TheUtah Addiction Center Report research clinical training education Volume 1 Issue 4 May 2005 Dedicated to research, clinical training, and education in chemical addiction A Message from the Director Methamphetamine Scourge Glen W. Hanson, Ph.D, D.D.S t s really unlike any other drug or Isubstance we ve ever dealt with. It causes harm in every direction, and it s a very, very difficult drug for people to get over. And it s quite possible we don t even know the worst of the long-term effects yet. These are the words of Jennifer Walrod, Director of the Investigative Division of Child and Family Services in Missoula The Utah Addiction Center is based in the office of the University of Utah Senior Vice President for Health Sciences Institutional Advisory Board A. Lorris Betz, M.D., Ph.D. Louis H. Callister, J.D. Edward B. Clark, M.D. Jay Graves Ph.D. Patrick Fleming, LSAC, MPA Raymond Gesteland, Ph.D. Bernard I. Grosser, M.D. Glen W. Hanson Ph.D, D.D.S, Barbara N. Sullivan, Ph.D. John R. Hoidal, M.D. Maureen Keefe, RN, Ph.D John W. Mauger, Ph.D. Ross VanVranken, ACSW Kim Wirthlin, MPA Phillip Bryant, D.O. Jannah Mather, Ph.D. Steve Ott, Ph.D. David Sperry, Ph.D. Montana, a community currently being overwhelmed by a methamphetamine (meth) epidemic (Health & Medicine Week, February 14, 2005). This quote summarizes the frustration and concern about problems associated with meth abuse and addiction. It has been reported that meth abuse is extremely high in western cities such as Honolulu, San Diego, Seattle and Salt Lake City and spreading eastward across the United States to urban, suburban and rural areas at a pace unrivaled by any drug in recent times (Available: www. drugabuse.gov/infofax/methamphetamine.html). This pattern of expanding abuse and addiction with meth is particularly troubling because of the ability of this potent psychostimulant to cause depression, suicidality, anxiety, psychosis, anger and extreme violent behavior and to exert long-term changes in the brain and its function. For these reasons, it is critical that we determine the cause and consequences of meth abuse/addiction in order to develop more effective methods for preventing and treating associated problems. Considerable research has been conducted to address these very issues. The results of such studies have helped us to appreciate that meth in high doses can be a potent neurotoxin that severely, and uniquely, damages the brain systems critical for cognitive functions, proper decision-making, appropriate motivation processing, and motor control. This occurs because meth promotes the production of free radical molecules (chemicals that can damage brain cells called neurons), resulting in the disruption of release and coordination of neurotransmitters (CNS chemical messengers) causing the meth addict to behave in an abnormal, even psychotic and antisocial, fashion. Interestingly, one of the systems most profoundly injured by abusing meth is the same brain pathway that deteriorates in Parkinson s disease, perhaps explaining why chronic meth use can cause problems with movement and balance.» See Message page 3 1
clinical training Meth is the most commonly abused illegal drug in Utah among men and women in rehab while Marijuana is the illicit drug of choice everywhere else in the country. Meth usage by Utah women has spiraled to epidemic proportions. Forty-five percent of female arrestees in Salt Lake City tested positive for Meth in 2003. The population of women inmates in Utah prisons has escalated, surpassing men, 7 percent to 2 percent. The Utah Addiction Center Report Rocky Mountain High: Utah s Growing Methamphetamine Epidemic Tina Duncan Prevention Services Quality Assurance Salt Lake County Division of Substance Abuse Services Treatment providers and law enforcement personnel agree that methamphetamine has replaced cocaine as the stimulant of choice. The powerful attraction of the drug is exacerbated by its relatively easy manufacture, plus its high last 12-20 times as long. Users get more buzz for the buck with meth costing about the same locally as cocaine. Methamphetamine abuse has become Salt Lake City s biggest drug problem. During previous, nationwide drug epidemics, smaller cities were often largely untouched by serious drug problems. Not so today. Methamphetamine use has invaded cities and small towns across the county, and the numbers are highest here in the Rocky Mountains where it accounts for nearly 90% of all drug cases. Although local meth lab seizures went down from 226 in 2000 to 96 in 2003, the reduction is deceiving. One might think the reduction in labs translates to less availability of meth and less use. Not so. According to a recent Deseret Morning News graphic, treatment admissions for meth use rose from 3,785 in 2000 to 4,736 in 2003. Why I Use Crack This information was submitted by women in treatment at the Cottonwood Family Treatment Center (CFTC). CFTC is a substance abuse treatment center for pregnant women and mothers with children aged 0-8. A priority population for Cottonwood is meth using women who are pregnant or who have a newborn infant. The main focus of the program is on parenting while in recovery. CFTC is one of Valley Mental Health s treatment programs. Why I Used Methamphetamine 1. It made me feel better about myself. 2. To have more friends. 3. To escape my feelings. 4. To loose weight. 5. I had more energy. 6. Because I could. 7. To have better sex. 8. Because it was fun. 9. It gave me status. 10. Because I couldn t stop. Why I Want To Be Clean 1. To get my kids back. 2. To be a better mom. 3. To like myself again. 4. To be honest. 5. To feel again. 6. Don t want legal problems. 7. To enjoy my life. 8. To have a future. 9. To be healthy. 10. To have positive relationships. Meth addiction causes users to neglect and abuse their children. A child born to an addict will be abnormally small and have an underdeveloped nervous system. The children are additionally imperiled by the residue of meth manufacturing which is highly toxic. According to the Utah Department of Human Services, 65 percent of children placed in foster care in Salt Lake County have been removed from the custody of meth-addicted parents. During 2002, 54 percent of these children tested positive for drugs metabolized in their system. The impact to a community lasts long after shut down of a meth lab. Each pound of meth produced leaves behind five to six pounds of toxic waste. Left over chemicals tend to go down household drains and eventually into local water supplies or groundwater. The toxic by products of meth can persist in the soil and groundwater for years. The burgeoning cost of methamphetamine abuse extends throughout Salt Lake City in the form of automobile accidents, increased criminal activity, domestic violence, emergency room and other medical costs, increased spread of infectious disease, loss of worker productivity, increased costs of law enforcement responses, court process, court-ordered drug rehab, incarceration, and child protective services intervention and foster care. Ultimately, taxpayers usually pay these costs. We may feel far removed from the growing methamphetamine problem in the family oriented culture of Salt Lake City, but that perception is just as false as the feeling of invincibility that comprises the drug s main attraction. 2
The Physician s Training Program: Helping Doctors Treat the Disease of Addiction Rachael Hardy Utah Addiction Center academic partnerships According to a survey conducted by the Harvard School of Public Health and The Robert Wood Johnson Foundation in 2000, substance abuse is the number one health concern for 82% of citizens surveyed. Despite substance abuse being the top concern for many citizens, substance abuse and addiction are allotted little time in the classrooms of medical schools. With the help of a grant from the Edward G. Callister Foundation, the Utah Addiction Center is working to educate physicians on the neurobiology of addiction, how to identify a person who has a substance abuse issue, how to conduct a basic assessment, how to educate the patient about the addiction and how it affects his or her brain, how to refer the client to professional treatment resources and how to address the specialized needs of the patient. In Utah, almost half of all referrals to treatment resources come from the justice system, while less than three percent come from healthcare providers. With this training, physicians will be more able to identify substance abuse and refer patients to appropriate, specialized treatment agencies. This training program also teaches physicians to be aware of their own stigmas and biases associated with addiction, such as substance abuse is often regarded as a criminal behavior, rather than a disease, that like most diseases is curable. Currently, the Physician s Training Program is working with medical residents in Family and Preventative Medicine, Addiction and Rehabilitation, Internal Medicine, and Pediatrics. The Utah Addiction Center would like to expand this program to other medical specialties as well as Nursing, Pharmacy, practicing physicians, medical students, and other healthcare professionals. For more information on the physician training program, please contact Barbara Sullivan at (801) 581 3646 or Barbara.Sullivan@hsc.utah.edu» Message continued from page 1 Because high-dose meth abuse causes brain damage, critical questions that require answers are: (i) can injured brains in meth addicts be restored to normal function; and (ii) what types of treatment are most likely to return the addict to mental and physical health. We do not yet have the definitive answers to these critical questions, although a recent article in NIDA Notes (vol. 19, No. 4 page 1, NIH Publication # 05-3478) suggests that some damaged brain regions of meth abusers do show modest recovery after at least 9 months abstinence from the drug. Unfortunately, other critical CNS areas in former meth users are still compromised as long as 17 months of being drug free. The take-home messages from these findings are both hopeful as well as disturbing. On the one hand, these results suggest that brain rehabilitation can occur even after intense meth insult; however, these findings also suggest that recovery is protracted and may not be complete for many months or even years. Findings such as these have critical therapeutic implications for the meth addict and the treatment provider. They help explain the apparent resistance by meth addicts to short-term therapies and suggest that effective treatment approaches for this group of drug abusers will require persistence and long-term commitment by the providers and support systems. We are only starting to comprehend the devastating impact of meth addiction on individuals, families and whole communities and must find ways to more effectively translate research findings into better solutions for the meth scourge. The Utah Addiction Center Report 3
Research The Utah Addiction Center Report Children Prenatally Exposed to Substances of Abuse: Current Status of Outcome Studies Karen Buchi Associate Professor, Pediatrics, University of Utah The most recent national data about the extent of drug abuse among pregnant women comes from a 1992/1993 NIDA hospital survey. The survey found that of the 4 million women who gave birth during the period, 757,000 women drank alcohol products and 820,000 women smoked cigarettes during their pregnancies. There was a strong link among cigarette, alcohol, and illegal drug use. Thirty-two There exists great opportunity for intervention. The general public needs frequent and accurate reminders about the negative effects of using substances of abuse while pregnant and while parenting. percent of those who reported use of one drug also smoked cigarettes and drank alcohol. Survey results also showed that 221,000 women used illegal drugs during their pregnancies that year, with marijuana and cocaine being the most prevalent. The survey estimated that the number of babies born to these women was 222,000. What does current research tell us about the long-term impact that maternal substance use has on children? The cocaine epidemic of the 80 s and 90 s resulted in numerous studies that attempted to measure the neonatal and long-term impact of in utero drug exposure, especially cocaine exposure. In the late 1990 s the major researchers in the field took a hard look at the results of these studies and the quality of the research. Many lessons were learned. One is that maternal substance use is a complicated problem. Women who abuse one drug almost invariably abuse other drugs that also impact the central nervous system. While each individual drug may have specific effects, when used with other drugs of abuse, they may exert different effects. This makes doing research in this area very difficult. It is easy to design animal studies on individual drugs. It is very difficult to design a study that replicates the real experience of a drug abuser. Another very important lesson learned is that measuring the outcome of drug-exposed children requires evaluation of the environment in which the child is raised. Most outcome studies do not adequately address the influence of the post-natal environment. Is the infant being parented by a mother with continued substance abuse and quite possibly mental health problems? How many foster placements has the child experienced? What is the educational level of the care provider? What is the socio-economic status of the home environment? What is the genetic profile of the biologic parents? Do they have attentional and learning problems? All of these factors can greatly influence how a child develops and behaves. Even with the above limitations, conclusions can be drawn from review of the currently published outcome studies of drug-exposed children: When drug effects are observed they tend to be found in more subtle domains of function rather than along gross developmental measures such as general mental or motor developmental scores or IQ. This means that these children do not stand out as different in a classroom setting. There is a relationship between drug exposure and early delivery and drug-exposed infants constitute a growing percentage of infants in special care nurseries. Prematurity alone, regardless of the etiology, is a risk factor for later behavioral and developmental problems. However, the vast majority of drug-exposed infants are not born prematurely. Drug-exposed infants are not a homogeneous group with respect to how they present medically or behaviorally. A working model of the effects of in utero drug exposure: In utero drug exposure may predispose the infant to a short-term vulnerability. The interaction between the neurodevelopmental vulnerability and the response of the caregiving environment determines the long-term developmental» See Prenatal page 7 4
Salt Lake City s COPS Methamphetamine Initiative Marjean Searcy Project Coordinator Salt Lake City Police Department education Multi-agency Collaboration The Salt Lake City s COPS Methamphetamine Initiative is comprised of over thirty local, state and federal agencies that provide a comprehensive multidisciplinary approach to combating methamphetamine and other dangerous drugs. The focus of their efforts involves enhanced enforcement and prosecution, child endangerment, civil remedies to repair neighborhood impact, public awareness campaigns and training initiatives. This task force meets monthly participating in subcommittees to provide new programs, pass legislation and create system change. Experts from key agencies are assigned to the Meth Initiative Office at the Salt Lake City Police Department to work alongside the Narcotics Unit on drug cases. This team is comprised of a child protection worker, environmental health specialist, attorney, research intern, project coordinator and intelligence staff. Most recently a substance abuse treatment specialist has been assigned to engage pregnant women/women with children into treatment services. Child Endangerment Salt Lake City s COPS Meth Initiative has placed a major focus on child endangerment since its inception in 1998. California s well established DEC programs provided the expertise, training and guidance the Methamphetamine Initiative required. Through their mentorship the Salt Lake City DEC Team was developed to provide initial response on narcotic cases involving children. Policy changes occurred to streamline services between law enforcement, child protection, medical and prosecution. In 2000, legislation passed that increased penalties from misdemeanor to felony charges for exposing children to drugs, paraphernalia and precursor chemicals. The Drug Endangered Children Medical Advisory Team (DECMAT) is a group of medical professionals in Utah that have expertise in the field of drug exposed children providing a long term focus to medical and psychological needs. Coordinating with the National DEC Alliance Dr. Karen Buchi is currently conducting a descriptive study of identified children. The Third District Juvenile Family Drug Court was developed to provide court oversight and intensive services to families. Drug Courts are an excellent combination of social services with judicial supervision that has shown marked lower recidivism rates. The Family Drug Court has provided an excellent option for parents with dependent children to obtain sobriety and learn successful parenting. In 2002, the creation of the Cottonwood Family Treatment Center provided early interventions for pregnant women and women with children to reduce mothers using while pregnant. This is an excellent addition to treatment services in our community. In March 2003, Salt Lake City COPS Meth Initiative sponsored the First Annual Drug Endangered Children Conference. The Second Annual DEC Conference was held in October 2004. These conferences provide training and a forum for discussion for professionals throughout Utah. Utah s focus is to develop long term support and services for children exposed to methamphetamine and other dangerous drugs. This will require additional research which is currently being conducted on a local and federal level. An additional emphasis on substance abuse treatment, prevention and mental health will take us from responding to the initial event to a comprehensive holistic approach. Identification of children exposed to illegal drugs and the crimes associated with drug activity is just the beginning of our responsibility. Developing strategies to provide a healthy stable home environment that ensures children develop into well adjusted productive adults requires the investment of the community as a whole. The Salt Lake City District Office of Drug Enforcement Administration has graciously offered to provide oversight in organizing the Utah DEC Alliance. An advisory group is being formed to assist in this effort. The Utah Addiction Center Report» See COPS page 6 5
» COPS continued from page 5 Environmental Health With the associated risk to neighborhoods resulting from the toxic waste left behind from clandestine drug labs. The Salt Lake Methamphetamine Initiative examined Washington State s Laws. In August 2001 the Salt Lake Valley Health Department implemented countywide regulations for the clean-up of chemically contaminated properties. In addition, statewide legislation passed in 2004 that mandates reporting contaminated properties, setting up state wide decontamination standards and establishing contractor certification. Research conducted by the National Jewish Medical and Research Center in Colorado supports regulations set by Salt Lake Valley Health Department in the recovery of these properties. Public Awareness Campaign The Salt Lake City COPS Meth Initiative has been running a successful Public Awareness Campaign consisting of PSA s, Billboards, Direct Neighborhood contacts, educational videos, brochures, and a collaborative training effort to educate the public to the health dangers that exist because of meth labs in their neighborhoods. Through the Public Awareness Campaign, citizens learn about the health dangers associated with methamphetamine and the impact on the community, both financially and in terms of neighborhood safety. As citizens come to recognize the indicators of methamphetamine, they become empowered to help keep their neighborhood safe. The involvement of the community is a key component to implementing long-term solutions. Methamphetamine Trend Through the focused efforts of multiple work groups on the local, state and federal level clandestine drug lab seizures decreased by over 50% from 2001-2003; 2004 numbers show a continuing declining trend. However, substance abuse treatment admissions for the primary drug choice of methamphetamine have continued to increase. Admissions for methamphetamine surpassed marijuana in 2001 and have continued to rise, increasing by over 26% in 2003. As labs decreased in the Salt Lake Valley, drug traffickers flooded the market bringing in large quantities of methamphetamine. The Arrestees Monitoring Drug Abuse Program numbers identify the same problem; individuals are testing positive for methamphetamine at alarming rates. Women in Utah use meth at a higher rate then men. Most women using methamphetamine are in their child bearing years. Prevention/Treatment Professionals are placing an additional emphasis on prevention and treatment. We know we can not arrest our way out of the methamphetamine epidemic. With an additional focus of quality treatment and prevention programs the trend of methamphetamine as the primary drug of choice in Utah will change. Legislation in the 2005 session is promising with the Drug Offenders Reform Act (DORA). Under DORA, judges know the offender s drug history. This bill calls for smarter sentencing and treatment with better outcomes and safer neighborhoods. Conclusion Salt Lake City COPS Methamphetamine Initiative is seen nationally as a successful approach to combating methamphetamine laboratories and abuse. Of all evaluated sites it proved to be the largest and most diverse project. The clearest success of the project was the communication and cooperation among partners. Through this cooperation, agencies institutionalized practices and procedures as well as keeping their staff participating in the initiative even after federal funding for the project ended. The Meth Initiative success is a result of focused partnerships, clear attainable goals, formalized protocols and procedures and education. Ideally this network of agencies would be taken advantage of and adopted for future city-wide projects. For information on the SLC COPS Methamphetamine Initiative: COPS http://www.cops.usdoj.gov The Utah Addiction Center Report 6
The University of Utah School on Alcoholism and Other Drug Dependencies Rachael Hardy Utah Addiction Center education This year, the University of Utah will be hosting its 54th annual School on Alcoholism. The School is internationally recognized for being on the cutting edge in the field of alcoholism and other drug dependencies. In keeping with its commitment to providing state of the art information, the School will be providing more sessions that translate current research into direct service practice. These sessions will focus on the neurobiology of addiction, brain development, and underlying mechanisms of use versus abuse. The 1990 s are known as the decade of the brain. During this time, the National Institute on Drug Abuse (NIDA) conducted a vast amount of research on the neurobiology of addiction. Recent technological advances, such as the fmri, have enabled researchers to determine the parts of the brain that are impacted by substance abuse and addiction. Most of this research has not been translated into useful information for practitioners. Rather general practice for preventing and treating alcoholism and other drug dependencies has focused on the social factors that influence alcoholism and other drug dependencies. Drs. Glen Hanson and Barbara Sullivan are, through the School, translating research findings gathered from these recent studies into application for prevention and treatment practitioners, so that they are able to create and implement more effective protocols. Also, Drs. Hanson and Sullivan are working to create an understanding that more comprehensive assessments, which address learning disabilities, traumatic brain injuries, brain functioning, and patient history, will lead to more effective prevention and treatment. The University of Utah School on Alcoholism will continue to be a leader in alcohol and drug dependency schools, because the faculty is dedicated to staying on the cutting edge of research and to supplying the most useful information to the practitioners who attend. Technologies such as fmri provide researchers with new ways to study how substance abuse impacts the brain.» Prental continued from page 4 outcome of the child. Biological vulnerability makes a child more susceptible to the effects of a poor caretaking environment. This is why it is essential that prenatal and pediatric care providers identify mothers with substance abuse problems and help them seek treatment. At this time, very little is known about the range of developmental outcomes to expect in drug-exposed children or It is essential that prenatal and pediatric care providers identify mothers with substance abuse problems and help them seek treatment. the etiology of such outcomes. It is probably fair to say that these children are at increased biological and social risk, that their outcome is undetermined, that the full range of intellectual and social-emotional outcomes are possible, and that neither biological nor environmental factors have been proven or disproven to determine the developmental outcome in these infants. This means there exists great opportunity for intervention. The general public needs frequent and accurate reminders about the negative effects of using substances of abuse while pregnant and while parenting. Prenatal and pediatric care providers must routinely screen their families for substance abuse problems and know where to send them for treatment. Substance abuse treatment must be better funded so that it is readily available when a mother, whether pregnant or not, seeks intervention. Only through education, identification, and treatment can we improve the outcomes of these vulnerable children. The Utah Addiction Center Report 7
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