Part I Background and Context

Scope of the Problem

Scope of the Problem

• Meth use has increased
• Use has spread from the West
• Accounts for a small percentage of the total number of people affected by drug and alcohol problems
• The impact of meth use on child welfare varies widely among States and among Counties

Meth/Amphetamine Treatment Admission Rate

Per 100,000 Population Aged 12 or Older - 1993-2003

Source: Treatment Episode Data Set (TEDS)

Eastward Spread of Methamphetamine

Treatment Admissions by Primary Substance - 2003

• Alcohol        42%
• Heroin/Other Opiates     18%
• Marijuana         15%
• Cocaine         14%
• Meth/Amphetamine and
  Other Stimulants        7%

Source: Treatment Episode Data Set (TEDS)

Impact of Increasing Methamphetamine Use

• Methamphetamine is affecting communities that have not experienced prior stimulant drug problems
• Child welfare agencies are dealing with more cases involving methamphetamine

Smoked Cocaine/Crack and Meth/Amphetamine Treatment Admissions by Race/Ethnicity

	Cocaine/Crack	Meth/Amphetamine
White	35	65
Hispanic	7.1	22.2
African American	55.3	3.2
Asian/PI	0.9	5.3
Native Amer/AK Native	0.7	2
Other	0.9	2.3

Source: Treatment Episode Data Set (TEDS)

Meth/Amphetamine & Cocaine Treatment Admissions

According to Census Division 2003               RATE per 100,000

Source: Treatment Episode Data Set (TEDS)

Gender Differences

• 47% of admissions are women
  This is a higher percentage of women admissions than for any other drug except tranquilizers
  • methamphetamine - ~ 1:1
  • cocaine - 1:2
  • heroin - 1:2+
  • marijuana & alcohol - 1:3
• Since women are often caretakers of children, more children are likely affected

Source: Vaughn, C. (2003)

Self-Reported Reasons for Starting Methamphetamine Use

	Male	Female
To lose weight	9%	37%
To relieve depression	25%	37%

Richard Rawson, Ph.D., Presentation to SAMHSA, August 2005

Treatment Admissions Meth/Amphetamine as Primary Substance by Gender

Source: Treatment Episode Data Set (TEDS)

Meth/Amphetamine Admissions
By Gender - 2003

	All ages	12-14 year-olds	15-17 year-olds
Male	0.55	0.3	0.44
Female	0.45	0.7	0.56

Source: Treatment Episode Data Set (TEDS)

Female Treatment Admissions States with Highest % of Meth/Amphetamine as Primary Substance

Source: Treatment Episode Data Set (TEDS)

Trends in Primary Substance UseTreatment Admissions for Pregnant Females by Primary Substance 1995-2003

Source: Treatment Episode Data Set (TEDS)

Natural Rewards Elevate Dopamine Levels

Effects of Drugs on Dopamine Levels

Source: Di Chiara and Imperato

Effects of Methamphetamine Addiction

Short-Term Effects of Methamphetamine

PHYSICAL Heart rate Respiration Blood pressure Pupil size Sensory acuity Energy Appetite Sleep Reaction time

PSYCHOLOGICAL Confidence Alertness Mood Sex drive Energy Talkativeness Boredom Loneliness Timidity

Source: Judith Cohen, Ph.D., Presentation to NASADAD, June 2005

MethamphetamineChronic Physical Effects

Tremors Weakness Headaches Sweating Coughing

Dry Mouth Oily skin/complextion Burned lips/sore nose Dental Weight Loss/Anorexia

Methamphetamine Chronic Psychological Effects

Confusion Concentration Hallucinations Fatigue Memory loss Insomnia

Irritability Paranoia Panic reactions Depression Anger Psychosis

Source: Richard Rawson, Ph.D., Presentation to SAMHSA, August 2005

Cognitive Effects

• Decreased ability to:
  • Recognize and recall words and pictures
  • Make inferences
  • Manipulate information
  • Ignore irrelevant information
  • Learn from experience
• Users and people in early recovery may find it difficult to:
  • Pay attention
  • Comprehend spoken and written information
  • Remember information

Source: Simon (1999)

Cognitive Effects

• Rate of recovery is associated with severity of abuse and days of abstinence.
• Study documented significant recovery with Meth abusers who were able to stay drug free for at least 9 months.
• After 4 years of abstinence, no deficits in:
  • Memory
  • Learning
  • Attention
  • Executive function
  • Motor function

Sources: Lundahl et al. (2004); Volkow et al. (2001)

Risks to Children When Parents Use Methamphetamine

Foster Care Population and Persons Who First Used Crack or Methamphetamine in Prior Year

Six Different Situations for Children

• Parent uses or abuses methamphetamine
• Parent is dependent on methamphetamine
• Mother uses meth while pregnant
• Parent “cooks” small quantities of meth
• Parent involved in trafficking
• Parent involved in super lab

Source: Nancy Young, Ph.D., Testimony before the U.S. House of Representatives Government Reform Subcommittee on Criminal Justice, Drug Policy, and Human Resources, July 26, 2005

Six Different Situations for Children

• Each situation poses different risks and requires different responses
• Child welfare workers need to know the different responses required
• The greatest number of children are exposed through a parent who uses or is dependent on the drug
• Relatively few parents "cook" the drug

Source: Nancy Young, Ph.D., Testimony before the U.S. House of Representatives Government Reform Subcommittee on Criminal Justice, Drug Policy, and Human Resources, July 26, 2005

Parent Uses or Abuses Meth

Risks to safety and well-being of children:

• Parental behavior under the influence: poor judgment, confusion, irritability, paranoia, violence
• Inadequate supervision
• Inconsistent parenting
• Chaotic home life
• Exposure to second-hand smoke
• Accidental ingestion of drug
• Possibility of abuse
• HIV exposure from needle use by parent

Source: Nancy Young, Ph.D., Testimony before the U.S. House of Representatives Government Reform Subcommittee on Criminal Justice, Drug Policy, and Human Resources, July 26, 2005

Parent Is Dependent on Meth

Risks to safety and well-being of children:

• All the risks of parents who use or abuse, but the child may be exposed more often and for longer periods
• Chronic neglect is more likely
• Household may lack food, water, utilities
• Chaotic home life
• Children may lack medical care, dental care, immunizations
• Greater risk of abuse
• Greater risk of sexual abuse if parent has multiple partners

Source: Nancy Young, Ph.D., Testimony before the U.S. House of Representatives Government Reform Subcommittee on Criminal Justice, Drug Policy, and Human Resources, July 26, 2005

Mother Uses Meth While Pregnant

• Risk to child depends on frequency and intensity of use, and the stage of pregnancy
• Risks include birth defects, growth retardation, premature birth, low birth weight, brain lesions
• Problems at birth may include difficulty sucking and swallowing, hypersensitivity to touch, excessive muscle tension (hypertonia)
• Long term risks may include developmental disorders, cognitive deficits, learning disabilities, poor social adjustment, language deficits

Sources: Anglin et al. (2000); Oro & Dixon, (1987); Rawson & Anglin (1999); Dixon & Bejar (1989); Smith et al. (2003); Shah (2002)

Mother Uses Meth While Pregnant

• Observed effects may be due to other substances, or combination of substances, used by the mother
  • For example, if the mother also smokes, growth retardation may be significant
• Observed effects may be complicated by other conditions, such as the health, environmental, or nutritional status of the mother

Source: Nancy Young, Ph.D., Testimony before the U.S. House of Representatives Government Reform Subcommittee on Criminal Justice, Drug Policy, and Human Resources, July 26, 2005

Mother Uses While Pregnant

• Scope of the problem:
  • An estimated 10% to 11% of all newborns are prenatally exposed to drugs or alcohol; this amounts to 400,000 to 480,000 newborns per year
  • Only about 5% of prenatally exposed newborns are placed in out-of-home care; the rest go home without assessment and services

Sources: Vega; SAMHSA, OAS, National Survey of Alcohol and Drug Use During Pregnancy, 2002 and 2003

Mother Uses While Pregnant

• Home environment is the critical factor in the child’s outcome
• Consequences can be mediated

Shah, R. (2005, June). From NASADAD presentation

Parent "Cooks" Small Quantities of Meth

• All the risks of parents who use or are dependent on meth, with added risks of manufacturing the drug:
  • Chemical exposure
  • Toxic fumes
  • Risk of fire and explosion

Source: Nancy Young, Ph.D., Testimony before the U.S. House of Representatives Government Reform Subcommittee on Criminal Justice, Drug Policy, and Human Resources, July 26, 2005

Environmental Methamphetamine Exposure and Risks

• Toxic effects of manufacturing
• Children more at risk:
  • Higher metabolic rates
  • Developing bone and nervous systems
  • Thinner skin than adults which absorbs chemicals faster
  • Children tend to put things in their mouth and use touch to explore

Source: Mason (2004)

Parent Involved in Trafficking

• Presence of weapons
• Possibility of violence
• Possibility of physical or sexual abuse by persons visiting the household

Source: Nancy Young, Ph.D., Testimony before the U.S. House of Representatives Government Reform Subcommittee on Criminal Justice, Drug Policy, and Human Resources, July 26, 2005

Parent Involved in Super Lab

• Lower likelihood of children on the site

Source: Nancy Young, Ph.D., Testimony before the U.S. House of Representatives Government Reform Subcommittee on Criminal Justice, Drug Policy, and Human Resources, July 26, 2005

Number of Children in Meth Labs

	2000	2001	2002	2003
Number of incidents	8,971	13,270	15,353	14,260
Incidents with children present	1,803	2,191	2,077	1,442
Percent with children present	20%	16.5%	13.5%	10%
Children taken into protective custody	353	78	1,026	724

4 years = 2,881; all children ~1,200,000

Source: El Paso Intelligence Center

National Alliance of Drug Endangered Children (DEC)

• Formed in October 2003
• Provides multi-disciplinary training for communities interested in starting or expanding DEC programs
• www.nationaldec.org

Multidisciplinary DEC TEAMS

• Medical and Mental Health Services
  • trained in diagnosing and treating children exposed to neglect and abuse, possible chemical hazards, and trauma
• Child Protective Services
  • determine the course of the child welfare investigation and share information with law enforcement officers, district attorneys’ offices, and health care and mental health agencies.
• Law Enforcement
  • must act to ensure the immediate safety of the children present, ensure that children are placed in a safe environment with a responsible caretaker.

DEC Team (cont.)

• Public Safety
  • Fire department personnel and hazardous materials professionals, play a key role in documenting conditions of child endangerment, including the potential for fire or explosion, presence of hazardous materials, improper storage of chemicals, and poor ventilation.
• Prosecution
  • Prosecutors are responsible for filing and supporting charges of child endangerment. In cases in which one parent or caregiver is not charged with endangerment but lesser charges are levied, the prosecutor can play an important role in safeguarding the child’s welfare by influencing the terms of probation. These terms often include drug treatment, parenting classes, and other rehabilitative measures.

Treatment for Methamphetamine

CSAT’s
Methamphetamine Treatment Project

• Largest randomized clinical trial of treatment for meth dependence
  • Intensive outpatient setting
  • Three to five visits per week of comprehensive counseling for at least the first three months
  • Cognitive behavioral approach
  • Contingency management

Source: Rick Rawson, Ph.D. Presentation to SAMHSA, August 2005

Matrix Model Treatment Outcomes

Similar Outcomes

• Treatment outcomes do not differ from other drugs of abuse
• Treatment outcomes have more to do with the quantity and quality of treatment than type of drug abused

Gender Differences and Implications for Treatment

• Co-occurring mental health problems
• Trauma
• Body image

Behavior Symptom Inventory (BSI)
Scores at Baseline

Source: Rick Rawson, Ph.D. Presentation to SAMHSA, August 2005

Histories of Violence among Clients Treated for Methamphetamine

• Persons in treatment for methamphetamine reported high rates of violence
  • 85% women
  • 69% men
• The most common source of violence:
  • For women, was a partner (80%)
  • For men, was strangers (43%)
• History of sexual abuse and violence:
  • 57% women
  • 16% men

Source: Cohen, J. (2003)

Prevalence of Co-Occurring Problems, and Violence and Trauma

• Women in treatment 2 times more likely to have history of sexual and physical abuse than general population
• Women who are dependent on meth usually have more severe problems than their male counterparts in many areas of their life
• Speaks to the need for comprehensive, and trauma-related services

Source: CSAT TIP 36

Gender Differences and Implications for Treatment

• Sexual behavior linked to methamphetamine is a significant clinical issue that needs to be addressed in women-only groups
• Co-occurring mental health issues complicate treatment and require longer duration for treatment
• Violence linked to meth use is related to trauma and safety needs which must be addressed in treatment
• Body image and nutrition need to be addressed

Gender Differences and Implications for Treatment

• Threats of violence and reduced cognitive capacity to manage activities of daily living suggest that a period of residential treatment or referral to safe houses or supervised housing may be indicated.
• Intensive outpatient treatment should be coupled with additional supports such as transportation, meals, child care.
• Gender specific treatment is indicated given women’s histories of trauma and violence

What Predicts Longer Abstinence?

Longer abstinence following treatment for women with:

• Longer time in treatment (e.g. those with 4 or more mo. of treatment have more than double the rate of 24-48 mo. abstinence)
• More sessions per month of individual counseling
• Treatment, intervention and case planning need to account for short-term effects, especially cognitive deficits and verbal communication
• Drug Court involvement
• Family involvement

M.L. Brecht, Ph.D., et al. (2005)

Summary

Summary

• Methamphetamine is a dangerous drug with serious physical, cognitive, and health consequences
• The effects of long-term use are reversible with prolonged abstinence
• Treatment for methamphetamine is as effective as treatment for other drugs

Summary

• A high percentage of methamphetamine users are women of child-bearing age
• Meth accounts for 7% of treatment admissions nationally, but in some States 30- 44% of women admitted were admitted for methamphetamine

Summary

• Scope of the problem:
  • The number of meth users is small compared to other drugs and alcohol
• Admissions increased through 2003
• Communities that have not experienced prior drug problems may lack the resources to handle a meth problem
• Meth use may be leveling off

Summary

• Parents’ use of methamphetamine puts their children at risk
• The best outcome for both child and parent is achieved when:
  • The parent receives immediate, effective treatment and comprehensive services
  • The child receives immediate assessment and services, as well as follow-up services

Summary

• Child welfare workers must distinguish between
  • Children whose parents use meth, and
  • Children whose parents manufacture meth
• They must learn the established medical protocols for children present in meth labs

Summary

• We need early diagnosis and intervention for children affected by meth before and after birth
• We need comprehensive, timely, and state-of-the-art treatment for parents referred to treatment as a condition of keeping or reunifying with their children
• We need information systems that capture the necessary data to support effective approaches

For Further Information

SAMHSA Resources

• Treatment Improvement Protocols (TIP 33)
  • Best Practice Guidelines for Treatment of Substance Abuse
  • Researched, Drafted, and Reviewed by Substance Use Disorder Professionals

SAMHSA Resources

• KAP Keys & Quick Guide
  • Developed to accompany the TIP Series
  • Based entirely on TIP #33
  • Designed to meet the needs of busy clinicians for concise, easily accessed “how-to” information
  • http://www.samhsa.gov

SAMHSA Resources

• SAMHSA’s Addiction Technology Transfer Centers (ATTC)
• Pacific Southwest ATTC
  http://www.psattc.org/events/cates/I/presentations/index.html
• Methamphetamine 101: Etiology and Physiology of an Epidemic

ATTC’s Introduction to Evidence-Based Treatments for Methamphetamine

• CD-ROM Learning Tools
• DVD Training Module
• Produced by: Applied Behavioral Health Policy at the University of Arizona for the Pacific Southwest ATTC
• web www.psattc.org

National Center on Substance Abuse and Child Welfare
A Program of the
Substance Abuse and Mental Health
Services Administration
Center for Substance Abuse Treatment
and the
Administration on Children, Youth and Families
Children’s Bureau
Office on Child Abuse and Neglect


NCSACW Mission

• To improve outcomes for families by promoting effective practice, and organizational and system changes at the local, state, and national levels
  • Developing and implementing a comprehensive program of information gathering and dissemination
  • Providing technical assistance

NCSACW Consortium

• American Public Human Services Association (APHSA)
• Child Welfare League of America (CWLA)
• National Association of State Alcohol and Drug Abuse Directors (NASADAD)
• National Council of Juvenile and Family Court Judges (NCJFCJ)
• National Indian Child Welfare Association (NICWA)

Recent NCSACW Products

• Understanding Substance Abuse and Facilitating Recovery: A Guide for Child Welfare Workers (A short monograph for front-line workers)
• On-Line Training – Now Available
  • Understanding Child Welfare and the Dependency Court: A Guide for Substance Abuse Treatment Professionals
  • Understanding Substance Use Disorders, Treatment and Family Recovery: A Guide for Child Welfare Professionals

Contact NCSACW

• www.ncsacw.samhsa.gov
  Project Director:
  Nancy Young, Ph.D.
  714-505-3525
• Government Project Officer:
  Sharon Amatetti, SAMHSA/CSAT
  240-276-1694
  sharon.amatetti@samhsa.hhs.gov

Part II Model Programs

Signs of Use and Warning Signs for Workers

Signs of Methamphetamine Use

and Use of Other Stimulants

• Euphoria
• Grinding of teeth
• Rapid breathing
• Sweating
• Hyperactivity
• Tremor - shaking hands
• Rapid or pressured speech
• Depression - when drug wears off
• Irritability, paranoia, suspiciousness
• Hallucinations
• Presence of drug paraphernalia

Warning Signs for Workers

• Client is extremely irritable, suspicious, or argumentative, or there is an escalation of irritability
• Regular client does not appear to know who worker is
• Evidence of paranoid thinking, delusions
• Client verbalizes implicit or explicit threat against worker

Source: Crowell & Webber (2001)

Other Severe Signs of Meth Use

• Scratch marks or scabs, particularly on client’s hands and arms - may be evidence of tactile hallucinations and indicate a prior episode of stimulant psychosis
• Severe damage to teeth and gums
• Drawn face and underweight
• Strong chemical odor - may indicate manufacturing of meth

Source: Crowell & Webber (2001)

Methamphetamine: Implications for Workers

Denial = Super-memory Imprinting

• Memory imprinting increases in power as dopamine activity increases.
• Addicts remember the "good-times" and fail to remember the "bad-times".

Research on Cognitive Impairments of MA addicts

• Ability to manipulate information (multi-relational or "synthesis").
• Ability to make inferences.
• Ability to ignore irrelevant information.
• Ability to learn new or recall information.

"Methamphetamine: Snapshot Phenomenon"
Wurscher & Martin

Oregon’s Response

Oregon Child Welfare 1997-99

• 60% of CW families A&D involved
• 54% of CW families DRUG involved
• 68% of CW DRUG families METH



• #1 reason for termination –
• No recovery - 46% METH

Oregon Child Welfare 2004

• 875,790 children ages 0-18
• 46,524 reports of suspected abuse
• 10,622 FOUNDED abuse cases
• 9.6% ^ over previous year
• 73.8% ^ since 1994
• 9.4% ^ in POPULATION since 1994
• 50% of removals METH related

Current Oregon Issues

• Meth Labs almost eliminated
• Meth Addiction Higher than ever
• 2003 - 30% reduction in A&D TX
• Foster Care Population Growing
• Meth cases most CHAOTIC

What Labs ARE NOT

• Chernobyl
  • – Meth Labs are not radioactive.
• Fatal to CPS Workers
  • – Meth Labs will not kill you.

Oregon METH Response

• Collaborate & Integrate
• Separation of issues – Labs & Addiction
• Governor’s METH Task Force
• Drug Endangered Child Response
• DEC Teams & OADEC
• Addiction Recovery Teams - ART
• Family Involvement Team - FIT

DEC - Drug Endangered Child Team Partners

• DHS Child Welfare
• Local Law Enforcement
• Meth Lab Law Enforcement
• Criminal Prosecuting District Attorneys
• Child Welfare Attorneys
• Local Medical Staff - Hospitals

DEC Collaboration Issues

• LEA will seek evidence for charges and arrest.
• DA’s will seek prosecution on both drug charges and child maltreatment.
• DEC Collaboration requires CPS to play active role in this process while advocating for the best outcomes for children.
• Can be conflicts in process.

CPS Requirements – On Site

• Focus - on Your CPS Safety Assessment
• Gather Info from Site Safety Officer
• Determine De-Contamination Need/Plan
• Focus - Be the Social Worker, not the Police Officer.
• Stay Behind the Police Barriers
• Transport Children Safely

Addiction Recovery Teams

• DHS & Contract Collaboration
• DHS staff person assigned to A&D
• Contracted A&D Counselor
• Contracted Outreach Worker
• Other Integrated Services
• Must be on site at child welfare

Family Involvement Team

• FIT Team
• Portland – Multnomah County
• A&D CW Services at the court
• On site DHS & A&D at all times
• On site transport & child visit
• Treatment Program Case Managers
• ASFA attentive & accountable

ADVANTAGES – ART & FIT

• All providers believe in RECOVERY
• Immediate focus on A&D TX needs
• Tracking clients toward recovery
• Relapse response with Outreach
• FIT – services offered at court
• FIT – TX site case management

ADVANTAGES – ART & FIT

• Parent focused service
• Caseworkers feel supported
• Treatment programs OK with CW
• Clients stick with TX
• Recovery modeled – Parent Mentors
• Reunited video asfavideo.org

ADVANTAGES ART - FIT

• Defense bar buys in
• Judges recommend & mandate services
• Negates punitive casework
• Promotes clinical approaches
• Drug testing seen as intervention
• Recovery is modeled to caseworkers

Oregon Resource People

Jay Wurscher Alcohol & Drug Services Coordinator OR Dept of Human Services Salem OR 503-945-6634 jay.m.wurscher@state.or.us

Samantha Byers Family Involvement Team/Parent Mentors OR Dept of Human Services Portland, OR 503-988-5464, Ext-126693 samantha.byers@state.or.us

Sacramento County’s Response

Program Context

• Sacramento County population: 1.5 million
• In 2004, there were approximately 7,000 substantiated child abuse/neglect referrals, in Sacramento1.
• An estimated 70 to 80% of child welfare cases involve families affected by substance use

Sacramento County Prior to STARS and Dependency Drug Court

• Reunification rate about 20-25%
• Parents unable to access AOD treatment
• Social workers, attorneys, courts often uninformed on parent progress
• Drug testing not uniform and results often delayed

Sacramento County After STARS and Dependency Drug Court

• Reunification rates at 40–45 percent
• Reunification is occurring faster
• Parents truly have "treatment on demand"
• All parties involved in the case are informed at every stage of treatment
• All parents receive random observed "instant" drug testing

Five Components of Sacramento County’s Comprehensive Reform

• Comprehensive cross-system joint training
• Substance Abuse Treatment System of Care
• Early Intervention Specialists
• Recovery Management Specialists (STARS)
• Dependency Drug Court

Reforms have been implemented over the past eleven years

Five Components of Sacramento County’s Comprehensive Reform

1. Comprehensive cross-system joint training

    Three Levels of Training


• AOD basics for all staff – 4 days required
• AOD screening, brief intervention, motivational enhancement and AOD treatment – 4 days required of all case carrying workers
• Group intervention skills – 4 days required of all ADS staff and voluntary for any CPS division staff

Five Components of Sacramento County’s Comprehensive Reform
2. Substance abuse treatment system of care



• Managed wait list
• Immediate access to substance abuse services Group services expansion and implementation of pre-treatment groups

Five Components of Sacramento County’s Comprehensive Reform
3. Early Intervention Specialists



• Review of every court petition to determine if substance use disorders may be present
• Immediate access to intervention and assessment at court hearings
• Immediate authorization of publicly-funded treatment services

Five Components of Sacramento County’s Comprehensive Reform
4. Recovery Management Specialists (STARS)



• Motivational enhancement
• Gender-specific services
• Immediate access to recovery management and treatment services
• Provider orientation of providing hope and accountability
• Compliance monitoring—twice monthlies

Five Components of Sacramento County’s Comprehensive Reform
5. Dependency Drug Court



• Parallel system to dependency petition
• 30, 60 and 90-day compliance hearings
• Structured incentives for compliance and sanctions for non-compliance
• Voluntary participation in on-going services

Sacramento CountyDependency Drug CourtEvaluation Findings

4940 Irvine Boulevard, Suite 202
Irvine, CA 92620
714.505.3525
Fax 714.505.3626
www.cffutures.org

Parents and Children in Evaluation

	Comparison	CO YR 1	CO YR 2	CO YR 3
Parents =847	111	324	249	274
Children =1,346	173	432	429	485

Total Mothers and Fathers in DDC Evaluation
Mothers  578
Fathers  210

Primary Drug Problem*

	Meth	Alcohol	Marijuana	Heroin	Cocaine/crack	Other
Comparison	41.1	17.9	21.4	7.1	12.5	0
Court Ordered	52.9	16.3	15	2.7	11.1	2

Percent of Mothers and Fathers by Mental Illness at Admission*
Mothers     34.8%
Fathers     10.0%

Percent of Mothers and Fathers by Treatment Modality*

	Residential	Out Patient
Mothers	30.7	69.3
Fathers	38.5	61.9

Treatment Admission Rates*
Comparison  50.5
Court OrderedFathers  86.4

Percent of Mothers and Fathers by Treatment Completion

	Completed	Left & Unsatisfactory Progress
Mothers	66	34
Fathers	71.6	28.4

24-Month Placement Outcomes*

	12 Months	18 Months	24 Months
Comparison	210.8	266.1	300.7
Court Ordered	187.1	266.6	284

Time to Reunification

	Reunified	Adoption	Guardianship	Continued FR/FC	Long-term Placement	Other
Comparison	27.2	31.8	13.3	1.7	18.5	7.5
CO YR 1	42.1	22.9	5.4	14.1	5.1	10.4

24-Month Cost Savings

• 27.2% - Reunification rate for comparison group children
• 42.1% - Reunification rate for court-ordered DDC group children
• 63 Additional DDC children reunified
• 33.1 – Average months in out-of-home care for comparison group children
• 8.6 - Average months to reunification for court-ordered DDC children

$2,953,639 estimated savings in out-of-home care costs

References

Anglin, M., Burke, C., Perrochet, B., Stamper, E. & Dawud-Noursi, S. (2000). History of the methamphetamine problem. Journal of Psychoactive Drugs, 32(2), 137-141.

Brecht, M.-L., M. D. Anglin, et al. (2005). "Coerced Treatment for Methamphetamine Abuse: Differential Patient Characteristics and Outcomes." The American Journal of Drug and Alcohol Abuse 31(2): 337.

Brecht, M.L.(2004) Women and Methamphetamine: Characteristics, Treatment Outcomes. Presentation to the Center For Substance Abuse Treatment, State Systems Development Conference. August 13.

Cohen, Judith, Ph.D. Presentation to NASADAD, June 2005.

Colorado DEC. Retrieved from www.colodec.org/decpapers/Documents/DEC%20Medical%20Protocol.pdf

Crowell and Webber, 2004. Retrieved from www.drugfreeinfo.org/PDFs/strengthensupervision.pdf.

Dixon, S.D., & Bejar, R. (1989). Echoencephalographic findings in neonates associated with maternal cocaine and methamphetamine use: Incidence and clinical correlates. Journal of Pediatrics, 115(5 Pt 1), 770-778.

Ferguson, T. (2001). Overview of medical toxicology and potential exposures to clandestine drug laboratories in California. Paper presented to the Minnesota Department of Health.

Lundahl, L.H., Keenan, P., Schuster, C.R., & Johanson, C.E. (2004, June). Neurocognitive function in chronic high dose methamphetamine abusers following long term abstinence. Poster session presented at the 66th Annual Scientific Meeting of the College on

Problems of Drug Dependence, San Juan, Puerto Rico. Mason, A. P. 2004. Methamphetamine labs. Presented at the annual conference of the North Carolina Family-Based, Services Association.

Obert, J.L., London, E.D., & Rawson, R.A. (2002). Incorporating brain research findings into standard treatment: An example using the Matrix Model. Journal of Substance Abuse Treatment, 23(2), 107-113.

Office of Applied Studies, Substance Abuse and Mental Health Services Administration, Treatment Episode Data Set (TEDS).

Office of Applied Studies, Substance Abuse and Mental Health Services Administration, National Survey of Alcohol and Drug Use During Pregnancy, 2002 and 2003.

References

Oro, A.S., & Dixon, S.D. (1987). Perinatal cocaine and methamphetamine exposure: Maternal and neonatal correlates. Journal of Pediatrics, 571-578.

Rawson, Richard, Ph.D., Presentation to SAMHSA, August 2005.

Rawson, R., & Anglin, M.D. (1999, June). Methamphetamine: New knowledge, new treatments. Retrieved April 2004, from the UCLA Integrated Substance Abuse Programs Web site: http://www.uclaisap.org/slides/Index46/index.htm

Simon, S. (1999). Cognitive impairment in individuals currently using methamphetamine. Retrieved April 2004, from the UCLA Integrated Substance Abuse Programs Web site: http://www.uclaisap.org/slides/Index46/sld034.htm

Smith, L., Yonekura, M.L., Wallace, T., Berman, N., Kuo, J., & Berkowitz, C. (2003). Effects of prenatal methamphetamine exposure on fetal growth and drug withdrawal symptoms in infants born at term. Journal of Developmental and Behavioral Pediatrics, 24(1):17-23.

Shah, R. (2005, June). From NASADAD presentation

Thompson, P.M., Hayashi, K.M., Simon, S.L., Geaga, J.A., Hong, M.S., Sui, Y., et al. (2004). Structural abnormalities in the brains of human subjects who use methamphetamine. Journal of Neuroscience, 24(26), 6028-6036.

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