Greenberg&Cohen EBCRP Methamphetamine: Understanding the Influence of Violence in Treatment Planning and Recovery Judith Cohen, PhD Rivka Greenberg, PhD Anna Talamo, MFT East Bay Community Recovery Project ADP 2008 Conference, Burlingame, CA June 18, 2008

Greenberg&Cohen EBCRP Methamphetamine A highly addictive stimulant that affects the central nervous system A highly addictive stimulant that affects the central nervous system Readily available and inexpensive Readily available and inexpensive Commonly called, "speed“, "meth“, "chalk." In smoked form, called, "crank“, "crystal“, "ice“ Commonly called, "speed“, "meth“, "chalk." In smoked form, called, "crank“, "crystal“, "ice“

Greenberg&Cohen EBCRP National Treatment Admissions for Methamphetamine Increase

Greenberg&Cohen EBCRP The Center for Substance Abuse Treatment Methamphetamine Treatment Project Funded by the CSAT, from 1999 – 2001 Funded by the CSAT, from 1999 – 2001 Eight outpatient sites, 1,000+ clients Eight outpatient sites, 1,000+ clients Belmont, Costa Mesa, Hayward, Lafayette, San Diego, Los Angeles, Billings Montana and Honolulu Hawaii Belmont, Costa Mesa, Hayward, Lafayette, San Diego, Los Angeles, Billings Montana and Honolulu Hawaii Abuse and Violence Questions Abuse and Violence Questions Treatment Randomized Treatment Randomized Matrix model -16 week program Matrix model -16 week program Treatment as usual Treatment as usual

Greenberg&Cohen EBCRP Baseline Demographics Participants served (n) Participants served (n) Age (mean) Age (mean) Education (mean) Education (mean) Methamphetamine use (mean) Methamphetamine use (mean) For those who used: For those who used: Alcohol use (mean) Alcohol use (mean) Marijuana use (mean) Marijuana use (mean) years 32.8 years 12.2 years 12.2 years 7.5 years 7.5 years 7.2 years 7.2 years 7.6 years 7.6 years

Greenberg&Cohen EBCRP Gender Distribution of Participants

Greenberg&Cohen EBCRP Ethnic Identification of Participants

Greenberg&Cohen EBCRP Psychological Problems Significantly high BSI scores on Significantly high BSI scores on Depression Depression Anxiety Anxiety Hostility Hostility Somatization Somatization Addiction Addiction Positive symptom total score Positive symptom total score

Greenberg&Cohen EBCRP Age That Physical Violence Began WomenMen Total reports of violence Percent of total N Percent of total N70%60% Began between 1 and 10 yrs Began between 11 and 18 yrs

Greenberg&Cohen EBCRP Abuse During Lifetime

Greenberg&Cohen EBCRP Implications For Treatment Screen carefully for Screen carefully for Abuse and violence Abuse and violence Psychiatric problems Psychiatric problems Recognize pervasive gender differences Recognize pervasive gender differences Need to address substance abuse, violence and psychiatric problems in an integrated treatment model Need to address substance abuse, violence and psychiatric problems in an integrated treatment model

Greenberg&Cohen EBCRP Treatment Engagement Women who said yes to the following questions were significantly more likely to Women who said yes to the following questions were significantly more likely to Leave treatment in the first month Leave treatment in the first month Do you feel afraid of your partner? Do you feel afraid of your partner? Are you sometimes afraid to go home? Are you sometimes afraid to go home? Do you feel your partner might kill you? Do you feel your partner might kill you?

Greenberg&Cohen EBCRP Treatment Completion Women who said yes to the following questions were significantly more likely to Women who said yes to the following questions were significantly more likely to Not complete treatment Not complete treatment Do you feel afraid of your partner? Do you feel afraid of your partner? Do you feel your partner might kill you? Do you feel your partner might kill you?

Greenberg&Cohen EBCRP Discussion Treatment engagement and retention for women who use methamphetamine is a major concern Treatment engagement and retention for women who use methamphetamine is a major concern The women identifying violence and/or abuse in their lives were significantly at risk for not staying or completing treatment The women identifying violence and/or abuse in their lives were significantly at risk for not staying or completing treatment Indicates the need to address the fear factor as a treatment component Indicates the need to address the fear factor as a treatment component Need to address ways for the women to keep themselves safe, physically and psychologically Need to address ways for the women to keep themselves safe, physically and psychologically

Greenberg&Cohen EBCRP Research to Practice These findings strongly indicate the need for These findings strongly indicate the need for Gender responsive treatment Gender responsive treatment Relational Relational Strength-based Strength-based Trauma informed Trauma informed Treatment environment in which women feel safe and comfortable (Perinatal Environmental Scan, 2007) Treatment environment in which women feel safe and comfortable (Perinatal Environmental Scan, 2007) Facility safety measures Facility safety measures

Greenberg&Cohen EBCRP Client Physical Safety Facility and Staff Facility and Staff What measures have been taken to assure the physical safety of clients and staff? What measures have been taken to assure the physical safety of clients and staff? Are staff trained in identification and reporting? Are staff trained in identification and reporting? How are the clients informed about the measures to ensure their safety? How are the clients informed about the measures to ensure their safety?

Greenberg&Cohen EBCRP Facility Atmosphere How do staff convey in their spirit and attitude an awareness and respect of the trauma in the lives of their clients? How do staff convey in their spirit and attitude an awareness and respect of the trauma in the lives of their clients? Supportive, engaging, respectful versus shaming and confrontational? Supportive, engaging, respectful versus shaming and confrontational? Are staff trained in the identification of possible re-traumatizing actions? Are staff trained in the identification of possible re-traumatizing actions? For example - For example -

Greenberg&Cohen EBCRP Addressing Trauma in Treatment Is safety planning a component of the treatment program? Is safety planning a component of the treatment program? Does the program assess for trauma? Does the program assess for trauma? Is trauma work identified in the treatment plan? Is trauma work identified in the treatment plan? Does the program have a trauma specific intervention as part of the program? Does the program have a trauma specific intervention as part of the program? Among those identified has having evidence based outcomes- Among those identified has having evidence based outcomes- Seeking Safety Seeking Safety Trauma Affect Regulation: Guide for Education and Therapy - TARGET Trauma Affect Regulation: Guide for Education and Therapy - TARGET Trauma Recovery and Empowerment Model – TREM Trauma Recovery and Empowerment Model – TREM

Greenberg&Cohen EBCRP cffutures.org/calwcf/documents/Pe rinatalEnvironmentalScanSummar y pdf The Next Generation California Pregnant Women in California, 2005 An estimated 100,000 infants are born prenatally exposed to alcohol each year An estimated 20,000 to 60,000 are born prenatally exposed to illicit drugs Fewer than 4,000 pregnant women entered treatment in California in 2005.

Greenberg&Cohen EBCRPcffutures.org/calwcf/docu ments/PerinatalEnvironmentalSca nSummary pdf Next Generation California Parents, 2005 Nationally, among parents living with their children, 8% of fathers & 4% of mothers were dependent on or abused substances in the past year An estimated 849,000 California children live with a parent who abuses or is dependent on alcohol or illicit drugs Approximately 103,000 parents were admitted to treatment

Greenberg&Cohen EBCRP Next Generation As trauma informed treatment comes increasingly an basic component of substance abuse treatment – how do we provide the needed interventions to the children – to interrupt the intergenerational cycle? As trauma informed treatment comes increasingly an basic component of substance abuse treatment – how do we provide the needed interventions to the children – to interrupt the intergenerational cycle? How to we replace risk factors with protective/resiliency factors? How to we replace risk factors with protective/resiliency factors?

Greenberg&Cohen EBCRP Further Information Cohen, J. C., Dickow, A., Horner, K., Zweben, J. E., Balabis, J.,Vandersloot, D., Reiber, C. (2003). Abuse and Violence History of Men and Women in Treatment for Methamphetamine Dependence. American Journal on Addictions, 12,