EXPERTS ADDRESS REALITIES, MYTHS OF METH EPIDEMIC, ESPECIALLY RECOVERY

Sixth In A Series On Meth Use In The Area

Although admitting methamphetamine or "meth" use and addiction are serious
problems, two regional experts -- Carol Falkowski of the Hazelden
Foundation in Minnesota, and Joyce Allen, Wisconsin's director for the
Bureau of Mental Health and Substance Abuse Services in Madison -- say the
picture of recovery is not as gloomy as some recovery experts and law
enforcement report.

Falkowski is the director of research communication at Hazelden, a
non-profit drug treatment center. She is one of 20 drug abuse researchers
in the county who monitors trends for the National Institute on Drug Abuse.
She has written on drug trends annually since 1986. She is also the author
of the book Dangerous Drugs, a reference book about drugs, and numerous
articles on methamphetamine use.

Falkowski has given congressional briefings on meth and was recently
interviewed for the Aug. 8 Newsweek magazine edition that addressed the
meth epidemic in America.

Serious Problem

As a drug expert, Falkowski says meth presents some difficult problems.

"Some things that distinguished meth from other drugs is the pattern of use
and because people use for prolong periods of time and tend to develop
severe paranoid delusion," she said. "It really affects public safety and
for that matter poses a heightened threat to the safety of people. They go
days for a time without eating, without sleeping, and hear things that
aren't really there; they see things that are not really there, and they
believe everyone is out to get them.

"This means it doesn't take very many meth addicts in a community to change
the relative safety of a community," Falkowski said.

She said the drug can cause permanent brain damage.

Another distinguishing trait of meth is its popularity with adolescents.

"People wondered when crack cocaine in the 1980s would trickle down and
affect adolescents," she said. "With crack, to a large degree, it never did.

"With meth, in a short period of time, it has become prevalent with
adolescents. The reasons are because it gives them a feeling of control and
power, at a time in their life when they don't have much of that. It gives
them feelings of confidence at a time in life when don't have that and it
is readily available and affordable," said Falkowski.

She said unlike some drugs in the past, meth has to met by action and not
just talk.

"It is one of the biggest drug threat we have seen in the Midwest and
Western states," she said. "In my opinion, business as usual, which means
doing more with less, will not be affective in curbing the spread of
methamphetamine. We need to have additional resources for law enforcement,
for treatment and for prevention to even come close to turning the tide of
methamphetamines, she said and added, "You can't arrest your way out of the
meth problem without addressing the addiction that underlines it."

Rural Reality, Meth Myths

She said the meth epidemic is shattering illusions of some living in rural
areas.

"Many years people in rural areas suffered from the erroneous belief that
addiction did not happen in rural areas," she said. "Methamphetamine has
really driven home that is not the case. Addiction happens everywhere. Meth
has shattered a lot people's ideally belief about the nature of addiction
and where it happens."

If meth has shattered illusions, Falkowski said it has also created a
number of myths.

"It seems that whenever there is a new drug trend on the horizon, there are
a number of myths that accompany it, and many of things that people are
saying of methamphetamines are reminiscent of what people said about crack
cocaine two decades ago."

The first myth she addressed is the addictive nature of meth.

"I get asked the most is, 'Is it instantly addicting?'" she said.

Falkowski said there those who have tried meth once and never used it again.

"I am not convinced any drug is instantly addicting and the danger with
saying a drug is instantly addicting is that many more use drugs than
become addicted to them," she said. "Particularly with adolescents, if one
of there friends uses meth and never uses it again so they say 'It's not
instantly addictive.' You have lost a lot of credibility."

Another persistent myth she hears is there is no effective treatment for meth.

"That is really not the case either," she said. "Hazelden was asked to give
a Congressional Briefing in Washington, DC in April of this year and
address meth treatment outcomes. At that briefing, we drew on the most
available science on addition and treatment and what we found is that
treatment for addiction is as effective as treatment for other disorders
that have behavioral components, such as asthma, diabetes, and hypertension.

"Many people don't appreciate that addiction is more than just drug abuse.
It is chronic behavioral disorder that requires life-long management and
periodic professional services.

"You need to change your behavior in order to manage it over the course of
a lifetime and what the National Institute of Drug Abuse found is that
there are three components to recovery: detox, treatment, and aftercare.

"Well with a lot of meth addicts. They do not always get after-care even if
they get treatment, which now has been harder to access than ever before.
We know the prognosis is quit poor if even if they have treatment and then
return to a living situation where people are buying the drug, selling the
drug and using the drug.

"All three components defined by National Institute of Drug Abuse are
critical but we have in reality a system of care delivery that doesn't
always include after-care and I think this is one of things that
contributes to the perception that treatment outcome for meth are not
good," she said.

Falkowski said Hazelden compared data on treating meth users against other
drug abusers and found the success rate of success about the same.

She said those states that use a matrix model of treatment, various
resources and strategies coordinated together, especially effective
after-care, have shown effective treatment for meth addicts.

"The bigger issues is getting meth addicts the treatment they need," said.
"Because access to treatment, these days, is difficult for people in the
best of circumstances and you can typically count on meth addicts presented
for treatment under the worst of circumstances. and it needs to be treated
by aftercare.

Another myth she hear is that meth users have to detox for months before
accepting treatment.

"That's another myth, [Detox takes months] it is a matter of days," she
said. "I hear quite often, 'How long does a meth addict take for
treatment?' Really what is critical here is that meth addicts, like all
addicts need individual assessment.

"You don't say, 'Someone has lung cancer. How long will they need treatment
for lung cancer?' It depends on the nature of the illness and the duration
of the illness and the characteristics of the individual, so to with
addiction. individual assessment is key. "Yet I have heard people say they
need incredible amounts of time.

"The answer is for how long is 'It depends on the outcome on an
individualize assessment of the severity of that person's addiction."

"In extreme cases we need to consider a longer term of engagement. whether
that means prolong treatment or time spent in jail before treatment or
receiving after care. We need to consider extreme cases and engaging people
for longer periods of time." She said it is important to remember that
treatment is a process.

"Some people who are learning about addiction for the first time in the
context of methamphetamine don't appreciate that multiple treatment
episodes are the norm more than the exception," she said. "It is not
uncommon for an alcoholic to receive treatment more than once; it is not
uncommon for a cocaine addict or a meth addict. People go to treatment and
it is not effective the first time. Multiple treatment is common."

Joyce Allen

Allen also emphasizes some of the same points made by Falkowski concerning
treating meth users.

"Some people believe there are no effective treatments and we know that is
not true," said Allen. "The National Institute on Drug Abuse has done a lot
of research regarding treatment and by and large the focus that work are
cognitive behavioral interventions working with someone to modify their
thinking and behavior over a long period of time.

"It doesn't happen in just a couple of outpatient visits. It takes time to
work with someone in a structure way, to increase their coping skills.

"We've found in research that the longer they stay in treatment the better
their outcome. The most effective treatment motivates people to stay in
treatment. There are motivational interview skills, how to use a positive
and not a confrontational approach. Sometimes, in the old days, we would do
the confrontational thing. What we are finding is that a positive approach
works better. She said the legal system can play an important role in recovery.

"We have found that in addition to positive enhancements, it is not all bad
when the criminal justice system gets involved," said Allen. "Research
shows that drug courts are really helpful to provide the structure to
continue in treatment and because they stay in treatment they have good
outcome.

"Some drug courts use what they call motivational enhancements. It uses
positive rewards for staying drug free. The business community donates
prizes and after they have been drug free for a few weeks they put their
names in a hat and the names are drawn out. It is little things but focuses
people on the next step of staying clean.

"Matrix model has been research a lot. A highly structure 16-week treatment
approach. It does uses various techniques . It uses motivational
interviewing, uses cognitive motivational behavioral therapy. It helps
teach people how to overcome a craving. It is a very structure approach for
dealing with that persons needs. It takes in account that when someone is
addicted to meth that they initially lose their ability to think clearly.

"You have to think of these people as not functioning at the level they had
been functioning before. Their brain is not working very well, so you do
have to modify your treatment to take that in consideration and the matrix
model does do that. It uses teaching and coaching at a pace that is
appropriate for that person.

Family Support

Allen Said Success In Therapy Must Also Involve The Users Family

"You can't just treat the person without treating and involving the
family," she said. "Results show it, if you don't involve the family. the
outcome just won't be as good.

"You need support; you can't do it on you own," she said. "The family has
to be part of the solution. Without that, we need structures built around
them. Their old peers may all be meth users and that is not going to help
them," she said. And Like Falkowski, Allen said the public needs realistic
expectation s on how treatment works.

"A lot of people have the feeling that someone going into treatment and
then relapse then that money is a waste," she said. "There are times when
people may not always make it. But the treatment that has gone before makes
it easier the next time. Treatment is a long term process. That's why you
need that support.

"Hopefully your family and member around you will bring you back to
treatment where you left off. It is one of those expectations. We should
say treatment takes time. That doesn't mean eventually it won't work for
them and statistics have shown most people initially relapse within the
first 12 months of treatment.

"People might say, 'O my god, I wasted all this time. We should realize it
going to happen, but we have to work again and keep moving on and have
follow up treatment available," said Allen

Outpatient Can Work

She said the long-term answer isn't necessarily residential, in-patient
treatment.

"After they [meth users] get through the initial detox, where they are no
longer psychotic or actually ill, I don't think residential treatment is
needed for that person necessarily. It can be done in an outpatient
treatment. If you meet in more intensive environment, more than 3 times a week.

"You may not need residential programs. Obviously, there are going to be
some people who may need some residential treatment and there are going to
be those who need intensive outpatient treatment. Ever user is different.
you have to craft their treatment where they are. Need for assessment," she
said.

Training

Allen said she knows that there are many clinicians in the field who are
exasperated and frustrated dealing with the meth epidemic.

She said this fall the state will provide more training and support
available for them, so the clinicians can better address the needs of
individual meth users.