D. Cross System Collaboration

The majority of treatment programs in Washington State do not provide treatment services that specifically target Meth users either alone or in combination with other stimulant abusers. Where specialized treatment models for Meth addicts exist in Washington State, they vary considerably from provider to provider. However, most of the treatment models targeting Meth addicts combine elements from several treatment models including the traditional Minnesota Model and Reality Therapy to provide an intense and long-term treatment program. These approaches attempt to integrate elements such as family therapy, group therapy, and 12-step abstinence-based programs with reality therapy techniques. Reality therapy elements help the patient reconnect with other people and their living environment to meet the basic human needs for survival, love, belonging, power, freedom, and fun.

Research at the national level is attempting to identify the most effective methodologies for treating Meth addiction. The National Institute of Drug Abuse (NIDA) recommends cognitive behavioral interventions as the most effective treatment for Meth addiction. According to NIDA, these approaches help modify the patient’s thinking, expectancies, behaviors, and increase skills for coping with various life stresses. NIDA also recommends that patients participate in long-term Meth recovery support groups in conjunction with treatment.

The most recognized model for treating Meth addiction is the MATRIX Center model. This model incorporates elements of behavioral therapy, motivational interviewing, positive reinforcement, drug education, 12-Step relapse prevention, and family cooperation.

The experiences of some programs with the MATRIX model, such as the New Leaf program, report better outcomes with a longer course of treatment. Data collected from MATRIX model participants indicate statistically significant reductions in drug and alcohol use, improvements in psychological indicators, and reduced risky sexual behaviors associated with HIV transmission.

In an effort to close the gap between Meth research and treatment practices, the Center for Substance Abuse Treatment (CSAT) recently awarded grants to seven agencies on the West Coast to study the effectiveness of the MATRIX model. Five grants were awarded to California programs, along with one in Hawaii and one in Montana.

According to the Substance Abuse and Mental Health Services Administration and its CSAT, and the recently published Public Health Service Recommendations, psychosocial treatment approaches that incorporate well established psychological principles of learning are appropriate for and effective in treating Meth addiction. The Consensus Panel organized by CSAT recommends a contingency management approach for treating stimulant users. Among those modalities especially cited by the Consensus Panel as effective is relapse prevention first and foremost.

Relapse prevention teaches clients critical skills to prevent resumption of use and minimize impacts of reuse, how to cope with cravings, substance refusal assertiveness skills, general coping and problem solving skills, and how to apply strategies to prevent a full-blown relapse should an episode of substance use re-occur.

It is difficult to estimate the number of children in Washington State who are at risk from parents addicted to Meth. The Division of Children and Family Services (DCFS) does not report data on drug use by the type of drug involved. Residential Meth lab cleanup crews estimate they find evidence that children are or have been at the lab site in at least 35 percent of the drug labs they are called to investigate. It is routine now for law enforcement to call in Child Protective Services (CPS) to intervene on behalf of these children.

In response to the danger faced by children and CPS workers exposed to Meth in the course of an investigation, the Department of Social and Health Services is working with the WSP, the Department of Health, and the Washington State Community, Trade and Economic Development to develop a model response protocol. Additional training is planned to help CPS workers recognize Meth situations how to work with CPS clients involved with Meth.

It is not surprising that children are usually removed from the home until Meth-addicted parents have stabilized and are no longer using drugs.

Children found in the homes of Meth addicts may be neglected and are often found living in filthy, unsanitary conditions. Dr. Alex Stalcup recommends four steps for family re-entry:

One way to document the impact Meth abuse has on families is to look at the data for dependency filings. One example is dependency filings in Clallam County where in 1996, eighty-four percent of the children had parents who were personally impacted by substance abuse. That percentage rose to 91 percent of the dependency filings for 1997. Due in large part to a unique approach of working with substance abusing parents, 71 percent of the children who were the subjects of dependency filings in Clallam County in 1997 have been successfully reunited with a parent.

The DCFS social workers of Clallam County have developed a community-wide, multi-agency approach for working with substance abusing families. This approach involves the use of an outreach worker to engage the client in treatment. The outreach worker also works actively with inpatient and outpatient treatment providers to assist in follow-through for assessment, referral to inpatient treatment, and post-inpatient services.

Proactive discharge planning targets family reunification needs, including an assessment of housing needs, which takes place while the client is still in inpatient treatment. Serenity House Shelter and Evergreen Family Village in Port Angeles are used successfully to provide stable, drug-free transitional housing. Following this, clients are often assisted with finding housing through the Clallam County Housing Authority and Section 8 Housing. Throughout the process, joint staffings are held with the CPS worker, the treatment provider, and other agencies working with the family. Random UAs (urine analysis to determine drug use) are continued throughout this process to ensure that the client is remaining drug-free. Their experience in working with Meth addicts is that this process works best when inpatient services are provided for three to six months, and parents have demonstrated the ability to remain drug-free before family reunification takes place.

The NEON program in King County is a community-based program that combines prevention, education, and treatment models for a specific, high-risk population. NEON stands for Needle and sex Education Outreach Network. The program targets Meth use among gay and bisexual men. NEON is a collaboration between Public Health – Seattle and King County, and Stonewall Recovery Services.

The NEON program incorporates behavioral change theory, ethnographic research, and input from members of the Meth-using population in its project design. NEON’s continuum of mutually-supporting prevention, education, and treatment options encourages Meth users to reduce the harmful effects of their Meth use by/through:

NEON activities include peer-based outreach/education, abstinence groups, individual and group counseling, and the production and distribution of educational pamphlets, brochures, and needle exchange services.

The National Institute on Drug Abuse recommends several steps be followed in building an effective prevention approach:

The risk and protective factor-based model for prevention programs used in Washington State is consistent with the recommendations for prevention programs issued by the National Institute on Drug Abuse. Washington prevention programs begin with a community assessment of indicator data for the risk factors associated with increased drug abuse prevalence. Research-based prevention strategies targeting specific risk factors can then be implemented. These strategies work by either directly reducing the risk factor or by creating buffers (or protective factors) that help youth cope with the conditions in family, school, community, and peer domains that increase the risk youth will choose to use and abuse drugs. A topic for discussion among the Meth Workgroup members was whether this approach is adequate to deal with the growing Meth problem in our state.

Recipes for Meth are readily available on the Internet, and new recipes are continually being refined to adapt to the materials available.

Currently, there are at least three different processes used in the clandestine manufacture of Meth. In part, the current increase in the illegal manufacture of Meth is due to a newer method of cooking Meth that is easier and requires less equipment and set-up than the previously used methods. This method is similar to on used by Germany during WWII and is, therefore, known as the Nazi method.

There is a serious health threat to public employees such as law enforcement officers, child welfare, and even community members who may inadvertently come into contact with substances from illegal labs. Containers of chemicals, such as anhydrous ammonia, may explode when improperly stored. Physical contact or inhalation of certain precursor chemicals can cause lung or liver damage.

One approach to controlling the illegal manufacture of Meth is to control access to the precursor substances used for its manufacture. This can be difficult since most are common substances that are readily available from public retail outlets. Examples include pseudo-ephedrine commonly used in cold tablets, anhydrous ammonia used in fertilizers and refrigeration, lithium used in camera batteries, and red phosphorus used in road flares and match striker plates. Other precursors include ephedrine, ethyl ether, iodine, thionyl chloride, chloroform, palladium, perchloric acid, tetrahydrofuran, ammonium chloride, and magnesium sulfate.

There are ongoing efforts in Washington State to inform retailers who sell the precursors used for manufacturing Meth. Large retail store chains such as Wal-Mart and 7-Eleven have been particularly helpful in controlling and reporting the sale of large volumes of lithium batteries and cold tablets containing pseudo-ephedrine. Costco has also responded by limiting sales of products containing pseudo-ephedrine to no more than two grams.

In 1999 a group from the FarWest Fertilizer and Agrichemical Association met in Moses Lake to learn how to protect themselves from theft, and how to identify a potential sale of anhydrous ammonia for illegal use in the manufacture of Meth. Following this meeting, the group researched what legislative action could assist in controlling this problem. Their efforts were instrumental in developing legislation passed during the 2000 state legislative session.

Anhydrous ammonia, which is 82 percent nitrogen, is widely used by farmers as an inexpensive fertilizer. Mark-up on the black market for anhydrous ammonia can be as much as 100 percent, making the storage tanks of fertilizer distributors as well as individual farmers targets for theft. Distributors and farmers are concerned about the dangers of tampering with storage tanks and the potential liability should anyone be injured during the theft or use of stolen anhydrous ammonia.

In 1998 the Washington Legislature took action to double the sentence for manufacturing Meth. Legislation was passed during the 2000 Washington State legislative session making theft, or possession of anhydrous ammonia with the intent to manufacture Meth, a Class C Felony. Another bill, passed during the 2000 legislative session, added two years to the standard sentence for persons convicted of manufacturing Meth when children are present.

Several other states, including Arkansas, Illinois, Iowa, Kansas, Mississippi, Missouri, Nevada, Tennessee, and Texas, have taken specific legislative action to control the sale of some precursors for the manufacture of Meth. Some state laws are specific to anhydrous ammonia, making it a felony to purchase it for the intent of producing a controlled substance. Other states, like Iowa, have included purchase of any of the major precursors in their legislation. Proof of intent varies. Some states place the burden of proof that the precursor substance was purchased for agricultural use on the defendant. Other states place the responsibility on the prosecutor to disprove agricultural use or to specify intent to use the chemicals for Meth production.

In Washington State, law enforcement works closely with the Department of Ecology and local health departments on the investigation and cleanup of drug labs. Illegal labs are most often found in rented houses, apartments, and motel rooms. However, an increasing number of labs are also being discovered in motor vehicles, abandoned dumps, campgrounds, restrooms, and on open public lands.

Law enforcement agencies responding to these reports have a primary responsibility to obtain evidence of illegal activity for arrest and prosecution. The health departments and the Department of Ecology are responsible for public health and environmental concerns from contamination of the structure and surrounding land and water by the toxic chemicals used in the manufacture of Meth. All are currently struggling to meet a demand for service that far exceeds their budgeted resources.

Meth use and manufacturing have severely impacted law enforcement in Washington State since first appearing in the 1980s. Meth use has been linked to a wide variety of crimes ranging from mail theft to homicide. As an example, Thurston County experienced seven homicides in 1999, with five related to Meth.

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