society: U.S. Public Policy V5M 1Y8. Ph: 604-687-3114. Fax: 604-687-3364.
www.groundworkpress.com.
There are two main approaches to reform- Improving Outcomes and Preventing
ing drug policy, which reflect differing Relapse in Cognitive-Behavioral
American values. One is the public health or Therapy The Crack Baby Myth: Teens and Parents
harm reduction or cost/benefit approach, Write about the Crack Epidemic
which implements the American value of Organized around specific psychological During the late 1980’s and early 1990’s the
pragmatism. It looks at the social science and disorders, this book brings together leading crack epidemic raced across the country, sweep-
bio-medical evidence regarding the effects of scientist-practitioners to present strategies for ing tens of thousands of children into foster care.
each drug, attempts to weigh the positive and maximizing the benefits of Cognitive- These stories, by teens who went into care and
negative consequences of various courses of Behavioral Therapy (CBT). It describes effec- parents who lost children, document the pain
action, and proposes policies with the best tive ways of overcoming frequently encoun- caused by crack, and show the resilience of teens
overall mix of outcomes. The other tered treatment obstacles, enhancing motiva- and some parents. Cost: $8.00.
approach—libertarian or rights-based—imple- tion and treatment compliance, complement- Youth Communications (2005). Youth
ments the American value of individualism. It ing CBT with other approaches, and targeting
Communications, 224 W. 29th Street, 2nd Floor,
views the private behavior of adults as none of the factors that contribute to relapse and New York, NY 10001. Ph: 212-279-0708.
the government’s business, and aims at maxi- recurrence. Cost: $45. Fax: 212-279-8856. www.youthcomm.org.
mizing individual freedom. Drugs and Society M. Antony, D. Roth Ledley, & R. Heimberg
explains these differing views in detail, and (2005). Guilford Publications, Inc., 72 Spring St,
offers the reader all the information needed to New York, NY 10012. Ph: 800-365-7006.
create an alternative drug policy. Cost: Fax: 212-966-6708. www.guilford.com.
$26.95.
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T H E S O U R C E , V O L U M E 1 5 , N O . 1 T H E N A T I O N A L A B A N D O N E D I N F A N T S A S S I S T A N C E R E S O U R C E C E N T E R
Matters of Substance: Drugs—and Why Treatment for Stimulant Users. A copy can be J. Jensen & M. Fraser (2006). SAGE
Everyone’s a User ordered free of charge from SAMHSA’s Publications, 2455 Teller Road, Thousand Oaks,
National Clearinghouse for Alcohol and Drug CA 91320. Ph: 800-818-7243.
Attitudes about and control of drugs across
Information (NCADI) website at Fax: 805-499-0871. www.sagepub.com.
the world are explored. Various uses and abuses
http://store.health.org/catalog/ProductDetails.
of drugs are examined within the web of ideas
aspx?ProductID=15318. Working with Traumatized Youth in
we hold about personal freedom, the right to
SAMHSA (1999), SAMHSA, 5600 Fishers Child Welfare
pleasure, the responsibilites of government, and
Ln, Rockville, MD 20857. Ph: 800-729-6686.
the impact of globalization. The author argues Integrating perspectives from the fields of
http://ncadi.samhsa.gov.
for a consideration of all drugs—from caffeine child welfare and trauma, this work helps
to crack—as more than the sum of their chemi- practitioners understand and address the spe-
cal structure. He shows that the effect of a drug Medication-Assisted Treatment for cial needs of maltreated children and their
is just as dependent on the social setting, his- Opioid Addiction in Opioid Treatment families. Current knowledge on attachment,
torical legacy, and psychology of an individual Programs, TIP #43 trauma, and risk and resilience is clearly
as it is on any inherent quality of the drug. This Treatment Improvement Protocol explained. Readers learn how to conduct
Cost: $24.95. (TIP) provides a detailed description of med- assessments and implement effective helping
G. Edwards (2005). Dunne Books/Saint ication-assisted treatment for opioid addic- strategies with youth in foster care and other
Martin’s Press, 175 5th Avenue, New York, NY tion, including optional approaches such as settings. Includes case illustrations.
10010. Fax: 212-674-6132. comprehensive maintenance treatment, detox- Cost: $36.00.
ification, and medically supervised withdraw- N. Boyd Webb (2005). Guilford Publications,
Psychotherapy with Women al. A PDF can be downloaded at no cost from Inc., 72 Spring St, New York, NY 10012.
SAMHSA’s National Clearinghouse for Ph: 800-365-7006. Fax: 212-966-6708.
This clinical resource provides insights and
Alcohol and Drug Information (NCADI) www.guilford.com.
interventions that have emerged out of decades
website at http://ncadi.samhsa.gov/media/
of work in the psychology of women. Chapters
from leading practitioners guide therapists and Prevline/pdfs/bkd524.pdf. Cost: Free. Building a Home Within: Meeting the
students to understand how gender, race, eth- SAMHSA (2005). SAMHSA, 5600 Fishers Emotional Needs of Children and Youth
nicity, sexual orientation, class, immigration Ln, Rockville, MD 20857. Ph: 800-729-6686. in Foster Care
status, religion, and other factors shape the http://ncadi.samhsa.gov. This book presents a proven solution
experiences and identities of diverse women, based on over 10 years of groundbreaking
and offer guidance on how to intervene effec- Relapse Prevention: Maintenance work by the Children’s Psychotherapy Project
tively in the multiple contexts of clients’ lives. Strategies in the Treatment of Addictive (CPP): When young people in foster care
Cost: $40. Behaviors work with the same therapist for as long as
M. Pravder Mirkin, K. Suyemoto & B. Okun Leading scientist-practitioners offer an they need to, they’ll make better progress
(2005). Guilford Publications, Inc., 72 Spring St, overview of relapse prevention across a range toward developing strong, healthy relation-
New York, NY 10012. Ph: 800-365-7006. of behaviors. Chapters present the latest ships and hope for the future. Experts from
Fax: 212- 966-6708. www.guilford.com. knowledge on the obstacles that arise in treat- the CPP give psychologists, social workers,
ing specific problem behaviors and the factors counselors, and program administrators a
Treatment for Stimulant Use Disorders, that may trigger relapse at different stages of complete, research-supported introduction to
TIP #33 recovery. Cost: $45. this successful “one child, one therapist, for as
This Treatment Improvement Protocol A. Marlatt & D. Donovan (2005). Guilford long as it takes” model as they share their tri-
(TIP) was researched, drafted, and reviewed by Publications, Inc., 72 Spring St, New York, NY umphs and challenges. Cost: $29.95.
a panel of substance use disorder professionals 10012. Ph: 800-365-7006. Fax: 212-966-6708. T. Vaughn Heineman & D. Ehrensaft (2006).
chaired by Dr. Richard Rawson. It describes www.guilford.com. Brookes Publishing Co., P.O. Box 10624,
Baltimore, MD 21285-0624. Ph: 800-638-3775.
basic knowledge about the nature and treat-
ment of stimulant use disorders, and reviews Social Policy for Children and Families: Fax: 410-337-8539. www.brookespublishing.com.
what is currently known about treating the A Risk and Resilience Perspective
medical, psychiatric, and substance Attachment from Infancy to Adulthood:
abuse/dependence problems associated with the This book uses a unique framework to The Major Longitudinal Studies
help readers understand effective public policy
use of two high profile stimulants: cocaine and development. The authors argue that a public This volume provides first-hand accounts
methamphetamine. The TIP provides informa- health framework rooted in ecological theory of the most important longitudinal studies of
tion on the effects of stimulant abuse, describes and based on principles of risk, protection, attachment. Presented are a range of research
effective treatment approaches, and makes rec- and resilience is essential for the successful programs that have broadened our under-
ommendations on the practical applications of design of social policy. This conceptual model standing of attachment in and outside of the
these treatment strategies, which include: is applied across the substantive areas of social family context and its role in individual adap-
Cognitive Behavioral Therapy/Relapse policy, including child welfare, education, tation throughout life. Themes addressed
Prevention; Contingency Management; mental health, health, developmental disabili- include the complexities of designing studies
Community Reinforcement Approach + ties, substance use, and juvenile justice. that span years or even decades; challenges in
Voucher; Motivational Interviewing; and the
Cost: $42.95.
Matrix Model of Intensive Outpatient Continued on page 26 . . .
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T H E S O U R C E , V O L U M E 1 5 , N O . 1 T H E N A T I O N A L A B A N D O N E D I N F A N T S A S S I S T A N C E R E S O U R C E C E N T E R
Continued from page 25 . . .
in-depth discussion and intervention dramati- video. The parents, most of whom were using
zations, the film conveys information on the methamphetamines when their children
translating theoretical constructs into age-
best ways to screen for drug use during preg- entered the child welfare system, voice their
appropriate assessments; and how attachment nancy and how to help pregnant women who desire to seek treatment and to be reunited
interacts with other key variables that shape
are using alcohol, tobacco, or illicit drugs. with their children. They acknowledge the
individual developmental trajectories. Cost: Available in both DVD and video. Cost: hard work that it takes to recover from sub-
$40.00.
$35.00. stance abuse, and acknowledge the rewards of
Klaus Grossmann, Karin Grossmann & E. National Training Institute (2005). working with the child welfare system. The
Waters (2005). Guilford Publications, Inc., 72 National Training Institute, 180 N Michigan Ave, video, which was funded by the Oregon
Spring St, New York, NY 10012. Ph: 800-365- Ste 700, Chicago, IL 60601. Ph: 312-726-4011. Department of Human Services under a
7006. Fax: 212-966-6708. www.guilford.com. Fax: 312-726-4021. Federal grant, also provides information about
http://www.childstudy.org/nti.cgi/vid-005.html. the Adoption and Safe Families Act (ASFA)
Forming Alliances: Working Together to and the time limits mandated by this Federal
Achieve Mutual Goals The Listening Heart law. Cost: $21.95 (includes shipping/han-
dling).
This guide describes a wide range of ways This 37-minute documentary chronicles E. Martin & J. Wurscher (2005). Oregon
nonprofit organizations can work with others, the day-to-day challenges of children, parents,
with emphasis on finding the simplest alliance and families who struggle with the conse- Department of Human Services, 2054 N
that will work to minimize time wasted on Vancouver Ave, Portland, OR 97227.
quences of Fetal Alcohol Syndrome (FAS). It
more complex partnerships. The book is filled tells the stories of four families, all of whom Ph: 503-231-8164. www.ASFAvideo.org
with examples and worksheets that lay the adopted a child with FAS. Each family’s story
groundwork for successful alliance building. focuses on a different aspect of FAS, ranging
Cost: $29.95.
from behavioral difficulties to learning disabil-
L. Hoskins & E. Angelica (2005). Fieldstone ities and social problems that affect the chil- ONLINE RESOURCES
Alliance, 60 Plato Blvd E, Ste 150, St. Paul, MN dren’s everyday functioning. The video offers
55107. Ph: 800-274-6024. Fax: 651-556-4517. hands-on methods, solutions, and techniques Faces and Voices of Recovery Regional
www.fieldstonealliance.org. to dealing with the issues of FAS. Available in Discussion Groups
DVD and video. Cost: $125.00.
Faces & Voices of Recovery announces
Maximizing Program Services through NTI Productions (2005). National Training
regional discussion groups for exchange of
Private Sector Partnerships and Institute, 180 N Michigan Ave, Ste 700, Chicago,
information about regional recovery advocacy,
Relationships: A Guide for Faith-and IL 60601. Ph: 312-726-4011. Fax: 312-726-
as well as opportunities for recovery advocacy
Community-Based Service Providers 4021. http://www.childstudy.org/nti/productions/ at the national level. The discussion groups
This publication provides practical guid- thelisteningheartmovie. can be accessed at http://www.facesandvoice-
ance about seeking and engaging the support sofrecovery.org/regions/map.php. Discussions
of corporate givers and foundation grant The Power of Our Stories: Speaking Out are archived at each region’s section of the
makers for substance abuse and mental illness for Addiction Recovery Faces & Voices web site.
services and programs. The book includes tips This 44-minute video aims to empower Faces & Voices of Recovery, 1010 Vermont Ave
on marketing, diversifying funding streams, people in recovery, their family members, #708, Washington, DC 20005.
and writing grant proposals. It also highlights friends, and allies to speak out for addiction Ph: 202-737-0690. Fax: 202-737-0695.
case studies of successful relationships and recovery. The video demonstrates how people www.facesandvoicesofrecovery.org.
partnerships between social service organiza- are using their stories to change attitudes and
tions and funders. Cost: Free online. policies that stigmatize and discriminate Methamphetamine and its Impact on
SAMHSA (2005). SAMHSA, 5600 Fishers against people seeking or in recovery from Women, Children and Families
Ln, Rockville, MD 20857. Ph: 800-729-6686. addiction to alcohol or drugs. The video is
This comprehensive online resource
http://www.samhsa.gov/FBCI/docs/Partner accompanied by a brochure and a worksheet
includes national and state Drug Endangered
Handbook_feb2006.pdf. with group and invidual exercises. It can be
Children (DEC) materials and protocols, fed-
viewed for free on the web, or can be pur-
eral/national reports, Substance Abuse and
chased for $15.95.
Mental Health Services Administration
Faces & Voices of Recovery (2006). Faces &
(SAMHSA) and National Institute on Drug
VIDEOS Voices of Recovery, 1010 Vermont Ave. #708, Abuse (NIDA) publications, reports and other
Washington, DC 20005. Ph: 202-737-0690. publications, methamphetamine conferences
I Am Concerned Training Film Fax: 202-737-0695. http://www.facesandvoices and trainings, videos from Washington State’s
ofrecovery.org/support/merch_video_bk.php. Alcohol and Drug Clearinghouse, and more.
This film is the newest component of the I
Am Concerned: A Brief Intervention for the Reunited Children and Family Futures, Inc., 4940
Irvine Blvd, Ste 202, Irvine, CA 92620.
Primary Prenatal Care Setting pre-treatment
manual. The film provides a step-by-step Substance-abusing parents whose children Ph: 714-505-3525. Fax: 714-505-3626.
guide on how to use the manual as an educa- have been removed by CPS speak openly http://www.cffutures.org/docs/Methamphetamine
tional and prevention tool. With both about their experiences in this 25-minute List.htm.
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T H E S O U R C E , V O L U M E 1 5 , N O . 1 T H E N A T I O N A L A B A N D O N E D I N F A N T S A S S I S T A N C E R E S O U R C E C E N T E R
National Alliance for Drug Integrated Substance Abuse Programs Continued from page 23 . . .
Endangered Children The website of UCLA’s ISAP has a
The growing problem of children endan- wealth of information about treatment, REFERENCES
gered by their caregivers’ manufacture, distri- research and training related to substance Berger, D.S. (July/August 2004). Crystal
bution, and abuse of drugs is the focus of this abuse issues. It has links to numerous organi- methamphetamine and HIV—A catastrophe. The
website maintained by the National Alliance zations including the Matrix Institute, and an Body: The Complete HIV/AIDS Resource. Retrieved on
for Drug Endangered Children. Designed for on-line community newsletter (ISAP News), March 8, 2006 from http://www.thebody.com/tpan/
law enforcement, medical, social work, and which is published quarterly. julaug_04/crystal_meth.html.
legal professionals who have responsibility for ISAP, Neuropsychiatric Institute and Healthology, Inc. (February 14, 2006). Club
addressing the safety and service needs of Hosptial, David Geffen School of Medicine at Drugs and HIV: Possible New Strain Offers Wake-up
Call. (retrieved on March 8, 2006 from http://abc-
these children, the site provides extensive UCLA. Ph: 310-445-0874.
news.go.com/Health/Healthology/story?id=499819.
resources, including research papers, news http://www.uclaisap.org/
Jernigan, T.L., Garnst, A.C., Archibald, S.L.,
articles, information on training and legisla- Fennem-Notestine, C. Rivera Mindt, M., Marcotte,
tive action, and links to related organizations. T.L., Heaton, R.K., Ellis, R.J., Grant, I. (2005).
National Alliance for Drug Endangered Effects of methamphetamine dependence and HIV
Children. Ph: 303-517-8278. OTHER RESOURCES infection on cerebral morphology. American Journal
www.nationaldec.org/index.asp. of Psychiatry, 162:1461-1472.
Klee, H. (1992). A new target for behavioral
National Hispanic Resource Help-Line
Join Together research-amphetamine misuse. British Journal of
The National Hispanic Resource Help- Addiction, 87: 439-446.
In addition to providing advocacy sup- Line provides support for Latinos throughout Molitor, F., Truax, S.R., Ruiz, J.D., & Sun,
port, technical assistance, and a variety of the nation who need information about edu- R.K. (1998). Association of methamphetamine use
other services, Join Together maintains a web- cational, health and human service providers. during sex with risky sexual behaviors and HIV infec-
site with a wealth of information on virtually The help-line provides early intervention and tion among non-injection drug users. Western Journal
any issue related to tobacco, alcohol or other resource support for individuals and families of Medicine, 168:93-97.
drugs. This includes current news, research, in crisis, and helps to simplify the maze of New York City Department of Health &
and funding opportunities. social service programs. The service reinforces Mental Hygiene (April 2004). Health Bulletin:
Join Together. Ph: 617-437-1500. Email: the individual’s capacity for self-reliance and Methamphetamine and HIV. Health & Mental
Hygiene News, 3(3).
info@jointogether.org. www.jointogether.org. self-determination through education, refer- Press Release (March 2, 2004). Crystal
rals, affirmation, advocacy, collaborative plan- methamphetamine use increases HIV Risk. Clinical
Meth Action Clearinghouse ning and problem solving. Infectious Diseases. Infectious Diseases Society of
The National Association of Counties Self Reliance Foundation/Acceso Hispano, America. Retrieved on February 27, 2006, from
has developed a clearinghouse of information 1126 16th Street, NW, Ste 350, Washington, DC http://www.idsociety.org/Content/ContentGroups/
on methamphetamines. This website has 20036. Ph: 800-473-3003. Fax: 202-637-8801. News_Releases/Crystal_Methamphetamine_Use_
results of research and surveys; updates on http://www.selfreliancefoundation.org/. Increases_HIV_Risk.htm.
Rawson, R.A., Washton, A., Domier, CP., and
federal, state and local legislation and advoca-
Reiber, C. (2002). Drugs and sexual effects: Role of
cy; recent articles and news releases; and other
drug type and gender. Journal of Substance Abuse
resources. Adoptive Families are Families for
Treatment, 22:103-108.
National Association of Counties, 440 First Keeps (2nd Edition) & Tara’s Guide to Semple, S.J., Grant, I., Patterson, T.L. (2004).
Street, NW, Washington, DC 20001. Ph: 202- Adoptive Families are Families for Female methamphetamine users: Social characteristics
393-6226. http://www.naco.org/Template.cfm? Keeps (CD) and sexual risk behavior. Women & Health, 40(3):
Section=Meth_Action_Clearinghouse&Template=/ 35-50.
This activity book is designed for social
TaggedPage/TaggedPageDisplay.cfm&TPLID=74& Semple, S.J., Patterson, T.L., Grant, I. (2004).
workers, parents, and other caregivers to use
ContentID=17541. The context of sexual risk behavior among heterosex-
with young children who are making the tran- ual methamphetamine users. Addictive Behavior,
sition from foster care to an adoptive family. 29:807-810.
MethResources.gov Children follow Tara on her journey from Urbina, A. & Jones, K. (2004). Crystal
Jointly sponsored by the White House foster care to adoption through a series of methamphetamine, its analogues, and HIV infection:
Office of National Drug Control Policy, activities and a story. The companion Medical and psychiatric aspects of a new epidemic.
Department of Justice, and Department of CD-ROM, Tara’s Guide to Adoptive Families Clinical Infectious Diseases, 38:890-894.
Health & Human Services, this website are Families for Keeps, highlights ideas and Volkow, N.D. (April 21, 2005).
includes the following information related to concepts from the activity book. Cost: $24.95 Methamphetamine Abuse—Testimony before the Senate
methamphetamines: publications and (book only), $12.95 (CD for Windows), Subcommittee on Labor, Health and Human Services,
research, upcoming conferences, programs, $34.95 (book/CD set). Education, and Related Agencies—Committee on
funding, training and technical assistance, and L. Cowan (2004). Groundwork Press, 2780 E Appropriations. National Institute on Drug Abuse,
National Institutes of Health, Department of Health
policy and legislation. It also includes a state- Broadway, Ste 101, Vancouver, BC, Canada V5M
and Human Services. (retrieved on March 8, 2006
by-state list of meth-related resources. 1Y8. Ph: 604-687-3114. Fax: 604-687-3364.
from http://www.drugabuse.gov/Testimony/
http://www.methresources.gov/ www.groundworkpress.com. 4-21-05Testimony.html).
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T H E S O U R C E , V O L U M E 1 5 , N O . 1 T H E N A T I O N A L A B A N D O N E D I N F A N T S A S S I S T A N C E R E S O U R C E C E N T E R
CONFERENCE LISTINGS
What it Takes: Promising Practice & DATE: May 17-19, 2006 First North American Conference on
Collaboration for Families with LOCATION: Daytona Beach, FL Spirituality and Social Work
Substance Abuse
SPONSORING AGENCY: Daniel Memorial This conference will bring together
and Child Welfare Issues
Institute American and Canadian academics, practition-
This conference will focus on promising, CONTACT: http://www.danielkids.org/sites/ ers, and students to discuss the important role
field tested, emerging methods and programs web/content.cfm?id=275 spirituality plays in social work practice and
for strengthening families that are struggling education. The conference theme, The
with child maltreatment and substance abuse Public Health Social Work in the Transforming Power of Spirituality: Breaking
issues. 21st Century Barriers and Creating Common Ground, reflects
an effort to remove barriers and create common
DATE: May 15-17, 2006 The goal of this one-day national confer- ground for the international exchange across
LOCATION: Phoenix/Mesa, Arizona ence is to bring together major stakeholders to borders.
SPONSORING AGENCY: American Humane dialogue and collaborate on enhancing the vis-
DATE: May 25-27, 2006
Association’s Rocky Mountain Quality ibility, revitalization, and importance of public
Improvement Center health social work, and build the basis for LOCATION: Waterloo, Ontario
future collaboration. SPONSORING AGENCY: Canadian Society for
CONTACT: http://www.americanhumane.org
DATE: May 19, 2006 Spirituality and Social Work
10th Annual Birth to Three Institute LOCATION: Boston, MA and the Society for Spirituality and Social
Work (USA)
The theme of this year’s institute is SPONSORING AGENCY: Boston University
CONTACT: Email: jcoates@stu.ca or
Continuity from Pre-Birth to Five: Enhancing Schools of Social Work and Public Health ann.nichols@asu.edu. Website:
Connections for Babies, Families & Com- CONTACT: www.bu.edu/ssw/mswmph
http://people.stu.ca/~jcoates/cnssw/index.html.
munities. A variety of training opportunities
will address the diverse needs and interests of Prevent Child Abuse America HIV/AIDS 2006: The Social Work
early care and education professionals working National Conference
Response
with infants, toddlers and families in Early
Head Start and child care programs. The conference theme—America's The theme of this year's conference is
DATE: May 16-19, 2006 Families: We All Play a Supporting Role—will HIV/AIDS at Year 25: Challenges and
be brought to life by nationally renowned Opportunities for Social Work. Over 600
LOCATION: Baltimore, MD keynote speakers as well as 90+ workshops on AIDS-care social workers are expected, and
SPONSORING AGENCY: Early Head Start a range of topics that are integral to child over 120 conference sessions on AIDS social
National Resource Center abuse prevention, family support, non-profit work practice will be offered.
CONTACT: Ph: (202) 638-1144. Website: management strategies, and other related
areas. DATE: May 25-28, 2006
http://www.ehsnrc.org/Activities/BirthTo
LOCATION: Miami, FL
ThreeInstitute.htm DATE: May 21-24, 2006
SPONSORING AGENCY: Boston College
LOCATION: San Diego, CA
Graduate School of Social Work
13th Annual National Foster Care
SPONSORING AGENCY: Prevent Child Abuse
Conference CONTACT: Ph: (617) 522-4038. Email:
America
lynchw@bc.edu. Website:
This conference will address a wide CONTACT: Ph: (312) 334-6809. Email:
http://socialwork.bc.edu/wp-content/
variety of problems facing foster care special- rloden@preventchildabuse.org. Website: pdf/flyer_hivaids06.pdf#search='HIV%2FAIDS
ists, foster parents and various social service http://www.preventchildabuse.org/events/ %202006%20%20The%20Social%20Work%
professionals who want to enhance their skills conference/index.shtml
in order to create the best foster home envi- 20Response'
ronment.
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T H E S O U R C E , V O L U M E 1 5 , N O . 1 T H E N A T I O N A L A B A N D O N E D I N F A N T S A S S I S T A N C E R E S O U R C E C E N T E R
43rd Annual Conference of the National Mental Health Association American Professional Society on the
Association of Family & Annual Meeting Abuse of Children Annual Colloquium
Conciliation Courts
This meeting focuses on strategies to grow This conference is a major source of
This conference, Juggling Conflict, Crises the power, reach and effectiveness of the mental information and research necessary for interdis-
and Clients in Family Court, brings together health movement in the U.S., as reflected in ciplinary professionals in the field of child
leading judges, mediators, parenting coordina- the theme and mission, Building the Movement. abuse and neglect.
tors, custody evaluators, researchers and DATE: June 7-10, 2006 DATE: June 21-24, 2006
others.
LOCATION: Washington, DC LOCATION: Nashville, TN
DATE: May 31-June 3, 2006 SPONSORING AGENCY: National Mental SPONSORING AGENCY: APSAC
LOCATION: Tampa, FL Health Association
CONTACT: http://apsac.fmhi.usf.edu/services/
SPONSORING AGENCY: AFCC CONTACT: www.nmha.org/annualmeeting services_colloqui.asp
CONTACT: Ph: (608) 664-3750.
Email: afcc@afcc@afccnet.org. 2006 Social Work Policy Conference Parenting Traumatized Children
Website: http://www.afccnet.org/ The conference, Shifting the Tides: This 1st annual, national conference will
Challenges for Policy Practice, provides oppor- focus on parent-oriented information and prac-
The 2nd International, Interdisciplinary tunities to share research and evaluation find- tical tools for parents and therapists/adoption
Conference on Clinical Supervision ings and discuss their implications for policy professionals to use when working with
This conference focuses on core issues in development and advocacy; to examine con- traumatized children.
clinical supervision that cut across professional temporary social welfare policies and their DATE: June 22-24, 2006
disciplines as well as issues specific to particu- impacts on diverse populations; to meet infor-
LOCATION: Norcross, GA
lar fields. It provides an opportunity for psy- mally with experts in policy formulation and
chologists (school, counseling, clinical), social education; and to honor students and faculty SPONSORING AGENCY: Attachment Disorder
workers, nurses, marriage and family thera- who have successfully influenced “state policy.” Network
pists, psychiatrists, substance abuse counselors, DATE: June 16-19, 2006 CONTACT: http://www.radzebra.org/events.htm
speech therapists, and other mental health
LOCATION: Washington, DC
professionals to meet and learn from each 12th Annual Drug Court Training
other about current issues, practice, and SPONSORING AGENCY: Virginia Common- Conference
research findings related to clinical supervision wealth University School of Social Work
This is the largest conference in the nation
of students and practitioners. CONTACT: http://www.vcu.edu/slwweb/
focusing on substance abuse and criminality.
DATE: June 1-3, 2006 PolicyConf06.html This year’s theme is Successful Partnering for
LOCATION: Buffalo, NY Recovery.
Children’s Bureau Annual Meeting of
SPONSORING AGENCY: University at Buffalo States & Tribes DATE: June 21-24, 2006
and other agencies LOCATION: Seattle, WA
The theme of this year’s annual confer-
CONTACT: Erin Bailey, U.B. School of Social ence is Many Paths, One Direction: Strategies SPONSORING AGENCY: National Association
Work. Ph: 716-645-3381, x276. for Achieving Lasting Reform in Child Welfare. of Drug Court Professionals
Email: eedb@buffalo.edu. Website:
This event will bring together invited policy CONTACT: http://www.nadcp.org/annual.html
www.socialwork.buffalo.edu/csconference
makers, State, local, and Tribal child welfare
directors and administrators, judges and court International Family Violence and Child
improvement personnel, State Liaison Officers, Victimization Research Conference
2006 Conference on Family Group Federal staff, representatives of national organi-
Decision Making zations, and other partners to explore the many This conference offers a unique opportu-
As reflected in the theme, We Belong paths that States and Tribes have taken as they nity for researchers and scientist/practitioners
Together, this annual conference will focus on have worked to strengthen their child welfare from a broad array of disciplines to come
the importance of finding connections and systems—honoring what is best in their sys- together for the purpose of sharing, integrating
relationships with family and the community. tems, while creating innovative approaches to and critiquing accumulated knowledge on
address new challenges. family violence.
DATE: June 5-8, 2006
DATE: June 19-22, 2006 DATE: July -12, 2006
LOCATION: San Antonio, TX
LOCATION: Portsmouth, NH
LOCATION: Arlington, VA
SPONSORING AGENCY: National Center on
SPONSORING AGENCY: Children’s Bureau, SPONSORING AGENCY:University of New
Family Group Decision Making
U.S. Department of Health and Human Hampshire
CONTACT: http://www.americanhumane.org
Services CONTACT: http://www.unh.edu/fr/conferences
/site/PageServer?pagename=pc_fgdm
CONTACT: http://www.statetribemeeting.com/
conf_schedule_main.htm
Continued on page 30 . . .
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T H E S O U R C E , V O L U M E 1 5 , N O . 1 T H E N A T I O N A L A B A N D O N E D I N F A N T S A S S I S T A N C E R E S O U R C E C E N T E R
Continued from page 29 . . . DATE: July 19-21, 2006 CONTACT: Jacqueline Manley, Conference
LOCATION: Washington, DC Coordinator. Ph: (858) 623-2777, ext. 427.
NTACCMH Training Institutes 2006 E-mail: fvconf@alliant.edu. Website:
SPONSORING AGENCY: National Resource
These institutes, Developing local systems Center for Child Welfare Data and Technology http://www.ivatcenters.org/conference.htm
of care for children and adolescents with emotion-
al disturbances and their families: Family-driven, CONTACT: http://www.nrccwdt.org/nrc_ 7th National Structured Decision
youth-guided services to improve outcomes, pro- conf/pres_2006_outline.html Making Conference
vide in-depth, practical information on how to North American Council on Adoptable This annual conference, Daily Practice
develop, operate and sustain comprehensive, Children 32nd Annual Conference for Performance Improvement, will provide a
coordinated, community-based systems of care, forum for supervisors, managers, and adminis-
and how to provide high quality, effective, clin- This conference is open to everyone inter- trators who use SDM™ to share their experi-
ical interventions and supports within them. ested in the welfare of children and families, ences, insights, innovations, successes, and
DATE: July 12-15, 2006 including adoptive, foster, and birth parents, lessons learned.
kinship care providers, child welfare profession-
LOCATION: Orlando, FL DATE: October 3-4, 2006
als, and other child advocates. It includes ses-
SPONSORING AGENCY: National Technical sions on recruiting permanent families, adop- LOCATION: Portsmouth, NH
Assistance Center for Children’s Mental Health tion support and preservation, permanency SPONSORING AGENCY: The Children’s
CONTACT: www.gucchd.georgetown.edu options, international adoption, parenting Research Center
children with challenges, advocacy and policy. CONTACT: Angela Noel. Ph: (608) 831-1180.
20th Annual Conference on Treatment
DATE: July 26-29, 2006 Website: http://www.nccd-crc.org/crc/pdf/
Foster Care LOCATION: Long Beach, CA sdm_conf_2006brochure.pdf
This conference is the only North SPONSORING AGENCY: North American
American-based annual conference developed Council on Adoptable Children
by and for treatment foster care professionals 29th National Children’s Law
CONTACT:
and foster parents. This year’s title is Treatment Conference
http://www.nacac.org/conference.html
Foster Care: Withstanding the Test of Time. Information about this annual confer-
DATE: July 16-19, 2006 XVI International AIDS Conference ence will be available in June.
LOCATION: Pittsburgh, PA DATE: October 12-15, 2006
AIDS 2006 will be a landmark opportu-
SPONSORING AGENCY: Foster Family-Based nity for science, government, community and LOCATION: Louisville, KY
Treatment Association leadership from around the world to advance SPONSORING AGENCY: National Association
CONTACT: Ph: (800) 414-3382, x121 or 113. our collective response to the epidemic. The of Counsel for Children
Email: ffta@ffta.org. Website: http://ffta.org/ theme, Time to Deliver, reflects the conference CONTACT: Ph: (888) 828-NACC.
conference/programinformation.html. focus on the promises and progress made to Email: advocate@naccchildlaw.org.
scale-up treatment, care and prevention.
Website: http://www.naccchildlaw.org/
NIMH Annual International Research DATE: August 13-18, 2006
training/conference.html
Conference on the Role of Families in
LOCATION: Toronto, Canada
Preventing & Adapting to HIV/AIDS
SPONSORING AGENCY: International AIDS
This conference is designed to present Society Blending Addiction Science & Practice:
research findings on family processes and HIV CONTACT: International AIDS Society, Bridges to the Future
disease.
Geneva, Switzerland. Ph: +41-(0)22-7 100 800. For more information about this confer-
DATE: July 19-21, 2006 Email: info@iasociety.org. www.ia ence, go to the website listed below and join
LOCATION: San Juan, Puerto Rico society.org or http://www.aids2006.org/ the conference mailing list.
SPONSORING AGENCY: National Institute of DATE: October 16-17, 2006
11TH International Conference on
Mental Health LOCATION: Seattle, WA
Violence, Abuse and Trauma
CONTACT: http://www.nimh.nih.gov/ SPONSORING AGENCY: National Institute
scientificmeetings/hivaids2006.cfm This multi-disciplinary conference is on Drug Abuse and Alcohol and Drug Abuse
designed to bring people, agencies and commu- Institute at the University of Washington
9th National Child Welfare Data & nities together to make an impact on creating
CONTACT: http://adai.washington.edu/
Technology Conference violence-free homes, communities and societies. Blending2006/
The theme of this year’s conference is DATE: September 14-19, 2006
Making IT Work: Improving Data and Practice LOCATION: San Diego, CA
in a Time of Change. SPONSORING AGENCY: Institute on Violence,
Abuse and Trauma; Children’s Institute, Inc.;
and Alliant International University
30
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RESOURCES AND PUBLICATIONS AVAILABLE
FROM THE NATIONAL AIA RESOURCE CENTER
Title of Publication Unit No. of Total
Price Copies Price
AIA Fact Sheets
— Women and children with HIV/AIDS (February 2006) ................................................FREE* ________
— Women with co-occurring mental illness and substance abuse (May 2005)...................FREE* ________
— Standby guardianship (December 2005)........................................................................FREE* ________
— Subsidized guardianship (December 2005) ....................................................................FREE* ________
— Boarder babies, abandoned infants, and discarded infants (December 2005).................FREE* ________
— Kinship care (May 2004)...............................................................................................FREE* ________
— Family planning with substance-using women (April 2004) ..........................................FREE* ________
— Perinatal substance exposure (February 2004)................................................................FREE* ________
— Recreational programs for HIV-affected children and families (September 2003)..........FREE* ________
— Shared family care (December 2002).............................................................................FREE* ________
Literature review: Effects on prenatal substance exposure on infant and early
childhood outcomes (2006)....................................................................................................5.00 ________ _______
Guide to Future Care and Custody Planning for Children, with Recommendations
for State Legislation (2005)................................................................................................... 15.00 ________ _______
From the Child’s Perspective: A Qualitative Analysis of Kinship Care Placements (2005) ......5.00 ________ _______
Discarded Infants and Neonatacide: A review of the literature (2004) ....................................5.00 ________ _______
AIA Best Practices: Lessons Learned from a Decade of Service to Children
and Families Affected by HIV and Substance Abuse (2003) .................................................10.00 ________ _______
Shared Family Care: Restoring Families Through Community Partnerships (2003)
in VHS or CD-ROM (please circle one).............................................................................FREE* ________ _______
Annual Report on Shared Family Care: Progress and Lessons Learned (2002)......................10.00 ________ _______
Expediting Permanency for Abandoned Infants:
Guidelines for State Policies and Procedures (2002) .............................................................10.00 ________ _______
Partners’ Influence on Women’s Addiction and Recovery (2002)..........................................10.00 ________ _______
Voluntary Relinquishment of Parental Rights: Considerations and Practices (1999) ............10.00 ________ _______
Integrating Services & Permanent Housing for Families Affected
by Alcohol and Other Drugs (1997).....................................................................................10.00 ________ _______
Service Outcomes for Drug- and HIV-Affected Families (1997)...........................................10.00 ________ _______
Family Planning & Child Welfare: Making The Connection (Video/Guide 1997) ..............10.00 ________ _______
Shared Family Care Program Guidelines (1996) ...................................................................10.00 ________ _______
* One copy free. For price of multiple copies, please contact the Resource Center.
Total Amount Enclosed _______
Look on-line (http://aia.berkeley.edu) for these and other publications
Name _____________________________________________________
Mail this form with your check
Affiliation __________________________________________________
(made payable to UC Regents) to:
Address ____________________________________________________
AIA Resource Center
City, State, Zip ______________________________________________ University of California, Berkeley
1950 Addison Street, Suite 104, #7402
Phone _____________________________________________________ Berkeley, CA 94720-7402
31
----------------------- Page 32-----------------------
The Source
EDITOR: Amy Price AIA RESOURCE CENTER
DESIGN: Betsy Joyce 1950 Addison St., Ste. 104, #7402
Berkeley, CA 94720-7402
PRINTING: Autumn Press Tel: (510) 643-8390
Fax: (510) 643-7019
CONTRIBUTING WRITERS: http://aia.berkeley.edu
Sharon Amatetti
Nirmala Desai PRINCIPAL INVESTIGATOR: Neil Gilbert, PhD
Cheryl Gallagher
Lori Keyser-Marcus DIRECTOR: Jeanne Pietrzak, MSW
Benita Panigrahi
ASSOCIATE DIRECTOR: Amy Price, MPA
Jeanne Pietrzak
Amy Price POLICY ANALYST: John Krall, MSW
Rakesh Rao
Dace Svikis RESEARCH ASSISTANT: Janise Miri Kim, BA
Martha Wunsch
Nancy Young TRAINING COORDINATOR: Kate Spohr, MA
SUPPORT STAFF: Paulette Ianniello, BA
The Source is published by the National AIA Resource Center
through a grant from the U.S. DHHS/ACF Children’s Bureau GRANT ADMINISTRATOR: Elisabeth Gordon, BS
(#90-CB-0126). The contents of this publication do not
necessarily reflect the views or policies of the Center or its
funders, nor does mention of trade names, commercial
products, or organizations imply endorsement. Readers are
encouraged to copy and share articles and information from
The Source, but please credit the AIA Resource Center.
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