THE EDUCATOR - Summer 2005

Treatment in Response to the Meth Epidemic

By Steven Freng, Psy.D., MSW Northwest HIDTA Prevention/Treatment Manager

It seems fitting that, as a draft of this article was being polished, a new survey conducted by the National Association of Counties (NACO) was released to the public. The survey entailed interviews with 500 county sheriffs and 303 county child welfare officials in 45 states. Among the findings of the survey, 58% of the sheriffs stated that methamphetamine abuse is the biggest drug problem in their counties. Seventy-seven percent reported an increase in meth-related arrests in the last year; over 50% reported that at least 20% of the inmates in their jails were arrested for meth-related crimes; 70% blamed meth for increases in robberies and burglaries; two-thirds said meth has caused an increase in domestic violence; and more the half stated that assaults are increasing, including attacks on jailers.

All this comes as states such as Washington report that the number of clandestine meth labs continues to decline -- yet, the impacts and consequences of meth use and addiction continue to increase. Unfortunately, the approximate five-year period during which meth labs proliferated allowed meth addiction to take deep root in this state, roots that are now being nourished by drug trafficking organizations and that may persist in families, communities and in our criminal justice system for generations.

Fortunately, the thousands of Washington State citizens who suffer meth addiction have at their disposal a sophisticated and effective addictions treatment system. And more encouraging, that system is expanding, maturing and if finding innovative ways to get at the roots of addiction.

The foundation of the treatment system is comprised of the Washington State Division of Alcohol and Substance Abuse (DASA) which, in collaboration with all 39 counties and over 350 treatment agencies, administers addiction treatment resources for not only those who can afford to pay for services but also those who cannot. Access to publicly funded treatment services is coupled with the individual's eligibility for assistance provided through the Department of Social and Health Services (DSHS), including financial assistance, medical assistance and food stamps. Persons who are applying for DSHS assistance may be referred for an ADATSA (“Alcoholism and Drug Addiction Treatment and Support Act”, passed by the Legislature in 1987) assessment, which in turn – if the individual is found to be addicted – leads to referrals for a range of services including detoxification, residential and outpatient treatment. Those who are already receiving DSHS assistance, by virtue of their Medicaid eligibility, can also access treatment services as one of their benefits.

In 2003, the average monthly statewide caseload of persons receiving addiction treatment services numbered approximately 13,700. Of those, nearly 6,000 – or approximately 44% -- reported methamphetamine to be their primary addiction. When looking back over the five-year period during which the meth lab epidemic swept across the state, the number of persons participating in treatment for meth addiction ballooned from 2,218 in 1997 to 5,994 in 2003, over a 270% increase.

Given the sweeping impacts that meth labs, meth addiction and meth-related crimes have had on our criminal justice system, it should not be surprising that efforts to innovate and expand treatment services have been largely focused in our courts, jails and prisons. Drug Courts, which had their genesis in Dade County, Florida in 1989, have been described as the most important innovation within the criminal justice system in the last 50 years. Drug Courts have since been implemented in over 1,500 jurisdictions across the country – including 17 county Superior Courts and 5 tribal nations in Washington State.

Drug Courts involve special calendars and caseloads that are organized to handle cases involving drug-using offenders through comprehensive supervision, drug testing, treatment services and immediate sanctions and incentives. They depart from the traditional adversarial relationships personified by the defense and prosecution and require the officers of the court, including the judge, and treatment professionals to function as a team in the interest of the offender. They involve a rigorous community-based program (usually lasting 12-18 months), random urinalyses and an active relationship with the Drug Court Judge in lieu of adjudication and incarceration, with the intention of stopping the “revolving door” for addicted offenders in the criminal justice system. Because the period of treatment participation – and the constant accountability to the court – is lengthy, Drug Courts are particularly well suited to treat persons with meth addictions. And, depending on the availability of services in a particular community, the courts are particularly well positioned to marshal other needed services for participants such as mental health care, transportation, housing and vocational services.

In addition, programs for drug-related offenders have been implemented throughout the state under the auspices of the Criminal Justice Treatment Act (CJTA), passed by the Legislature in 2003. CJTA funds help support Drug Court programs in some counties and have allowed other counties to implement very innovative programs for drug-related offenders. During the 2003-05 biennium, 5,730 drug-related offenders received treatment services funded by CJTA – and, not surprisingly, nearly 30% reported addiction or involvement with meth.

Several counties have taken the Drug Court model a step further – spurred by the prevalence of meth addiction in the child welfare system -- by also implementing Family Treatment Courts. Returning briefly to the recent NACO survey, 40% of the child welfare workers surveyed across the country said that meth addiction on the part of parents puts more children in foster care or some other out-of-home placement. Almost 60% stated that meth is such a persistent problem that it makes reunification of families nearly impossible. In Washington State, there are over 11,000 children in out-of-home placements, and 80% of the removals are attributed to drug addiction by one or both biological parents. And parents who are separated from their children due to addiction are more likely to have their children permanently removed because they don't achieve timely and sustainable sobriety.

Family Treatment Courts are typically presided by a Superior Court Judge and include specifically assigned Social Workers from the Washington State Division of Children's and Family Services (DCFS), Assistant Attorney Generals and parental attorneys, Court Appointed Special Advocates (CASAs) and treatment professionals who work as a team. The Court seeks to intervene early in the family's situation in order to involve parents in services with increased judicial supervision. Program services can include detoxification, addiction treatment (residential and outpatient), therapeutic childcare, economic and vocational services, parenting classes and in-home services. The Family Court team can apply sanctions for program violations such as community service, increased court appearances, day reporting and warrants for Failure to Appear; in turn, incentives are provided to families who are progressing well through the program. There are currently 5 Family Treatment Courts (3 of which are supported by the Washington State Meth Initiative) operating in Washington State, with several more in the planning stage.

In each of these venues, an innovative treatment approach, developed specifically for meth addiction, is being introduced. The Matrix model is a 16-week intensive treatment protocol that combines techniques and materials from the cognitive-behavioral therapy literature. Matrix includes education about meth's effects, family education, 12-step program participation and positive reinforcement for behavior change and treatment compliance. When participants in the Matrix model were compared to participants in “traditional” treatment programs, Matrix participants attended more clinical sessions, stayed in treatment longer (a particularly important goal for meth addiction), had more clean urinalyses and had longer periods of abstinence from meth use than those in the comparison group. The Matrix model can be found in at least 8 CJTA-funded programs in Washington State, with several other jurisdictions preparing to implement the program at this writing.

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