Methamphetamine by Rand L. Kannenberg
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Methamphetamine by Rand L. Kannenberg

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  • 1. Corrections and Substance Abuse Training METHAMPHETAMINE Warning: This seminar and seminar manual and case studies, inevitably contain material with adult content due to the nature of the subject. The speaker apologizes to anyone offended. Edited by Rand L. Kannenberg, M.A., CCM, LAC, CCS
  • 2. Part 1. Social Implications
    • Screening, Assessment and Evaluation
    • Prevention, Intervention and Treatment
    Part 2. Clinical Strategy The History of Methamphetamine Trends in Law Enforcement/Public Policy Page 3.
  • 3.
    • Learner Objectives
    • Identify and explain the chemical properties of methamphetamine.
    • Describe the difference between methamphetamine and other stimulants.
    • Summarize recent law enforcement trends regarding methamphetamine manufacturing and trafficking in the U.S.
    • Increase knowledge and skill in assessment of methamphetamine abuse and dependence as well as methamphetamine induced psychosis, depression, mania and anxiety.
    • Utilize effective treatment options for methamphetamine abuse and dependence.
    • Administer written exercises and worksheets designed for the therapy and education of methamphetamine users.
    Page 4.
  • 4. History of Amphetamines
    • First synthesized in 1887.
    • Commercially available in the 1930s.
    • Methamphetamine Treatment Project
    • DEA Number 1100.
    • Classified as a Schedule II Narcotic (drug has current accepted medical use and high potential for abuse). Also known as “Dexedrine” and “Biphetamine.”
    • Drug Enforcement Administration (DEA)
    • Illicit laboratories first appeared in the 1960s.
    Page 4.
  • 5. History of Methamphetamine
    • A derivative of amphetamine first developed by a pharmacologist in Japan in 1919.
    • Used in the 1930s to treat asthma and narcolepsy as well as obesity.
    • Methamphetamine Treatment Project, KCI: The Anti-Meth Site (formerly the Koch Crime Institute)
    • Given to soldiers during war. Used under the name of “Pervitin” by Germany and its allies during World War II.
    • Webster’s Dictionary
    • DEA Number 1105.
    • Classified as a Schedule II Narcotic, Controlled Substances Act (CSA), Title II, Comprehensive Drug Abuse Prevention and Control Act of 1970. Also known as “Desoxyn” and “D-desoxyephedrine.”
    • Drug Enforcement Administration (DEA)
    Page 5.
  • 6. In the 1960s manufactured illegally mostly by outlaw motorcycle gangs and used frequently by long distance truck drivers. It was usually DL-methamphetamine (dextro-levo-methamphetamine, a.k.a., “levo-methamphetamine”) using the phenyl-2-propanone (P-2-P) (also known as Phenylacetone) method. Methamphetamine with P-2-P was more toxic and less potent than the D-methamphetamine (dextro-methamphetamine) more commonly made since the late 1980s using across the counter cold medications (P-2-P became a Schedule II controlled substance in 1980). National Drug Intelligence Center (NDIC), National Institute on Drug Abuse (NIDA) Also smuggled from Taiwan and South Korea into Hawaii since the 1980s. Distribution spread to the U.S. mainland by 1990. KCI: The Anti-Meth Site
  • 7. Methamphetamine as a Stimulant
    • Has greater central nervous system affects than amphetamine.
    • NIDA
    • More effective than amphetamine.
    • Lasts longer than amphetamine.
    • More soluble in lipids (i.e., easily absorbed into the fatty tissue of the brain).
    • Dextro is 3 to 4 times more potent than levo.
    • NIDA
    • Average purity decreased from 71.9% in 1994 to 40.1% in 2001.
    • ONDCP
    • Intentional fillers to dilute or cut the methamphetamine (with products that are similar in appearance, taste and/or action) include lactose, lidocaine, procaine (another local anesthetic), caffeine, quinine (anti-malarial drug) or sodium bicarbonate (aka, “baking soda”).
    • NIDA
    Page 6.
  • 8. Methamphetamine Hydrochloride Tablets United States Pharmacopeia (USP)
    • Desoxyn ® CII (Desoxyephedrine)
    • Pronounced: des-OK-sin
    • Developed in the U.S. in 1942
    • Initially manufactured and marketed by Abbott Laboratories.
    • They produced an immediate-release tablet.
    • Production of sustained-release formulation “Desoxyn Gradumet” was discontinued in 1999 for “manufacturing difficulties.”
    • Abbott sold their rights to Ovation Pharmaceuticals, Inc. in 2002.
    • Food and Drug Administration (FDA) gave Able Laboratories, Inc. approval to market the first generic version of Desoxyn in February 2004.
    • In May 2005 Able suspended manufacturing and distribution of all products.
    • In June 2005 the FDA announced that there were serious concerns about producing drugs at Able according to quality assurance standards.
    • At the same time Able recalled all of its products.
    Physicians’ Desk Reference® (PDR) Page 6.
  • 9. Desoxyn ® by Ovation
    • Chemically known as (S)-N,α-dimethylbenzeneethanamine
    • hydrochloride, is a member of the amphetamine group of
    • sympathomimetic amines (i.e., mimics effects of adrenaline).
    • DESOXYN tablets contain 5 mg of methamphetamine hydrochloride
    • for oral administration.
    • Indications/Usage and Dosage/Administration:
    • Attention-Deficit/Hyperactivity Disorder (ADHD)
    • (20-25 mg daily in two divided doses). Used instead of Adderall (Amphetamine-Dextroamphetamine) or Ritalin (Methylphenidate)
    • Exogenous Obesity (caused by overeating) for short-term only (a few weeks)
    • (5 mg one half hour before each meal)
    • Ovation Pharmaceuticals, Inc.
    (PDR) Page 7.
  • 10. Off Label Uses
    • Desoxyn® has also been used to treat narcolepsy (the compulsion to sleep) , depression, and Parkinson’s disease (another neurological disease that involves low production of dopamine).
    • Newsweek
    • Desoxyn® tablets cannot be smoked, snorted or injected.
    Page 7.
  • 11. Methamphetamine
    • An extremely powerful and highly addictive “upper.”
    • Made and sold as tablets, capsules, chunks, clear chunky crystals resembling frozen water, and powder.
    • Can be swallowed, injected, snorted or smoked.
    • Similar to adrenaline (the hormone epinephrine) chemically. Can be synthesized from ephedrine.
    • Most common precursor (initial compound) is pseudoephedrine.
    • Other dangerous chemicals are added to create a new drug.
    • When ingested, bursts of dopamine are released in the brain.
    • Desired effects are strong euphoria, heightened sense of well being, increased vigor, giddiness, sense of enhanced mental activity and performance, increased alertness, suppressed appetite, enhanced sensory awareness, and an increase in energy/alleviation of fatigue.
    • CSAT, Methamphetamine Treatment Project, Newsweek, KCI: The Anti-Meth Site, Webster’s Dictionary, NIDA
    DEA Page 8.
  • 12. Abbreviations MA Meth mAMPH Page 8.
  • 13. Slang for MA
    • 222 (Chicago) Agua Albino Poo Alffy All Tweakend Long
    • Amp
    • Annie
    • Anything Going On Bache Knock Bache Rock Bag Chasers Baggers Barney Dope Batak (Philippine Street Name) Bato Bato (Philippine Street Name) Batu Kilat (in Malaysia it means shining rocks) Batu or Batunas (Hawaii) Batuwhore Beegokes
    KCI: The Anti-Meth Site, Office of National Drug Control Policy (ONDCP) Page 9.
  • 14. Bikerdope Biker’s Coffee Billy, Or Whiz (in Britain after a cartoon character in a kids comic called Billy Whiz) Bitch Biznack Blanco Blizzard Blue Acid Blue Belly Blue Meth Blue Funk (Southwest Area of San Diego) Bomb Booger Boorit-Cebuano (Filipino Street Name) Boo-Yah! (Southwest Area of San Diego) Brian Ed Buff Stick Bugger Sugar Buggs Bumps Buzzard Dust
  • 15. Caca Candy Cankinstien CC Chach ChaChaCha Chalk Chalk Dust Chank Cheebah Cheese Chicken Flippin Chikin or Chicken Chicken Feed Chingadera Chittle Chizel Chiznad Choad Cinnamon Clavo
  • 16. Coco Coffee Cookies CR (California Central Valley) Crack Whore Crank Crank Is "Walk" & Coke Is "Talk" Crankster Gangsters Cri,Cri (Mexican Border in Southwest Arizona) Criddle Cringe Crink Cristy (Smokable) Critty Crizzy Crothch Dope Crow Crunk Crypto Crystal Crystal Meth Crystalight Cube
  • 17. Debbie, Tina, And Crissy Desocsins Devil Dust Devils Dandruff Devils Drug Dingles Dirt Dirty Dizzy D D-Monic Or D Do Da Doody Doo-My-Lau Dope Drano Dummy Dust Dyno Epimethrine Epod Eraser Dust
  • 18. Ethyl-M Evil Yellow Fatch (Mexican Border In The Southwest Arizona Area) Fedrin Fil-Layed Fizz Wizz Gackle-a Fackle-a Gak Gas Gear Or Get Geared Up Geep Gemini Glass (Smokable) Go Go Fast Go-ey Go-Go Go-Go Juice Gonzales (like the cartoon "Speedy")
  • 19. Got Anything Granulated Orange Grit Gumption Gyp Hawaiian Salt Hank Hanyak (Smokable) High Speed Chicken Feed Highthen Hillbilly Crack Hippy Crack Homework (because homework is generally done on paper which has lines) Hoo Horse Mumpy (Tampa, Florida) Hot Ice Hydro Hypes Ice (Smokable) Ice Cream Icee
  • 20. Ish Izice Jab Jasmine Jenny Crank Program Jetfuel Jib Jib Nugget Jinga Juddha Juice Junk (San Diego) Kaksonjae Kibble Killer KooLAID Kryptonite L.A. (Smokable) L.A. Glass (Smokable) Lamer Laundry Detergent
  • 21. Lemon Drop Life Lily Linda Lost Weekend (Bay Area/San Francisco) Love Low Lucille M Man Magic Meth Meth Monsters Methaine Methandfriend Methandfriendsofmine Methanfelony Methatrim Methlies Quick Methmood Method
  • 22. Nazi Dope Ned Newday No Doze Nose Candy On A Good One OZs Patsie Peaking Peanut Butter Peel Dope Pepsi (means crank) Pepsi One (means crystal) Phazers Phets Philopon (East Asia) Pieta Pink Poison Poop Poop'd Out Poor Man's Cocaine
  • 23. Pootananny Powder Powder Monkeys Powder Point Project Propellant Puddle Pump (Bay Area/San Francisco) Q'd Quartz (Smokable) Quick (Canada) Quill Rachet Jaw Rails Rank Redneck Heroin (Atlanta) Richie Rich Rip Rock
  • 24. Rocket Fuel Rocky Mountain High Rosebud Rudy's Rumdumb Running Pizo Sack Sam's Sniff Sarahs Satan Dust Scante (Hispanic Population in Southern California) Scap Schlep Rock Scooby Snax Scud Scwadge Shab Sha-Bang Shabs (San Francisco)
  • 25. Shabu Shamers Shards Shit Shiznack, Shiznac, Sciznac or Shiznastica Shiznit Shiznitty Shizzo Shnizzie Snort Shwack Sixty Four (64) Glass Skeech Sketch Ski Skitz Sky Rocks Sliggers Smiley Smile Smurf Dope
  • 26. Smzl Snaps Sniff Snow, Motivation (Colorado Springs, CO) Space Food Spaceman Spagack Sparacked Sparked Sparkle Speed Speed Racer Spin, Spin, Spin Spinack Spindarella Spinney Boo Spinning Spishak Spook Spoosh Sprack
  • 27. Sprizzlefracked Sprung (Mississippi) Spun Ducky Woo Squawk Stallar Sto-Pid Stove Top Styels Sugar Suger Super Ice Sweetness Swerve Syabu (pronounced "shabu" in Southeast Asia) Ta'doww (San Diego) Talkie Tasmanian Devil Tenner The New Prozac The White House Tical Tick Tick Tina Or Teena Tish (Shit backwards) (California)
  • 28. Tobats Toots Torqued Trash Trippin Trip Tubbytoast Tutu (Hawaii) Twack Twacked Out Tweak Tweedle Doo Tweek (a Methamphetamine- like substance) Tweezwasabi Twiz Twizacked Ugly Dust Vanilla Pheromones Wake Wash Way We We We Whacked White Bitch
  • 29. White Cross White Crunch White Ink White Junk White Lady White Pony (Ridin' the White Pony) White Who-Ha Wigg Working Man’s Cocaine Xaing Yaba (Thailand) YAMA (Pattaya, Phuket, Ko Samui And Bangkok) Yammer Bammer Yank Yankee Yay Yead Out Yellow Barn Yellow Powder Zingin Zip Zoiks Zoom
  • 30. TERMS USED FOR THE FEELING OF MA INTOXICATION
    • Ampin' Amped Bache Knock 2 Rock Bachin "BOB" as is discombobulated Buzzed Cranked Up Crank Whore Jamie Feelin Shitty Foiled Fried Gakked Gassing Geeked Geekin Gurped Heated Jacked Lit Ripped Pissed Pumped Psychosis
    KCI: The Anti-Meth Site Ring Dang Doo Rollin or Rollin Hard Scattered Schlep Heads Sketching Spin-Jo Speeding Sparked Spracked Spun Spun Monkey or Spun Turkey Stoked Talkie Twacked Tweeked Twisted Wide Open or Awake Wired Worked Wooop Chicken Zipper Zoomin Page 17.
  • 31. Nicknames for MA Users KCI: The Anti-Meth Site basehead battery bender cluckers, chicken-headed clucks crack heads crackies crankster or cranker doorknobers (Nova Scotia) fienda fiends fiendz gacked geek(ers) geekin geeter go go loser jibby jibby bear jibbhead loker or lokers neck creature shadow people sketchpad or schetchers skitzers sketchpads sketch cookie sketch monster spin doctors spinsters tweakers tweekin/the go wiggers Page 18.
  • 32. Other MA Related Terminology
    • Crank Craters - sores on your face caused by meth
    • Tooter - the straw used to snort
    • Paper - a quarter gram
    • Teenager - 1/16 ounce
    • Needles - called points, rigs, slammers
    • Paraphernalia - medical supplies or utensils
    • Tina Or Teena - name derives from the fact that meth is commonly bought in sixteenths of an ounce packages (aka "baggies")
    • Eightball - (eighth of an ounce) = 3.5 grams (dealer absorbs the difference)
    KCI: The Anti-Meth Site Page 18.
  • 33. Cost of MA
    • 1 ounce of MA=approximately 110 MA “hits” (uses)
    • 1 ounce=28.35 grams
    • 1 hit=1/4 gram
    • KCI: The Anti-Meth Site
    • 1/4 gram=250 mg
    • (10 times daily dose of Desoxyn ® for ADHD)
    • Average cost of ¼ gram of powdered MA is $10-50. Most common price nationally is $20 and many users will define ¼ gram as “$20.”
    • Average cost of ice MA is $30-125.
    • 32% of MA users report daily use.
    • ONDCP
    Page 19.
  • 34. Effects of Route of Administration for Cocaine & MA Cook, 1991; Gold, 1997; Gold & Miller, 1997; Sowder & Beschner, 1993; NIDA; KCI: The Anti-Meth Site; DEA; ONDCP; Substance Abuse and Mental Health Services Administration (SAMHSA), North Carolina Governor’s Crime Commission (NCGCC) Page 19. 45 to 90 minutes for cocaine/ 3 to 5 hours for MA No “rush” or “flash.” 10 to 30 minutes POWDER/PILL Usually white, but can also be yellow, red, brown or other colors. Usually, “low intensity users.” ORAL Swallowing pills, or putting on food or paper and eating it. Includes Yaba for MA (the Thai name for very small and brightly colored tablets with logos, mixed with caffeine, that look like MDMA or Ecstasy and are becoming popular within the rave scene). Duration of “High” Onset of Action for Cocaine and MA Form of Drug Route of Administration
  • 35. 10 to 20 minutes for cocaine/ 2 to 4 hours for MA No “rush” or “flash.” 3 to 5 minutes POWDER Usually, “low intensity users.” INTRANASAL Duration of “High” Onset of Action for Cocaine and MA Form of Drug Route of Administration
  • 36. 10 to 20 minutes for cocaine/ 4 to 6 hours for MA Following a 3 minute intense sensation called a “rush” or “flash.” 5 to 10 seconds SOLUTION Drug mixed with water and injected. Usually, “binge users” or “high intensity users.” INTRAVENOUS On a binge (aka, a “run”), user may inject 1 gram every 2 to 3 hours. Cocaine binges usually last no more than 72 hours. MA binges may last up to 1 week. “Tweaking” (delusional thinking and sometimes violence) follows the binge. “Crashing” (a phase that involves sleeping up to 3 days) follows the tweaking. Duration of “High” Onset of Action for Cocaine and MA Form of Drug Route of Administration
  • 37. 5 to 20 minutes for crack/ 8 to 24 hours for ice Following a 3 minute intense sensation called a “rush” or “flash.” 5 to 10 seconds CRACK COCAINE/ ICE (MA) Rock form or clear chunky crystals. Usually, “binge users” or “high intensity users.” INHALATION Smoked in glass pipe, drug is heated and fumes are inhaled, or drug is sprinkled on tobacco or marijuana and smoked. Duration of “High” Onset of Action for Cocaine and MA Form of Drug Route of Administration
  • 38. Other Differences Between Cocaine & MA
    • COCAINE
    • Plant-derived (obtained from coca leaves)
    • Eliminated from the body in 1 hour
    • Used as a local anesthetic in some surgical procedures
    • MA
    • Man-made
    • Eliminated from the body in 12 hours
    • Used for ADHD and obesity (as discussed earlier)
    NIDA Page 21.
  • 39. Symptoms of MA Use
    • Inability to sleep
    • Loss of appetite and weight, thin/gaunt
    • Increased sensitivity to noise
    • Agitation, restlessness, irritability, aggressiveness
    • Dizziness
    • Confusion, impaired judgment
    • Diarrhea and gastrointestinal complaints
    • Difficulty breathing
    • Headaches
    • Tremors or seizures
    • Nausea and vomiting
    • Numbness
    • Profuse sweating, often with chills
    • Muscle cramping, pain and tenderness
    • Dehydration
    • Low magnesium level, low potassium level
    • Stale urine smell due to ammonia constituents used to manufacture MA
    • Dilated pupils
    • Chest pain
    • Increased or decreased heart rate
    • Increased blood pressure
    • Fever or hyperthermia (life-threatening above 104 °F)
    • Impaired speech and language
    • Mania
    • Psychosis with hallucinations and delusions
    • Anxiety, panic, fear of impending doom
    • Depression and suicidal ideation
    • Poor hygiene and body malodor
    • Missing teeth, bleeding gums, infected gums, dental caries/decay/cavities (dry mouth/removed enamel/teeth grinding)
    • Skin aging and damage (dryness, roughness, wrinkles, broken veins)
    • Dermatitis around the mouth from smoking hydrochloride salt (from hydrochloric acid and amine)
    • Skin ulceration and infection (as a result of picking at imaginary bugs under the skin), acne or sores
    • Hair loss (from repetitious pulling)
    SAMHSA, KCI: The Anti-Meth Site, NAADAC News, CSAT, Texas Alcohol and Drug Testing Service, Inc., NIDA Page 22.
  • 40. ABC Channel 7 News Denver Page 22.
  • 41. Oregon Narcotics Enforcement Association Page 23.
  • 42. The News & Observer/Associated Press Page 23.
  • 43.
    • If “tweaking” (a term also applied to using alcohol while on MA) the users’ eyes will involuntarily jerk back and forth when they look out at the corner of their eyes (i.e., a horizontal-gaze nystagmus).
    • An overdose of MA may result in heart attack or stroke and high body temperature.
    • Presence of paraphernalia such as
    • razor blades, mirrors, straws for
    • snorting.
    • Presence of paraphernalia such as syringes, heated spoons, surgical
    • tubing for injecting.
  • 44. Helpful Hints if Interviewing a “Tweaker”
    • Keep a social distance
    • Slow your speech and lower your voice
    • Slow your movements
    • Keep your hands visible
    NCGCC Page 24.
  • 45. Other Ways to Reduce the Risk of Violence with MA Users
    • Identify yourself and use the client’s name.
    • Use a space that is quiet, subdued and not too confining.
    • Remove any objects from the room that could in any way be used as weapons.
    • Make certain that the client does not have any weapons.
    • Do not let the client get between the interviewer and the door, however, the client should also have an easy exit.
    • Acknowledge agitation and distress. Tolerate repetition.
    • Remain nonconfrontational. Reinforce any progress made.
    • Have a show of force ready as needed. Notify others that their assistance may be required and have a plan.
    • Have physical and chemical restraints ready as needed.
    • CSAT
    Page 25.
  • 46. Short & Long Term Effects of MA
    • MA can cause cardiovascular damage, collapse and sudden death from toxicity and contaminants in MA production.
    • MA can cause permanent damage to blood vessels in the brain resulting in seizures, vision loss, strokes and sudden death.
    • MA can cause renal damage from sustained hypertension (high blood pressure).
    • MA can cause impaired sexual performance and reproductive functioning.
    • MA is neurotoxic (i.e., poisonous to nerves/nerve tissues) by damaging brain cells that contain the neurotransmitters dopamine and serotonin.
    • Chronic MA use may cause persistent anxiety and depression, or memory impairment and cognitive disturbance/deficits similar to Alzheimer’s or another type of dementia.
    NIDA, CSAT Page 25.
  • 47.
    • After chronic use, MA decreases production of dopamine and the user may have symptoms similar to Parkinson disease (e.g., tremor at resting position, a fixed facial expression, peculiar posture and involuntary movement, etc.).
    • After using large amounts of MA, the nerve endings (“terminals”) of dopamine and serotonin containing neurons are cut back and may not regrow.
    • MA use can cause respiratory problems, irregular heart beat and anorexia.
  • 48. MA, HIV & Hepatitis B & C
    • IV MA users may get infections and sores at injection site
    • IV MA users may get infections of heart lining and valves
    • IV MA users who share needles may contract HIV, hepatitis B and hepatitis C
    • IV MA use is increasingly common in gay clubs in New York City and elsewhere in the U.S.
    • KCI: The Anti-Meth Site, NIDA
    Page 26.
  • 49. MA Use During Pregnancy
    • May result in the following damage to the infant:
          • Premature labor and delivery
          • Detachment of the placenta
          • Low birth weight
          • Neurological damage
          • “ Worm Heart” (Transposition of the Great Vessels) (i.e., backward with holes)
          • Birth defects
          • Tremors
          • Excessive crying
          • Withdrawal
          • Dysphoria (“unpleasant mental and emotional state”)
          • Agitation
          • Lethargy
          • Behavioral disorders
          • Attention-Deficit/Hyperactivity Disorder
    Greater Dallas Council on Alcohol and Drug Abuse (GDCADA), KCI: The Anti-Meth Site, PDR Page 27.
  • 50. Substance Abuse Treatment Admissions for MA
    • In 1992 14,554
    • admissions in U.S. for MA
    • In 2002 104,481 admissions in U.S. for MA
    • (Almost
    • 725%
    • Increase in
    • 10 Years)
    • ONDCP
    • In 2003
    • 56% of treatment admissions in Hawaii
    • for primary MA
    • abuse or dependence
    • 51% of treatment admissions in San Diego
    • for primary MA
    • abuse or dependence
    • NIDA
    Page 27.
  • 51. Emergency Department Mentions of MA 1994-2002
    • MA that was recorded during an ED Visit that “was induced by or related to the use of drug(s).” Has fluctuated over the years.
    • Lowest 1999 10,447
    • Highest 2002 17,696
    • (nearly 170% increase)
    ONDCP Page 28.
  • 52. MA Mortality Data
    • 2002 Fatalities
    • Phoenix 132 deaths
    • San Diego 81 deaths
    • Las Vegas 72 deaths
    • 2003 Fatalities
    • MA or amphetamines in the top 5 drugs in drug misuse deaths in 5 metropolitan areas:
    • Minneapolis-St. Paul
    • Ogden-Clearfield
    • Phoenix
    • San Diego
    • San Francisco
    • Drug Abuse Warning Network (DAWN)
    Page 28.
  • 53. MA Use Among Adolescents
    • 6.2%
    • of high school seniors report use of MA in their lifetime
    • Monitoring the Future Study (MTF)
    Page 29.
  • 54. Overall Use of MA
    • 12.4 million Americans (5.3% of the population) 12 years of age and older have tried MA at least once in their lifetimes.
    • An estimated 583,000 people in the U.S. were current users of MA in 2004 (same/similar as in 2002 and 2003).
    • National Survey on Drug Use and Health (NSDUH)
    Page 29.
  • 55. MA & Law Enforcement Trends
    • “ Operation Wildfire”
    • (first nationally coordinated operation to fight MA in the U.S.)
    • June-August 2005
    • DEA & local police in 200 cities involved
    • 427 people arrested
    • 209 pounds of MA seized
    • 56 clandestine labs seized
    • 123 weapons discovered
    • 30 children removed from homes with MA labs
    • DEA
    Page 30.
  • 56. “ Biggest Drug Problem” Based on Drug Related Arrests in 2005 According to 500 Law Enforcement Agencies in 45 States National Association of Counties (NACo) Page 30.
  • 57. Specific Regions of the U.S.
    • 76% of the counties in the Southwest
    • report that MA is the biggest drug problem
    • 75% of the counties in the Northwest
    • report that MA is the biggest drug problem
    • 67% of the counties in the Upper Midwest report that MA is the biggest drug problem
    Page 31.
  • 58. Total Arrests in U.S. Counties MA Related
    • 75%
    • of all counties report that
    • 40 to 50% of total arrests made in the last five years are MA related .
    NACo Page 31.
  • 59. Other Crimes Resulting from MA
    • 70% of counties report increase in robberies or burglaries because of MA
    • 62% of counties report increase in domestic violence because of MA
    • 53% of counties report increase in simple assaults because of MA
    • 27% of counties report increase in identity thefts because of MA
    NACo Page 32.
  • 60. Race & Gender
    • DEA arrests for MA:
    • 94% white
    • 78.5% male
    • Federal offenders sentenced for MA:
    • 59.3% white
    • 85.9% male
    ONDCP Page 32.
  • 61. Adult Female Arrestees Testing Positive for MA by City
    • 54% in Honolulu
    • 42% in Phoenix
    • 47% in San Diego
    NIDA Page 33.
  • 62. MA & Incarceration Rates
    • 20 to 75%
    • of current county jail inmates are incarcerated because of MA related crimes according to 35% of U.S. counties.
    • NACo
    • 76.9%
    • of federal offenders sentenced for MA are
    • U.S. Citizens.
    • 11.2%
    • of federal offenders sentenced for MA
    • had a weapon involved.
    • ONDCP
    Page 33.
  • 63. Mandatory Minimum Sentences for MA under Federal Law
    • 10 grams (pure)
    • =
    • 5 years in prison
    • 100 grams (pure)
    • =
    • 10 years in prison
    KCI: The Anti-Meth Site Page 34.
  • 64. Increase in Children Out-of-Home Placements Associated with MA Use? NACo Page 34.
  • 65.
    • 64% of counties with populations above 500,000 reported increases in children out-of-home placements associated with MA use 2002-2005
    • 66% of counties in the Southwest reported increases in children out-of-home placements associated with MA use 2002-2005
    • 70% of Colorado counties reported increases in children out-of-home placements associated with MA use 2002-2005
    • 69% of counties in Minnesota reported a growth in out of home placements associated with MA use 2004-2005
    • 54% of counties in North Dakota reported a growth in out of home placements associated with MA use 2004-2005
    • Children in homes with MA labs often have
    • asthma or other respiratory problems.
  • 66. DEA Page 35.
  • 67. Page 36. M0 2788; IA 1335; TN 1327; IN 1074; IL 1058
  • 68. 1996 Midwest High Intensity Drug Trafficking Area (HIDTA)
    • Iowa, Kansas, Missouri, Nebraska & South Dakota
    • “ To reduce and disrupt the importation, distribution, and clandestine manufacture of methamphetamine in the five state region.”
    ONDCP Page 36.
  • 69. MA Labs On/Adjacent to Federal Land
    • In or near:
    • Caves
    • Cabins
    • Recreational areas
    • Abandoned mines
    • Private vehicles
    • 83 seizures on Department of Interior property in 2003
    • 187 seizures on National Forest System property in 2002
    ONDCP Page 37.
  • 70. “ Super Labs” in Mexico (i.e., capable of producing in excess of 10 pounds of MA in 24 hours) and Chemicals from Canada
    • 20 Mexican MA trafficking organizations have been identified in the Midwest and West.
    • These Mexican cartels entered the market in 1994.
    • In 2005, Mexican super labs now dominate the trade (between 70-80% of MA used in the U.S.). The remaining 20-30% is made by motor cycle gangs, other independent lab operators or individuals in so-called, “small toxic labs,” “mom and pop labs” or “Beavis and Butt-Head labs” in this country.
    • Mexican super labs commonly use methylsulfonylmethane (MSM), a legal dietary supplement for horses and humans, to cut the MA.
    • Pseudoephedrine is often shipped from Canada to Mexico to be used in the super labs.
    • Ephedra plants are also being imported from Asia to the U.S. and Mexico.
    DEA, ONDCP, NCGCC Page 37.
  • 71. Possible Indications of a MA Lab
    • “ Unusual, strong odors (like cat urine, ether, ammonia, acetone or other chemicals).
    • Residences with windows blacked out.
    • Renters who pay their landlords in cash. (Most drug dealers trade exclusively in cash.)
    • Lots of traffic - people coming and going at unusual times. There may be little traffic during the day, but at night the activity increases dramatically.
    • Excessive trash including large amounts of items such as: antifreeze containers, lantern fuel cans, red chemically stained coffee filters, drain cleaner and duct tape.
    • Unusual amounts of clear glass containers being brought into the home.”
    KCI: The Anti-Meth Site Page 38.
  • 72. Chemicals Commonly Used to Manufacture MA
    • Ephedrine
    • Pseudoephedrine
    • Acetone (Nail Polish Remover)
    • Denatured Alcohol (Solvent/Cleaner/Fuel)
    • Alcohol (Isopropyl or Rubbing)
    • Methanol/Alcohol (Gasoline Additives)
    • Toluene (Brake Cleaner)
    • Ether (Engine Starter/Starter Fluid)
    • Kerosene or Lantern Fuel
    • Sulfuric Acid (Drain Cleaner)
    • Salt (Table/Rock)
    • Lithium (Camera Batteries)
    • Anhydrous Ammonia (Farm Fertilizer/Industrial Refrigerant)
    • Sodium Hydroxide (Lye: used to make glass and soap)
    • Red Phosphorus (Matches/Road Flares)
    • Muriatic Acid (Toilet Bowl Cleaner)
    • Iodine (Teat Dip or Flakes/Crystal)
    • Trichloroethane (Industrial Solvent)
    • Sodium Metal (mixed with alcohol: starting material for the production of most drugs)
    Stopmeth.com Page 38.
  • 73. Equipment Commonly Used to Manufacture MA
    • Pyrex or Corning Dishes
    • Jugs
    • Bottles
    • Funnels
    • Coffee Filters
    • Cheesecloth
    • Blender
    • Rubber Tubing
    • Paper Towels
    • Rubber Gloves
    • Gas Can
    • Tape/Clamps
    • Hotplate
    • Strainer
    • Aluminum Foil
    • Propane Cylinder (20-lb)
    • Books "How to Make Methamphetamine"
    Stopmeth.com Page 39.
  • 74. Steps of Manufacturing MA ($100 in materials will produce approximately $1,000 in MA)
    • The over the counter or prescription medication(s) (e.g., remedies for cold, cough, diet, energy, allergy or asthma, etc.) may be ground into a powder.
    • The powder may be dissolved and the liquid chemicals may be added to the solution to start the process of extracting the active ingredients.
    • The solution may be “cooked” in glassware.
    • The “cold” method may involve adding red phosphorous and iodine to the mixture.
    • The solution may be poured through materials such as coffee filters to remove the undesired residue.
    • The solution may be stored in jars until the liquid layers separate to create a more pure mixture.
    • Other elements such as sodium, potassium, lithium and/or anhydrous ammonia may be added.
    • Once the ammonia evaporates, the mixture may return to white.
    • The reaction of the residual sodium metal and water may form sodium hydroxide which may convert the mixture into MA.
    • The MA may be ready for dilution and sale.
    Stopmeth.com, DEA Page 39.
  • 75. MA Labs: Health & Environment Concerns
    • The chemicals used in MA labs are volatile and flammable. The by-products created in MA labs are toxic acids and gases. According to the Hazardous Substances Emergency Events Surveillance (HSEES), MA related events have a higher percentage of persons with injuries than non MA events.
    • The most common complaints from first responders exposed to the chemicals and by-products in MA labs are:
            • respiratory and eye irritations,
            • headaches,
            • dizziness,
            • nausea and
            • shortness of breath.
    • ONDCP
    • Fumes in a MA user’s clothing or hair can make others ill.
    • Avoid close contact in a poorly ventilated area with a MA user.
    • Always wear gloves if touching the skin or belongings of MA users.
    Page 40.
  • 76. Fumes in furniture, carpeting/other flooring, walls and window coverings, etc. of a house, office or hotel room where MA was cooked can make others ill. Every pound of MA produced creates five to six pounds of toxic waste. Seized labs often involve leftover chemicals and by-product being poured down drains and into the ground. MA lab locations are considered hazardous waste sites by most governments. The average cost of cleanup of a MA lab is approximately $5,000, however, some labs cost as much as $150,000 to clean. KCI: The Anti-Meth Site, NCGCC
  • 77. MA & Federal Legislation
    • Comprehensive Methamphetamine Control Act of 1996 (MCA)
    • Increased penalties for the trafficking/manufacturing of MA and chemicals used in production of MA
    • Expanded controls of products containing ephedrine, pseudoephedrine, phenylpropanolamine (PPA)*
    • *(FDA announced in 2000 that this ingredient in OTC cough, cold and weight loss medications increased the risk of stroke in women.)
    • Methamphetamine Anti-Proliferation Act of 2000
    • Strengthened sentencing guidelines
    • Provided training for federal and state law enforcement
    • Put in place controls on the distribution of chemical ingredients
    • Expanded substance abuse prevention efforts
    ONDCP Page 41.
  • 78. 2005 Federal Legislation
    • Combat Meth Act of 2005 (HR 314/S 103)
    • Would reclassify pseudoephedrine to a Schedule V drug. Access would be restricted to 7.5 grams a month (i.e., 250 tablets at 30mg each=8 plus per day). Purchasers would be required to show a photo ID and sign for the purchase.
    • Methamphetamine Blister Pack Loophole Elimination Act of 2005 (HR 1350)
    • Would amend the Controlled Substances Act to eliminate the existing exemption of pseudoephedrine products sold in blister packs.
    • Clean, Learn, Educate, Abolish, Neutralize and Undermine Production (CLEAN-UP) of Methamphetamine Act (HR 13)
    • Would provide state and local governments with grants to clean up MA contaminated lands; to educate students about the dangers of MA; and to treat children effected by the production, distribution or use of MA. It would also increase resources for the Meth Hot Spots program.
    • Methamphetamine Remediation Act of 2005 (HR 798)
    • Would authorize the Environmental Protection Agency (EPA) to establish voluntary guidelines for the remediation of former MA labs.
    • NACo
    Page 41.
  • 79. Congressional Caucus to Fight and Control Methamphetamine
    • “ To direct members attention to growing nationwide problems and dangers associated with abuse and production of methamphetamine.”
    • 1 (800) 662-HELP
    • 1 (800) 662-4357
    • National Drug Information Treatment and Referral Hotline
    Page 42.
  • 80. State Laws and MA
    • Oklahoma HB 2176
    • Pseudoephedrine must be sold behind the counter.
    • Customers must show ID.
    • Amount purchased limited to 9 grams in 30 days*.
    • *300 tablets at 30 milligrams each/10 a day
    • Arkansas, Georgia, Illinois, Iowa, Kentucky, Kansas, Mississippi, Oregon, South Dakota, Tennessee, West Virginia and Wyoming have similar laws now.
    • 20 additional states in the U.S. are considering legislation that would limit the sale of pseudoephedrine to combat MA.
    Page 42. Colorado’s HB05-1110 signed by the Governor on 5/27/05 limits retail sales of precursor drugs to blister packs or unit dose packets/pouches and no more than 3 packages per purchase. The focus is on the seller. A violation is a Class 2 Misdemeanor.
  • 81. Oklahoma and Oregon and MA
    • Another law in Oklahoma …
    • … creates an online database of pseudoephedrine purchases for pharmacies to make it more difficult for customers to exceed the maximum monthly amount by simply shopping at different stores.
    • Oregon’s law requires that any medication with pseudoephedrine as an ingredient be prescribed by a physician in writing or it cannot be purchased.
    • It also states that homeowners have six months to decontaminate houses used as MA labs.
    Page 43.
  • 82. Corporate Policies Effecting MA
    • Retailers nationwide are voluntarily moving non prescription medicines with pseudoephedrine behind the counter.
    • Examples:
            • Target
            • Wal-Mart
            • Albertson’s
            • CVS
            • Rite Aid
            • Longs
    Page 43.
  • 83. What Medication Manufacturers are Doing about MA
    • Some companies that make cold and allergy medications are using phenylephrine instead of pseudoephedrine. It’s another decongestant that cannot be used to make MA. This way their products are still easily accessible to the customers (i.e., they do not have to be stored behind the counter if there’s no pseudoephedrine).
    • Phenylephrine hydrochloride is used to increase blood pressure, as a nasal decongestant, and to dilate the pupil.
    • CAUTION: The pills look the same.
    • The blister packs/packages look the same.
    • The strength and directions may be different with the new ingredients!
    • Example: Sudafed PE
    • (Was 30mg ii q 4-6 hrs original formula. Now 10mg i q 4 hours.)
    Page 44.
  • 84. Adult Antisocial Behavior APA
    • “ This category can be used when the focus of clinical attention is adult antisocial behavior that is not due to a mental disorder (e.g., Conduct Disorder, Antisocial Personality Disorder, or an Impulse-Control Disorder).
    • Examples include the behavior of some professional thieves, racketeers, or dealers in illegal substances.”
    Page 44.
  • 85. Antisocial Personality Disorder APA
      • “ A. There is a pervasive pattern of disregard for and violation of the rights of others occurring since age 15 years, as indicated by three (or more) of the following:
      • (1) failure to conform to social norms with respect to lawful behaviors as indicated by repeatedly performing acts that are grounds for arrest
      • (2) deceitfulness, as indicated by repeated lying, use of aliases, or conning others for personal profit or pleasure
      • (3) impulsivity or failure to plan ahead
      • (4) irritability and aggressiveness, as indicated by repeated physical fights or assaults
      • (5) reckless disregard for safety of self or others
      • (6) consistent irresponsibility, as indicated by repeated failure to sustain consistent work behavior or honor financial obligations
      • (7) lack of remorse, as indicated by being indifferent to or rationalizing having hurt, mistreated, or stolen from another
      • B. The individual is at least age 18 years.
      • C. There is evidence of Conduct Disorder with onset before age 15 years.
      • D. The occurrence of antisocial behavior is not exclusively during the course of Schizophrenia or a Manic Episode.”
    Page 45.
  • 86.
    • MA Dependence
    • (requires 3 or more of the following):
    • Increased Tolerance;
    • Withdrawal;
    • Increased Quantity or Duration;
    • Persistent Desire or Inability to Decrease or Discontinue Use;
    • Increased Time to Obtain or Recover;
    • Social/Occupational/Recreational Impairment;
    • Continued Use Despite Awareness of Related Physical or Psychological Problems.
    • MA Abuse
    • (requires 1 or more of the following):
    • Recurrent Use Resulting in Social/Occupational/Educational Problems;
    • Recurrent Use in Physically Hazardous Situations;
    • Recurrent Substance-Related Legal Problems;
    • Continued Use Despite Awareness of Related Social or Interpersonal Problems.
    Amphetamine-Like (MA) Dependence/Abuse APA Page 45.
  • 87. Amphetamine-Like (MA) Intoxication APA
    • A. Recent use of MA.
    • B. Clinically significant maladaptive behavioral or psychological changes (e.g., euphoria or affective blunting; changes in sociability; hypervigilance; interpersonal sensitivity; anxiety, tension, or anger; stereotyped behaviors; impaired judgment; or impaired social or occupational functioning) that developed during, or shortly after, use of MA.
    • C. Two (or more) of the following, developing during, or shortly after, use of MA:
        • tachycardia (resting heart rate of over 100 beats per minute) or bradycardia (heart rate of under 60 beats per minute)
        • Pupillary dilation
        • Elevated or lowered blood pressure
        • Perspiration or chills
        • Nausea or vomiting
        • Evidence of weight loss
        • Psychomotor (thought and physical movements) agitation or retardation
        • Muscular weakness, respiratory depression, chest pain, or cardiac arrhythmias (irregular heart contraction)
        • Confusion, seizures, dyskinesias (bad or abnormal movements), dystonias (involuntary, sustained muscle contractions), or coma
    • D. The symptoms are not due to a general medical condition and are not better accounted for by another mental disorder.
    • Specify if:
    • With Perceptual Disturbance: This specifier may be noted when hallucinations with intact reality testing or auditory, visual, or tactile illusions (distortion of a sensory perception) occur in the absence of a delirium. Intact reality testing means that the person knows that the hallucinations are induced by the substance and do not represent external reality. When hallucinations occur in the absence of intact reality testing, a diagnosis of MA-Induced Psychotic Disorder, With Hallucinations, should be considered.
    Page 46.
  • 88. Amphetamine-Like (MA) Intoxication Delirium APA
    • Disturbance of consciousness (i.e., reduced clarity of awareness of the environment) with reduced ability to focus, sustain, or shift attention.
    • A change in cognition (such as memory deficit, disorientation, language disturbance) or the development of a perceptual disturbance that is not better accounted for by a preexisting, established, or evolving dementia.
    • The disturbance develops over a short period of time (usually hours to days) and tends to fluctuate during the course of the day.
    • There is evidence from the history, physical examination, or laboratory findings of either 1. or 2.:
      • The symptoms in Criteria A and B developed during MA Intoxication
      • Medication use is etiologically related to the disturbance (Note: The diagnosis should be recorded as Substance-Induced Delirium if related to medication use.)
    • Note: This diagnosis should be made instead of a diagnosis of Substance Intoxication only when the cognitive symptoms are in excess of those usually associated with the intoxication syndrome and when the symptoms are sufficiently severe to warrant independent clinical attention.
    Page 46.
  • 89. Amphetamine-Like (MA)-Induced Psychotic Disorder APA
    • A. Prominent hallucinations or delusions. Note: Do not include hallucinations if the person has insight that they are substance induced.
    • B. There is evidence from the history, physical examination, or laboratory findings of either 1) or 2):
      • the symptoms in Criterion A developed during, or within a month of, MA Intoxication or Withdrawal
      • Medication use is etiologically related to the disturbance
    • C. The disturbance is not better accounted for by a Psychotic Disorder that is not substance induced. Evidence that the symptoms are better accounted for by a Psychotic Disorder that is not substance induced might include the following: the symptoms precede the onset of the substance use (or medication use); the symptoms persist for a substantial period of time (e.g., about a month) after the cessation of acute withdrawal or severe intoxication, or are substantially in excess of what would be expected given the type or amount of the substance used or the duration of use; or there is other evidence that suggests the existence of an independent non-substance-induced Psychotic Disorder (e.g., a history of recurrent non-substance-related episodes).
    • D. The disturbance does not occur exclusively during the course of a delirium.
      • Note: This diagnosis should be made instead of a diagnosis of MA Intoxication or MA Withdrawal only when the symptoms are in excess of those usually associated with the intoxication or withdrawal syndrome and when the symptoms are sufficiently severe to warrant independent clinical attention.
      • Specify if predominated by delusions or hallucinations:
      • With Delusions
      • With Hallucinations
      • Specify if criteria are met for and if the symptoms develop during intoxication or withdrawal syndrome:
      • With Onset During Intoxication
      • With Onset During Withdrawal
    Page 47.
  • 90. Amphetamine-Like (MA) Withdrawal APA
    • A. Cessation of (or reduction in) MA use that has been heavy and prolonged.
    • B. Dysphoric mood and two (or more) of the following physiological changes, developing within a few hours to several days after Criterion A:
        • Fatigue
        • Vivid, unpleasant dreams
        • Insomnia or hypersomnia (an excessive amount of sleepiness)
        • Increased appetite
        • Psychomotor retardation or agitation
    • C. The symptoms in Criterion B cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.
    • D. The symptoms are not due to a general medical condition and are not better accounted for by another mental disorder.
    Page 47.
  • 91. Amphetamine-Like (MA) Withdrawal Delirium APA
    • Disturbance of consciousness (i.e., reduced clarity of awareness of the environment) with reduced ability to focus, sustain, or shift attention.
    • A change in cognition (such as memory deficit, disorientation, language disturbance) or the development of a perceptual disturbance (false perception) that is not better accounted for by a preexisting, established, or evolving dementia.
    • The disturbance develops over a short period of time (usually hours to days) and tends to fluctuate during the course of the day.
    • There is evidence from the history, physical examination, or laboratory findings that the symptoms in Criteria A and B developed during, or shortly after, a withdrawal syndrome.
    • Note: This diagnosis should be made instead of a diagnosis of Substance Withdrawal only when the cognitive symptoms are in excess of those usually associated with the withdrawal syndrome and when the symptoms are sufficiently severe to warrant independent clinical attention.
    Page 48.
  • 92. Amphetamine-Like (MA)-Induced Anxiety Disorder APA
    • Prominent anxiety, Panic Attacks, or obsessions or compulsions predominate in the clinical picture.
    • There is evidence from the history, physical examination, or laboratory findings of either 1) or 2):
      • The symptoms in Criterion A developed during, or within 1 month of, Substance Intoxication or Withdrawal
      • Medication use is etiologically related to the disturbance
    • The disturbance is not better accounted for by an Anxiety Disorder that is not substance induced. Evidence that the symptoms are better accounted for by an Anxiety Disorder that is not substance induced might include the following: the symptoms precede the onset of the substance use (or medication use); the symptoms persist for a substantial period of time (e.g., about a month) after the cessation of acute withdrawal or severe intoxication, or are substantially in excess of what would be expected given the type or amount of the substance used or the duration of use; or there is other evidence that suggests the existence of an independent non-substance-induced Anxiety Disorder (e.g., a history of recurrent non-substance-related episodes).
    • The disturbance does not occur exclusively during the course of a delirium.
    • The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.
    • Note: This diagnosis should be made instead of a diagnosis of Substance Intoxication or Substance Withdrawal only when the anxiety symptoms are in excess of those usually associated with the intoxication or withdrawal syndrome and when the anxiety symptoms are sufficiently severe to warrant independent clinical attention.
      • Specify if predominated by excessive anxiety or worry, panic attacks, obsessions or compulsions or phobic symptoms: With Generalized Anxiety, With Panic Attacks, With Obsessive-Compulsive Symptoms, or With Phobic Symptoms
      • Specify if criteria are met for and if the symptoms develop during intoxication or withdrawal syndrome: With Onset During Intoxication, or With Onset During Withdrawal
    Page 48.
  • 93. Amphetamine-Like (MA)-Induced Mood Disorder APA
    • A prominent and persistent disturbance in mood predominates in the clinical picture and is characterized by either (or both) of the following:
      • Depressed mood or markedly diminished interest or pleasure in all, or almost all, activities
      • Elevated, expansive, or irritable mood
    • There is evidence from the history, physical examination, or laboratory findings of either 1) or 2):
      • The symptoms in Criterion A developed during, or within 1 month of, Substance Intoxication or Withdrawal
      • Medication use is etiologically related to the disturbance
    • The disturbance is not better accounted for by a Mood Disorder that is not substance induced. Evidence that the symptoms are better accounted for by a Mood Disorder that is not substance induced might include the following: the symptoms precede the onset of the substance use (or medication use); the symptoms persist for a substantial period of time (e.g., about a month) after the cessation of acute withdrawal or severe intoxication, or are substantially in excess of what would be expected given the type or amount of the substance used or the duration of use; or there is other evidence that suggests the existence of an independent non-substance-induced Mood Disorder (e.g., a history of recurrent Major Depressive Episodes).
    • The disturbance does not occur exclusively during the course of a delirium.
    • The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.
    • Note: This diagnosis should be made instead of a diagnosis of Substance Intoxication or Substance Withdrawal only when the mood symptoms are in excess of those usually associated with the intoxication or withdrawal syndrome and when the symptoms are sufficiently severe to warrant independent clinical attention.
      • Specify if the predominant mood is depressed, elevated/euphoric/irritable, or mixed: With Depressive Features, With Manic Features, With Mixed Features
      • Specify if criteria are met for and if the symptoms develop during intoxication or withdrawal syndrome: With Onset During Intoxication, or With Onset During Withdrawal
    Page 49.
  • 94. Other Amphetamine-Like (MA) Disorders
    • MA-Induced Sexual Dysfunction (With Impaired Desire, With Impaired Arousal, With Impaired Orgasm, With Sexual Pain)
    • MA-Induced Sleep Disorder (Insomnia Type, Hypersomnia Type, Parasomnia Type: sleepwalking, night terrors, sleep talking, restless leg syndrome, etc .; Mixed Type; With Onset During Intoxication, With Onset During Withdrawal)
    • MA-Related Disorder Not Otherwise Specified (N0S)
    Page 49.
  • 95. MA Resources
    • MAMa
    • (Mothers Against Meth-Amphetamine)
    • www.mamasite.net
    • Crystal Meth Anonymous
    • (CMA)
    • www.crystalmeth.org
    • Other Resources
    • New D.A.R.E.
    • (Drug Abuse Resistance Education)
    • www.dare.com
    Page 50.
  • 96. MA and Recovery
    • “ Wall” period lasts 6 to 8 months for casual users and 2 to 3 years for regular users.
    • During this extended time of 6 months to 3 years, people in recovery from MA commonly have:
        • depression
        • difficulty with decision making, concentration and memory
        • lack of pleasure in daily activities
        • Meth-addiction.com
    Page 50.
  • 97. MA Users and Relapse
    • 98% of MA users entering outpatient treatment have already relapsed at least one time following a previous admission.
    • 50-70% of MA users relapse in the first 30 days of attempted recovery.
    • Methamphetamine.org
    Page 51.
  • 98. MA Treatment
    • MTP
    • (Methamphetamine Treatment Project)
    • UCLA Integrated Substance Abuse Programs (ISAP)
    • Matrix Institute on Addictions
    • Matrix Model (aka, “neurobehavioral model”)
    • 8, 16 & 24 Week Protocols for MA Use Disorders
    • Now free at www.health.org !
    SAMHSA and Center for Substance Abuse Treatment (CSAT) Page 51.
  • 99. Cognitive Behavioral Treatment
    • Teaching options and alternatives.
    • communication
    • decision making
    • problem solving
    • Practicing the newly learned skills.
    • Graduating only once able to demonstrate change.
    • Success is equal to change.
    Page 52.
  • 100.
    • MA Case Study
    • Referral Information
    • The client was referred by _____ , Probation Officer, _____ . Officer _____ called with the referral on June 21st. On June 24th the client called to schedule his appointment. The evaluation was held at 9:00 AM on Wednesday, July 3, 2002. The client was on time. He paid in full. He was cooperative, polite and friendly.
    • The client is a thirty-seven year old “Caucasian and Native American Indian” male. He was born and raised in _____. He graduated from _____ High School there in 1983. He is divorced. He has been married twice. His second marriage of five years ended in 1997. The client states that this is when his drug and legal problems became serious. “I was depressed and devastated. She got tired and left.” He admits to having an affair two years earlier and thinks that his wife never got over it. He has two boys (ages six and eight) from that marriage. He proudly showed this evaluator a picture of himself together with his sons. He is not dating currently. He lives with his mother and stepfather (married since the client was five) in their rented house. His biological father is a retired homicide detective in _____. The client describes their relationship as “rocky because I went to prison for drugs.” He works for his stepfather _____ (a collection agency) as a file clerk. He has been there for two months. His stepfather is the general manager of the company. The client states that he is also looking for a part time second job “to keep busy and make extra money.” He would also like to attend _____ Community College in the near future. His interest is in computer technology.
    • He was convicted in _____ of possession (of methamphetamine), possession of intent to distribute, felony eluding and possession of paraphernalia. He served seven months in county jail and thirteen months in state prisons there (_____ Correctional Facility and _____ Correctional Facility). He was released in May 2002. He states that he received no write-ups while in custody. He is on probation in the _____ of _____ for a period of eight years, from May 2002 until May 2010 (interstate compact from _____ because his mother and stepfather live here).
    Page 52.
  • 101.
    • History
    • The client first started using methamphetamine (MA) when he was nineteen years old. He used on weekend fishing trips initially. His use increased significantly (he snorted, smoked and injected up to 1/16 th of an ounce to an “eight ball” per day) for one and a half years until he was arrested. He was seen driving a car with a headlight that was out. He refused to pull over. There was a police chase. He reports that he was badly beaten (broken ribs and other injuries) by the police once he surrendered.
    • The client denies use of MA or any other drugs since 4/16/01. He admits to drinking two beers when out to dinner last month. He says he already discussed this with his probation officer and was told not to drink anymore while on probation. He agrees not to drink. He considers himself an “addict” and calls his drinking last month a “slip.” He likes beer. He does not like hard liquor.
    • He has also used marijuana, heroin, Lortab, Morphine, Demerol and cocaine in the past.
    • Findings
    • The client consented in writing to being asked a series of confidential questions about health and substance abuse behaviors. He also signed a release of information form allowing disclosure of the results to his probation officer. He does meet the criteria for risk status for exposure to HIV/AIDS and TB, however, he reports being tested in prison three times for HIV with negative results and three times for TB (by skin) with negative results.
    • The client does meet the criteria for risk status for exposure to Hepatitis A (while incarcerated in the past couple of years there may have been an outbreak of Hepatitis A in one of the correctional facilities according to the client).
  • 102.
    • The client does meet the criteria for risk status for exposure to Hepatitis B (he shared drug needles as recent as five years ago; and two years ago he gave himself a tattoo, even though he says he wore gloves and used a new tattoo needle).
    • The client does meet the criteria for risk status for exposure to Hepatitis C (he admits to a lengthy history injecting illegal drugs).
    • The client has insurance pending with _____ (through his new job). He was told that he should contact them, the _____ County Department of Health and Environment, or another qualified healthcare professional to be tested for these infections.
    • The client has no known drug allergies.
    • He reports having a severe allergic reaction (anaphylaxis) to bee stings. He does not have a bee sting allergy kit currently. He plans to go camping in the mountains soon (if approved by his probation officer). He was told that he should contact the Allergy and Asthma department at _____ ASAP (and definitely before camping).
    • He denies any other major medical problems.
    • The client states that he uses across the counter Metabolife® products for weight and nutrition. He was encouraged to discuss this with his probation officer and the agency doing his urine drug screens.
    • He started drug testing at _____ yesterday. He said his color is “black.” He thinks the frequency is twice monthly. He calls the color line daily and does not mind submitting.
  • 103.
    • He denies any history of psychiatric treatment.
    • He reports completing a ten-month stay in a therapeutic community (TC) at _____ Correctional Facility. He received his certificate of completion and says that his graduation papers are in the mail. He is very positive about the TC experience. He has already written and sent them a couple of thank you letters since his release.
    • He also attended Narcotics Anonymous (NA) meetings while at _____ and is going to NA (“junkie church”) on Sunday mornings in _____ and occasionally during the week as well.
    • The client had a normal mini mental status exam (he received a perfect score of 30 out of 30).
    • There is no evidence of Conduct Disorder before the age of 15 (i.e., the client states that he was not aggressive to people or animals, he did not have problems with deceitfulness or theft, and he did not have serious violations of rules or laws).
    • As an adult, he has engaged in the drug-related crimes discussed earlier. He has also been involved in careless behavior (unsafe sex and sharing needles), has failed to maintain an enduring attachment to a spouse and has failed to honor financial obligations. He reports wanting to get a copy of his own credit report and start working on paying companies what he owes them. He is also eager to start dating responsibly.
    • Diagnoses:
    • Adult Antisocial Behavior (discussed above) that is not due to Antisocial Personality Disorder, not due to Conduct Disorder, and not due to an Impulse Control Disorder.
    • Amphetamine-like (MA) Dependence, Sustained Full Remission (no use for more than twelve months), In a Controlled Environment (restricted access in prison based TC). Has had past problems of increased tolerance, increased quantity and duration, persistent desire to discontinue use and social/legal impairment.
    • History of Substance Abuse.
  • 104.
    • Strengths:
    • The client reports a good relationship with his mother and stepfather, he is doing well at work, wants to get a second job and go to college, likes his probation officer, and is interested in maintaining his sobriety and abstinence.
    • Recommendations
    • Random/unannounced urine drug screens should continue to be administered. His only complaint about _____ yesterday is that they were “slow.” Other referrals for drug testing are available upon request.
    • The client would benefit from continued participation in NA meetings. He should attend at least twice per week.
    • The client is appropriate for a relapse prevention program for criminal offenders. This evaluator offers such a service called, “Offender Recovery Group.” Meetings are held on Mondays from 7:30-9:00 PM at _____, _____ in _____. There are sixteen sessions. The cost is $25 per visit plus a one-time fee of $10 for the workbook. The curriculum is approved by the U.S. Department of Health and Human Services SAMHSA program. If interested in this program for the client, please call _____ or _____ to refer him to the “Offender Recovery Group.” A free intake would be scheduled at 5:30 PM the client’s first night attending. You would receive monthly progress reports and immediate notification about missed visits or any other incidents. Note that other agencies also provide relapse prevention if there are issues about cost or location of this program.
    • The client should contact _____ and/or the _____ Health Department for the important health reasons mentioned earlier.
  • 105. Appendix Evaluation and Treatment Forms Page 55.
  • 106.
    • HEALTH SCREENING Criminal Justice Addiction Services
    • Hepatitis A Screening
    • If one or more items are checked below in this section, the client meets the criteria for risk status for exposure to hepatitis A and should be referred to the health department or another qualified healthcare professional to be tested for this infection.
    • ___household/sexual contact of hepatitis A infected person(s)
    • ___international traveler
    • ___resident of American Indian reservation or Alaska Native village or other region with
    • endemic hepatitis A
    • ___employee of day care center during outbreak of hepatitis A
    • ___gay male sex during outbreak of hepatitis A
    • ___injecting drug user during outbreak of hepatitis A
    • ___resident of correctional facility/other residential program or day treatment program
    • during outbreak of hepatitis A
    • Hepatitis B Screening
    • If one or more items are checked below in this section, the client meets the criteria for risk status for exposure to hepatitis B and should be referred to the health department or another qualified healthcare professional to be tested for this infection.
    • ___has ever had a sexually transmitted disease
    • ___has had sex with more than one (1) partner in the past six (6) months
    • ___has ever shared needles
    • ___has ever been an injecting drug user
    • ___has undergone kidney dialysis
    • ___has received blood transfusions
    • ___household/close contact with someone who has hepatitis B
    • ___resident of or traveler to Africa, China, Middle East, South America, Southeast Asia,
    • the Pacific Islands, or other high risk parts of the world
    • ___has undergone any body piercing or tattooing
    • ___has ever shared toothbrushes or razors with anyone
    • ___employee or volunteer in healthcare facility who comes in contact with blood or
    • other body fluids
    Page 56.
  • 107.
    • Hepatitis C Screening
    • If one or more items are checked below in this section, the client meets the criteria for risk status for exposure to hepatitis C and should be referred to the health department or another qualified healthcare professional to be tested for this infection.
    • ___has received blood from a donor who later tested positive for hepatitis C
    • ___has received a blood or blood component transfusion (including during childbirth)
    • before July, 1992
    • ___has received a solid organ transplant before July, 1992
    • ___has received clotting factor before 1987
    • ___has ever injected illegal drugs
    • ___has ever been on long term kidney dialysis
    • ___has ever been a healthcare worker who has had a needle stick, sharp or mucous
    • membrane exposure to hepatitis C positive blood
    • ___born to a mother infected with hepatitis C virus
    • HIV/AIDS Screening
    • If one or more items are checked below in this section, the client meets the criteria for risk status for exposure to HIV/AIDS and should be referred to the health department or another qualified healthcare professional to be tested for this virus.
    • ___had sex without knowing for certain that the person or persons do not have HIV
    • ___had sex with someone who does have HIV or AIDS
    • ___had any disease passed on by sex, such as genital herpes or syphilis
    • ___had sex with many men or women or had sex with someone else who has had sex
    • with many men or women
    • ___had sex with someone who has used needles to take drugs
    • ___shared needles or works to take drugs
    • ___shared items such as toothbrushes, razors, and devices used during sex which may
    • be contaminated with blood, semen, or vaginal fluids
  • 108.
    • TB Screening
    • If one or more items are checked below in this section, the client meets the criteria for risk status for exposure to TB and should be referred to the health department or another qualified healthcare professional to be tested for this disease.
    • ___has or is at risk for HIV infection (one or more items checked above in previous
    • section)
    • ___close contacts with someone who has infectious active TB
    • ___has medical conditions such as end-stage renal disease, gastrectomy, and
    • immunosuppressive therapy
    • ___injection drug user
    • ___foreign born in endemic area
    • ___medically underserved, low income individual
    • ___farm worker or homeless individual
    • ___resident of long-term care facility
  • 109. Antisocial Personality Disorder/Substance Use Disorder Screening™ Referrals to APD, SUD or Resocial Group™/Other Co-occurring Cognitive Behavioral Treatment   © 1999-2002 Rand L. Kannenberg, M.A., LAC, CCS, CCM All rights reserved. Criminal Justice Addiction Services Lakewood, CO rtkannenberg@juno.com (303) 232-0767   APD/SUD Screening ™ Page 59.
  • 110. Part 1: Antisocial Personality Disorder¹ (APD) Screening (All 4 blanks must be checked to meet APD screening criteria)   _____Before the age of 15 years, at least 3 of the following are indicated (circle the 3 or more that apply):   aggression to people or animals destruction of property deceitfulness or theft serious violations of rules or laws _____Is at least 18 years-old currently. _____Since the age of 15 years, at least 3 of the following are indicated (circle the 3 or more that apply):   repeatedly performs acts that are grounds for arrest repeatedly lies, uses aliases or cons others for personal profit or pleasure repeatedly fails to plan ahead repeatedly involved in physical fights or assaults repeatedly unsafe or dangerous with self or others repeatedly fails to sustain consistent work behavior or honor financial obligations (and/or to maintain an enduring attachment to a spouse or romantic partner and/or to be a responsible parent) repeatedly indifferent to or rationalizing having hurt, mistreated, or stolen from another _____The 3 or more indicators seen above do not occur exclusively during the course of Schizophrenia or a Manic Episode.  
  • 111. Part 2: Substance Use Disorder¹ (SUD) Screening (At least 1 blank must be checked to meet SUD screening criteria)   _____Past or present, at least 3 of the following are indicated (circle the 3 or more that apply):   increased tolerance withdrawal increased quantity or duration persistent desire or inability to decrease or discontinue use increased time to obtain or recover social/occupational/recreational impairment continued use despite awareness of related physical or psychological problems   _____Past or present, at least 1 of the following are indicated (circle the 1 or more that apply):   recurrent use resulting in social/occupational/educational problems recurrent use in physically hazardous situations recurrent substance-related legal problems continued use despite awareness of related social or interpersonal problems  
  • 112. Part 3: Referral (Circle 1 appropriate disposition)   A. Refer to cognitive behavioral treatment that deals with pervasive pattern of disregarding and violating the rights of others if only APD screening criteria are met.   OR   B. Refer to cognitive behavioral treatment that deals with substance abuse or substance dependence if only SUD screening criteria are met.   OR   C. Refer to RESOCIAL GROUP™ or other cognitive behavioral treatment that deals with co-occurrence of pervasive pattern of disregarding and violating the rights of others and substance abuse or substance dependence if both APD and SUD screening criteria are met.
  • 113. Alcohol and Drug Addiction Test
    • Gorski, Terence T. & Kelley, John M. (1999). Relapse Prevention Workbook for Chemically Dependent Criminal Offenders. Substance Abuse and Mental Health Services Administration, Public Health Service, U.S. Department of Health and Human Services.
    Page 63.
  • 114.
    • Use to feel better: I use alcohol or drugs to get away from things that bother me or are hard to face.
    • Use to solve most problems : I use alcohol or drugs to try to solve most of my problems and things that bother me.
    • It takes more : It takes more or stronger kinds of alcohol or drugs to get the same feelings than it used to.
    • Memory loss : Sometimes after I have been using, I do not remember what happened.
    • Sneaking : Sometimes I hide from other people how much I'm using or drinking. This might be because I do not want people to know or because I do not want to share.
    • Dependence : I rarely do anything for fun unless I use alcohol or drugs.
    • Fast start : I use stronger alcohol or drugs or use a lot quickly at first to get a "good start."
    • Feel guilty : I feel guilty about using alcohol or drugs or about the things that I do when I use.
    • Do not listen : Other people complain or try to talk to me about my using but I do not listen.
    • Regular blackouts : I do not remember what happened and I get into trouble when I use alcohol or drugs.
    • 11. Excuses : I use problems in my life as an excuse for using alcohol or
    • drugs. I feel that I have to use to deal with these problems.
    • 12. Using more than others : I use more than most people, so I hang
    • around people who use as much or more so that I feel that I fit in.
    Yes No
  • 115. 21. Neglect food : I do not eat healthy foods or eat at regular times, especially when I'm using. 22. Resentment : I feel like other people are out to get me, and I feel angry a lot. 23. Withdrawal : I need a drink or a drug in the morning or else I get the shakes or sweats because I feel terrible. 24. Can't make decisions : I can't make decisions about even small things. I just wait until things happen. 19. Work and money troubles : I have problems on the job, owe money or can't work at all because of my using. 20. Avoid friends and family : I avoid old friends and family that do not use—unless I need something from them. 18. Make changes : I change jobs, move, or leave a relationship to try to make my life better, but it doesn't make any difference. 17. Give up other things : I've stopped doing things that I used to do that didn't involve using alcohol or drugs. 16. Control : I try to control my use, but it doesn't work. 15. Promises : I promise to get my life in order and do better. I mean it, but it doesn't work out that way. 14. Show off : I show off or get pushy with other people to feel better and prove that I am okay. 13. Feel bad : I feel bad about how my using hurts other people, but I don't know what to do about it.
  • 116. 37. Confinement : I have been in jails and mental wards because of my using. 36. Desperation : I am willing to do anything to get better. 35. I'm lost : I don't try to pretend my life is normal. I know I am an addict or an alcoholic. believe that things will never change. 34. Turn to God : I want God or religion to save me from my life. 33. Using is everything : Getting something to use, using, and getting over using are my whole life. 32. Give up : I don't try to change anything. I just wait to see what happens. 31. Afraid : I feel like something terrible might happen to me, people are out to get me, and I have to be on guard at all times. 30. Major damage : Even when I'm not using, I have a hard time thinking, remembering, and doing things that used to be easy. 29. Find someone worse : I try to use with people who are worse off than I am so that I feel better. 28. Use all the time : I use whenever I can, and I don't try to have a normal life. 27. Over the line : I do things I said I would never do or things that do not reflect the way I was raised. 26. Decrease in amount to get high : It takes less for me to get high or doesn't matter how much I use because I can't get the effect I want. 25. Health problems : I am sick, have lost a lot of weight, or feel physically bad most of the time.
  • 117. Scoring Sheet for Alcohol and Drug Addiction Test Early Stage Addiction Count up the number of yes answers you checked in questions 1–12 and write the number below. Number of checks for questions 1–12 _____ If you have one or more checks in this section, there is a possibility that you are addicted to alcohol or drugs. This means that you use alcohol or drugs to try to solve problems and to make yourself feel better. While using alcohol or drugs will not really make things better, it will feel like it does. If you have any checks in this section, you have a possibility of becoming addicted if you keep using. The closer your score is to 12, the higher your chance of addiction. Middle Stage Addiction Count up the number of yes answers you checked in questions 13–24 and write the number below. Number of checks for questions 13–24 ____ Any number of checks in this section means that you are addicted and have started to have bad things happen to you because of your addiction. During this stage, you may try to do things to control your addiction. Some of these may work for a while, but not for long. For questions 13–24, the closer your score is to 12, the more addicted you are, and the worse things will get if you do not get help. Late Stage Addiction Count up the number of yes answers you checked in questions 25–37 and write the number below. Number of checks for questions 25–37 ____ Any number of checks in this section means that you are in the late stage of addiction. During this stage, you may have given up and thought that you could not do anything to change. Serious life problems, such as being sick, or going to jail or a mental ward, have happened or will happen to you if you do not try to get help. For questions 25–37, the closer your score is to 13, the more addicted you are. Your chances of dying are high if you continue to use.
  • 118. Offender Personality Self-Test
    • Gorski, Terence T. & Kelley, John M. (1999). Relapse Prevention Workbook for Chemically Dependent Criminal Offenders. Substance Abuse and Mental Health Services Administration, Public Health Service, U.S. Department of Health and Human Services.
    Page 68.
  • 119.
    • Part 1: Before Age 15
    • 1. Skipped school : I often skipped school because I didn't want to be there or because I wanted to do other things.
    • 2. Ran away : I ran away from home or from where I lived at least two times, overnight.
    • 3. Fights : I started physical fights with others more than once.
    • 4. Weapons : I used a gun, knife, club, chain, or other weapon in more than one fight.
    • 5. Sex : I forced someone into sex or sexual activity.
    • 6. Cruelty to animals : Sometimes I was cruel to or hurt animals.
    • 7. Cruelty to people : I physically hurt other people sometimes.
    • 8. Property damage : I destroyed or damaged other people's property on purpose.
    • 9. Fires : I set fires on purpose.
    • 10. Lying : I often lied to other people.
    • 11. Theft : I took things that didn't belong to me, forged checks, or broke into places to steal more than once.
    • 12. Robbery : I forced people to give me things that belonged to them.
    Yes No
  • 120.
    • Part 2: Since Age 15
    • 13. Work problems : I haven't worked when work was available, have skipped work or classes because I wanted to, or have quit several jobs or schools without any plans for the future.
    • 14. Illegal activities : I have committed crimes or done illegal things that I could have been arrested for.
    • 15. Using violence : I have had many physical fights or have beaten up my spouse, lover, or children.
    • 16. Avoid money responsibilities : I have failed to pay bills or child support, or I have failed to take care of my family.
    • 17. Moving around : I have moved without having a job, drifted from place to place, or have lived without a home for more than a month at a time.
    • 18. Conning : I have lied, used false names, or conned people to get what I want.
    • 19. Reckless : I have driven a car recklessly while using or drinking or have acted in ways that caused danger to others.
    • 20. Parenting : I have failed to take care of my children by leaving them alone, not feeding them, or depending on others to take care of them for me.
    • 21. Relationships : I have never been able to stay faithful to a sexual partner for more than 1 year.
    • 22. Remorse : I do not feel bad most of the time when I steal from, hurt, or treat someone else badly.
  • 121. Scoring : Add up the check marks in the yes column for questions 1–12 and put the number in the space above. Do the same for the no column. If you have three or more yes answers, you act and think similarly to people who commit crimes. This behavior usually starts very early in life. This means you will have to work hard to change the way you think and act. Scoring : Add up the check marks in the yes column for questions 13–22 and put the number in the space above. Do the same for the no column. If you have four or more yes answers, it means you act and think similarly to other people who commit crimes. If you did not have three or more yes answers on the section before age 15, it may mean that your offender behavior is completely connected to your alcohol and drug use. One way to make sure is to review your yes answers on questions 13–22 and ask yourself if these things always happened when you were trying to get alcohol or drugs, using alcohol or drugs, or because you had been using alcohol or drugs recently. If alcohol and drugs were not part of why you did these things, ask yourself what happened or changed in your life that made you start doing them.
  • 122. Page 72.
  • 123.  
  • 124. Page 74.
  • 125.  
  • 126.
    • Relapse Prevention Workbook for Chemically Dependent Criminal Offenders (TAP 19)
    • Exercise No. 1: Why Do I Want To Change?
    • Purpose . In this exercise, you will look at why you want to change. It is important to ask yourself this question. If you only want to escape the problems that you are facing right now, this workbook will not help you. If you want to change your life, it will.
    • Instructions . Complete the following sentences.
    • The reason I decided to try to get sober and clean this time is . . . (Tell what happened that made you seek help, such as job, health, or legal problems.)
    • Unless I really want to give up alcohol and drugs, I will not get better. Things might get better for a short time, but this will not last. I want to change because . . .
    SAMHSA Page 76.
  • 127.
    • Exercise No. 2: Reasons for Relapse
    • Purpose . This exercise will show you why you have trouble with recovery. By knowing this, you will know more about what you need to change.
    • When someone is having trouble staying sober and clean, it is because that person is having trouble with one of four major areas of recovery:
    • Acceptance of their disease : People who are having trouble accepting their disease believe they can still use alcohol or drugs and learn to control their use.
    • Unable to stabilize : Every time they try to stop using, they become sick, feel crazy, or cannot think about anything except drugs or alcohol. Therefore, they use alcohol or drugs to feel better.
    • Cannot get comfortable being sober : When they stop using, they do not know how to change the way they live so they can enjoy sobriety.
    • Relapse : They get sober and clean, they attend AA or NA meetings and enjoy sobriety, but then something happens, and they become unhappy and start to use again.
    • Instructions . Answer the following questions.
    • True False
    • ________ I believe that I can learn to drink or use drugs and control my use so that it will not hurt me.
    • ________ I know that I should not use alcohol or drugs at all, but every time I try to quit, I get sick and feel crazy, so I use alcohol or drugs to feel better.
    • ________ I know I cannot use alcohol or drugs, but when I quit for a while, I always end up using again.
    • ________ I know I cannot use alcohol or drugs, and I attend AA or NA and do everything I can to stay sober and clean. Sometimes I get very happy in recovery, but I still end up using again.
    • Notice if your above answers change as you complete the next exercise.
    SAMHSA Page 77.
  • 128. Anger Management for Substance Abuse and Mental Health Clients
    • Session 1: Overview of Anger Management Treatment
    • In this first session, you will get a general overview of the anger management treatment. This includes the purpose of the group, group rules, definitions of anger and aggression, myths about anger, anger as a habitual response, and the introduction of the anger meter used to monitor anger.
    • I. Purpose of the Group
    • 1) Learn to manage anger effectively.
    • 2) Stop violence or the threat of violence.
    • 3) Develop self-control over thoughts and actions.
    • 4) Receive support from others.
    • II. Group Rules
    • 1) Group Safety: No violence or threats of violence toward staff or other group members are permitted. It is very important that you view the group as a safe place to share your experiences and feelings without threats or fear of physical harm.
    • 2) Confidentiality: Group members should not discuss outside of the group what other members say. (The group leader should determine the limits of the laws or rules pertaining to confidentiality in his or her State.)
    • 3) Homework Assignments: Brief homework assignments will be given each week. Doing the homework assignments will improve your anger management skills and allow you to get the most from the group experience.
    • 4) Absences and Cancellations: You should call or notify the group leader in advance if you cannot attend a group session. Because of the amount of material presented in each session, you may not miss more than 3 of the 12 sessions.
    • If you miss more than three sessions, you may continue attending the weekly sessions, but you will not receive a certificate of completion.
    • 5) Timeouts: The group leader reserves the right to call a timeout at any time. Eventually, you will learn to call a timeout yourself if you feel that you may be losing control because your anger is escalating.
    SAMHSA Page 78.
  • 129.
    • III. Definitions
    • In the most general sense, anger is a feeling or emotion that ranges from mild irritation to intense fury and rage. Many people often confuse anger with aggression. Aggression is behavior that is intended to cause harm or injury to another person or damage to property. Hostility, on the other hand, refers to a set of attitudes and judgments that motivate aggressive behaviors.
    • • Before you learned these definitions, did you ever confuse anger with aggression?
    • Please explain how.
    • ________________________________________________________________________
    • ________________________________________________________________________
    • IV. When Does Anger Become a Problem?
    • Anger becomes a problem when it is felt too intensely, is felt too frequently, or is expressed inappropriately. Feeling anger too intensely or frequently places extreme physical strain on the body.
    • • List some ways anger may be affecting you physically.
    • ________________________________________________________________________
    • ________________________________________________________________________
    • ________________________________________________________________________
    • ________________________________________________________________________
    • V. Payoffs and Consequences
    • The inappropriate expression of anger initially has apparent payoffs (e.g., releasing tension, controlling people). In the long-term, however, these payoffs lead to negative consequences. That is why they are called “apparent” payoffs; the long-term negative consequences far outweigh the short-term gains.
    • • List some payoffs to using anger that you are familiar with.
    • ________________________________________________________________________
    • ________________________________________________________________________
    • ________________________________________________________________________
    • ________________________________________________________________________
  • 130.
    • • List the negative consequences that you have experienced as a result of expressing your anger inappropriately.
    • ________________________________________________________________________
    • ________________________________________________________________________
    • ________________________________________________________________________
    • ________________________________________________________________________
    • VI. Myths About Anger
    • Myth #1: Anger Is Inherited. One misconception or myth about anger is that the way people express anger is inherited and cannot be changed. Evidence from research studies, however, indicates that people are not born with set and specific ways of expressing anger. Rather, these studies show that the expression of anger is learned behavior and that more appropriate ways of expressing anger can also be learned.
    • Myth #2: Anger Automatically Leads to Aggression. A related myth involves the misconception that the only effective way to express anger is through aggression. There are other more constructive and assertive ways, however, to express anger. Effective anger management involves controlling the escalation of anger by learning assertiveness skills, changing negative and hostile “self-talk,” challenging irrational beliefs, and employing a variety of behavioral strategies. These skills, techniques, and strategies will be discussed in later sessions.
    • Myth #3: You Must Be Aggressive To Get What You Want. Many people confuse assertiveness with aggression. The goal of aggression is to dominate, intimidate, harm, or injure another person—to win at any cost. Conversely, the goal of assertiveness is to express feelings of anger in a way that is respectful of other people. Expressing yourself in an assertive manner does not blame or threaten other people and minimizes the chance of emotional harm. You will learn about the topic of assertiveness skills in more detail in sessions 7 and 8.
    • Myth #4: Venting Anger Is Always Desirable. For many years, there was a popular belief that the aggressive expression of anger, such as screaming or beating on pillows, was therapeutic and healthy. Research studies have found, however, that people who vent their anger aggressively simply get better at being angry. In other words, venting anger in an aggressive manner reinforces aggressive behavior.
    • • Before our discussion, did you believe any of these myths about anger to be true?
    • ________________________________________________________________________
    • ________________________________________________________________________
    • ________________________________________________________________________
    • ________________________________________________________________________
  • 131.
    • VII. Anger Is a Habit
    • Anger can become a routine, familiar, and predictable response to a variety of situations. When anger is displayed frequently and aggressively, it can become a maladaptive habit. A habit, by definition, means performing behaviors automatically, over and over again, without thinking. The frequent and aggressive expression of anger can be viewed as a maladaptive habit because it results in negative consequences.
    • • Has anger become a habit for you? How?
    • ________________________________________________________________________
    • ________________________________________________________________________
    • ________________________________________________________________________
    • ________________________________________________________________________
    • • In what ways has it been maladaptive?
    • ________________________________________________________________________
    • ________________________________________________________________________
    • ________________________________________________________________________
    • ________________________________________________________________________
    • VIII. Breaking the Anger Habit
    • You can break the anger habit by becoming aware of the events and circumstances that trigger your anger and the negative consequences that result from it. In addition, you need to develop a set of strategies to effectively manage your anger. You will learn more about strategies to manage anger in session 3.
    • • List some anger control strategies that you might know or that you may have used
    • in the past.
    • ________________________________________________________________________
    • ________________________________________________________________________
    • ________________________________________________________________________
    • ________________________________________________________________________
  • 132.
    • IX. Anger Meter
    • A simple way to monitor your anger is to use a 1 to 10 scale called the anger meter. A score of 1 on the anger meter represents a complete lack of anger or a total state of calm, whereas 10 represents an angry and explosive loss of control that leads to negative consequences.
    • • For each day of the upcoming week, monitor and record the highest number you reach on the anger meter.
    • _____ M _____ T _____ W _____ Th _____ F _____ Sat _____ Sun
    • • Be prepared to report the highest level of anger you reached during the week in next week’s group.
    • Anger Meter
    • • Explosion
    • • Violence
    • • Loss of Control
    • • Negative Consequences
    • • You Lose!
    • • You have a choice!
    • • Use your anger control
    • plan to avoid reaching 10!
    • 10
    • 9
    • 8
    • 7
    • 6
    • 5
    • 4
    • 3
    • 2
    • 1
  • 133.
    • Session 2: Events and Cues
    • In this session, you begin to learn how to analyze an episode of anger. This involves learning
    • how to identify events and cues that indicate an escalation of anger.
    • I. Events That Trigger Anger
    • When you get angry, it is because you have encountered an event in your life that has provoked
    • your anger. Many times, specific events touch on sensitive areas. These sensitive areas or “red
    • flags” usually refer to long-standing issues that can easily lead to anger. In addition to events
    • that you experience in the here and now, you may also recall an event from your past that
    • made you angry. Just thinking about these past events may make you angry now. Here are
    • examples of events or issues that can trigger anger:
    • Long waits to see your doctor
    • Traffic congestion
    • Crowded buses
    • A friend joking about a sensitive topic
    • A friend not paying back money owed to you
    • Being wrongly accused
    • Having to clean up someone else’s mess
    • Having an untidy roommate
    • Having a neighbor who plays the stereo too loud
    • Being placed on hold for long periods of time while on the telephone
    • Being given wrong directions
    • Rumors being spread about your relapse that are not true
    • Having money or property stolen from you.
    • • What are some of the general events and situations that trigger anger for you?
    • ______________________________________________________________________________
    • ______________________________________________________________________________
    • ______________________________________________________________________________
    • ______________________________________________________________________________
    SAMHSA Page 83.
  • 134.
    • What are some of the red-flag events and situations that trigger anger for you?
    • ______________________________________________________________________________
    • ______________________________________________________________________________
    • ______________________________________________________________________________
    • ______________________________________________________________________________
    • II. Cues to Anger: Four Cue Categories
    • A second important way to monitor anger is to identify the cues that occur in response to the
    • anger-provoking event. These cues serve as warning signs that you have become angry and
    • that your anger is escalating. Cues can be broken down into four cue categories: physical,
    • behavioral, emotional, and cognitive (or thought) cues. After each category, list the cues that
    • you have noticed when you get angry.
    • 1) Physical Cues (how your body responds; e.g., with an increased heart rate, tightness in the
    • chest, feeling hot or flushed)
    • ______________________________________________________________________________
    • ______________________________________________________________________________
    • ______________________________________________________________________________
    • ______________________________________________________________________________
    • 2) Behavioral Cues (what you do; e.g., clench your fists, raise your voice, stare at others)
    • ______________________________________________________________________________
    • ______________________________________________________________________________
    • ______________________________________________________________________________
    • ______________________________________________________________________________
    • 3) Emotional Cues (other feelings that may occur along with anger; e.g., fear, hurt, jealousy,
    • disrespect)
    • ______________________________________________________________________________
    • ______________________________________________________________________________
    • ______________________________________________________________________________
    • ______________________________________________________________________________
  • 135.
    • 4) Cognitive Cues (what you think about in response to the event; e.g., hostile self-talk, images
    • of aggression and revenge)
    • ______________________________________________________________________________
    • ______________________________________________________________________________
    • ______________________________________________________________________________
    • ______________________________________________________________________________
    • III. Check-In Procedure: Monitoring Anger for the Week
    • In this session, you began to learn to monitor your anger and to identify anger-provoking events
    • and situations. In each weekly session, there will be a Check-In Procedure to follow up on the
    • homework assignment from the previous week and to report the highest level of anger reached
    • on the anger meter during the past week. You will also be asked to identify the event that triggered
    • your anger, the cues that were associated with your anger, and the strategies you used
    • to manage your anger in response to the event. You will be using the following format to check
    • in at the beginning of each session:
    • 1) What was the highest number you reached on the anger meter during the past week?
    • ______________________________________________________________________________
    • 2) What was the event that triggered your anger?
    • ______________________________________________________________________________
    • ______________________________________________________________________________
    • ______________________________________________________________________________
    • ______________________________________________________________________________
    • 3) What cues were associated with the anger-provoking event?
    • Physical cues __________________________________________________________________
    • Behavioral cues ________________________________________________________________
    • Emotional cues ________________________________________________________________
    • Cognitive cues ________________________________________________________________
  • 136.
    • 4) What strategies did you use to avoid reaching 10 on the anger meter?
    • ______________________________________________________________________________
    • ______________________________________________________________________________
    • ______________________________________________________________________________
    • ______________________________________________________________________________
    • • For each day of the upcoming week, monitor and record the highest number you reach on
    • the anger meter.
    • _____ M _____ T _____ W _____ Th _____ F _____ Sat _____ Sun
    • Events, Cues, and Strategies Identified During the Check-In Procedure
    • Event Cues Strategies
  • 137.
    • Session 3: Anger Control Plans
    • In this session, you will begin learning about specific strategies to manage your anger. The anger
    • control plan refers to the list of strategies you will identify to manage and control your anger.
    • I. Anger Control Plans
    • Up to now the group has been focusing on how to monitor anger. In the first session, you
    • learned how to use the anger meter to rate your anger. Last week, you learned how to identify
    • the events that trigger your anger, as well as the physical, behavioral, emotional, and cognitive
    • cues associated with each event. In this session, you will begin to develop your own anger control
    • plans and learn how you can use specific strategies, such as timeouts and relaxation, to
    • control anger. Some people refer to their anger control plans as their toolbox and the specific
    • strategies they use to control their anger as the tools in their toolbox.
    • An effective set of strategies for controlling anger should include both immediate and preventive
    • strategies. Examples of immediate strategies include timeouts, deep-breathing exercises,
    • and thought stopping. Examples of preventive strategies include developing an exercise program
    • and changing irrational beliefs. These strategies will be discussed in later sessions.
    • Timeouts
    • The timeout is a basic anger management strategy that should be in everyone’s anger control
    • plan. A timeout can be used formally or informally. In its simplest form, it means taking a few
    • deep breaths and thinking instead of reacting. It may also mean leaving the situation that is
    • causing the escalation or simply stopping the discussion that is provoking your anger.
    • The formal use of a timeout involves our relationships with other people. These relationships
    • may involve family members, friends, and coworkers. The formal use of a timeout involves having
    • an agreement, or a prearranged plan, by which any of the parties involved can call a timeout
    • and to which all parties have agreed in advance. The person calling the timeout can leave
    • the situation, if necessary. It is agreed, however, that he or she will return to either finish the
    • discussion or postpone it, depending on whether the parties involved feel they can successfully
    • resolve the issue.
    • A timeout is important because it can be used effectively in the heat of the moment. Even if a
    • person’s anger is escalating quickly as measured on the anger meter, he or she can prevent
    • reaching 10 by taking a timeout and leaving the situation.
    • A timeout is also effective when used with other strategies. For example, you can take a timeout
    • and go for a walk. You can also take a timeout and call a trusted friend or family member
    • or write in your journal. These other strategies help you calm down during your timeout period.
    SAMHSA Page 87.
  • 138.
    • Can you think of situations where you would use the timeout strategy? Please describe
    • them.
    • ______________________________________________________________________________
    • ______________________________________________________________________________
    • ______________________________________________________________________________
    • ______________________________________________________________________________
    • • Can you think of specific strategies that you might use to control your anger? Please
    • describe them.
    • ______________________________________________________________________________
    • ______________________________________________________________________________
    • ______________________________________________________________________________
    • ______________________________________________________________________________
    • Sample of an Anger Control Plan
    • Anger Control Plan
    • 1. Take a timeout (formal or informal)
    • 2. Talk to a friend (someone you trust)
    • 3. Use the Conflict Resolution Model to express anger
    • 4. Exercise (take a walk, go to the gym, etc.)
    • 5. Attend 12-Step meetings
    • 6. Explore primary feelings beneath the anger
  • 139.
    • II. Relaxation Through Breathing
    • End this session by practicing a deep-breathing exercise as a relaxation technique. You can
    • practice this exercise on your own by focusing on your breathing, taking several deep breaths,
    • and trying to release any tension you might have in your body. You should practice this exercise
    • as often as possible. Here are the directions.
    • Find a comfortable position in your chair. If you would like, close
    • your eyes; if not, just gaze down at the floor. Take a few moments
    • to settle yourself. Now become aware of your body. Check for any
    • tension, beginning with your feet, moving upward to your head.
    • Notice any tension you might have in your legs, stomach, hands
    • and arms, shoulders, neck, and face. Try to let go of any tension.
    • Now, become aware of your breathing. Pay attention to your breath
    • as it enters and leaves your body. This can be very relaxing.
    • Take a deep breath. Notice your lungs and chest expanding. Now
    • slowly exhale through your nose. Again, take a deep breath. Fill
    • your lungs and your chest. Notice how much air you can take in.
    • Hold it for a second. Now release it and exhale slowly. Inhale slowly
    • and fully one more time. Hold it for a second, and release.
    • Continue breathing in this way for another couple of minutes.
    • Continue to focus on your breath. With each inhalation and exhalation,
    • feel your body becoming more and more relaxed. Use your
    • breathing to wash away any remaining tension.
    • Now take another deep breath. Inhale fully, hold it for a second,
    • and release. Inhale again, hold, and release. Continue to be aware
    • of your breath as it fills your lungs. Once more, inhale fully, hold it
    • for a second, and release.
    • When you feel that you are ready, open your eyes. How was that?
    • Did you notice any new sensations while you were breathing? How
    • do you feel now?
    • This breathing exercise can be shortened to just three deep
    • inhalations and exhalations. Even that can be effective in helping
    • you relax when your anger is escalating. You can practice this at
    • home, at work, on the bus, while waiting for an appointment, or
    • even while walking. The key to using deep-breathing as an effective
    • relaxation technique is to practice it frequently and to apply it
    • in a variety of situations.
  • 140.
    • III. Monitoring Anger for the Week
    • 1) What was the highest number you reached on the anger meter during the past week?
    • ______________________________________________________________________________
    • 2) What was the event that triggered your anger?
    • ______________________________________________________________________________
    • ______________________________________________________________________________
    • ______________________________________________________________________________
    • ______________________________________________________________________________
    • 3) What cues were associated with the anger-provoking event?
    • Physical cues ___________________________________________________________________________
    • Behavioral cues ___________________________________________________________________________
    • Emotional cues __________________________________________________________________
    • Cognitive cues ___________________________________________________________________________
    • 4) What strategies did you use to avoid reaching 10 on the anger meter?
    • ______________________________________________________________________________
    • ______________________________________________________________________________
    • ______________________________________________________________________________
    • ______________________________________________________________________________
    • • For each day of the upcoming week, monitor and record the highest number you reach on
    • the anger meter.
    • _____ M _____ T _____ W _____ Th _____ F _____ Sat _____ Sun
  • 141. Treatment for Stimulant Use Disorders (TIP 33)
    • Recreational and Leisure Activities (Worksheet 21) When you were using stimulants, there were times when your life focused on obtaining, using, and recovering from the effects of the drugs. There were times when your life was probably chaotic, out of control, and without structure. Recovery is an opportunity for you to develop a structure to your life and fill it with healthy activities.
    • Recreational activities are experiences in which you actively participate in an organized activity, generally with others, to have fun and enjoy life. They include participation in sports, arts and crafts endeavors, and table games, as well as sober dances, bowling, touch football, and card games. Some involve physical exercise. Leisure activities are things that you do primarily for relaxation and pleasure, and which don't involve much work. These include taking walks, having friendly conversations, reading books, watching movies, or watching sports activities.
    • Before you began using stimulants, what type of recreational activities did you enjoy? What type of leisure activities did you enjoy? What were some of the benefits that you obtained from these activities?
    • On Client Worksheet 22, Examples of Recreational and Leisure Activities , there are lists of recreational activities. Which of these do you find interesting? What are some of the benefits that you might obtain from these activities? In what ways could you incorporate these into your recovery program?
    • On Client Worksheet 22 there are lists of leisure activities. Which of these do you find interesting? What are some of the benefits that you might obtain from these activities? In what ways could you incorporate these into your recovery program?
    • Do you have any healthy hobbies? Do you see anything on Client Worksheet 22 that grabs your attention? Can you think of something else that would be personally satisfying?
    • Action plan Which recreational and leisure activities would you like to do within the next couple of weeks? Where would you go? When would you go? With whom would you go?
    • What obstacles do you think you might encounter? What do you need to do to overcome these obstacles?
    • What steps do you need to take in order to engage in these activities? Do you need help to organize the activities? When can you take the first step?
    SAMHSA Page 91.
  • 142. Examples of Recreational and Leisure Activities (Worksheet 22) Recreational activities, leisure activities, and hobbies are all ways in which you can have fun, enjoy being with others, and add healthy activities to your life. They can also help you take your mind off drugs, add structure to your life, and maybe even learn something new. They can help you avoid being bored and restless. They can help you reduce stress and anxiety. SAMHSA Page 92. Other: _____________ Writing Watching movies and TV Other: _____________ Walks in parks Woodworking Visiting museums Other: _____________ Volunteering Talking to friends Weightlifting Stained glass making Sunbathing Volleyball Singing Sightseeing Touch football Sewing Roller skating Table tennis Playing music Reading books Swimming Photography Playing video games Surfboarding Model building Picnics Skin-diving Hunting Painting Skiing Home decorating Listening to music Shuffleboard Genealogy Horseback riding Sailing/boating Gardening Hiking Playing cards Flower arranging Fishing Ice skating Electronics Driving Golf Cooking/baking Dining out Dancing Computers Crossword puzzles Chess Coaching Little League Coin collecting Checkers Ceramics/pottery Bird watching Canoeing Carpentry Bicycling Camping Auto repairing Attending sports events Bowling Astronomy Attending plays Billiards/playing pool Arts and crafts Attending concerts Basketball Aquarium making Attending auto races Baseball/softball Amateur radio Attending auctions Backpacking Hobbies Leisure Activities Recreational Activities
  • 143.
    • Exercise and Recovery (Worksheet 23)
    • Some people find having a regular schedule of intense exercise workouts, such as aerobics and step-aerobics especially enjoyable. But exercise doesn't always have to be intense to be healthy and can be somewhat more gentle, such as vigorous walks, bike rides, and skating. Also, some people find it difficult to engage in exercise just for the sake of exercise. They may find greater satisfaction in exercise activities that are social and involve groups of people. This can include dancing, tennis, swimming, or having entire groups going for walks, taking bike rides, going for runs, and skating.
    • Some of the benefits of exercise include increasing your physical well-being, improving your emotional well-being, improving your mental alertness, improving your sleep, providing you with more energy, and reducing your stress and anxiety. Exercise also provides structure to your life and can help to prevent weight gain.
    • When was the last time that you engaged in regular exercise? What kind of exercise have you been involved with in the past?
    • What type of exercise appeals to you the most? Intense, vigorous workouts by yourself? Competing with others? Social and gentle aerobic activities?
    • What would you like to gain from exercise? What is the primary thing that would motivate you to exercise?
    • Look at Client Worksheet 24, Types of Exercise Activities. What specific types of exercise would you consider doing? What would be a reasonable exercise schedule that you could incorporate into your recovery program?
    • What obstacles might get in the way of your engaging in regular exercise? What steps can you take to overcome these obstacles? Are there clubs or organizations that you could join?
    SAMHSA Page 93.
  • 144.
    • Types of Exercise Activities (Worksheet 24) You may not have noticed, but there are numerous opportunities for participating in exercise activities nearby. Unless you live in a very rural area (and maybe even if you do), you probably live near a county or city recreation department, a local YMCA gym, a Jewish Community Center, and private exercise clubs and gyms. Many of these, especially gyms that are sponsored by non-profit organizations, offer services that are low-cost or even free. You can get local information through the yellow pages under "gyms," "exercise," "recreation," and by contacting the local city or county recreation department.
    Traditional activities Jogging Walking Bicycling Skating Swimming Weightlifting Nautilus-type workouts Exercise classes Aerobics classes Jazz-aerobics Low-impact aerobics High-impact aerobics Step-aerobics classes Water-aerobics Martial arts Judo Jujitsu Karate Kung-Fu Tai-Chi Sports-type exercise Baseball Basketball Racquetball Roller hockey Softball Soccer Tennis Volleyball Dance classes Ballet dancing Ballroom dancing Country and western Ethnic dancing Jazz dancing Latin dancing Modern dancing Swing dancing Tap dancing SAMHSA Page 94.
  • 145.
    • Nutritional Self-Assessment (Worksheet 25)
    • If you are typical, your use of stimulants and other drugs, especially alcohol, has had a bad impact on your diet. Stimulants suppress your appetite by making you feel as if your hunger is satisfied, even though you have not eaten anything. When your appetite is artificially suppressed by stimulants, you eat less and therefore do not consume sufficient calories and nutrition. At the same time, stimulants speed up the metabolism of your body, creating an even greater need for calories. Also, if you typically use alcohol in combination with stimulants, you may have gotten most of your calories from alcohol, often called "empty calories."
    • In addition to not eating frequently enough, you may have learned poor ways of eating. For instance, you may have learned to eat impulsively. Also, you may have developed the habit of eating foods with little nutritional value when you did eat.
    • Nutritional self-assessment
    • If you tended to use stimulants in binges, for how many days did you binge? During a typical stimulant binge, how many days would you go without eating? What was the longest period of time that you went without eating?
    • During a typical stimulant binge, how many times did you actually stop and eat a meal? Did you frequently "forget" to stop and eat?
    • During or following a stimulant binge, when you did eat, what did you eat? What would you eat for breakfast? What would you eat for lunch? What would you eat for dinner?
    • When you did eat, did you make plans to prepare and eat meals or did you eat impulsively?
    • Now, during your recovery, do you make plans to prepare and eat meals or do you eat "when you can?"
    • What did you eat for breakfast today? What did you have for lunch today or yesterday? What did you have for dinner yesterday?
    • Do you notice that there are times when you crave fats and sweets?
    SAMHSA Page 95.
  • 146.
    • The Food Guide Pyramid (Worksheet 26)
    • You probably remember reading something about the Food Guide Pyramid, a guide to daily food choices, although you may not have thought about how it applies to you. Reviewing these five food groups and incorporating this information into your life can be important aspects of your recovery. Eating regularly, and eating meals that are balanced among these food groups, can help to decrease stimulant cravings, increase sleep, increase concentration, decrease withdrawal-related anxiety and depression, and provide sufficient energy required for recovery. The following provides a basic description of the five food groups and the recommended number of servings per day for each food group. Keep in mind that a "serving" is actually a fairly small amount.
    • Fruit group and vegetable group These are good sources of fiber and vitamins. Having sufficient fiber prevents constipation. Having sufficient vitamins ensures the healthy functioning of the brain, nerves, muscles, skin, and bones. Some vitamins help energy to be released from food. A healthy diet should include three to five servings of vegetables and between two and four servings of fruits each day. A serving can consist of 1/2 cup of fruit or vegetables, a small salad, one medium potato, or a wedge of lettuce.
    • Bread, rice, cereal, and pasta
    • These are good sources of protein, vitamins, and minerals. Proteins are the primary building blocks of muscle, skin, blood, and bones. The brain chemicals that become depleted by chronic stimulant use are made from proteins. A healthy diet should include between 6 and 11 servings from this group each day. A serving can consist of 1 slice of bread, 1/2 cup of pasta or rice, or 1 ounce of cereal.
    • Milk and cheese
    • These include milk, ice cream, yogurt, cheeses, and cottage cheese. These foods are a source of calcium, protein, and vitamins. Calcium is required for healthy bones and teeth. A healthy diet should include at least two to three servings each day. A serving can consist of 1 cup of skim milk, 1 1/2 cups of natural cheese, 1 1/2 cups of lowfat ice cream, or 1 1/4 ounces of hard cheese.
    • Meat, poultry, fish, dry beans, eggs, and nuts
    • These foods are rich in protein, minerals, and vitamins. A healthy diet should be limited to two to three servings per day from this food group. A serving can consist of 2 to 3 ounces of chicken, fish, or lean beef; 1 egg; 1/2 cup of cooked dry beans; 1/2 cup of nuts; or 2 tablespoons of peanut butter, which is equivalent to 1 ounce of lean meat.
    • Fats, oils, and sweets
    • No serving sizes are suggested because these foods should be eaten sparingly.
    • Write out all of the foods that you ate yesterday. How many of the essential food groups did you consume yesterday?
    • Which of the food groups do you need to increase? Which do you need to cut down? What steps do you need to take to make that happen?
    SAMHSA Page 96.
  • 147.
    • My Nutrition Improvement Action Plan (Worksheet 27)
    • Stimulant-addicted people learn to act on impulse. It becomes commonplace to not eat regularly, to eat on the run, and to select foods based only on taste and not nutritional value. There is often no set schedule for meals, no meal planning, and an over reliance on high-calorie, high-fat fast foods, such as hamburgers and fries. However, with a little planning, eating can be transformed from an impulsive activity to an important and healthy component of recovery.
    • Make a schedule and a commitment It is important to stop eating on the run. Making a schedule for meals can be a simple but very effective way to help add structure to your day. If you live with family members, mealtime can be a point during which all family members come together at least briefly. Take the time to list your daily and weekly priorities, such as 12-Step and recovery group meetings, and make a schedule that includes both meals and recovery priorities. Then make a commitment to continue and update this pattern.
    • Plan a few meals
    • It may seem foolish at first, but take the time to reflect on what meals you would like to have over the next several days or week. You don't have to plan out each meal. Rather, make a decision about some of the meals that you would like to have over the next several days, especially for dinner. In this way, you can plan ahead and purchase only those grocery items that you need to make the meals.
    • Make a grocery list
    • Once you have decided which meals you would like to have over the next several days, take the time to make a list of the grocery items that you need to prepare the meals. This helps you to avoid walking around the grocery store without a plan and buying groceries impulsively. Also, it will save money. You can divide your list into breakfast items, lunch items, dinner items, and snacks. Consider getting fruit as the primary type of snacks.
    • Plan meal preparation
    • Many people don't like to cook or clean up. If you live with others, it can be valuable to make a schedule about who does what. You can make agreements with others so that if one person cooks, another person cleans up.
    • Plan exceptions to the schedule
    • Most people enjoy eating out from time to time. You may have a favorite restaurant. However, eating out is often an impulsive behavior learned during periods of stimulant use. Thus, you can learn to incorporate eating out into your weekly schedule. In this way, eating out can be seen as a treat or a reward for keeping a healthy dining schedule.
    SAMHSA Page 97.