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Corrections and Substance Abuse Training METHAMPHETAMINE Warning: This seminar and seminar manual and case studies, inevit...
Part 1.  Social Implications <ul><li>Screening, Assessment and Evaluation </li></ul><ul><li>Prevention, Intervention and T...
  <ul><li>Learner Objectives </li></ul><ul><li>Identify and explain the chemical properties of methamphetamine. </li></ul>...
History of Amphetamines <ul><li>First synthesized in 1887.  </li></ul><ul><li>Commercially available in the 1930s. </li></...
History of Methamphetamine <ul><li>A derivative of amphetamine first developed by a pharmacologist in Japan in 1919. </li>...
In the 1960s manufactured illegally mostly by outlaw motorcycle gangs and used frequently by long distance truck drivers. ...
Methamphetamine as a Stimulant <ul><li>Has greater central nervous system affects than amphetamine. </li></ul><ul><li>NIDA...
Methamphetamine Hydrochloride Tablets United States Pharmacopeia (USP)   <ul><li>Desoxyn ® CII (Desoxyephedrine) </li></ul...
Desoxyn ® by Ovation <ul><li>Chemically known as (S)-N,α-dimethylbenzeneethanamine </li></ul><ul><li>hydrochloride, is a m...
Off Label Uses <ul><li>Desoxyn® has also been used to treat narcolepsy (the compulsion to sleep) , depression, and Parkins...
Methamphetamine <ul><li>An extremely powerful and highly addictive “upper.” </li></ul><ul><li>Made and sold as tablets, ca...
Abbreviations MA Meth mAMPH Page 8.
Slang for MA <ul><li>222 (Chicago) Agua Albino Poo Alffy All Tweakend Long </li></ul><ul><li>Amp </li></ul><ul><li>Annie <...
Bikerdope Biker’s Coffee Billy, Or Whiz (in Britain after a cartoon character in a kids comic called Billy Whiz) Bitch Biz...
Caca Candy Cankinstien CC Chach ChaChaCha Chalk Chalk Dust Chank Cheebah Cheese Chicken Flippin Chikin or Chicken Chicken ...
Coco Coffee Cookies CR (California Central Valley) Crack Whore Crank Crank Is &quot;Walk&quot; & Coke Is &quot;Talk&quot; ...
Debbie, Tina, And Crissy Desocsins Devil Dust Devils Dandruff Devils Drug Dingles Dirt Dirty Dizzy D D-Monic Or D Do Da Do...
Ethyl-M Evil Yellow Fatch (Mexican Border In The  Southwest Arizona Area) Fedrin Fil-Layed Fizz Wizz Gackle-a Fackle-a Gak...
Got Anything Granulated Orange Grit Gumption Gyp Hawaiian Salt Hank Hanyak (Smokable) High Speed Chicken Feed Highthen Hil...
Ish Izice  Jab Jasmine Jenny Crank Program Jetfuel Jib Jib Nugget Jinga Juddha Juice Junk (San Diego) Kaksonjae Kibble Kil...
Lemon Drop Life Lily Linda Lost Weekend (Bay Area/San Francisco) Love Low Lucille M Man Magic Meth Meth Monsters Methaine ...
Nazi Dope Ned Newday No Doze Nose Candy On A Good One OZs Patsie Peaking Peanut Butter Peel Dope  Pepsi (means crank) Peps...
Pootananny Powder Powder Monkeys Powder Point Project Propellant Puddle Pump (Bay Area/San Francisco) Q'd Quartz (Smokable...
Rocket Fuel Rocky Mountain High Rosebud Rudy's Rumdumb Running Pizo Sack Sam's Sniff Sarahs Satan Dust Scante (Hispanic Po...
Shabu Shamers Shards Shit Shiznack, Shiznac, Sciznac or Shiznastica Shiznit Shiznitty Shizzo Shnizzie Snort Shwack Sixty F...
Smzl Snaps Sniff Snow, Motivation (Colorado Springs, CO) Space Food Spaceman Spagack Sparacked Sparked Sparkle Speed Speed...
Sprizzlefracked Sprung (Mississippi) Spun Ducky Woo Squawk Stallar Sto-Pid Stove Top Styels Sugar Suger Super Ice Sweetnes...
Tobats Toots Torqued Trash Trippin Trip Tubbytoast Tutu (Hawaii) Twack Twacked Out Tweak Tweedle Doo Tweek (a Methamphetam...
White Cross White Crunch White Ink White Junk White Lady White Pony (Ridin' the White Pony) White Who-Ha Wigg Working Man’...
TERMS USED FOR THE FEELING OF MA INTOXICATION  <ul><li>Ampin' Amped Bache Knock 2 Rock Bachin &quot;BOB&quot; as is discom...
Nicknames for MA Users KCI: The Anti-Meth Site basehead battery bender cluckers, chicken-headed clucks crack heads crackie...
Other MA Related Terminology <ul><li>Crank Craters - sores on your face caused by meth   </li></ul><ul><li>Tooter - the st...
Cost of MA <ul><li>1 ounce of MA=approximately 110 MA “hits” (uses) </li></ul><ul><li>1 ounce=28.35 grams </li></ul><ul><l...
Effects of Route of Administration for Cocaine & MA Cook, 1991; Gold, 1997; Gold & Miller, 1997; Sowder & Beschner, 1993; ...
10 to 20 minutes for cocaine/  2 to 4 hours for MA   No “rush” or “flash.” 3 to 5 minutes POWDER Usually, “low intensity u...
10 to 20 minutes for cocaine/  4 to 6 hours for MA   Following a 3 minute intense sensation called a “rush” or “flash.” 5 ...
5 to 20 minutes for crack/  8 to 24 hours for ice   Following a 3 minute intense sensation called a “rush” or “flash.” 5 t...
Other Differences Between Cocaine & MA <ul><li>COCAINE </li></ul><ul><li>Plant-derived (obtained from coca leaves) </li></...
Symptoms of MA Use <ul><li>Inability to sleep </li></ul><ul><li>Loss of appetite and weight, thin/gaunt </li></ul><ul><li>...
ABC Channel 7 News Denver Page 22.
Oregon Narcotics Enforcement Association Page 23.
The News & Observer/Associated Press Page 23.
<ul><li>If “tweaking” (a term also applied to using alcohol while on MA) the users’ eyes will involuntarily jerk back and ...
Helpful Hints if Interviewing a “Tweaker” <ul><li>Keep a social distance </li></ul><ul><li>Slow your speech and lower your...
Other Ways to Reduce the Risk of Violence with MA Users <ul><li>Identify yourself and use the client’s name. </li></ul><ul...
Short & Long Term Effects of MA <ul><li>MA can cause cardiovascular damage, collapse and sudden death from toxicity and co...
<ul><li>After chronic use, MA decreases production of dopamine and the user may have symptoms similar to Parkinson disease...
MA, HIV & Hepatitis B & C <ul><li>IV MA users may get infections and sores at injection site </li></ul><ul><li>IV MA users...
MA Use During Pregnancy <ul><li>May result in the following damage to the infant: </li></ul><ul><ul><ul><ul><li>Premature ...
Substance Abuse Treatment Admissions for MA <ul><li>In 1992  14,554   </li></ul><ul><li>admissions in U.S. for MA </li></u...
Emergency Department  Mentions of MA 1994-2002 <ul><li>MA that was recorded during an ED Visit that “was induced by or rel...
MA Mortality Data <ul><li>2002 Fatalities </li></ul><ul><li>Phoenix 132 deaths </li></ul><ul><li>San Diego 81 deaths </li>...
MA Use Among Adolescents <ul><li>6.2%   </li></ul><ul><li>of high school seniors report use of MA  in their lifetime </li>...
Overall Use of MA <ul><li>12.4 million Americans (5.3% of the population) 12 years of age and older have tried MA at least...
MA & Law Enforcement Trends <ul><li>“ Operation Wildfire” </li></ul><ul><li>(first nationally coordinated operation to fig...
“ Biggest Drug Problem”  Based on Drug Related Arrests in 2005 According to 500 Law Enforcement Agencies in 45 States  Nat...
Specific Regions of the U.S. <ul><li>76%  of the counties in the  Southwest   </li></ul><ul><li>report that MA is the bigg...
Total Arrests in U.S. Counties MA Related <ul><li>75%   </li></ul><ul><li>of all counties report that  </li></ul><ul><li>4...
Other Crimes Resulting from MA <ul><li>70%  of counties report  increase in  robberies or burglaries  because of MA </li><...
Race & Gender <ul><li>DEA arrests for MA: </li></ul><ul><li>94% white  </li></ul><ul><li>78.5% male </li></ul><ul><li>Fede...
Adult Female Arrestees  Testing Positive for MA by City <ul><li>54%  in  Honolulu   </li></ul><ul><li>42%  in  Phoenix </l...
MA & Incarceration Rates <ul><li>20 to 75%   </li></ul><ul><li>of current county jail inmates are incarcerated because of ...
Mandatory Minimum Sentences for MA under Federal Law <ul><li>10 grams (pure) </li></ul><ul><li>= </li></ul><ul><li>5 years...
Increase in Children Out-of-Home Placements Associated with MA Use? NACo Page 34.
<ul><li>64% of counties with populations above 500,000 reported increases in children out-of-home placements associated wi...
DEA Page 35.
Page 36. M0  2788; IA  1335; TN 1327; IN  1074; IL  1058
1996 Midwest High Intensity Drug Trafficking Area (HIDTA) <ul><li>Iowa, Kansas, Missouri, Nebraska & South Dakota </li></u...
MA Labs On/Adjacent to  Federal Land <ul><li>In or near: </li></ul><ul><li>Caves </li></ul><ul><li>Cabins </li></ul><ul><l...
“ Super Labs” in Mexico  (i.e., capable of producing in excess of 10 pounds of MA in 24 hours) and   Chemicals from Canada...
Possible Indications of a MA Lab <ul><li>“ Unusual, strong odors (like cat urine, ether, ammonia, acetone or other chemica...
Chemicals Commonly Used to Manufacture MA <ul><li>Ephedrine  </li></ul><ul><li>Pseudoephedrine  </li></ul><ul><li>Acetone ...
Equipment Commonly Used to Manufacture MA <ul><li>Pyrex or Corning Dishes  </li></ul><ul><li>Jugs  </li></ul><ul><li>Bottl...
Steps of Manufacturing MA ($100 in materials will produce approximately $1,000 in MA) <ul><li>The over the counter or pres...
MA Labs:    Health & Environment Concerns <ul><li>The chemicals used in MA labs are volatile and flammable.  The by-produc...
Fumes in furniture, carpeting/other flooring, walls and window coverings, etc. of a house, office or hotel room where MA w...
MA & Federal Legislation <ul><li>Comprehensive Methamphetamine Control Act of 1996 (MCA) </li></ul><ul><li>Increased penal...
2005 Federal Legislation  <ul><li>Combat Meth Act of 2005 (HR 314/S 103) </li></ul><ul><li>Would reclassify pseudoephedrin...
Congressional Caucus to Fight and Control Methamphetamine <ul><li>“ To direct members attention to growing nationwide prob...
State Laws and MA <ul><li>Oklahoma HB 2176 </li></ul><ul><li>Pseudoephedrine must be sold behind the counter. </li></ul><u...
Oklahoma and Oregon and MA <ul><li>Another law in  Oklahoma … </li></ul><ul><li>… creates an online database of pseudoephe...
Corporate Policies Effecting MA <ul><li>Retailers nationwide are voluntarily moving non prescription medicines with pseudo...
What Medication Manufacturers  are Doing about MA <ul><li>Some companies that make cold and allergy medications are using ...
Adult Antisocial Behavior  APA <ul><li>“ This category can be used when the focus of clinical attention is adult antisocia...
Antisocial Personality Disorder  APA <ul><ul><li>“ A. There is a pervasive pattern of disregard for and violation of the r...
<ul><li>MA Dependence   </li></ul><ul><li>(requires 3 or more of the following): </li></ul><ul><li>Increased Tolerance; </...
Amphetamine-Like  (MA) Intoxication APA <ul><li>A.  Recent use of MA. </li></ul><ul><li>B.  Clinically significant maladap...
Amphetamine-Like  (MA) Intoxication Delirium APA <ul><li>Disturbance of consciousness (i.e., reduced clarity of awareness ...
Amphetamine-Like  (MA)-Induced Psychotic Disorder APA <ul><li>A.  Prominent hallucinations or delusions.  Note:  Do not in...
Amphetamine-Like  (MA) Withdrawal APA <ul><li>A. Cessation of (or reduction in) MA use that has been heavy and prolonged. ...
Amphetamine-Like  (MA) Withdrawal Delirium APA <ul><li>Disturbance of consciousness (i.e., reduced clarity of awareness of...
Amphetamine-Like (MA)-Induced Anxiety Disorder APA <ul><li>Prominent anxiety, Panic Attacks, or obsessions or compulsions ...
Amphetamine-Like (MA)-Induced Mood Disorder APA <ul><li>A prominent and persistent disturbance in mood predominates in the...
Other Amphetamine-Like  (MA) Disorders <ul><li>MA-Induced Sexual Dysfunction   (With Impaired Desire, With Impaired Arousa...
MA Resources <ul><li>MAMa  </li></ul><ul><li>(Mothers Against Meth-Amphetamine) </li></ul><ul><li>www.mamasite.net </li></...
MA and Recovery <ul><li>“ Wall” period lasts 6 to 8 months for casual users and 2 to 3 years for regular users. </li></ul>...
MA Users and Relapse <ul><li>98% of MA users entering outpatient treatment have already relapsed at least one time followi...
MA Treatment <ul><li>MTP </li></ul><ul><li>(Methamphetamine Treatment Project) </li></ul><ul><li>UCLA Integrated Substance...
Cognitive  Behavioral  Treatment <ul><li>Teaching options and alternatives.   </li></ul><ul><li>communication </li></ul><u...
<ul><li>MA Case Study </li></ul><ul><li>Referral Information </li></ul><ul><li>The client was referred by  _____ , Probati...
<ul><li>History </li></ul><ul><li>The client first started using methamphetamine (MA) when he was nineteen years old.  He ...
<ul><li>The client does meet the criteria for risk status for exposure to Hepatitis B (he shared drug needles as recent as...
<ul><li>He denies any history of psychiatric treatment. </li></ul><ul><li>He reports completing a ten-month stay in a ther...
<ul><li>Strengths:  </li></ul><ul><li>The client reports a good relationship with his mother and stepfather, he is doing w...
Appendix Evaluation and Treatment Forms Page 55.
<ul><li>HEALTH SCREENING  Criminal Justice Addiction Services </li></ul><ul><li>Hepatitis A Screening </li></ul><ul><li>If...
<ul><li>Hepatitis C Screening </li></ul><ul><li>If one or more items are checked below in this section, the client meets t...
<ul><li>TB Screening </li></ul><ul><li>If one or more items are checked below in this section, the client meets the criter...
Antisocial Personality Disorder/Substance Use Disorder Screening™ Referrals to APD, SUD or Resocial Group™/Other Co-occurr...
Part 1:  Antisocial Personality Disorder¹ (APD) Screening (All 4 blanks must be checked to meet APD screening criteria)   ...
Part 2:  Substance Use Disorder¹ (SUD) Screening (At least 1 blank must be checked to meet SUD screening criteria)   _____...
Part 3:  Referral (Circle 1 appropriate disposition)   A.  Refer to cognitive behavioral treatment that deals with pervasi...
Alcohol and Drug Addiction Test <ul><li>Gorski, Terence T. & Kelley, John M. (1999).  Relapse Prevention Workbook for Chem...
<ul><li>Use to feel better:  I use alcohol or drugs to get away from things that bother me or are hard to face. </li></ul>...
21. Neglect food : I do not eat healthy foods or eat at regular times, especially when I'm using.  22. Resentment : I feel...
37. Confinement : I have been in jails and mental wards because of my using.  36. Desperation : I am willing to do anythin...
Scoring Sheet for Alcohol and Drug Addiction Test  Early Stage Addiction Count up the number of  yes  answers you checked ...
Offender Personality Self-Test <ul><li>Gorski, Terence T. & Kelley, John M. (1999).  Relapse Prevention Workbook for Chemi...
<ul><li>Part 1: Before Age 15   </li></ul><ul><li>1.  Skipped school : I often skipped school because I didn't want to be ...
<ul><li>Part 2: Since Age 15   </li></ul><ul><li>13.  Work problems : I haven't worked when work was available, have skipp...
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...
Page 72.
 
Page 74.
 
<ul><li>Relapse Prevention Workbook  for Chemically Dependent Criminal Offenders (TAP 19) </li></ul><ul><li>Exercise No. 1...
<ul><li>Exercise No. 2: Reasons for Relapse </li></ul><ul><li>Purpose . This exercise will show you why you have trouble w...
Anger Management for Substance Abuse and Mental Health Clients <ul><li>Session 1: Overview of Anger Management Treatment <...
<ul><li>III. Definitions </li></ul><ul><li>In the most general sense, anger is a feeling or emotion that ranges from mild ...
<ul><li>•  List the negative consequences that you have experienced as a result of expressing your anger inappropriately. ...
<ul><li>VII. Anger Is a Habit </li></ul><ul><li>Anger can become a routine, familiar, and predictable response to a variet...
<ul><li>IX. Anger Meter </li></ul><ul><li>A simple way to monitor your anger is to use a 1 to 10 scale called the anger me...
Methamphetamine by Rand L. Kannenberg
Methamphetamine by Rand L. Kannenberg
Methamphetamine by Rand L. Kannenberg
Methamphetamine by Rand L. Kannenberg
Methamphetamine by Rand L. Kannenberg
Methamphetamine by Rand L. Kannenberg
Methamphetamine by Rand L. Kannenberg
Methamphetamine by Rand L. Kannenberg
Methamphetamine by Rand L. Kannenberg
Methamphetamine by Rand L. Kannenberg
Methamphetamine by Rand L. Kannenberg
Methamphetamine by Rand L. Kannenberg
Methamphetamine by Rand L. Kannenberg
Methamphetamine by Rand L. Kannenberg
Methamphetamine by Rand L. Kannenberg
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Transcript of "Methamphetamine by Rand L. Kannenberg"

  1. 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. 2. Part 1. Social Implications <ul><li>Screening, Assessment and Evaluation </li></ul><ul><li>Prevention, Intervention and Treatment </li></ul>Part 2. Clinical Strategy The History of Methamphetamine Trends in Law Enforcement/Public Policy Page 3.
  3. 3. <ul><li>Learner Objectives </li></ul><ul><li>Identify and explain the chemical properties of methamphetamine. </li></ul><ul><li>Describe the difference between methamphetamine and other stimulants. </li></ul><ul><li>Summarize recent law enforcement trends regarding methamphetamine manufacturing and trafficking in the U.S. </li></ul><ul><li>Increase knowledge and skill in assessment of methamphetamine abuse and dependence as well as methamphetamine induced psychosis, depression, mania and anxiety. </li></ul><ul><li>Utilize effective treatment options for methamphetamine abuse and dependence. </li></ul><ul><li>Administer written exercises and worksheets designed for the therapy and education of methamphetamine users. </li></ul>Page 4.
  4. 4. History of Amphetamines <ul><li>First synthesized in 1887. </li></ul><ul><li>Commercially available in the 1930s. </li></ul><ul><li>Methamphetamine Treatment Project </li></ul><ul><li>DEA Number 1100. </li></ul><ul><li>Classified as a Schedule II Narcotic (drug has current accepted medical use and high potential for abuse). Also known as “Dexedrine” and “Biphetamine.” </li></ul><ul><li>Drug Enforcement Administration (DEA) </li></ul><ul><li>Illicit laboratories first appeared in the 1960s. </li></ul>Page 4.
  5. 5. History of Methamphetamine <ul><li>A derivative of amphetamine first developed by a pharmacologist in Japan in 1919. </li></ul><ul><li>Used in the 1930s to treat asthma and narcolepsy as well as obesity. </li></ul><ul><li>Methamphetamine Treatment Project, KCI: The Anti-Meth Site (formerly the Koch Crime Institute) </li></ul><ul><li>Given to soldiers during war. Used under the name of “Pervitin” by Germany and its allies during World War II. </li></ul><ul><li>Webster’s Dictionary </li></ul><ul><li>DEA Number 1105. </li></ul><ul><li>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.” </li></ul><ul><li>Drug Enforcement Administration (DEA) </li></ul>Page 5.
  6. 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. 7. Methamphetamine as a Stimulant <ul><li>Has greater central nervous system affects than amphetamine. </li></ul><ul><li>NIDA </li></ul><ul><li>More effective than amphetamine. </li></ul><ul><li>Lasts longer than amphetamine. </li></ul><ul><li>More soluble in lipids (i.e., easily absorbed into the fatty tissue of the brain). </li></ul><ul><li>Dextro is 3 to 4 times more potent than levo. </li></ul><ul><li>NIDA </li></ul><ul><li>Average purity decreased from 71.9% in 1994 to 40.1% in 2001. </li></ul><ul><li>ONDCP </li></ul><ul><li>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”). </li></ul><ul><li>NIDA </li></ul>Page 6.
  8. 8. Methamphetamine Hydrochloride Tablets United States Pharmacopeia (USP) <ul><li>Desoxyn ® CII (Desoxyephedrine) </li></ul><ul><li>Pronounced: des-OK-sin </li></ul><ul><li>Developed in the U.S. in 1942 </li></ul><ul><li>Initially manufactured and marketed by Abbott Laboratories. </li></ul><ul><li>They produced an immediate-release tablet. </li></ul><ul><li>Production of sustained-release formulation “Desoxyn Gradumet” was discontinued in 1999 for “manufacturing difficulties.” </li></ul><ul><li>Abbott sold their rights to Ovation Pharmaceuticals, Inc. in 2002. </li></ul><ul><li>Food and Drug Administration (FDA) gave Able Laboratories, Inc. approval to market the first generic version of Desoxyn in February 2004. </li></ul><ul><li>In May 2005 Able suspended manufacturing and distribution of all products. </li></ul><ul><li>In June 2005 the FDA announced that there were serious concerns about producing drugs at Able according to quality assurance standards. </li></ul><ul><li>At the same time Able recalled all of its products. </li></ul>Physicians’ Desk Reference® (PDR) Page 6.
  9. 9. Desoxyn ® by Ovation <ul><li>Chemically known as (S)-N,α-dimethylbenzeneethanamine </li></ul><ul><li>hydrochloride, is a member of the amphetamine group of </li></ul><ul><li>sympathomimetic amines (i.e., mimics effects of adrenaline). </li></ul><ul><li>DESOXYN tablets contain 5 mg of methamphetamine hydrochloride </li></ul><ul><li>for oral administration. </li></ul><ul><li>Indications/Usage and Dosage/Administration: </li></ul><ul><li>Attention-Deficit/Hyperactivity Disorder (ADHD) </li></ul><ul><li>(20-25 mg daily in two divided doses). Used instead of Adderall (Amphetamine-Dextroamphetamine) or Ritalin (Methylphenidate) </li></ul><ul><li>Exogenous Obesity (caused by overeating) for short-term only (a few weeks) </li></ul><ul><li>(5 mg one half hour before each meal) </li></ul><ul><li>Ovation Pharmaceuticals, Inc. </li></ul>(PDR) Page 7.
  10. 10. Off Label Uses <ul><li>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). </li></ul><ul><li>Newsweek </li></ul><ul><li>Desoxyn® tablets cannot be smoked, snorted or injected. </li></ul>Page 7.
  11. 11. Methamphetamine <ul><li>An extremely powerful and highly addictive “upper.” </li></ul><ul><li>Made and sold as tablets, capsules, chunks, clear chunky crystals resembling frozen water, and powder. </li></ul><ul><li>Can be swallowed, injected, snorted or smoked. </li></ul><ul><li>Similar to adrenaline (the hormone epinephrine) chemically. Can be synthesized from ephedrine. </li></ul><ul><li>Most common precursor (initial compound) is pseudoephedrine. </li></ul><ul><li>Other dangerous chemicals are added to create a new drug. </li></ul><ul><li>When ingested, bursts of dopamine are released in the brain. </li></ul><ul><li>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. </li></ul><ul><li>CSAT, Methamphetamine Treatment Project, Newsweek, KCI: The Anti-Meth Site, Webster’s Dictionary, NIDA </li></ul>DEA Page 8.
  12. 12. Abbreviations MA Meth mAMPH Page 8.
  13. 13. Slang for MA <ul><li>222 (Chicago) Agua Albino Poo Alffy All Tweakend Long </li></ul><ul><li>Amp </li></ul><ul><li>Annie </li></ul><ul><li>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 </li></ul>KCI: The Anti-Meth Site, Office of National Drug Control Policy (ONDCP) Page 9.
  14. 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. 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. 16. Coco Coffee Cookies CR (California Central Valley) Crack Whore Crank Crank Is &quot;Walk&quot; & Coke Is &quot;Talk&quot; 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. 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. 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 &quot;Speedy&quot;)
  19. 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. 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. 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. 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. 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. 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. 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. 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. 27. Sprizzlefracked Sprung (Mississippi) Spun Ducky Woo Squawk Stallar Sto-Pid Stove Top Styels Sugar Suger Super Ice Sweetness Swerve Syabu (pronounced &quot;shabu&quot; 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. 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. 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. 30. TERMS USED FOR THE FEELING OF MA INTOXICATION <ul><li>Ampin' Amped Bache Knock 2 Rock Bachin &quot;BOB&quot; 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 </li></ul>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. 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. 32. Other MA Related Terminology <ul><li>Crank Craters - sores on your face caused by meth </li></ul><ul><li>Tooter - the straw used to snort </li></ul><ul><li>Paper - a quarter gram </li></ul><ul><li>Teenager - 1/16 ounce </li></ul><ul><li>Needles - called points, rigs, slammers </li></ul><ul><li>Paraphernalia - medical supplies or utensils </li></ul><ul><li>Tina Or Teena - name derives from the fact that meth is commonly bought in sixteenths of an ounce packages (aka &quot;baggies&quot;) </li></ul><ul><li>Eightball - (eighth of an ounce) = 3.5 grams (dealer absorbs the difference) </li></ul>KCI: The Anti-Meth Site Page 18.
  33. 33. Cost of MA <ul><li>1 ounce of MA=approximately 110 MA “hits” (uses) </li></ul><ul><li>1 ounce=28.35 grams </li></ul><ul><li>1 hit=1/4 gram </li></ul><ul><li>KCI: The Anti-Meth Site </li></ul><ul><li>1/4 gram=250 mg </li></ul><ul><li>(10 times daily dose of Desoxyn ® for ADHD) </li></ul><ul><li>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.” </li></ul><ul><li>Average cost of ice MA is $30-125. </li></ul><ul><li>32% of MA users report daily use. </li></ul><ul><li>ONDCP </li></ul>Page 19.
  34. 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. 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. 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. 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. 38. Other Differences Between Cocaine & MA <ul><li>COCAINE </li></ul><ul><li>Plant-derived (obtained from coca leaves) </li></ul><ul><li>Eliminated from the body in 1 hour </li></ul><ul><li>Used as a local anesthetic in some surgical procedures </li></ul><ul><li>MA </li></ul><ul><li>Man-made </li></ul><ul><li>Eliminated from the body in 12 hours </li></ul><ul><li>Used for ADHD and obesity (as discussed earlier) </li></ul>NIDA Page 21.
  39. 39. Symptoms of MA Use <ul><li>Inability to sleep </li></ul><ul><li>Loss of appetite and weight, thin/gaunt </li></ul><ul><li>Increased sensitivity to noise </li></ul><ul><li>Agitation, restlessness, irritability, aggressiveness </li></ul><ul><li>Dizziness </li></ul><ul><li>Confusion, impaired judgment </li></ul><ul><li>Diarrhea and gastrointestinal complaints </li></ul><ul><li>Difficulty breathing </li></ul><ul><li>Headaches </li></ul><ul><li>Tremors or seizures </li></ul><ul><li>Nausea and vomiting </li></ul><ul><li>Numbness </li></ul><ul><li>Profuse sweating, often with chills </li></ul><ul><li>Muscle cramping, pain and tenderness </li></ul><ul><li>Dehydration </li></ul><ul><li>Low magnesium level, low potassium level </li></ul><ul><li>Stale urine smell due to ammonia constituents used to manufacture MA </li></ul><ul><li>Dilated pupils </li></ul><ul><li>Chest pain </li></ul><ul><li>Increased or decreased heart rate </li></ul><ul><li>Increased blood pressure </li></ul><ul><li>Fever or hyperthermia (life-threatening above 104 °F) </li></ul><ul><li>Impaired speech and language </li></ul><ul><li>Mania </li></ul><ul><li>Psychosis with hallucinations and delusions </li></ul><ul><li>Anxiety, panic, fear of impending doom </li></ul><ul><li>Depression and suicidal ideation </li></ul><ul><li>Poor hygiene and body malodor </li></ul><ul><li>Missing teeth, bleeding gums, infected gums, dental caries/decay/cavities (dry mouth/removed enamel/teeth grinding) </li></ul><ul><li>Skin aging and damage (dryness, roughness, wrinkles, broken veins) </li></ul><ul><li>Dermatitis around the mouth from smoking hydrochloride salt (from hydrochloric acid and amine) </li></ul><ul><li>Skin ulceration and infection (as a result of picking at imaginary bugs under the skin), acne or sores </li></ul><ul><li>Hair loss (from repetitious pulling) </li></ul>SAMHSA, KCI: The Anti-Meth Site, NAADAC News, CSAT, Texas Alcohol and Drug Testing Service, Inc., NIDA Page 22.
  40. 40. ABC Channel 7 News Denver Page 22.
  41. 41. Oregon Narcotics Enforcement Association Page 23.
  42. 42. The News & Observer/Associated Press Page 23.
  43. 43. <ul><li>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). </li></ul><ul><li>An overdose of MA may result in heart attack or stroke and high body temperature. </li></ul><ul><li>Presence of paraphernalia such as </li></ul><ul><li>razor blades, mirrors, straws for </li></ul><ul><li>snorting. </li></ul><ul><li>Presence of paraphernalia such as syringes, heated spoons, surgical </li></ul><ul><li>tubing for injecting. </li></ul>
  44. 44. Helpful Hints if Interviewing a “Tweaker” <ul><li>Keep a social distance </li></ul><ul><li>Slow your speech and lower your voice </li></ul><ul><li>Slow your movements </li></ul><ul><li>Keep your hands visible </li></ul>NCGCC Page 24.
  45. 45. Other Ways to Reduce the Risk of Violence with MA Users <ul><li>Identify yourself and use the client’s name. </li></ul><ul><li>Use a space that is quiet, subdued and not too confining. </li></ul><ul><li>Remove any objects from the room that could in any way be used as weapons. </li></ul><ul><li>Make certain that the client does not have any weapons. </li></ul><ul><li>Do not let the client get between the interviewer and the door, however, the client should also have an easy exit. </li></ul><ul><li>Acknowledge agitation and distress. Tolerate repetition. </li></ul><ul><li>Remain nonconfrontational. Reinforce any progress made. </li></ul><ul><li>Have a show of force ready as needed. Notify others that their assistance may be required and have a plan. </li></ul><ul><li>Have physical and chemical restraints ready as needed. </li></ul><ul><li>CSAT </li></ul>Page 25.
  46. 46. Short & Long Term Effects of MA <ul><li>MA can cause cardiovascular damage, collapse and sudden death from toxicity and contaminants in MA production. </li></ul><ul><li>MA can cause permanent damage to blood vessels in the brain resulting in seizures, vision loss, strokes and sudden death. </li></ul><ul><li>MA can cause renal damage from sustained hypertension (high blood pressure). </li></ul><ul><li>MA can cause impaired sexual performance and reproductive functioning. </li></ul><ul><li>MA is neurotoxic (i.e., poisonous to nerves/nerve tissues) by damaging brain cells that contain the neurotransmitters dopamine and serotonin. </li></ul><ul><li>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. </li></ul>NIDA, CSAT Page 25.
  47. 47. <ul><li>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.). </li></ul><ul><li>After using large amounts of MA, the nerve endings (“terminals”) of dopamine and serotonin containing neurons are cut back and may not regrow. </li></ul><ul><li>MA use can cause respiratory problems, irregular heart beat and anorexia. </li></ul>
  48. 48. MA, HIV & Hepatitis B & C <ul><li>IV MA users may get infections and sores at injection site </li></ul><ul><li>IV MA users may get infections of heart lining and valves </li></ul><ul><li>IV MA users who share needles may contract HIV, hepatitis B and hepatitis C </li></ul><ul><li>IV MA use is increasingly common in gay clubs in New York City and elsewhere in the U.S. </li></ul><ul><li>KCI: The Anti-Meth Site, NIDA </li></ul>Page 26.
  49. 49. MA Use During Pregnancy <ul><li>May result in the following damage to the infant: </li></ul><ul><ul><ul><ul><li>Premature labor and delivery </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Detachment of the placenta </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Low birth weight </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Neurological damage </li></ul></ul></ul></ul><ul><ul><ul><ul><li>“ Worm Heart” (Transposition of the Great Vessels) (i.e., backward with holes) </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Birth defects </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Tremors </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Excessive crying </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Withdrawal </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Dysphoria (“unpleasant mental and emotional state”) </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Agitation </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Lethargy </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Behavioral disorders </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Attention-Deficit/Hyperactivity Disorder </li></ul></ul></ul></ul>Greater Dallas Council on Alcohol and Drug Abuse (GDCADA), KCI: The Anti-Meth Site, PDR Page 27.
  50. 50. Substance Abuse Treatment Admissions for MA <ul><li>In 1992 14,554 </li></ul><ul><li>admissions in U.S. for MA </li></ul><ul><li>In 2002 104,481 admissions in U.S. for MA </li></ul><ul><li>(Almost </li></ul><ul><li>725% </li></ul><ul><li>Increase in </li></ul><ul><li>10 Years) </li></ul><ul><li>ONDCP </li></ul><ul><li>In 2003 </li></ul><ul><li>56% of treatment admissions in Hawaii </li></ul><ul><li>for primary MA </li></ul><ul><li>abuse or dependence </li></ul><ul><li>51% of treatment admissions in San Diego </li></ul><ul><li>for primary MA </li></ul><ul><li>abuse or dependence </li></ul><ul><li>NIDA </li></ul>Page 27.
  51. 51. Emergency Department Mentions of MA 1994-2002 <ul><li>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. </li></ul><ul><li>Lowest 1999 10,447 </li></ul><ul><li>Highest 2002 17,696 </li></ul><ul><li>(nearly 170% increase) </li></ul>ONDCP Page 28.
  52. 52. MA Mortality Data <ul><li>2002 Fatalities </li></ul><ul><li>Phoenix 132 deaths </li></ul><ul><li>San Diego 81 deaths </li></ul><ul><li>Las Vegas 72 deaths </li></ul><ul><li>2003 Fatalities </li></ul><ul><li>MA or amphetamines in the top 5 drugs in drug misuse deaths in 5 metropolitan areas: </li></ul><ul><li>Minneapolis-St. Paul </li></ul><ul><li>Ogden-Clearfield </li></ul><ul><li>Phoenix </li></ul><ul><li>San Diego </li></ul><ul><li>San Francisco </li></ul><ul><li>Drug Abuse Warning Network (DAWN) </li></ul>Page 28.
  53. 53. MA Use Among Adolescents <ul><li>6.2% </li></ul><ul><li>of high school seniors report use of MA in their lifetime </li></ul><ul><li>Monitoring the Future Study (MTF) </li></ul>Page 29.
  54. 54. Overall Use of MA <ul><li>12.4 million Americans (5.3% of the population) 12 years of age and older have tried MA at least once in their lifetimes. </li></ul><ul><li>An estimated 583,000 people in the U.S. were current users of MA in 2004 (same/similar as in 2002 and 2003). </li></ul><ul><li>National Survey on Drug Use and Health (NSDUH) </li></ul>Page 29.
  55. 55. MA & Law Enforcement Trends <ul><li>“ Operation Wildfire” </li></ul><ul><li>(first nationally coordinated operation to fight MA in the U.S.) </li></ul><ul><li>June-August 2005 </li></ul><ul><li>DEA & local police in 200 cities involved </li></ul><ul><li>427 people arrested </li></ul><ul><li>209 pounds of MA seized </li></ul><ul><li>56 clandestine labs seized </li></ul><ul><li>123 weapons discovered </li></ul><ul><li>30 children removed from homes with MA labs </li></ul><ul><li>DEA </li></ul>Page 30.
  56. 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. 57. Specific Regions of the U.S. <ul><li>76% of the counties in the Southwest </li></ul><ul><li>report that MA is the biggest drug problem </li></ul><ul><li>75% of the counties in the Northwest </li></ul><ul><li>report that MA is the biggest drug problem </li></ul><ul><li>67% of the counties in the Upper Midwest report that MA is the biggest drug problem </li></ul>Page 31.
  58. 58. Total Arrests in U.S. Counties MA Related <ul><li>75% </li></ul><ul><li>of all counties report that </li></ul><ul><li>40 to 50% of total arrests made in the last five years are MA related . </li></ul>NACo Page 31.
  59. 59. Other Crimes Resulting from MA <ul><li>70% of counties report increase in robberies or burglaries because of MA </li></ul><ul><li>62% of counties report increase in domestic violence because of MA </li></ul><ul><li>53% of counties report increase in simple assaults because of MA </li></ul><ul><li>27% of counties report increase in identity thefts because of MA </li></ul>NACo Page 32.
  60. 60. Race & Gender <ul><li>DEA arrests for MA: </li></ul><ul><li>94% white </li></ul><ul><li>78.5% male </li></ul><ul><li>Federal offenders sentenced for MA: </li></ul><ul><li>59.3% white </li></ul><ul><li>85.9% male </li></ul>ONDCP Page 32.
  61. 61. Adult Female Arrestees Testing Positive for MA by City <ul><li>54% in Honolulu </li></ul><ul><li>42% in Phoenix </li></ul><ul><li>47% in San Diego </li></ul>NIDA Page 33.
  62. 62. MA & Incarceration Rates <ul><li>20 to 75% </li></ul><ul><li>of current county jail inmates are incarcerated because of MA related crimes according to 35% of U.S. counties. </li></ul><ul><li>NACo </li></ul><ul><li>76.9% </li></ul><ul><li>of federal offenders sentenced for MA are </li></ul><ul><li>U.S. Citizens. </li></ul><ul><li>11.2% </li></ul><ul><li>of federal offenders sentenced for MA </li></ul><ul><li>had a weapon involved. </li></ul><ul><li>ONDCP </li></ul>Page 33.
  63. 63. Mandatory Minimum Sentences for MA under Federal Law <ul><li>10 grams (pure) </li></ul><ul><li>= </li></ul><ul><li>5 years in prison </li></ul><ul><li>100 grams (pure) </li></ul><ul><li>= </li></ul><ul><li>10 years in prison </li></ul>KCI: The Anti-Meth Site Page 34.
  64. 64. Increase in Children Out-of-Home Placements Associated with MA Use? NACo Page 34.
  65. 65. <ul><li>64% of counties with populations above 500,000 reported increases in children out-of-home placements associated with MA use 2002-2005 </li></ul><ul><li>66% of counties in the Southwest reported increases in children out-of-home placements associated with MA use 2002-2005 </li></ul><ul><li>70% of Colorado counties reported increases in children out-of-home placements associated with MA use 2002-2005 </li></ul><ul><li>69% of counties in Minnesota reported a growth in out of home placements associated with MA use 2004-2005 </li></ul><ul><li>54% of counties in North Dakota reported a growth in out of home placements associated with MA use 2004-2005 </li></ul><ul><li>Children in homes with MA labs often have </li></ul><ul><li>asthma or other respiratory problems. </li></ul>
  66. 66. DEA Page 35.
  67. 67. Page 36. M0 2788; IA 1335; TN 1327; IN 1074; IL 1058
  68. 68. 1996 Midwest High Intensity Drug Trafficking Area (HIDTA) <ul><li>Iowa, Kansas, Missouri, Nebraska & South Dakota </li></ul><ul><li>“ To reduce and disrupt the importation, distribution, and clandestine manufacture of methamphetamine in the five state region.” </li></ul>ONDCP Page 36.
  69. 69. MA Labs On/Adjacent to Federal Land <ul><li>In or near: </li></ul><ul><li>Caves </li></ul><ul><li>Cabins </li></ul><ul><li>Recreational areas </li></ul><ul><li>Abandoned mines </li></ul><ul><li>Private vehicles </li></ul><ul><li>83 seizures on Department of Interior property in 2003 </li></ul><ul><li>187 seizures on National Forest System property in 2002 </li></ul>ONDCP Page 37.
  70. 70. “ Super Labs” in Mexico (i.e., capable of producing in excess of 10 pounds of MA in 24 hours) and Chemicals from Canada <ul><li>20 Mexican MA trafficking organizations have been identified in the Midwest and West. </li></ul><ul><li>These Mexican cartels entered the market in 1994. </li></ul><ul><li>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. </li></ul><ul><li>Mexican super labs commonly use methylsulfonylmethane (MSM), a legal dietary supplement for horses and humans, to cut the MA. </li></ul><ul><li>Pseudoephedrine is often shipped from Canada to Mexico to be used in the super labs. </li></ul><ul><li>Ephedra plants are also being imported from Asia to the U.S. and Mexico. </li></ul>DEA, ONDCP, NCGCC Page 37.
  71. 71. Possible Indications of a MA Lab <ul><li>“ Unusual, strong odors (like cat urine, ether, ammonia, acetone or other chemicals). </li></ul><ul><li>Residences with windows blacked out. </li></ul><ul><li>Renters who pay their landlords in cash. (Most drug dealers trade exclusively in cash.) </li></ul><ul><li>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. </li></ul><ul><li>Excessive trash including large amounts of items such as: antifreeze containers, lantern fuel cans, red chemically stained coffee filters, drain cleaner and duct tape. </li></ul><ul><li>Unusual amounts of clear glass containers being brought into the home.” </li></ul>KCI: The Anti-Meth Site Page 38.
  72. 72. Chemicals Commonly Used to Manufacture MA <ul><li>Ephedrine </li></ul><ul><li>Pseudoephedrine </li></ul><ul><li>Acetone (Nail Polish Remover) </li></ul><ul><li>Denatured Alcohol (Solvent/Cleaner/Fuel) </li></ul><ul><li>Alcohol (Isopropyl or Rubbing) </li></ul><ul><li>Methanol/Alcohol (Gasoline Additives) </li></ul><ul><li>Toluene (Brake Cleaner) </li></ul><ul><li>Ether (Engine Starter/Starter Fluid) </li></ul><ul><li>Kerosene or Lantern Fuel </li></ul><ul><li>Sulfuric Acid (Drain Cleaner) </li></ul><ul><li>Salt (Table/Rock) </li></ul><ul><li>Lithium (Camera Batteries) </li></ul><ul><li>Anhydrous Ammonia (Farm Fertilizer/Industrial Refrigerant) </li></ul><ul><li>Sodium Hydroxide (Lye: used to make glass and soap) </li></ul><ul><li>Red Phosphorus (Matches/Road Flares) </li></ul><ul><li>Muriatic Acid (Toilet Bowl Cleaner) </li></ul><ul><li>Iodine (Teat Dip or Flakes/Crystal) </li></ul><ul><li>Trichloroethane (Industrial Solvent) </li></ul><ul><li>Sodium Metal (mixed with alcohol: starting material for the production of most drugs) </li></ul>Stopmeth.com Page 38.
  73. 73. Equipment Commonly Used to Manufacture MA <ul><li>Pyrex or Corning Dishes </li></ul><ul><li>Jugs </li></ul><ul><li>Bottles </li></ul><ul><li>Funnels </li></ul><ul><li>Coffee Filters </li></ul><ul><li>Cheesecloth </li></ul><ul><li>Blender </li></ul><ul><li>Rubber Tubing </li></ul><ul><li>Paper Towels </li></ul><ul><li>Rubber Gloves </li></ul><ul><li>Gas Can </li></ul><ul><li>Tape/Clamps </li></ul><ul><li>Hotplate </li></ul><ul><li>Strainer </li></ul><ul><li>Aluminum Foil </li></ul><ul><li>Propane Cylinder (20-lb) </li></ul><ul><li>Books &quot;How to Make Methamphetamine&quot; </li></ul>Stopmeth.com Page 39.
  74. 74. Steps of Manufacturing MA ($100 in materials will produce approximately $1,000 in MA) <ul><li>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. </li></ul><ul><li>The powder may be dissolved and the liquid chemicals may be added to the solution to start the process of extracting the active ingredients. </li></ul><ul><li>The solution may be “cooked” in glassware. </li></ul><ul><li>The “cold” method may involve adding red phosphorous and iodine to the mixture. </li></ul><ul><li>The solution may be poured through materials such as coffee filters to remove the undesired residue. </li></ul><ul><li>The solution may be stored in jars until the liquid layers separate to create a more pure mixture. </li></ul><ul><li>Other elements such as sodium, potassium, lithium and/or anhydrous ammonia may be added. </li></ul><ul><li>Once the ammonia evaporates, the mixture may return to white. </li></ul><ul><li>The reaction of the residual sodium metal and water may form sodium hydroxide which may convert the mixture into MA. </li></ul><ul><li>The MA may be ready for dilution and sale. </li></ul>Stopmeth.com, DEA Page 39.
  75. 75. MA Labs: Health & Environment Concerns <ul><li>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. </li></ul><ul><li>The most common complaints from first responders exposed to the chemicals and by-products in MA labs are: </li></ul><ul><ul><ul><ul><ul><li>respiratory and eye irritations, </li></ul></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>headaches, </li></ul></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>dizziness, </li></ul></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>nausea and </li></ul></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>shortness of breath. </li></ul></ul></ul></ul></ul><ul><li>ONDCP </li></ul><ul><li>Fumes in a MA user’s clothing or hair can make others ill. </li></ul><ul><li>Avoid close contact in a poorly ventilated area with a MA user. </li></ul><ul><li>Always wear gloves if touching the skin or belongings of MA users. </li></ul>Page 40.
  76. 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. 77. MA & Federal Legislation <ul><li>Comprehensive Methamphetamine Control Act of 1996 (MCA) </li></ul><ul><li>Increased penalties for the trafficking/manufacturing of MA and chemicals used in production of MA </li></ul><ul><li>Expanded controls of products containing ephedrine, pseudoephedrine, phenylpropanolamine (PPA)* </li></ul><ul><li>*(FDA announced in 2000 that this ingredient in OTC cough, cold and weight loss medications increased the risk of stroke in women.) </li></ul><ul><li>Methamphetamine Anti-Proliferation Act of 2000 </li></ul><ul><li>Strengthened sentencing guidelines </li></ul><ul><li>Provided training for federal and state law enforcement </li></ul><ul><li>Put in place controls on the distribution of chemical ingredients </li></ul><ul><li>Expanded substance abuse prevention efforts </li></ul>ONDCP Page 41.
  78. 78. 2005 Federal Legislation <ul><li>Combat Meth Act of 2005 (HR 314/S 103) </li></ul><ul><li>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. </li></ul><ul><li>Methamphetamine Blister Pack Loophole Elimination Act of 2005 (HR 1350) </li></ul><ul><li>Would amend the Controlled Substances Act to eliminate the existing exemption of pseudoephedrine products sold in blister packs. </li></ul><ul><li>Clean, Learn, Educate, Abolish, Neutralize and Undermine Production (CLEAN-UP) of Methamphetamine Act (HR 13) </li></ul><ul><li>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. </li></ul><ul><li>Methamphetamine Remediation Act of 2005 (HR 798) </li></ul><ul><li>Would authorize the Environmental Protection Agency (EPA) to establish voluntary guidelines for the remediation of former MA labs. </li></ul><ul><li>NACo </li></ul>Page 41.
  79. 79. Congressional Caucus to Fight and Control Methamphetamine <ul><li>“ To direct members attention to growing nationwide problems and dangers associated with abuse and production of methamphetamine.” </li></ul><ul><li>1 (800) 662-HELP </li></ul><ul><li>1 (800) 662-4357 </li></ul><ul><li>National Drug Information Treatment and Referral Hotline </li></ul>Page 42.
  80. 80. State Laws and MA <ul><li>Oklahoma HB 2176 </li></ul><ul><li>Pseudoephedrine must be sold behind the counter. </li></ul><ul><li>Customers must show ID. </li></ul><ul><li>Amount purchased limited to 9 grams in 30 days*. </li></ul><ul><li>*300 tablets at 30 milligrams each/10 a day </li></ul><ul><li>Arkansas, Georgia, Illinois, Iowa, Kentucky, Kansas, Mississippi, Oregon, South Dakota, Tennessee, West Virginia and Wyoming have similar laws now. </li></ul><ul><li>20 additional states in the U.S. are considering legislation that would limit the sale of pseudoephedrine to combat MA. </li></ul>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. 81. Oklahoma and Oregon and MA <ul><li>Another law in Oklahoma … </li></ul><ul><li>… 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. </li></ul><ul><li>Oregon’s law requires that any medication with pseudoephedrine as an ingredient be prescribed by a physician in writing or it cannot be purchased. </li></ul><ul><li>It also states that homeowners have six months to decontaminate houses used as MA labs. </li></ul>Page 43.
  82. 82. Corporate Policies Effecting MA <ul><li>Retailers nationwide are voluntarily moving non prescription medicines with pseudoephedrine behind the counter. </li></ul><ul><li>Examples: </li></ul><ul><ul><ul><ul><ul><li>Target </li></ul></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>Wal-Mart </li></ul></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>Albertson’s </li></ul></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>CVS </li></ul></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>Rite Aid </li></ul></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>Longs </li></ul></ul></ul></ul></ul>Page 43.
  83. 83. What Medication Manufacturers are Doing about MA <ul><li>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). </li></ul><ul><li>Phenylephrine hydrochloride is used to increase blood pressure, as a nasal decongestant, and to dilate the pupil. </li></ul><ul><li>CAUTION: The pills look the same. </li></ul><ul><li>The blister packs/packages look the same. </li></ul><ul><li>The strength and directions may be different with the new ingredients! </li></ul><ul><li>Example: Sudafed PE </li></ul><ul><li>(Was 30mg ii q 4-6 hrs original formula. Now 10mg i q 4 hours.) </li></ul>Page 44.
  84. 84. Adult Antisocial Behavior APA <ul><li>“ 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). </li></ul><ul><li>Examples include the behavior of some professional thieves, racketeers, or dealers in illegal substances.” </li></ul>Page 44.
  85. 85. Antisocial Personality Disorder APA <ul><ul><li>“ 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: </li></ul></ul><ul><ul><li>(1) failure to conform to social norms with respect to lawful behaviors as indicated by repeatedly performing acts that are grounds for arrest </li></ul></ul><ul><ul><li>(2) deceitfulness, as indicated by repeated lying, use of aliases, or conning others for personal profit or pleasure </li></ul></ul><ul><ul><li>(3) impulsivity or failure to plan ahead </li></ul></ul><ul><ul><li>(4) irritability and aggressiveness, as indicated by repeated physical fights or assaults </li></ul></ul><ul><ul><li>(5) reckless disregard for safety of self or others </li></ul></ul><ul><ul><li>(6) consistent irresponsibility, as indicated by repeated failure to sustain consistent work behavior or honor financial obligations </li></ul></ul><ul><ul><li>(7) lack of remorse, as indicated by being indifferent to or rationalizing having hurt, mistreated, or stolen from another </li></ul></ul><ul><ul><li>B. The individual is at least age 18 years. </li></ul></ul><ul><ul><li>C. There is evidence of Conduct Disorder with onset before age 15 years. </li></ul></ul><ul><ul><li>D. The occurrence of antisocial behavior is not exclusively during the course of Schizophrenia or a Manic Episode.” </li></ul></ul>Page 45.
  86. 86. <ul><li>MA Dependence </li></ul><ul><li>(requires 3 or more of the following): </li></ul><ul><li>Increased Tolerance; </li></ul><ul><li>Withdrawal; </li></ul><ul><li>Increased Quantity or Duration; </li></ul><ul><li>Persistent Desire or Inability to Decrease or Discontinue Use; </li></ul><ul><li>Increased Time to Obtain or Recover; </li></ul><ul><li>Social/Occupational/Recreational Impairment; </li></ul><ul><li>Continued Use Despite Awareness of Related Physical or Psychological Problems. </li></ul><ul><li>MA Abuse </li></ul><ul><li>(requires 1 or more of the following): </li></ul><ul><li>Recurrent Use Resulting in Social/Occupational/Educational Problems; </li></ul><ul><li>Recurrent Use in Physically Hazardous Situations; </li></ul><ul><li>Recurrent Substance-Related Legal Problems; </li></ul><ul><li>Continued Use Despite Awareness of Related Social or Interpersonal Problems. </li></ul>Amphetamine-Like (MA) Dependence/Abuse APA Page 45.
  87. 87. Amphetamine-Like (MA) Intoxication APA <ul><li>A. Recent use of MA. </li></ul><ul><li>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. </li></ul><ul><li>C. Two (or more) of the following, developing during, or shortly after, use of MA: </li></ul><ul><ul><ul><li>tachycardia (resting heart rate of over 100 beats per minute) or bradycardia (heart rate of under 60 beats per minute) </li></ul></ul></ul><ul><ul><ul><li>Pupillary dilation </li></ul></ul></ul><ul><ul><ul><li>Elevated or lowered blood pressure </li></ul></ul></ul><ul><ul><ul><li>Perspiration or chills </li></ul></ul></ul><ul><ul><ul><li>Nausea or vomiting </li></ul></ul></ul><ul><ul><ul><li>Evidence of weight loss </li></ul></ul></ul><ul><ul><ul><li>Psychomotor (thought and physical movements) agitation or retardation </li></ul></ul></ul><ul><ul><ul><li>Muscular weakness, respiratory depression, chest pain, or cardiac arrhythmias (irregular heart contraction) </li></ul></ul></ul><ul><ul><ul><li>Confusion, seizures, dyskinesias (bad or abnormal movements), dystonias (involuntary, sustained muscle contractions), or coma </li></ul></ul></ul><ul><li>D. The symptoms are not due to a general medical condition and are not better accounted for by another mental disorder. </li></ul><ul><li>Specify if: </li></ul><ul><li>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. </li></ul>Page 46.
  88. 88. Amphetamine-Like (MA) Intoxication Delirium APA <ul><li>Disturbance of consciousness (i.e., reduced clarity of awareness of the environment) with reduced ability to focus, sustain, or shift attention. </li></ul><ul><li>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. </li></ul><ul><li>The disturbance develops over a short period of time (usually hours to days) and tends to fluctuate during the course of the day. </li></ul><ul><li>There is evidence from the history, physical examination, or laboratory findings of either 1. or 2.: </li></ul><ul><ul><li>The symptoms in Criteria A and B developed during MA Intoxication </li></ul></ul><ul><ul><li>Medication use is etiologically related to the disturbance (Note: The diagnosis should be recorded as Substance-Induced Delirium if related to medication use.) </li></ul></ul><ul><li>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. </li></ul>Page 46.
  89. 89. Amphetamine-Like (MA)-Induced Psychotic Disorder APA <ul><li>A. Prominent hallucinations or delusions. Note: Do not include hallucinations if the person has insight that they are substance induced. </li></ul><ul><li>B. There is evidence from the history, physical examination, or laboratory findings of either 1) or 2): </li></ul><ul><ul><li>the symptoms in Criterion A developed during, or within a month of, MA Intoxication or Withdrawal </li></ul></ul><ul><ul><li>Medication use is etiologically related to the disturbance </li></ul></ul><ul><li>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). </li></ul><ul><li>D. The disturbance does not occur exclusively during the course of a delirium. </li></ul><ul><ul><li>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. </li></ul></ul><ul><ul><li>Specify if predominated by delusions or hallucinations: </li></ul></ul><ul><ul><li>With Delusions </li></ul></ul><ul><ul><li>With Hallucinations </li></ul></ul><ul><ul><li>Specify if criteria are met for and if the symptoms develop during intoxication or withdrawal syndrome: </li></ul></ul><ul><ul><li>With Onset During Intoxication </li></ul></ul><ul><ul><li>With Onset During Withdrawal </li></ul></ul>Page 47.
  90. 90. Amphetamine-Like (MA) Withdrawal APA <ul><li>A. Cessation of (or reduction in) MA use that has been heavy and prolonged. </li></ul><ul><li>B. Dysphoric mood and two (or more) of the following physiological changes, developing within a few hours to several days after Criterion A: </li></ul><ul><ul><ul><li>Fatigue </li></ul></ul></ul><ul><ul><ul><li>Vivid, unpleasant dreams </li></ul></ul></ul><ul><ul><ul><li>Insomnia or hypersomnia (an excessive amount of sleepiness) </li></ul></ul></ul><ul><ul><ul><li>Increased appetite </li></ul></ul></ul><ul><ul><ul><li>Psychomotor retardation or agitation </li></ul></ul></ul><ul><li>C. The symptoms in Criterion B cause clinically significant distress or impairment in social, occupational, or other important areas of functioning. </li></ul><ul><li>D. The symptoms are not due to a general medical condition and are not better accounted for by another mental disorder. </li></ul>Page 47.
  91. 91. Amphetamine-Like (MA) Withdrawal Delirium APA <ul><li>Disturbance of consciousness (i.e., reduced clarity of awareness of the environment) with reduced ability to focus, sustain, or shift attention. </li></ul><ul><li>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. </li></ul><ul><li>The disturbance develops over a short period of time (usually hours to days) and tends to fluctuate during the course of the day. </li></ul><ul><li>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. </li></ul><ul><li>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. </li></ul>Page 48.
  92. 92. Amphetamine-Like (MA)-Induced Anxiety Disorder APA <ul><li>Prominent anxiety, Panic Attacks, or obsessions or compulsions predominate in the clinical picture. </li></ul><ul><li>There is evidence from the history, physical examination, or laboratory findings of either 1) or 2): </li></ul><ul><ul><li>The symptoms in Criterion A developed during, or within 1 month of, Substance Intoxication or Withdrawal </li></ul></ul><ul><ul><li>Medication use is etiologically related to the disturbance </li></ul></ul><ul><li>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). </li></ul><ul><li>The disturbance does not occur exclusively during the course of a delirium. </li></ul><ul><li>The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning. </li></ul><ul><li>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. </li></ul><ul><ul><li>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 </li></ul></ul><ul><ul><li>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 </li></ul></ul>Page 48.
  93. 93. Amphetamine-Like (MA)-Induced Mood Disorder APA <ul><li>A prominent and persistent disturbance in mood predominates in the clinical picture and is characterized by either (or both) of the following: </li></ul><ul><ul><li>Depressed mood or markedly diminished interest or pleasure in all, or almost all, activities </li></ul></ul><ul><ul><li>Elevated, expansive, or irritable mood </li></ul></ul><ul><li>There is evidence from the history, physical examination, or laboratory findings of either 1) or 2): </li></ul><ul><ul><li>The symptoms in Criterion A developed during, or within 1 month of, Substance Intoxication or Withdrawal </li></ul></ul><ul><ul><li>Medication use is etiologically related to the disturbance </li></ul></ul><ul><li>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). </li></ul><ul><li>The disturbance does not occur exclusively during the course of a delirium. </li></ul><ul><li>The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning. </li></ul><ul><li>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. </li></ul><ul><ul><li>Specify if the predominant mood is depressed, elevated/euphoric/irritable, or mixed: With Depressive Features, With Manic Features, With Mixed Features </li></ul></ul><ul><ul><li>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 </li></ul></ul>Page 49.
  94. 94. Other Amphetamine-Like (MA) Disorders <ul><li>MA-Induced Sexual Dysfunction (With Impaired Desire, With Impaired Arousal, With Impaired Orgasm, With Sexual Pain) </li></ul><ul><li>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) </li></ul><ul><li>MA-Related Disorder Not Otherwise Specified (N0S) </li></ul>Page 49.
  95. 95. MA Resources <ul><li>MAMa </li></ul><ul><li>(Mothers Against Meth-Amphetamine) </li></ul><ul><li>www.mamasite.net </li></ul><ul><li>Crystal Meth Anonymous </li></ul><ul><li>(CMA) </li></ul><ul><li>www.crystalmeth.org </li></ul><ul><li>Other Resources </li></ul><ul><li>New D.A.R.E. </li></ul><ul><li>(Drug Abuse Resistance Education) </li></ul><ul><li>www.dare.com </li></ul>Page 50.
  96. 96. MA and Recovery <ul><li>“ Wall” period lasts 6 to 8 months for casual users and 2 to 3 years for regular users. </li></ul><ul><li>During this extended time of 6 months to 3 years, people in recovery from MA commonly have: </li></ul><ul><ul><ul><li>depression </li></ul></ul></ul><ul><ul><ul><li>difficulty with decision making, concentration and memory </li></ul></ul></ul><ul><ul><ul><li>lack of pleasure in daily activities </li></ul></ul></ul><ul><ul><ul><li>Meth-addiction.com </li></ul></ul></ul>Page 50.
  97. 97. MA Users and Relapse <ul><li>98% of MA users entering outpatient treatment have already relapsed at least one time following a previous admission. </li></ul><ul><li>50-70% of MA users relapse in the first 30 days of attempted recovery. </li></ul><ul><li>Methamphetamine.org </li></ul>Page 51.
  98. 98. MA Treatment <ul><li>MTP </li></ul><ul><li>(Methamphetamine Treatment Project) </li></ul><ul><li>UCLA Integrated Substance Abuse Programs (ISAP) </li></ul><ul><li>Matrix Institute on Addictions </li></ul><ul><li>Matrix Model (aka, “neurobehavioral model”) </li></ul><ul><li>8, 16 & 24 Week Protocols for MA Use Disorders </li></ul><ul><li>Now free at www.health.org ! </li></ul>SAMHSA and Center for Substance Abuse Treatment (CSAT) Page 51.
  99. 99. Cognitive Behavioral Treatment <ul><li>Teaching options and alternatives. </li></ul><ul><li>communication </li></ul><ul><li>decision making </li></ul><ul><li>problem solving </li></ul><ul><li>Practicing the newly learned skills. </li></ul><ul><li>Graduating only once able to demonstrate change. </li></ul><ul><li>Success is equal to change. </li></ul>Page 52.
  100. 100. <ul><li>MA Case Study </li></ul><ul><li>Referral Information </li></ul><ul><li>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. </li></ul><ul><li>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. </li></ul><ul><li>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). </li></ul>Page 52.
  101. 101. <ul><li>History </li></ul><ul><li>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. </li></ul><ul><li>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. </li></ul><ul><li>He has also used marijuana, heroin, Lortab, Morphine, Demerol and cocaine in the past. </li></ul><ul><li>Findings </li></ul><ul><li>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. </li></ul><ul><li>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). </li></ul>
  102. 102. <ul><li>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). </li></ul><ul><li>The client does meet the criteria for risk status for exposure to Hepatitis C (he admits to a lengthy history injecting illegal drugs). </li></ul><ul><li>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. </li></ul><ul><li>The client has no known drug allergies. </li></ul><ul><li>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). </li></ul><ul><li>He denies any other major medical problems. </li></ul><ul><li>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. </li></ul><ul><li>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. </li></ul>
  103. 103. <ul><li>He denies any history of psychiatric treatment. </li></ul><ul><li>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. </li></ul><ul><li>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. </li></ul><ul><li>The client had a normal mini mental status exam (he received a perfect score of 30 out of 30). </li></ul><ul><li>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). </li></ul><ul><li>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. </li></ul><ul><li>Diagnoses: </li></ul><ul><li>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. </li></ul><ul><li>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. </li></ul><ul><li>History of Substance Abuse. </li></ul>
  104. 104. <ul><li>Strengths: </li></ul><ul><li>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. </li></ul><ul><li>Recommendations </li></ul><ul><li>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. </li></ul><ul><li>The client would benefit from continued participation in NA meetings. He should attend at least twice per week. </li></ul><ul><li>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. </li></ul><ul><li>The client should contact _____ and/or the _____ Health Department for the important health reasons mentioned earlier. </li></ul>
  105. 105. Appendix Evaluation and Treatment Forms Page 55.
  106. 106. <ul><li>HEALTH SCREENING Criminal Justice Addiction Services </li></ul><ul><li>Hepatitis A Screening </li></ul><ul><li>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. </li></ul><ul><li>___household/sexual contact of hepatitis A infected person(s) </li></ul><ul><li>___international traveler </li></ul><ul><li>___resident of American Indian reservation or Alaska Native village or other region with </li></ul><ul><li>endemic hepatitis A </li></ul><ul><li>___employee of day care center during outbreak of hepatitis A </li></ul><ul><li>___gay male sex during outbreak of hepatitis A </li></ul><ul><li>___injecting drug user during outbreak of hepatitis A </li></ul><ul><li>___resident of correctional facility/other residential program or day treatment program </li></ul><ul><li>during outbreak of hepatitis A </li></ul><ul><li>Hepatitis B Screening </li></ul><ul><li>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. </li></ul><ul><li>___has ever had a sexually transmitted disease </li></ul><ul><li>___has had sex with more than one (1) partner in the past six (6) months </li></ul><ul><li>___has ever shared needles </li></ul><ul><li>___has ever been an injecting drug user </li></ul><ul><li>___has undergone kidney dialysis </li></ul><ul><li>___has received blood transfusions </li></ul><ul><li>___household/close contact with someone who has hepatitis B </li></ul><ul><li>___resident of or traveler to Africa, China, Middle East, South America, Southeast Asia, </li></ul><ul><li>the Pacific Islands, or other high risk parts of the world </li></ul><ul><li>___has undergone any body piercing or tattooing </li></ul><ul><li>___has ever shared toothbrushes or razors with anyone </li></ul><ul><li>___employee or volunteer in healthcare facility who comes in contact with blood or </li></ul><ul><li>other body fluids </li></ul>Page 56.
  107. 107. <ul><li>Hepatitis C Screening </li></ul><ul><li>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. </li></ul><ul><li>___has received blood from a donor who later tested positive for hepatitis C </li></ul><ul><li>___has received a blood or blood component transfusion (including during childbirth) </li></ul><ul><li>before July, 1992 </li></ul><ul><li>___has received a solid organ transplant before July, 1992 </li></ul><ul><li>___has received clotting factor before 1987 </li></ul><ul><li>___has ever injected illegal drugs </li></ul><ul><li>___has ever been on long term kidney dialysis </li></ul><ul><li>___has ever been a healthcare worker who has had a needle stick, sharp or mucous </li></ul><ul><li>membrane exposure to hepatitis C positive blood </li></ul><ul><li>___born to a mother infected with hepatitis C virus </li></ul><ul><li>HIV/AIDS Screening </li></ul><ul><li>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. </li></ul><ul><li>___had sex without knowing for certain that the person or persons do not have HIV </li></ul><ul><li>___had sex with someone who does have HIV or AIDS </li></ul><ul><li>___had any disease passed on by sex, such as genital herpes or syphilis </li></ul><ul><li>___had sex with many men or women or had sex with someone else who has had sex </li></ul><ul><li>with many men or women </li></ul><ul><li>___had sex with someone who has used needles to take drugs </li></ul><ul><li>___shared needles or works to take drugs </li></ul><ul><li>___shared items such as toothbrushes, razors, and devices used during sex which may </li></ul><ul><li>be contaminated with blood, semen, or vaginal fluids </li></ul>
  108. 108. <ul><li>TB Screening </li></ul><ul><li>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. </li></ul><ul><li>___has or is at risk for HIV infection (one or more items checked above in previous </li></ul><ul><li>section) </li></ul><ul><li>___close contacts with someone who has infectious active TB </li></ul><ul><li>___has medical conditions such as end-stage renal disease, gastrectomy, and </li></ul><ul><li>immunosuppressive therapy </li></ul><ul><li>___injection drug user </li></ul><ul><li>___foreign born in endemic area </li></ul><ul><li>___medically underserved, low income individual </li></ul><ul><li>___farm worker or homeless individual </li></ul><ul><li>___resident of long-term care facility </li></ul>
  109. 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. 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. 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. 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. 113. Alcohol and Drug Addiction Test <ul><li>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. </li></ul>Page 63.
  114. 114. <ul><li>Use to feel better: I use alcohol or drugs to get away from things that bother me or are hard to face. </li></ul><ul><li>Use to solve most problems : I use alcohol or drugs to try to solve most of my problems and things that bother me. </li></ul><ul><li>It takes more : It takes more or stronger kinds of alcohol or drugs to get the same feelings than it used to. </li></ul><ul><li>Memory loss : Sometimes after I have been using, I do not remember what happened. </li></ul><ul><li>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. </li></ul><ul><li>Dependence : I rarely do anything for fun unless I use alcohol or drugs. </li></ul><ul><li>Fast start : I use stronger alcohol or drugs or use a lot quickly at first to get a &quot;good start.&quot; </li></ul><ul><li>Feel guilty : I feel guilty about using alcohol or drugs or about the things that I do when I use. </li></ul><ul><li>Do not listen : Other people complain or try to talk to me about my using but I do not listen. </li></ul><ul><li>Regular blackouts : I do not remember what happened and I get into trouble when I use alcohol or drugs. </li></ul><ul><li>11. Excuses : I use problems in my life as an excuse for using alcohol or </li></ul><ul><li>drugs. I feel that I have to use to deal with these problems. </li></ul><ul><li>12. Using more than others : I use more than most people, so I hang </li></ul><ul><li>around people who use as much or more so that I feel that I fit in. </li></ul>Yes No
  115. 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. 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. 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. 118. Offender Personality Self-Test <ul><li>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. </li></ul>Page 68.
  119. 119. <ul><li>Part 1: Before Age 15 </li></ul><ul><li>1. Skipped school : I often skipped school because I didn't want to be there or because I wanted to do other things. </li></ul><ul><li>2. Ran away : I ran away from home or from where I lived at least two times, overnight. </li></ul><ul><li>3. Fights : I started physical fights with others more than once. </li></ul><ul><li>4. Weapons : I used a gun, knife, club, chain, or other weapon in more than one fight. </li></ul><ul><li>5. Sex : I forced someone into sex or sexual activity. </li></ul><ul><li>6. Cruelty to animals : Sometimes I was cruel to or hurt animals. </li></ul><ul><li>7. Cruelty to people : I physically hurt other people sometimes. </li></ul><ul><li>8. Property damage : I destroyed or damaged other people's property on purpose. </li></ul><ul><li>9. Fires : I set fires on purpose. </li></ul><ul><li>10. Lying : I often lied to other people. </li></ul><ul><li>11. Theft : I took things that didn't belong to me, forged checks, or broke into places to steal more than once. </li></ul><ul><li>12. Robbery : I forced people to give me things that belonged to them. </li></ul>Yes No
  120. 120. <ul><li>Part 2: Since Age 15 </li></ul><ul><li>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. </li></ul><ul><li>14. Illegal activities : I have committed crimes or done illegal things that I could have been arrested for. </li></ul><ul><li>15. Using violence : I have had many physical fights or have beaten up my spouse, lover, or children. </li></ul><ul><li>16. Avoid money responsibilities : I have failed to pay bills or child support, or I have failed to take care of my family. </li></ul><ul><li>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. </li></ul><ul><li>18. Conning : I have lied, used false names, or conned people to get what I want. </li></ul><ul><li>19. Reckless : I have driven a car recklessly while using or drinking or have acted in ways that caused danger to others. </li></ul><ul><li>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. </li></ul><ul><li>21. Relationships : I have never been able to stay faithful to a sexual partner for more than 1 year. </li></ul><ul><li>22. Remorse : I do not feel bad most of the time when I steal from, hurt, or treat someone else badly. </li></ul>
  121. 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. 122. Page 72.
  123. 124. Page 74.
  124. 126. <ul><li>Relapse Prevention Workbook for Chemically Dependent Criminal Offenders (TAP 19) </li></ul><ul><li>Exercise No. 1: Why Do I Want To Change? </li></ul><ul><li>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. </li></ul><ul><li>Instructions . Complete the following sentences. </li></ul><ul><li>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.) </li></ul><ul><li>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 . . . </li></ul>SAMHSA Page 76.
  125. 127. <ul><li>Exercise No. 2: Reasons for Relapse </li></ul><ul><li>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. </li></ul><ul><li>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: </li></ul><ul><li>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. </li></ul><ul><li>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. </li></ul><ul><li>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. </li></ul><ul><li>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. </li></ul><ul><li>Instructions . Answer the following questions. </li></ul><ul><li>True False </li></ul><ul><li>________ I believe that I can learn to drink or use drugs and control my use so that it will not hurt me. </li></ul><ul><li>________ 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. </li></ul><ul><li>________ I know I cannot use alcohol or drugs, but when I quit for a while, I always end up using again. </li></ul><ul><li>________ 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. </li></ul><ul><li>Notice if your above answers change as you complete the next exercise. </li></ul>SAMHSA Page 77.
  126. 128. Anger Management for Substance Abuse and Mental Health Clients <ul><li>Session 1: Overview of Anger Management Treatment </li></ul><ul><li>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. </li></ul><ul><li>I. Purpose of the Group </li></ul><ul><li>1) Learn to manage anger effectively. </li></ul><ul><li>2) Stop violence or the threat of violence. </li></ul><ul><li>3) Develop self-control over thoughts and actions. </li></ul><ul><li>4) Receive support from others. </li></ul><ul><li>II. Group Rules </li></ul><ul><li>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. </li></ul><ul><li>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.) </li></ul><ul><li>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. </li></ul><ul><li>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. </li></ul><ul><li>If you miss more than three sessions, you may continue attending the weekly sessions, but you will not receive a certificate of completion. </li></ul><ul><li>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. </li></ul>SAMHSA Page 78.
  127. 129. <ul><li>III. Definitions </li></ul><ul><li>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. </li></ul><ul><li>• Before you learned these definitions, did you ever confuse anger with aggression? </li></ul><ul><li>Please explain how. </li></ul><ul><li>________________________________________________________________________ </li></ul><ul><li>________________________________________________________________________ </li></ul><ul><li>IV. When Does Anger Become a Problem? </li></ul><ul><li>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. </li></ul><ul><li>• List some ways anger may be affecting you physically. </li></ul><ul><li>________________________________________________________________________ </li></ul><ul><li>________________________________________________________________________ </li></ul><ul><li>________________________________________________________________________ </li></ul><ul><li>________________________________________________________________________ </li></ul><ul><li>V. Payoffs and Consequences </li></ul><ul><li>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. </li></ul><ul><li>• List some payoffs to using anger that you are familiar with. </li></ul><ul><li>________________________________________________________________________ </li></ul><ul><li>________________________________________________________________________ </li></ul><ul><li>________________________________________________________________________ </li></ul><ul><li>________________________________________________________________________ </li></ul>
  128. 130. <ul><li>• List the negative consequences that you have experienced as a result of expressing your anger inappropriately. </li></ul><ul><li>________________________________________________________________________ </li></ul><ul><li>________________________________________________________________________ </li></ul><ul><li>________________________________________________________________________ </li></ul><ul><li>________________________________________________________________________ </li></ul><ul><li>VI. Myths About Anger </li></ul><ul><li>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. </li></ul><ul><li>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. </li></ul><ul><li>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. </li></ul><ul><li>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. </li></ul><ul><li>• Before our discussion, did you believe any of these myths about anger to be true? </li></ul><ul><li>________________________________________________________________________ </li></ul><ul><li>________________________________________________________________________ </li></ul><ul><li>________________________________________________________________________ </li></ul><ul><li>________________________________________________________________________ </li></ul>
  129. 131. <ul><li>VII. Anger Is a Habit </li></ul><ul><li>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. </li></ul><ul><li>• Has anger become a habit for you? How? </li></ul><ul><li>________________________________________________________________________ </li></ul><ul><li>________________________________________________________________________ </li></ul><ul><li>________________________________________________________________________ </li></ul><ul><li>________________________________________________________________________ </li></ul><ul><li>• In what ways has it been maladaptive? </li></ul><ul><li>________________________________________________________________________ </li></ul><ul><li>________________________________________________________________________ </li></ul><ul><li>________________________________________________________________________ </li></ul><ul><li>________________________________________________________________________ </li></ul><ul><li>VIII. Breaking the Anger Habit </li></ul><ul><li>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. </li></ul><ul><li>• List some anger control strategies that you might know or that you may have used </li></ul><ul><li>in the past. </li></ul><ul><li>________________________________________________________________________ </li></ul><ul><li>________________________________________________________________________ </li></ul><ul><li>________________________________________________________________________ </li></ul><ul><li>________________________________________________________________________ </li></ul>
  130. 132. <ul><li>IX. Anger Meter </li></ul><ul><li>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.
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