Methamphetamine: What Professionals Need to Know Jackie McReynolds Washington State University Vancouver

What is Methamphetamine? A very powerful stimulant A highly addictive, synthetic drug A powder or crystallized form Can be taken orally (tablet), injected, or inhaled (smoked), absorbed through skin

Addiction Potential 42% of first time users go on to 2nd use. 84% of 2nd time users go on to develop regular use. OHSU.Org

Physiological Impact Increased metabolic rate, heart rate, and blood pressure (blood flow restricted as vessels contract) Body temperature rises (sweat glands shut down; more prevalent in men than women) Body energy surges, excessive activity may result Loss of appetite as digestive tract slows down Extreme euphoria within 5-20 minutes Enhanced sociability Increased sexual arousal; loss of inhibitions

Phases of Meth Use Rush (5-30 minutes): all about pleasure High (4-16 hours): aggressive & argumentative Binge (3-15 days): hyperactivity Tweaking (most dangerous): hallucinations Crash (1-3 days): mostly asleep Normal (2-14 days): back to a slightly deteriorated normal state Withdrawal (30-90 days): depression, lethargy, cravings, suicidal tendencies

Negative Side Effects: Immediate and Long-term Stroke Cardiac arrhythmia Stomach cramps Convulsions & shaking Significant weight loss Lung disorders similar to asbestos exposure Insomnia Chronic sinus infections; deviated septum Paranoia and hallucinations; high-level anxiety; aggression Brain damage; risk factor for development of Parkinson’s Skin rashes and dental decay; burns Poor personal hygiene (bathing is physically uncomfortable)

The Faces of Meth

Homemade Meth Ingredients Pseudoephedrine Red phosphorous (matches) Drain cleaner Sulfuric acid Paint thinner Iodine Freon Driveway cleaner Lye Acetone (nail polish remover) Methanol (brake fluid) Ammonia Ether Lithium metal (batteries) Pesticide Anhydrous ammonia

Shake and Bake Meth

“Parents who are addicted to drugs have a primary commitment to chemicals, not to their children.” Beckwith, 1989

Meth Mouth

Meth Bugs

How Does Meth Impact Brain Function? Immediately begins to change brain chemistry Damages neurons more severely in ways that other drugs do not Not all areas of the brain affected: centers for reward, memory, and judgment are most heavily impacted Profound changes in dopamine and seratonin systems PET scans resemble Parkinson’s patients Brain chemistry resembles paranoid schizophrenics In children, integration of sensory-based functions is most vulnerable

The Brain Chemistry Effect

Nerve Cell Damage

PET Scan of Meth User

Loss of Memory, Emotion, and Reward Systems in the Meth Brain

Brain Scans: Healthy vs. a 15-year user of Meth

How Does Meth Hurt Children?

Double Jeopardy for Children Children are at risk due to prenatal exposure and postnatal environmental effects Poverty Chaotic and dangerous lifestyles Symptoms of psychopathology (personality disorders, depressive symptoms) History of sexual abuse Domestic violence

Developmental Vulnerabilities Immature organ systems, faster metabolic rates, weaker immune systems Eat more food, drink more fluids, and breathe more air per pound of body weight Typical behaviors expose them to more hazards Increased potential for cerebral damage (strokes, brain lesions)

Digestive Difficulties Permanent brain damage causes difficulty in glucose metabolism (12-17 mo. to repair some) Stomach lining is weakened by high levels of acidity, leading to gastritis H pylori bacterial infection ensues Symptoms may include an aversion to food, acid reflux-like symptoms, abdominal cramps, ulcer-like symptoms

Treatment for H pylori No safe protocol documented for children For adults a three-pronged approach: Amoxicillin or other antibiotic Bismuth (i.e., Pepto: some risk of Reye syndrome) Metronidazole (i.e., Pepcid) Hypersensitive to taste and smell: go for bland Lactose intolerance: move to soy-based products

IDEAL Study The Infant Development, Environment and Lifestyle (IDEAL Study: Dr. Barry Lester of Brown University) Clinical outcomes: - smaller head size - evidence of feeding difficulties - sleep disturbances - delays in development domains - ADD - early and multiple interventions produce positive outcomes (healthcare, mental health, social services)

Pre-Natal Meth Exposure Easily crosses the placenta; metabolized differently by fetal brain; brain is more sensitive Constricts blood flow, restricting oxygen and slowing growth Linked to a greater incidence of multiple births, prematurity, and low birth-weight Pregnant women and new mothers are less likely to seek help than other addicted women Mothers who are clean during the 3rd trimester reduce fetal involvement significantly

Special Needs Attachment intervention Medication (chronic and short-term) Hydration and tube feeding Cardiac monitoring Foster care placement Therapeutic child care

Minimizing Stress for Infants Provide a quiet, calm environment with minimal noise & bright lights Ensure warmth and comfort by bundling the child in blankets Encourage habituation by providing sucking opportunity with a pacifier Initiate gentle rocking or soothing motions to help achieve neurobehavioral organization Limit exposure to cigarette smoke

Working With Young Children up to Two Years of Age 6-18 months of age is referred to as a “honeymoon” period of development for drug- exposed children All external measures may well indicate the child is symptom-free Toward the end of this period (18-24 months), speech and language difficulties may appear Appropriate interventions need to occur as difficulties emerge

Interventions: Infants and Toddlers Design quiet environments with limited sensory stimulation Implementation of an emotionally centered, attachment focused program (Circle of Security; Promoting First Relationships) Consistency in schedule, adult contacts, physical stimulation Use of sign language Referral for sensory integration therapy; sensory screening

Children 3 Years and Older Attention deficit may become more pronounced as more demands are placed on the child in group settings May have difficulty controlling emotions and social exchanges Problems adjusting to a changing environment Spatial learning and memory (object recognition) are deficient Tendencies toward aggressive behavior, hypervigilance, and parentification Type II diabetes and high blood pressure are common Unstable family units exacerbate problems

Preschool (young school-aged) Psychosocial Problems Low self-esteem Core boundary issues Regressive behaviors Fear and anxiety Food and object hoarding Grief and loss behaviors Influence of family disruption Initiative (guilt): Preschool Industry (inferiority): School age

Why environmental organization?

Dangers of Home Visits

Recognizing a Meth House Unusual odors (ammonia, ether, cat urine, rotten eggs, or old mayonnaise) Covered windows Strange ventilation Elaborate security Dead vegetation Excessive/unusual trash Frequent visitors and/or deliveries Uncharacteristic display of wealth Round-the-clock activity, followed by quiet days

Recognizing Meth Production An unusually large supply of main meth ingredients in the home or trash - blister packs of cold meds (Sudafed or comparable), batteries, camp fuel, and others Presence of equipment or apparatus used to make meth - stained coffee filters, funnels, turkey basters, improvised glassware, tubing

Treatment & Recommendations

What About Treatment? Communities are unprepared for treatment of meth addicts (effective 40-50%) Meth addicts are particularly challenging: *poor engagement rates *high drop-out rates *high relapse rates *protracted depression, paranoia, anxiety Some emerging info on histamine effect (OHSU) First 4-6 months of treatment are most critical to recovery

Does Treatment Work?

The Matrix Model of Treatment Combines the following aspects: - individual counseling (non-judgmental and non-confrontational) - cognitive behavioral therapy - motivational interviewing - family education program - regular u.a. (once per week) - aspects of the traditional 12-step program Rawson, R. (1996)

Resources Am. Assn. of Retired Persons, aarp.org/grandparents/ Drug Endangered Children (DEC), nationaldec.org Children of Alcoholic Families www.coaf.org Natl. Inst. On Drug Abuse: nida.nih.gov Zero to Three, Zerotothree.org ACE Study (child impact), ChildTrauma.org Circle of Security, Circleofsecurity.org Through the Eyes of a Child, University of Wisconsin fact sheets DSHS: www1.dshs.gov/kinshipcare/raisingchildren.shtml Vol. 12(2) 2007 of Child Maltreatment, http://cmx.sagepub.com/archive/ Brown Center for the Study of Children at Risk, www.brown.edu/Departments/Children_at_Risk/Home

Other Useful Web Resources Govt. Meth Resources: Methresources.gov Montana Meth Project: Montanameth.org Alcoholics Anonymous :alcoholics-anonymous.org Al-Anon/Alateen al-anon.alateen.org Narcotics Anonymous: na.org

Other Non-fiction Reading Addict in the Family by Beverly Conyers Painted Rocks by Kimberly Ann Freel The Year of Magical Thinking by Joan Didion The Way We Are, an essay by Thomas Lynch (included in Bodies in Motion and at Rest) Under the Influence by Katherine Ketcham & James R. Milan What About the Kids: Raising Your Children Before, During and After Divorce by Judith Wallerstein and Sandra Blakeslee Beautiful Boy: A Father’s Journey Through His Son’s Meth Addiction by David and Nic Sheff Tweaked: A Crystal Meth Memoir, by Patrick Moore

Presenter Contact Info Jackie McReynolds, M.S. Senior Instructor/Academic Coordinator Dept. of Human Development Washington State University Vancouver, WA 98686-9600 360-546-9740 mcreynol@vancouver.wsu.edu FAX: 360-546-9076