LIMITED TREATMENT OPTIONS AVAILABLE TO METH USERS

Limited Treatment Options Available To Meth Users

Help Nonexistent In Rural Areas Of State

CLINTON -- Donna Goddard, a 31-year-old amphetamine user and opiate addict
facing criminal charges in Anderson County, says she desperately wants to
get sober but is unable to do so because of a lack of available treatment
options.

During a recent interview in the Anderson County Detention Facility, after
she was picked up for allegedly violating her probation on a drug charge,
the haggard-looking Oak Ridge woman described a life rent by substance
abuse since she began drinking at age 9.

On the day of the interview, Goddard had only been out of the hospital for
a few days after a life-threatening bout with an infection caused by
intravenous drug use.

"I got a staph infection, and it got in my bloodstream," she said. "It
damaged my heart valves. I had to stay in the hospital and a nursing home
for four weeks taking IV antibiotics."

Goddard's use of IV drugs has also given her hepatitis C. Her body is
covered with sores and she looks at least 10 years older than her actual
age -- the legacy, she says, of too much hard living.

After alcohol, Goddard began using illegal drugs including marijuana,
cocaine and opiates like morphine and Oxycontin. She eventually progressed
to crack, stayed clean from opiates for a while after getting on a
methadone maintenance program, but then slipped back into drug use with
opiates and meth.

Goddard's first experience with meth, an amphetamine-based drug, was
relatively recent and she doesn't believe she's addicted to it. She liked
mixing the drug with morphine, a depressant, to achieve a "speedball effect."

"It's a big buzz," she said.

When asked if she feels like she needs meth -- or what she calls "crank" --
to get by, Goddard replied: "I don't the crank, but I do the morphine."

She has two daughters, one of whom is only a year old and the other is 12.
Their grandmother has had custody of the children since her youngest child
was born.

"I was on morphine when she was born, and she was born addicted," Goddard said.

Goddard's older daughter saw firsthand what the drugs did to her parents,
and Goddard now worries about the impact her experiences will have.

"I worry about her trying things because she's at that age," Goddard said.
"I just want to be drug free. ... Get off all drugs, not have to worry
about probation, jail. I want to get back to my family."

Challenge of treatment

Thousands of East Tennesseans have stories similar to Goddard's, and the
question as to how, or even if, to treat them is very much in the mind of
policy makers struggling to come to grips with a rising epidemic of
amphetamine abuse, especially the potent derivative called methamphetamine.

To Cumberland County Sheriff Butch Burgess, trying to rehabilitate
methamphetamine addicts is a waste of time.

Burgess, who in addition to his law enforcement duties has kept more than
30 displaced children in his after-hours role as a foster parent, believes
that meth addicts can't be rehabilitated and that any money spent on
treating them could be better used elsewhere.

Burgess is especially sensitive to the plight of the hundreds of children
who have been removed from their parents' custody because of meth labs in
their homes.

"We're basing this on what we've seen," Burgess said. "We're not seeing a
lot of success. ... The relapse rate is unreal. I don't have any problem
with adults trying to get rehab or anything, but they spend a fortune
sending off these parents without much of an outlook that they're going to
be successful.

"You can't just put the children on hold for a year or two."

But while law enforcement officials across East Tennessee claim that meth
addicts experience a 94 to 96 percent failure rate in treatment, medical
authorities maintain that such statistics are simply not true.

"The idea that meth users are somehow disproportionately untreatable is
just not supported by any data I'm aware of," said Dr. Richard Rawson,
associate director of the University of California at Los Angeles'
Integrated Substance Abuse Programs.

In fact, meth addicts seem to experience a relapse rate of approximately 60
percent, which is the same rate seen in cocaine addicts, he said.

"Nobody's satisfied with it, nobody thinks 40 percent (success rate) is
good," Rawson said. "But the fact is that the treatment response to
methamphetamine is almost identical to cocaine using the treatments that we
have."

Rawson, a meth expert who recently helped complete a long-term study of
1,000 meth addicts in six communities in the western United States, said
that follow-up studies made a year after treatment showed that 40 percent
of the test subjects were drug-free.

The UCLA facility has been studying meth use for nearly 20 years, Rawson said.

Rawson said. "The big trick is keeping them in treatment in an outpatient
setting. If you're doing the right things with your treatment strategies,
you can keep about half of them in treatment," Rawson said.

Rawson stressed that many meth addicts -- like those addicted to other
substances like alcohol or heroin -- don't seek treatment unless they're
looking at some kind of legal trouble if they don't. In California, voters
recently passed a measure allowing treatment instead of jail for certain
drug users.

"The ability to get them into treatment is challenging, but it's
challenging for all drug users," Rawson said. "We're desperately looking
for new behavior treatments and medicines."

Samuel A. MacMaster, an assistant professor in the College of Social Work
at the University of Tennessee, said the state doesn't have adequate
treatment facilities for addicts.

"One of the issues in Tennessee is that there is limited treatment of any
kind available, and that in the rural areas treatment is nonexistent," he
said. "It is much simpler to assume that if we arrest and incarcerate
individuals we have done society a service by removing the individual from
the community.

"This does not improve the individual's life and the cost to incarcerate
the individual is much higher than any treatment costs and continue to cost
the state and local governments money over many, many years."

Difficult recovery

Methamphetamine and related types of speed are known by a wide variety of
street names, including crystal meth, crank and ice. Users often refer to
the high they get as "tweaking," a slang term that's also sometime used to
describe the very similar effects of cocaine.

Dr. Robert J. Algaier, a substance abuse expert at Peninsula Behavioral
Health in Knoxville, said meth produces its pleasurable effects by
triggering neurotransmitters that flood the brain with dopamine, a
naturally occurring substance that regulates moods.

The effects of meth abuse are severe, Algaier said, with some users
suffering permanent brain damage after one or two doses. Users are able to
stay up for long periods and experience a euphoric "rush," but the
long-term effects include symptoms similar to Parkinson's disease, tremors,
uncontrollable movements, strokes, heart inflammation and death.

"The treatment, depending on symptoms, is to always look at stabilizing
body functions, controlling high blood pressure, psychotic symptoms,"
Algaier said. "It might require inpatient treatment if they are being
monitored and need medication. On an outpatient basis, it would shift to
behavioral and cognitive treatments."

Algaier believes that many substance abusers are "self-medicating" to treat
other psychological problems. He also said that managed health-care plans
sometimes restrict how much treatment patients can receive.

"What seems to be the underlying draw to meth, why do people use it?" he
asked. "Are we looking at pure addictive personalities or addictive
behaviors? I'd say probably not. I'd say we're looking at underlying mood
disorders in a number of people, like depression."

At times, it's hard to diagnose patients with meth addictions because the
symptoms of meth abuse can be identical to certain types of psychosis.

The long-term effects of meth addiction are still being studied, but it's
already clear that some users never recover from their time spent using the
drug, said Anne Young, program director at The Lighthouse, an outpatient
center operated by Peninsula.

"The body makes dopamine naturally, and meth triggers the mechanism that
releases it," Young said. "That's bad in the long run in that it causes
your body to stop making as much dopamine. ... There's dependence,
addiction, severe paranoia, hallucinations.

"Meth is a very difficult drug to recover from. The craving is so intense,
and it messes with your thinking in such a way that you don't think you
need help."

Meth's children

The issue of relapse rates is crucial to the debate of how far society
should go in treating meth addiction versus simply locking up offenders or
terminating their parental rights.

Authorities say the most heartbreaking element of the meth problem in East
Tennessee is the number of children who have been pulled from their homes
- -- approximately 500 between January 2002 and July of this year, according
to Department of Children's Services statistics.

A new provision in state law allows authorities to remove children from
homes where meth-production is discovered because such activity is now
classified as severe child abuse.

"We're trying to make a push to get these kids out of that environment,"
Sheriff Burgess said. "Let them become normal. We removed 35 children (in
Cumberland County) through August of this year. ... We're going to have to
get prepared to do a whole lot more than that. Right now, we're just
recycling the adults. Most of them won't go anywhere for treatment."

Meth labs are considered environmental hazards, and some children exposed
to the vapors often develop health problems afterward, according to Diane
Easterly, team coordinator for the Tennessee Department of Children's
Services in Grundy, Franklin, Marion and Sequatchie counties.

Easterly's district saw the beginning of the current meth epidemic in the
mid-1990s, and her workers have filed petitions to remove 31 children since
January.

"A lot of the children we get are young children, and they're down on the
floor crawling, picking up everything in the house," Easterly said. "What
we're seeing out of those children are a lot of respiratory problems, we're
seeing shaking, seizures, uncontrollable crying -- symptoms that in the
past we might have associated with crack babies."

While DCS is able to place most of the children with relatives, some end up
in the foster-care system, straining an already overburdened resource to
the breaking point, she said.

"If we didn't have relatives, I don't know what we'd do," Easterly said.