Ensuring/Creating Effective Treatment for Drug Abusing Parents. TTaylor Behavioral Health

Transcription

1 Ensuring/Creating Effective Treatment for Drug Abusing Parents Nicolas Taylor, Ph.D., CAC III TBH TTaylor Behavioral Health 242 West Main Street, #9 Montrose, CO

2 Children in Substance-Abusing Homes Based on SAMHSA's National Household Survey on Drug Abuse, in 2001 more than 6 million children lived with at least one parent who abused or was dependent on alcohol or an illicit drug during the past year. 10% of children aged 5 or younger 8% of children aged 6 to 11 9% of youths aged 12 to 17

3 FOR DRUG ENDANGERED CHILDREN Agree. Disagree. In the end, we cannot REALLY help drug endangered children (DECs) until we have effective treatment for the drug addicted parents (DAPs).

4 Because the only alternative is to separate the kids from their parent(s) and then to terminate parental rights. Our systems and communities simply aren t equipped to deal with that many foster to adopt children. Furthermore, the argument is still raging, but most researchers conclude that in general children are best off if they can be raised by their safe biological parent(s).

5 Effective treatment is second in importance, really, to only one other thing... PREVENTION

6 BUT! Unless we are starting out brand new before a problem has grown into anything significant, PREVENTION doesn t take care of existing cases. We need effective treatment. Treatment that WORKS.

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9 Effective substance abuse treatment is Community Based. The community influence in helping to develop effective substance abuse treatment is pivotal and powerful. The Persuader

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13 Effective substance abuse treatment is Community Based. The community influence in helping to develop effective substance abuse treatment is pivotal and powerful. The Persuader

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15 What is the difference DEC alliances can make to substantially improve substance abuse treatment for Drug Addicted Parents? Understand how substance abuse issues are thoroughly and effectively evaluated. Advocate for quality evaluations. Know the connection between the abuse of various substances and the effect they have on parenting behaviors. Establish an irrefutable tie between the parents substance abuse and care provided to the child(ren). Assist in identifying key elements to be addressed in treatment. Help establish objective behavioral benchmarks to measure treatment progress. Tirelessly advocate for REAL signs of progress and treatment program accountability.

16 Importance of Quality Evaluations How can you know what to do if you don t know what you have? You could be barking up the wrong tree. Good information creates the foundation of everything that follows. But, there is a problem

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19 Psychometric Use Monitoring

20 Psychometric Testing for Substance Abuse Substance Abuse Subtle Screening Inventory, Third Edition (SASSI-3) Adult Self Assessment Profile (AdSAP) Minnesota Multiphasic Personality Inventory, Second Edition (MMPI-2) Millon Clinical Multiaxial Inventory, Third Edition (MCMI-III) III)

21 1. T F I sometimes get so angry I feel like smashing things. 2. T F Most cops are crooks. 3. T F I am easily bored. 4. T F I sometimes get so lost in movies or novels that I don t hear my name even if it is spoken directly to me. 5. T F It is impossible to truly know how someone feels unless you have been through what they have had to deal with. People who clearly have substance abuse problems People who clearly have substance abuse problems but who are lying about it People who clearly do not have substance abuse problems

22 How accurate are the psychometric instruments? The SASSI-3 has been tested in many different clinical settings with a variety of subjects. Overall, the SASSI-3 identifies substance dependence disorder in blind administrations with an empirically tests accuracy of 94% The SASSI-3 is also 93% accurate at identifying those who do not have a substance dependence disorder.

23 How accurate are the psychometric instruments? The MacAndrew Alcoholism Scale-Revised (MAC-R) on the MMPI-2 has been found to correctly identify 82% of alcoholic and non- alcoholic subjects although its internal consistency is questionable. The Addiction Potential Scale (APS) on the MMPI-2 correctly identified 71% of substance abusers and 86% of non-substance abusers

24 It is clinically inappropriate and an abuse of these instruments if they are used as the sole basis for determining the presence of substance abuse problems.

25 Urinanalyses Schedule must reflect drug metabolism Sleep Time and ethyl glucuronide testing Use Monitoring This metabolite remains detectable in the urine for up to 80 hours after the elimination of alcohol from the body Sweat patch 24/7 Monitoring Cannot be worn for longer than 1 week Need plan for handling fall offs

26 Saliva testing Use Monitoring Can be administered by either gender Tests for seven substances Much less intrusive Cheap and reliable, esp. for alcohol Hair testing Good mainly for whether or not questions about the past Have to have hair Blood testing

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28 Drug Use Clinical Interviews Can be structured or semi-structuredstructured Addictions Severity Index (ASI) Self-report data can be compared with interview data and collateral data for cross validation Questions should be asked to not only determine quantity and frequency but also history and contexts. Marijuana Alcohol Age

29 Advocate for Quality Evaluations Ask questions of the evaluator such as: So, how do you know that? How can you support your conclusions? Did you do more than just talk to the person? With whom else did you speak about the person s drug and alcohol use? What sources of bias are openly acknowledged? Should the parent receive treatment from you or from someone else? Why do you recommend this level of care? What is your patient placement criteria? What should happen if the level of care you have recommended doesn t work?

30 The Abuse of Various Substances and How They Effect Parenting

31 The Abuse of Various Substances and How They Effect Parenting

32 The Abuse of Various Substances and How They Effect Parenting

33 Principal Control Centers of the Brain Affected by Alcohol Brain regions influenced by moderate doses of alcohol Brain region suppressed by moderately high doses of alcohol Brain regions suppressed by very high doses of alcohol

34 The Abuse of Various Substances and How They Effect Parenting Alcohol Disinhibiting Effect Loss of restraint Inappropriate behaviors/boundary violations Judgment Child care decisions Assessment of the effect of their drinking on children Dangerous behaviors Driving Neglect Modeling

35 Marijuana Drugs that activate cannabinoid receptors in the brain and create altered perceptions, and euphoric high.

36 The Abuse of Various Substances and How They Effect Parenting Marijuana Avolitional syndrome Coping skills deficit Socialization around lawlessness Modeling

37 The Abuse of Various Substances and How They Effect Parenting Prescription Medication Abuse Availability and neglect Judgment Dangerous behaviors Access to harmful medications Modeling Cocaine Criminal element Paranoia Extremes in mood and behavior Financial strain

38 The Abuse of Various Substances and How They Effect Parenting Methamphetamine Neglect and exposure to harmful caretakers Paranoia Violence Exposure to chemicals Sexual abuse Erratic moods and verbal abuse Parentified oldest siblings Parental use leads to early experimentation, use and addiction

39 The Irrefutable Tie Between Parental Substance Abuse and Harm to Children Under Their Care Perhaps it is more of a per se issue. Is it abuse or neglect if the using parent leaves the child in the care of a responsible sober adult while they are intoxicated? Psychological harm and the importance of modeling The specifics of referral incidents must be addressed not just the generalities

40 Assist in Identifying Key Elements to be Addressed in Treatment Leave specific level of care issues up to substance abuse treatment specialists Use biopsychosocial model to organize issues Careful with assumptions Meth addicts are untreatable It takes at least one year for treatment to work All severe addicts or alcoholics need inpatient treatment to get them away from relapse situations She must love the drugs more than she does her own kids

41 Once someone is addicted to meth, they can t ever stop using. In other words, meth addicts are untreatable.

42 The fact remains people can and do recover from methamphetamine addiction

43 Outcome data reported by the National Association of State Alcohol and Drug Abuse Directors (NASADAD) show that: In the state of Colorado during the year of 2003, 80% of meth users were abstinent at discharge from treatment. In the state of Iowa a 2003 study found that 71.2% of meth users were abstinent 6 months after treatment. A study done by the Tennessee Bureau of Alcohol and Drug Abuse found that 65% of meth clients were abstinent 6 months after discharge from treatment. The Texas Department of State Health Services examined outcome data for publicly funded services from and found that approximately 88% of meth clients were abstinent 60 days after discharge. Utah s Division of Substance Abuse and Mental Health reported that in State Fiscal Year 2004, 60.8% of meth clients were abstinent at discharge. Source: NASADAD (May, 2005) Fact Sheet: Methamphetamine, National Association of State Alcohol and Drug Abuse Directors (publisher): Washington D.C.

44 In addition, a recent study of 978 methamphetamine dependent individuals receiving treatment at eight outpatient treatment programs in the states of California, Montana and Hawaii, found that: 40% of those who enrolled in the programs successfully completed them (maximum length, 16 weeks). 69% of those who completed treatment tested negative for methamphetamine use during their discharge interview and then again six months later. Source: Rawson, R.A. et al., (2004) A multi-site comparison of psychosocial approaches for the treatment of methamphetamine dependence. Addiction, 99,

45 The magical rule of thirds seems to apply to methamphetamine treatment as it does to other forms of treatment as well. 1/3 rd 1/3 rd 1/3 rd Successfully complete treatment and remain abstinent Drop out during treatment and do not return Do not successfully complete treatment THIS TIME, but are able to do so later

46 So, treatment for methamphetamine addiction can work. Although not for every user, and not every time someone engages in treatment. It may take more than one go at it. Like with attempts to stop smoking... The best predictor of success is how many times the person has tried to quit in the past.

47 It takes at least one year for treatment to work No, it takes behavior change for treatment to work The myth of duration expectations Parents in treatment aren t like rolls in an oven Treatment progress should be measured by objective behavioral benchmarks of change as opposed to amount of time spent in treatment

48 All addicts and alcoholics need inpatient treatment. All addicts and alcoholics need is inpatient treatment.

49 Inpatient treatment is only as good as the outpatient follow-up. Outpatient Treatment Where the rubber meets the road.

50 She must love the drugs more than she does her own children.

51 The issue of...

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53 What is it? Nucleus Accumbens Part of the mesotelencephalic dopamine pathway

54 Nucleus Accumbens (cont.) What does it do? Part of the basal ganglia so important in voluntary motor responses An important part of the reward circuits in the brain.

55 Tirelessly advocate for real signs of progress and treatment program accountability

56 The Structure (What makes treatment possible) Accountability Incremental and immediate sanctions and rewards Use monitoring Daily planning Retention plan The Treatment (Those things that have to change for someone to stop using meth) Psychological Change expectations about meth Biological Establish regular sleep patterns Eat healthy Be active Change expectations about sobriety Learn to feel natural pleasure Learn to cope without meth Social Stop hanging out with meth addicts Develop a sober social support group

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58 Nicolas Taylor, Ph.D., CAC III 242 West Main Street, #9 Montrose, CO (970) (970) Fax 2008