The Cognitive, Emotional, Medical, and Psychiatric Impact of Meth Use: What Do We Know and What Do W

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The Cognitive, Emotional, Medical, and
Psychiatric Impact of Meth Use What Do We
Know and What Do We Do about It?

• Sherry Larkins, Ph.D.Thomas Freese, Ph.D.
• UCLA Integrated Substance Abuse Programs
• Pacific Southwest Addiction Technology Transfer
  Center

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EPHEDRINE
H
H
H
C
C
N
CH
CH
OH
3
3
3
Primary Amphetamine/Methamphetamine TEDS
Admission Rates(per 100,000 aged 12 and over)
1992
lt 5
47-107
220 or more
5-46
108-219
Incomplete Data
SOURCE SAMHSA Treatment Episode Data Set (TEDS).
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Primary Amphetamine/Methamphetamine TEDS
Admission Rates (per 100,000 aged 12 and over)
SOURCE SAMHSA Treatment Episode Data Set (TEDS).
5
Primary Amphetamine/Methamphetamine TEDS
Admission Rates(per 100,000 aged 12 and over)
SOURCE SAMHSA Treatment Episode Data Set (TEDS).
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Primary Amphetamine/Methamphetamine TEDS
Admission Rates(per 100,000 aged 12 and over)
SOURCE SAMHSA Treatment Episode Data Set (TEDS).
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Why do people take drugs?
To feel better To lessen Anxiety
Worries Fears Depression Hopelessness Withdrawal
To feel good To have novel Feelings Sensations Ex
periences AND To share them
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In other words A Major Reason People Take a
Drug is they Like What It Does to Their Brains
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Meth
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Meth
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Their Brains have been
Re-Wired by Drug Use
In other words
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Natural Rewards Elevate Dopamine Levels
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Effects of Drugs on Dopamine Release
Source Shoblock and Sullivan Di Chiara and
Imperato
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Prolonged Drug Use Changes the Brain In
Fundamental and Long-Lasting Ways
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Decreased dopamine transporter binding in METH
users resembles that in Parkinsons Disease
Control Meth PD
Source McCann U.D.. et al.,Journal of
Neuroscience, 18, pp. 8417-8422, October 15, 1998.
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PET Scan of Long-Term Impact of Methamphetamine
on the Brain
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• Cognitive and
• Memory Effects

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Dopamine Transporters in Methamphetamine Abusers

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Differences between Stimulant and Comparison
Groups on tests requiring perceptual speed
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Memory Difference between Stimulant and
Comparison Groups
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Longitudinal Memory Performance
number correct
test
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Control gt MA
4
3
2
1
0
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MA gt Control
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Labeling of Emotion
Brain scans were taken while people answered
the question below looking at the following
pictures
What did their brains show?
Which of the two bottom pictures matches the
emotion shown on top?
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Control Subjects and Methamphetamine Abusers
Activate Emotion Face Processing Areas
Control
Methamphetamine

• amygdala

• amygdala

D Payer et al., Abstr. Soc. Neurosci., 2005
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How much does the brain heal?
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PET Scan of Long-Term Meth Brain Damage
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Partial Recovery of Brain Dopamine Transporters
in Methamphetamine (METH) Abuser After Protracted
Abstinence
3
0
ml/gm
METH Abuser (1 month detox)
Normal Control
METH Abuser (24 months detox)
Source Volkow, ND et al., Journal of
Neuroscience 21, 9414-9418, 2001.
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Partial Recovery of Brain Metabolism in
Methamphetamine (METH) Abuserafter Protracted
Abstinence
70
0
µmol/100g/min
Control Subject (30 y/o, Female)
METH Abuser (27 y/o, Female) 3 months detox
METH Abuser (27 y/o, Female) 13 months detox
Source Wang, G-J et al., Am J Psychiatry 1612,
February 2004.
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Brain Serotonin Transporter Density and
Aggression in Abstinent Methamphetamine Abusers

• Sekine, Y, Ouchi, Y, Takei, N, et al. Brain
  Serotonin Transporter Density and Aggression in
  Abstinent Methamphetamine Abusers. Arch Gen
  Psychiatry. 20066390-100.

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Objective of Study

• Investigate the status of brain serotonin neurons
  and their possible relationship with clinical
  characteristics in currently abstinent
  methamphetamine abusers.

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Results

• Serotonin transporter density in global brain
  regions was significantly lower in
  methamphetamine abusers
• Suggests that abuse of methamphetamine leads to a
  global and severe reduction in the density of
  human brain serotonin transporters
• Values of serotonin transporter density in widely
  distributed brain regions were found to
  negatively correlate with the duration of
  methamphetamine use.
• Suggests that the longer methamphetamine is used,
  the more severe the decrease in serotonin
  transporter density.

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Results (Continued)

• Magnitude of aggression in methamphetamine
  abusers increased significantly with decreasing
  serotonin transporter densities in some brain
  regions.
• Bitofrontal cortex, anterior cingulate, temporal
  cortex
• No correlation between a representative measure
  of serotonin transporter density and the duration
  of methamphetamine abstinence. Individuals
  abstinent for gt 1 year still had a substantial
  decrease in serotonin transporter density.
• Suggests reductions in the density of the
  serotonin transporter in the brain could persist
  long after methamphetamine use ceases.

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Effects of Methamphetamine and Treatment
Implications
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MethamphetamineAcute Physical Effects

• Increases
• Heart rate
• Blood pressure
• Pupil size
• Respiration
• Sensory acuity
• Energy

• Decreases
• Appetite
• Sleep
• Reaction time

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MethamphetamineAcute Psychological Effects

• Increases
• Confidence
• Alertness
• Mood
• Sex drive
• Energy
• Talkativeness

• Decreases
• Boredom
• Loneliness
• Timidity

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and just when you thought it couldnt get any
better
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MethamphetamineChronic Physical Effects

• Tremor
• Weakness
• Dry mouth
• Weight loss
• Cough
• Sinus infection

• Sweating
• Burned lips sore nose
• Oily skin/complexion
• Headaches
• Diarrhea
• Anorexia

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Cardiovascular problems

• ? heart rate
• Palpitations
• Arrhythmia
• ? blood pressure
• Chest Pain
• Valve thickening

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Neurological problems

• Seizures
• Stroke
• Cerebral hemorrhage
• Cerebral vasculitis
• Mydriasis

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Respiratory problems

• Dyspnea
• Pulmonary hypertension
• Pleuritic chest pain

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Other problems

• Eye ulcers
• Over-heating
• Rhabdomyolysis
• Obstetric complications
• Anorexia / weight loss

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Speed Bumps
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Faces of MethamphetamineSpeed Bumps

• Images courtesy Multnomah County Sheriffs Office

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METH Use Leads to Severe Tooth Decay
Source Richards, JR and Brofeldt, BT, J
Periodontology, August 2000.
METH Mouth
Source The New York Times, June 11, 2005.
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Outpatient Treatment for Methamphetamine Abuse
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Investigational Medicationfor High Blood Pressure
Treatment Works!!!
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Investigational Medicationfor Asthma
Treatment Works!!!
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Investigational Medicationfor Methamphetamine Use
Treatment Failed!!!
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Relapse Rates Are Similar for Drug Dependence
and Other Chronic Illnesses
100
90
80
70
60
Percent of Patients Who Relapse
50
40
30
20
10
0
Drug Dependence
Type I Diabetes
Hypertension
Asthma
Source McLellan, A.T. et al., JAMA, Vol 284(13),
October 4, 2000.
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Tips for HIV Clinicians Working with
Methamphetamine Users
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Tips for HIV Clinicians Working with
Methamphetamine Users

• Tips for HIV clinicians working with active and
  recovering meth users
• Maintain calm and create an accepting environment
• Be prepared to refer to specialists familiarize
  yourself with COD and local medical professionals
  who treat COD
• Maintain support and vigilance for depression

SOURCE http//www.aidsetc.org/pdf/p02-et/et-03-00
/methusers.pdf
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Tips for HIV Clinicians Working with
Methamphetamine Users

• More tips for HIV clinicians working with active
  and recovering meth users
• Write down instructions/explain instructions
  visually
• Address issues of meth use and HIV medications
• Discuss issues of sex, sexuality, HIV disclosure,
  and stigma
• Know your community support services

SOURCE http//www.aidsetc.org/pdf/p02-et/et-03-00
/methusers.pdf
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Behavioral Treatments for Drug Abuse

• Cognitive/Behavioral Therapy-CBT
• Motivational Interviewing-MI
• Contingency Management-CM
• Matrix Model of Outpatient Treatment

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Cognitive Behavioral Therapy

• Social Learning Theory concepts (Bandura and
  others)
• Also referred to as Relapse Prevention Therapy
• Applied to treatment of alcoholism, cocaine
  dependence, nicotine dependence and marijuana
  abuse.
• Major Publications/Studies
• Alcohol - Marlatt Gordon (1985) D. Donovan T
  Gorski Project MATCH (Numerous Authors)
• Cocaine- Carroll K (multiple studies) NIDA
  Collaborative Study (Crits-Christoph et al 2001)
  Rawson et al (2002)
• Nicotine - S. Shoptaw et al (2002)
• Marijuana - R. Roffman et al M. Dennis et al (In
  Press)

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CBT Basic Assumptions

• Concepts similar to those for depression
• Emphasizes cognitive aspects of drug/alcohol use
  as learned behavior
• Role of cognitions in abstinence
• Treatment is a teaching process, coaching and
  reinforcing therapist is a teacher/coach
• No assumption of underlying psychopathology
• New, alternative behaviors must be established
• Can be delivered in group or individual settings

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CBT Key Concepts

• Encourage and reinforce behavior change
• Recognize and avoid high risk settings
• Behavioral planning (scheduling)
• Skills for coping with conditioned triggers
• Understand and deal with craving
• Abstinence violation effect getting back on
  the wagon
• Understanding basic psychopharmacology principles
• Self-efficacy

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CBT Evidence Based Concepts

• McKay et al., 1997 noted that CBT/RP elements
  included in most current therapies for drug
  dependence, including 12-Step
• Alcohol Empirical support for some elements In
  Project MATCH (2000), outcome comparable to other
  therapies
• Cocaine Carrolls research Superiority to
  interpersonal therapy sleeper effect. In NIDA
  collaborative study, comparable outcome to other
  therapies. Rawson studies evidence of efficacy,
  plus superior sustained reductions.
• Nicotine Shoptaw et al. Reduces cigarette use
  when in combination with nicotine substitution.
• Marijuana Roffman and Dennis studies both
  support efficacy

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Cognitive Behavioral Therapy

• Effective as behavioral therapy platform for
  medication studies (e.g., Shoptaw et al., 2002)
• Concepts can be tailored to address cultural
  specificities without starting from scratch
• Using cultural referents for core concepts
• Integrating HIV as a target results in a 3-fold
  reduction in sexual risk behaviors, independent
  of drug abuse outcomes (Shoptaw et al., in
  review)
• Flexible lengths for treatment

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Cognitive Behavioral Therapy

• Resources
• Marlatt and Gordon 1985
• NIDA CB Manual (Brief et al., 1998)
• NIAAA Project Match CB Manual
• Gorski Publications
• Washton Publications

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Motivational Interviewing

• Based upon Prochaska and DiClemente Stages of
  Change Theoretical Model
• Also referred to as Motivational Enhancement
  Therapy
• Client Centered approach to interventions
  emphasizes ambivalence toward drug abstinence
• Applied with many substances, data primarily with
  alcoholics
• Major Publications/Studies Miller and Rollnick,
  1991 Project MATCH, 2000

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MI Basic Assumptions

• People change their thinking and behavior
  according to a series of stages
• Individuals may enter treatment at different
  stages of change
• It is possible to influence the natural change
  process with MI techniques
• MI can be used to engage individuals in longer
  term treatment and to promote specific behavior
  changes
• Confrontation of denial can be
  counterproductive and or harmful to some
  individuals

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Motivational Interviewing

• Can be brief as few as 3-5 sessions
• Used internationally with methamphetamine abuse
  (Ali et al., 2002 Marsden et al., 2002)
• Some therapists unable to conduct high quality MI

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Four Principles ofMotivational Interviewing
1. Express empathy 2. Develop discrepancy 3. Avoi
d argumentation 4. Support self-efficacy
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1. Express Empathy
Acceptance facilitates change Skillful reflective
listening is fundamental Ambivalence is normal
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2. Develop Discrepancy
Awareness of consequences is important Discrepancy
between behaviors and goals motivates
change Have the client present reasons for change
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3. Avoid Argumentation
Resistance is signal to change strategies Labeling
is unnecessary Shift perceptions Clients
attitudes shaped by their words, not yours
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4. Support Self-Efficacy
Belief that change is possible is important
motivator Client is responsible for choosing
and carrying out actions to change There is hope
in the range of alternative approaches available
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BUILDING MOTIVATIONOARS

• Open-ended questioning
• Affirming
• Reflective listening
• Summarizing

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Motivational Interviewing

• Resources
• Miller and Rollnick 1991
• NIAAA Project MATCH manual
• CSAT TIP on Motivational Techniques
• NIDA Tool Box

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Contigency ManagementakaMotivational
Incentives
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Contingency Management

• Operant conditioning approach
• Proper contingent relationships between behavior
  and consequences will modify behavior
• No therapy or counseling
• Major Publications
• Opiates Stitzer et al (numerous articles)
• Cocaine Higgins et al (numerous articles)
  Silverman et al (numerous articles) Amass et al
  (several articles) Petry (several articles)
  Rawson et al, 2002) Roll (several articles)

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CM Basic Assumptions

• Drug and alcohol behavior can be controlled using
  operant reinforcement procedures
• Vouchers can be used as proxies for money or
  goods
• Vouchers should be redeemed for items
  incompatible with drug use
• Escalating value of the reinforcer for
  continuous abstinence promotes better
  performance Rapid reset following relapse is
  critical
• Counseling/therapy may or may not be required in
  conjunction with CM procedure

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CM Key Concepts

• Behavior to be modified must be objectively
  measured and monitored frequently
• Reinforcement must be immediate
• Penalties for unsuccessful behavior (eg positive
  sample) reduce voucher amount
• Vouchers can be applied to a wide range of
  prosocial alternative behaviors

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Tailoring CM Specific Targets

• Kiddorf used therapist time as reinforcer to
  increase treatment response (2001)
• Dirty urine gets more time with therapist clean
  urine gets less
• Iguchi reinforces clients pro-social behaviors
  (e.g., job seeking) therapists goal-setting
  behaviors with clients
• Milby uses CM to promote job skills in rural
  cocaine users rehabilitates dilapidated housing
  stock
• Petry uses CM to promote attendance at HIV clinic

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Contingency Management Research Findings

• Higgins review of CM literature
• 11 studies positive treatment effects
• 2 studies with no significant differences
• Most powerful behavioral treatment for cocaine
  dependence
• Size of vouchers positively associated with
  outcomes (fish bowl Petry 2000)
• Available resources in community can be used to
  conduct CM (Amass et al., in review)

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MATRIX MODEL TREATMENT
Components of Stimulant
Addiction Syndrome
Behavioral Disruption
Cognitive Disruption
Emotional Disruption
Family/Relationship Disruption
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Days of Methamphetamine Use in Past 30 (ASI)
Possible is 0-30 tpaired20.90 p-valuelt0.000
(highly sig.)
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Beck Depression Inventory (BDI) Total Scores
Possible is 0-63 tpaired16.87 p-valuelt0.000
(highly sig.)
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Drop Rates by Route
Plt.05
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Treatment Length by Route
Plt.05
95
Treatment Completion by Route
Plt.05
96
MA-Free Samples by Route
Plt.05
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STAGES OF RECOVERY - STIMULANTS
OVERVIEW
DAY 180
DAY 0
DAY 15
DAY 45
DAY 120
Adjustment
Honeymoon
The Wall
Withdrawal
Resolution
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Stages of Recovery - Stimulants
WITHDRAWAL STAGE
DAY 0
DAY 15

• Medical Problems
• Alcohol Withdrawal
• Depression
• Difficulty Concentrating
• Severe Cravings

• Contact with Stimuli
• Excessive Sleep

PROBLEMS ENCOUNTERED
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MATRIX MODEL TREATMENT
Primary Manifestation of Withdrawal Stage
Behavioral
Cognitive
Confusion Inability to Concentrate
Behavioral Inconsistency
Relationship
Emotional
Depression/Anxiety- Self-Doubt
Mutual Hostility- Fear
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Matrix Model TreatmentKey Concept Structure

• Self-designed structure (scheduling)
• Eliminate avoidable triggers
• Makes concrete the concept of One day at a time
• Reduces anxiety
• Counters the addict lifestyle
• Provides basic foundation for ongoing recovery

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MATRIX MODEL TREATMENT
STRUCTURE
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MATRIX MODEL TREATMENT Structure - Ways to Create

• Time scheduling
• Attending 12-step meetings
• Going to treatment
• Exercising
• Attending school
• Going to work
• Performing athletic activities
• Attending church

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MATRIX MODEL TREATMENT Structure - Pitfalls

• Scheduling unrealistically
• Neglecting recreation
• Being perfectionistic
• Therapist imposing schedule
• Spouse/parent imposing schedule

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MATRIX MODEL TREATMENT Relapse Factors -
Withdrawal Stage

• Unstructured time
• Proximity of triggers
• Alcohol/marijuana use
• Powerful cravings
• Paranoia
• Depression
• Disordered sleep patterns

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Stages of Recovery - Stimulants
HONEYMOON STAGE
DAY 15
DAY 45

• Over-involvement With Work
• Overconfidence
• Inability to Initiate Change

• Inability to Prioritize
• Alcohol Use
• Episodic Cravings
• Treatment Termination

PROBLEMS ENCOUNTERED
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MATRIX MODEL
Primary Manifestation of Honeymoon Stage
Behavioral
Cognitive
High Energy- Unfocused Behavior
Inability to Prioritize
Relationship
Emotional
Overconfidence/ Feeling Cured
Denial of Addiction Disorder
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MATRIX MODEL TREATMENT
INFORMATION
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MATRIX MODEL TREATMENT Information - What
- Substance abuse - Sex and recovery and
the brain - Relapse prevention issues -
Triggers and cravings - Emotional
readjustment - Stages of recovery - Medical
effects - Relationships and recovery -
Alcohol/marijuana
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MATRIX MODEL TREATMENT Information - Why

• Reduces confusion and guilt
• Explains addict behavior
• Gives a roadmap for recovery
• Clarifies alcohol/marijuana issue
• Aids acceptance of addiction
• Gives hope/realistic perspective for family

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MATRIX MODEL TREATMENT Relapse Factors -
Honeymoon Stage

• Overconfidence
• Secondary alcohol or other drug use
• Discontinuation of structure
• Resistance to behavior change
• Return to addict lifestyle
• Inability to prioritize
• Periodic paranoia

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MATRIX MODEL
Primary Manifestation of the Wall Stage
Behavioral
Cognitive
Sluggish Low Energy/Inertia
Relapse Justification
Relationship
Emotional
Depression/Anhedonia
Irritability/ Mutual Blaming/Impatience
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PROTRACTED ABSTINENCE
Return to Old Behaviors Anhedonia Anger Depression
Emotional Swings Unclear Thinking Isolation Family
Problems
Cravings Return Irritability Abstinence Violation
THE WALL
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The Wall

• One Patients Account

Physical Symptoms Lack of energy was almost
constant even if I slept for hours. Lack of
memory, inability to concentrate and a grey film
over my vision clouded my world. My sleep became
mixed-up. I would be dead tired during the day
and experience insomnia at night.
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The Wall

• One Patients Account

Apathy Throughout The Wall I didnt care about
anything or anybody. Including myself. Nothing
seemed important, nothing felt good. Boredom and
hopelessness were constant companions. I felt
the whole thing would never end.
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The Wall

• One Patients Account

Loneliness and Isolation More than anything I
felt alone. I felt like I was the only person in
the world who knew how I felt. Even my therapist
and my C.A group didnt understand. I went to
meetings and often still felt alone.
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Relapse Factors - Sexual Behavior

• Concern about sexual dysfunction
• Concern over sexual abstinence
• Concern over sexual disinterest
• Loss of intensity of sexual enjoyment
• Shame/Guilt about sexual behavior
• Sexual arousal producing craving
• Sexual behavior and intimacy
• Sobriety and monogamy

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Relapse Factors - Alcohol/Marijuana

• Cortical disinhibition
• Stimulant craving induction
• Pharmacologic coping method
• 12-Step philosophy conflict
• Abstinence violation effect
• Marijuana amotivational syndrome
• Interferes with new behaviors

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Key Concept Relapse Justification

• Definition
• The rational part of the brain attempts to
  provide a logical explanation for justifying
  behavior which moves the client closer to his
  drug of choice
• Relapse thoughts gain power when not openly
  recognized and discussed

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Associates Use Justifies Own Use

• My wife used so
• I was doing fine until he brought it home
• I went to the beach with my sister and
• My brother came over for dinner and brought some
• I wanted to see my friend just once more and he
  offered me some...

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I Needed it for a Specific Purpose

• I was getting fat again and needed to control my
  weight
• I couldnt get the energy I needed without it
• I cant have a satisfying sexual experience
  without it
• Life is too boring without
• I cant be comfortable in social situations
  without it
• I dont know how to meet people without the
  social lubricant, cocaine magnet, etc.

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I Was Testing Myself

• I wanted to see if it would work better
• I wanted to see my friends again and Im stronger
  now
• I needed a little money and thought I could sell
  a little without using
• I wanted to see if I could use just a little and
  no more
• I wanted to see if I could be around it and say
  no
• I thought I could drink without using

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The Situation Wasnt My Fault

• It was right before my period and I was depressed
• I had an argument with my spouse
• My parents were bugging me
• My mate slept with another person
• The weather was gloomy
• I was only going to have a drink or two and...

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Accidental Triggering of Cravings

• I was in a bar and someone offered me some
  cocaine
• I went to a lecture and saw a program about
• A friend called to see how I was doing and we
  were talking and decided to get together
• I was at work and someone offered
• I found some in my car

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Feelings Easily Lead to Use

• Life is so boring I may as well use
• I was so happy I felt like celebrating so
• I was feeling depressed so
• My job wasnt going well and I was frustrated so
• I was feeling sorry for myself

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It Came to Me

• I was in my car and suddenly it was heading
  toward
• I bumped into an old friend and we got to talking
  and
• A friend came by and wanted to take me to a party
• I found some I forgot I had...

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Relapse Factors - The Wall Stage
- Increased emotions - Dissolution of
structure - Interpersonal conflict - Behavioral
drift - Relapse justification - Secondary
alcohol or - Anhedonia/loss of other drug
use motivation - Resistance to exercise -
Insomnia/low energy/fatigue - Paranoia
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MATRIX MODEL
Primary Manifestation of Adjustment Stage
Behavioral
Cognitive
Sloppiness Regarding Limits
Drifting From Commitment to
Recovery
Relationship
Emotional
Experiencing Normal Emotions
Surfacing of Long-Term Issues
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Lack of Goals Guilt and Shame
Relationship Problems Boredom
ADJUSTMENT/RESOLUTION
Underlying Psychopathology May Surface or
Resurface
Career Dissatisfaction
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Relapse Factors - Adjustment Stage

• Secondary alcohol or other drug use
• Relaxation of structure
• Struggle over acceptance of addiction
• Maintenance of recovery momentum/commitment
• Six-month syndrome
• Re-emergence of underlying pathology

130
Statistics for Women

• A comparison of treatment outcomes between women
  diagnosed with MA dependence and all other
  diagnostic groups indicated no between group
  differences
• Retention rates
• In-treatment urinalysis data
• Completion rates
• All these measures indicate that MA users respond
  in an equivalent manner as individuals admitted
  for other drug abuse problems.

131
MA-Dependent Women and Domestic Violence

• Data from a broad sample of MA-Dependent women
• from CA, HI, and MT.
• When asked about current or previous partners
• 61 had been threatened to be hurt or killed.
• 64 had been prevented from entering or leaving
  the house, seeing friends, or using the phone.
• 20 had been prevented from getting/keeping a job
  or continuing education.
• 15 had been prevented from seeking medical or
  drug treatment.

132
Victimization and Severity of MA Use

• Data from a broad sample of MA-Dependent women
• from CA, HI, and MT.
• 89 of those in severe violent relationships had
  been sexually, physically, or emotionally abused
  as children.
• 85 of all severe MA users were abused as
  children.
• Sexual partners are a primary predictor for
  relapse among MA-dependent women.

133
MA-Dependent Women

• Compared with men, women MA users
• Have different pathways to addiction
• Continue to use MA for different reasons
• Enter substance abuse treatment for different
  reasons.

Brecht et al., 2004 Rawson et al., 2006
134
Women Use MA as a Coping Mechanism

• Compared with men, women
• Are more frequently initiated to MA use by their
  partners
• Have patterns of MA use that revolve around
  relationships
• Cite weight loss, increased energy, and enhanced
  sexual response as reasons for use
• Continue to use MA in order to more easily cope
  with abusive relationships.

Brecht et al., 2004 Messina et al., (in press).
135
Women Use MA to Cope with Past Current Abuse

• Compared with men, women
• Have more severe histories of sexual/physical/emot
  ional abuse in childhood
• Abuse often continues into adolescence and
  adulthood
• More often report instances of incest and/or
  molestation while growing up and prior to abusing
  MA.

Brecht et al., 2004 Messina et al., (in press).
136
Women Use MA to Self-Medicate

• Compared with men, women
• Are more likely to suffer from depression or
  PTSD
• Are more likely to have a panic or eating
  disorder
• Are more likely to have been prescribed
  medication for psychological disorders
• Are less likely to inject MA.

Brecht et al., 2004 Messina et al., (in press).
137
Women are Primary Caregivers

• Compared with men, women
• Have children under 18
• Are the primary caregivers to children
• Children need protection from domestic violence.

138
MA USERS EXCLUDED!

• A major demand that competes for scarce community
  resources is the care and treatment needs of
  those who have become addicted to MA.
• MA-dependent women are frequently turned away
  from shelters and domestic violence programs.

139
Services for MA-Using Women

• Domestic violence shelters and treatment programs
  and personnel tend to be unprepared for the
  influx of MA users.
• Although some traditional elements may be
  appropriate, many staff report feeling unprepared
  to address many of the clinical challenges
  presented by these patients.

140
Treatment and Care Womens Issues

• Relationship issues
• Domestic Violence
• Fear of losing partner
• Fear of losing children
• Fear of sex without
• drugs
• Shame and Stigma
• Weight gain and hygiene
• Histories of sexual and physical abuse

Covington (1997 1998 2002).
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Implications

• All women deserve a safe and secure place to
  recover.
• Programs should focus on an empowerment
  approach to aid in recovery.
• Use trauma-informed techniques.
• MA-dependent women need separation from
  triggers to aid in recovery (e.g., partners).

142
Treatment Curricula for Women

• Helping Women Recover (Stephanie Covington)
• Beyond Trauma (Stephanie Covington)
• Voices Empowerment for Girls (S. Covington)
• Seeking Safety (Lisa Najavits)
• Trauma Recovery Empowerment Model (TREM)
• Curriculum for MA-dependent women is
  forthcoming.

143
The End
Slides available at www.psattc.org in the
Powerpoint Gallery
For more information, please contact Tom Freese
tefreese_at_ix.netcom.com Sherry Larkins
larkins_at_ucla.edu www.uclaisap.org or
www.psattc.org