Greenberg&Cohen EBCRP Methamphetamine: Understanding the Influence of Violence in Treatment Planning and Recovery Judith Cohen, PhD Rivka Greenberg, PhD

Greenberg&Cohen EBCRPGreenberg&Cohen EBCRP

Methamphetamine: Methamphetamine: Understanding the Influence of Understanding the Influence of Violence in Treatment Planning Violence in Treatment Planning

and Recoveryand RecoveryJudith Cohen, PhDJudith Cohen, PhD

Rivka Greenberg, PhDRivka Greenberg, PhDAnna Talamo, MFTAnna Talamo, MFT

East Bay Community Recovery ProjectEast Bay Community Recovery ProjectADP 2008 Conference, Burlingame, CAADP 2008 Conference, Burlingame, CA

June 18, 2008 June 18, 2008


MethamphetamineMethamphetamine

A highly addictive stimulant that A highly addictive stimulant that affects the central nervous system affects the central nervous system

Readily available and inexpensiveReadily available and inexpensive Commonly called, "speed“, "meth“, Commonly called, "speed“, "meth“,

"chalk." In smoked form, called, "chalk." In smoked form, called, "crank“, "crystal“, "ice“"crank“, "crystal“, "ice“


National Treatment Admissions National Treatment Admissions for Methamphetamine Increasefor Methamphetamine Increase


The Center for Substance Abuse Treatment

Methamphetamine Treatment Project Funded by the CSAT, from 1999 – Funded by the CSAT, from 1999 –

20012001 Eight outpatient sites, 1,000+ clientsEight outpatient sites, 1,000+ clients

Belmont, Costa Mesa, Hayward, Belmont, Costa Mesa, Hayward, Lafayette, San Diego, Los Angeles, Lafayette, San Diego, Los Angeles, Billings Montana and Honolulu HawaiiBillings Montana and Honolulu Hawaii

Abuse and Violence QuestionsAbuse and Violence Questions Treatment RandomizedTreatment Randomized

Matrix model -16 week programMatrix model -16 week program Treatment as usualTreatment as usual


Baseline DemographicsBaseline Demographics

Participants served (n)Participants served (n) Age (mean)Age (mean) Education (mean)Education (mean) Methamphetamine use Methamphetamine use

(mean)(mean) For those who used:For those who used: Alcohol use (mean)Alcohol use (mean) Marijuana use (mean)Marijuana use (mean)

10161016 32.8 years32.8 years 12.2 years12.2 years 7.5 years7.5 years

7.2 years7.2 years 7.6 years7.6 years


Gender Distribution of Participants

45

55

0

10

20

30

40

50

60

female male

Gender

Per

cen

t


Ethnic Identification of Participants

60

2 3

17 18

0

10

20

30

40

50

60

Ethnic Identification

Per

cent

caucasian

african amer

native amer

asian/pac isl

hispanic


Psychological ProblemsPsychological Problems

Significantly high BSI scores onSignificantly high BSI scores on DepressionDepression AnxietyAnxiety HostilityHostility SomatizationSomatization AddictionAddiction Positive symptom total scorePositive symptom total score


Age That Physical Violence Age That Physical Violence BeganBegan

WomenWomen MenMen

Total reports of violenceTotal reports of violence 365365 324324

Percent of total NPercent of total N 70%70% 60%60%

Began between 1 and 10 Began between 1 and 10 yrs. yrs.

158158 135135

Began between 11 and 18 Began between 11 and 18 yrs.yrs.

207207 189189


Abuse During LifetimeAbuse During Lifetime

7

36

62

29

64

84

0 20 40 60 80 100

SexualAbuse

PhysicalAbuse

EmotionalAbuse

% Women% Men


Implications For Treatment Implications For Treatment

Screen carefully for Screen carefully for Abuse and violence Abuse and violence Psychiatric problemsPsychiatric problems

Recognize pervasive gender differencesRecognize pervasive gender differences Need to address substance abuse, Need to address substance abuse,

violence and psychiatric problems in an violence and psychiatric problems in an integrated treatment modelintegrated treatment model


Treatment EngagementTreatment Engagement Women who said Women who said yesyes to the following to the following

questions were questions were significantlysignificantly more likely more likely toto

Leave treatment in the first monthLeave treatment in the first month

Do you feel afraid of your partner? Do you feel afraid of your partner? Are you sometimes afraid to go home?Are you sometimes afraid to go home? Do you feel your partner might kill you? Do you feel your partner might kill you?


Treatment CompletionTreatment Completion

Women who said Women who said yesyes to the following to the following questions were questions were significantlysignificantly more likely more likely toto

Not complete treatmentNot complete treatment

Do you feel afraid of your partner?Do you feel afraid of your partner? Do you feel your partner might kill you? Do you feel your partner might kill you?


DiscussionDiscussion Treatment engagement and retention for Treatment engagement and retention for

women who use methamphetamine is a women who use methamphetamine is a major concernmajor concern

The women identifying violence and/or The women identifying violence and/or abuse in their lives were significantly at risk abuse in their lives were significantly at risk for not staying or completing treatmentfor not staying or completing treatment Indicates the need to address the fear factor as Indicates the need to address the fear factor as

a treatment componenta treatment component Need to address ways for the women to keep Need to address ways for the women to keep

themselves safe, physically and psychologicallythemselves safe, physically and psychologically


Research to PracticeResearch to Practice

These findings strongly indicate the These findings strongly indicate the need for need for Gender responsive treatmentGender responsive treatment

RelationalRelational Strength-basedStrength-based Trauma informedTrauma informed Treatment environment in which women feel Treatment environment in which women feel

safe and comfortable safe and comfortable (Perinatal Environmental Scan, 2007)(Perinatal Environmental Scan, 2007)

Facility safety measures Facility safety measures


Client Physical SafetyClient Physical Safety

Facility and StaffFacility and Staff What measures have been taken to What measures have been taken to

assure the physical safety of clients and assure the physical safety of clients and staff?staff?

Are staff trained in identification and Are staff trained in identification and reporting?reporting?

How are the clients informed about the How are the clients informed about the measures to ensure their safety?measures to ensure their safety?


Facility AtmosphereFacility Atmosphere How do staff convey in their spirit and How do staff convey in their spirit and

attitude an awareness and respect of attitude an awareness and respect of the trauma in the lives of their clients?the trauma in the lives of their clients? Supportive, engaging, respectful versus Supportive, engaging, respectful versus

shaming and confrontational?shaming and confrontational? Are staff trained in the identification of Are staff trained in the identification of

possible re-traumatizing actions? possible re-traumatizing actions? For example -For example -


Addressing Trauma in Addressing Trauma in TreatmentTreatment

Is safety planning a component of the Is safety planning a component of the treatment program?treatment program?

Does the program assess for trauma?Does the program assess for trauma? Is trauma work identified in the treatment Is trauma work identified in the treatment

plan?plan? Does the program have a trauma specific Does the program have a trauma specific

intervention as part of the program? intervention as part of the program? Among those identified has having evidence Among those identified has having evidence

based outcomes-based outcomes- Seeking SafetySeeking Safety Trauma Affect Regulation: Guide for Education and Trauma Affect Regulation: Guide for Education and

Therapy -TARGETTherapy -TARGET Trauma Recovery and Empowerment Model – TREMTrauma Recovery and Empowerment Model – TREM

Greenberg&Cohen EBCRP Greenberg&Cohen EBCRP cffutures.org/calwcf/documents/Pcffutures.org/calwcf/documents/PerinatalEnvironmentalScanSummerinatalEnvironmentalScanSumm

ary5-17-07.pdfary5-17-07.pdf

The Next GenerationThe Next GenerationCaliforniaCalifornia

Pregnant Women in California, 2005 An estimated 100,000 infants are born

prenatally exposed to alcohol each year An estimated 20,000 to 60,000 are born

prenatally exposed to illicit drugs Fewer than 4,000 pregnant women

entered treatment in California in 2005.

Greenberg&Cohen Greenberg&Cohen EBCRPcffutures.org/calwcf/docuEBCRPcffutures.org/calwcf/documents/PerinatalEnvironmentalScaments/PerinatalEnvironmentalSca

nSummary5-17-07.pdfnSummary5-17-07.pdf

Next GenerationNext Generation California Parents, 2005

Nationally, among parents living with their children, 8% of fathers & 4% of mothers were dependent on or abused substances in the past year

An estimated 849,000 California children live with a parent who abuses or is dependent on alcohol or illicit drugs

Approximately 103,000 parents were admitted to treatment


Next GenerationNext Generation

As trauma informed treatment comes As trauma informed treatment comes increasingly an basic component of increasingly an basic component of substance abuse treatment – how do substance abuse treatment – how do we provide the needed interventions we provide the needed interventions to the children – to interrupt the to the children – to interrupt the intergenerational cycle? intergenerational cycle?

How to we replace risk factors with How to we replace risk factors with protective/resiliency factors?protective/resiliency factors?


Further InformationFurther Information

Cohen, J. C., Dickow, A., Horner, K., Zweben, J. E., Balabis, J.,Vandersloot, D., Reiber, C. (2003). Abuse and Violence

History of Men and Women in Treatment for Methamphetamine Dependence. American Journal on Addictions, 12, 377-385.

Documents

Greenberg&Cohen EBCRP Methamphetamine: Understanding the Influence of Violence in Treatment Planning and Recovery Judith Cohen, PhD Rivka Greenberg, PhD