Methamphetamine: a Primer for Therapists Presented at Sunserve Valuing our Families Professionals Mini-Conference November 11, 2005 : Methamphetamine: a Primer for Therapists Presented at Sunserve Valuing our Families Professionals Mini-Conference November 11, 2005
David Fawcett, PhD, LCSW
1975 East Sunrise Blvd, Suite 722
Fort Lauderdale, Florida 33304
(954) 764-6466 davidfawcett@earthlink.net
www.fortlauderdalecounseling.com
Topics : Topics Definitions/ Classifications
History of meth
The current epidemic
In the kitchen
Physiological effects
Meth and the brain
Topics : Topics (continued)
Meth and HIV
Meth and Sex
Best Practices
Prevention campaigns
Definitions : Definitions
What is Methamphetamine? : What is Methamphetamine?
“Tina”
Amphetamines…. : Amphetamines…. Amphetamine
Methamphetamine
MDMA
Benzedrine
Cocaine
Ephedrine
What is Methamphetamine? : What is Methamphetamine? SAMHSA Classification:
Stimulatory Hallucinogenics (former psychotomimetics)
produce a mixture of psychomotor stimulant and hallucinogenic effects, depending on dose and other factors; no therapeutic uses, except ketamine as a veterinary anesthetic.
Examples: MDMA (ecstasy), phencyclidine (PCP), ketamine
What is Methamphetamine? : What is Methamphetamine? (SAMHSA)
Psychomotor Stimulants
stimulate psychological and sensory-motor functioning; are used therapeutically to treat ADHD and narcolepsy, sometimes as an appetite suppressant, occasionally for fatigue, formerly for asthma and for sinus decongestion.
Examples: amphetamine, methamphetamine, cocaine, methylphenidate
What is Methamphetamine? : What is Methamphetamine? (SAMHSA)
Other Stimulants
similar to psychomotor stimulants but with much less efficacy; various therapeutic effects including caffeine compounded with aspirin in some OTC pain relievers, ephedrine in OTC asthma medicines, pseudoephedrine in OTC sinus decongestants and OTC appetite suppressants.
Examples: caffeine, nicotine, ephedrine, pseudoephedrine
Medical Uses of Meth : Medical Uses of Meth Compounds Containing Methamphetamine Hydrochloride
Amerital (Merit)
Amphaplex (Palmedico)
Carrtussin Syrup (Carrtone)
Desbutal (Abbott)
Desoxyn (Abbott)
Meditussin (Palmedico)
Methedrine (Burroughs-Wellcome & Co.)
Obedrin (Massengill)
Medical Uses of Meth : Medical Uses of Meth Compounds Containing Amphetamine Sulfate
Benzedrine Sulfate (Smith, Kline & French)
Compounds Containing Dextro-Amphetamine-Sulfate
Adderal (Shire)
Amphaplex (Palmedico)
Amvicel (Stuart)
Appetrol (Wallace)
Dexedrine Sulfate (Smith, Kline & French)
Eskatrol Spansule Capsules (Smith, Kline & French)
Vi-Dexemine (Smith, Kline & French)
Medical Uses of Meth : Medical Uses of Meth Compounds Containing Methamphetamine Preparations
Ampheplex (Palmedico)
Obetrol (Obetrol)
Span-RD (Metro Med)
Drugs with Amphetamine-Like Action
Meratran (pipradrol)
Ritalin (methylphenidate)
Tenuate (diethylpropion)
Preludin (phenmetrazine)
History of Meth : History of Meth
History of Meth : History of Meth 1887 Methamphetamine first created in Germany
1919 Meth in crystalline powder form created in Japan
1919 – 1930
Meth used medically as a bronchial dilator and to stimulate CNS.
Benzedrine available OTC
History of Meth : History of Meth 1930s
Meth commonly used by athletes
Better than strychnine
Prevents heat stroke
Whoops….Fatalities
History of Meth : History of Meth 1940s
Japanese soldiers use meth
Nazi soldiers use meth
Pervitin
Hitler a meth addict
Allied soldiers use meth
5 meth tablets in each soldier’s kit
History of Meth : History of Meth 1950s
Methedrine and Dexedrine pushed by pharmaceutical companies
Huge post-war meth epidemic in Japan
History of Meth : History of Meth 1950s
America’s love affair with speed
History of Meth : History of Meth America’s love affair with speed
History of Meth : History of Meth America’s love affair with speed
History of Meth : History of Meth America’s love affair with speed
History of Meth : History of Meth America’s love affair with speed
History of Meth : History of Meth America’s love affair with speed
History of Meth : History of Meth America’s love affair with speed
History of Meth : History of Meth (1950s)
Doping
1952 Winter Olympics
“Speed” skaters in trouble
History of Meth : History of Meth 1960s
Meth labs appear in California
Problem in San Diego where meth manufactured for pilots flying Pacific
Doping
1960 Olympic cyclist Kurt Jensen dies of heart attack
1967 Tour de France: British Tommy Simpson dies
1968 IOC bans methamphetamine
History of Meth : History of Meth 1995 – present
Epidemic sweeps west to east
2003
Friendly fire by Americans in Afghanistan attributed to “Go Pills”
Clandestine Labs : Clandestine Labs
Clan Labs : Clan Labs
Clan Labs : Clan Labs Clan Lab Dangers
Explosion
Fire
Inhalation of fumes
Skin contact of chemicals
Clan Lab Medical Problems : Clan Lab Medical Problems Acids/Bases
Burns
Inhalation
Solvents
Liver
Kidney
Bone Marrow
Clan Lab Medical Problems : Clan Lab Medical Problems Iodine/Red Phosphorus
Burns
Ephedrine/Meth
Seizures
Phosphene gas
Odorless at 200 ppm
Heavier than air
Highly toxic, colorless, flammable
Clan Lab Medical Problems : Clan Lab Medical Problems Mobile Labs
Automobiles
Motel Rooms
Your neighbor
Clan Labs and Children : Clan Labs and Children
Clan Labs and Children : Clan Labs and Children Dangerous and stressful environment
Exposed to drug and its toxic precursors and byproducts
Can ingest drug through inhalation of fumes, second-hand smoke
Nationally, over 20% of seized meth labs in 2002 had children present
Social workers now accompanying law enforcement in lab seizures where children are involved.
DEC response teams (Drug Endangered Children)
in high prevalence meth states
Clan Labs and Children : Clan Labs and Children
Clan Lab Hazard : Clan Lab Hazard
In the Kitchen : In the Kitchen
Methods of Manufacture : Methods of Manufacture Red Phosphorus Method
Nazi (anhydrous ammonia method) Totse
Red Phosphorus Method : Red Phosphorus Method 1. Extraction of Precursor (epinephrine from cold medications)
Sometimes a blender used to break up pills
Solvent (alcohol, methanol, water)
Unwanted tablet binder sinks to bottom of container
Solvent containing pseudoepinephrine poured through coffee filter
Solvent evaporated off using corning ware and heating plate
Red Phosphorus Method : Red Phosphorus Method
Red Phosphorus Method : Red Phosphorus Method
Red Phosphorus Method : Red Phosphorus Method 2. Cook
Pseudoepinephrine placed in reaction vessel with red phosphorus and Hydriolic acid. Heated – often in a coffee pot
Matches, road flares, roll caps are sources
Hydrioloic acid created by mixing iodine crystals, distilled water, and red phosphorus
Iodine crystals can be created by mixing iodine with hydrogen peroxide. Muriatic acid can speed up this process.
Red Phosphorus Method : Red Phosphorus Method
Red Phosphorus Method : Red Phosphorus Method Mixture poured through coffee filters to remove red phosphorus which is saved for future use.
Sodium hydroxide is added to MA in solution to create amphetamine base.
Sodium hydroxide found in many drain opening products like Red Devil Lye.
Ice is added to this exothermic reaction to slow it down.
Solvents which are not water soluble like ether, Freon, or Coleman fuel are added to separate the mixture. The MA is drawn to the solvent base.
Red Phosphorus Method : Red Phosphorus Method
Red Phosphorus Method : Red Phosphorus Method The layer containing the MA is separated from the mixture. A sun tea container or turkey baster with spigot at bottom are used for this procedure.
HCl is bubbled into the MA base. The pH of the mixture drops to neutral and the MA crystals are formed.
HCl is created by adding sulfuric acid to table or rock salt.
This is generally done in a plastic gas can with tubing attached to the opening.
When MA crystals are no longer forming the mixture is poured through coffee filters. The crystals are left to dry leaving MA HCl.
Acetone is poured over the crystals to clean and whiten them.
Red Phosphorus Method : Red Phosphorus Method
Nazi Method : Nazi Method Basically similar, except anhydrous ammonia substituted for hydriolic acid
Nazi Method : Nazi Method
Nazi Method : Nazi Method
Nazi Method : Nazi Method
Nazi Method : Nazi Method
On the street : On the street Quarter = ¼ gram $50
Half = ½ gram
8 ball = 1/8 ounce (3.5 grams)
$250
7 quarters
Physiology : Physiology
Methods of Ingestion : Methods of Ingestion Smoke
Snort
Booty bump
Slam
Duration of Action 10-12 hours
Methods of Ingestion : Methods of Ingestion
Methods of Ingestion : Methods of Ingestion
Meth Purity : Meth Purity South Florida has purest meth in US
80-90%
Current Epidemic : Current Epidemic
Meth Epidemic : Meth Epidemic San Diego ground zero
Distribution by Outlaw Motorcycle Gang (“crank”)
Homegrown after security increases due to 911
Cost efficient compared to cocaine
“Hillbilly cocaine”
Follows I-70 eastward through rural America
Meth Epidemic : Meth Epidemic
Meth Epidemic : Meth Epidemic Last year almost 300 labs were seized in Florida
Meth in the Body : Meth in the Body MA Acute Physical Effects
Increases heart rate, blood pressure, pupil size, respiration, sensory acuity, energy
Decreases appetite, sleep, reaction time
Meth in the Body : Meth in the Body MA Acute Psychological Effects
Increases confidence, alertness, mood, sex drive, energy, talkativeness
Decreases boredom, loneliness, timidity
Meth in the Body : Meth in the Body MA Chronic Physical Effects
Tremor, weakness, dry mouth, weight loss, cough, sinus infection, sweating, burned lips, sore nose, oily skin/ complexion, headaches, diarrhea, anorexia
Meth in the Body : Meth in the Body MA Chronic Psychological Effects
Confusion, concentration, hallucinations, fatigue, memory loss, insomnia, irritability, paranoia, panic reactions, depression, anger,psychosis, formication, scarring
Meth in the Body : Meth in the Body
Meth in the Body : Meth in the Body
Meth in the Body : Meth in the Body
Meth in the Body : Meth in the Body
Meth in the Body : Meth in the Body
Meth in the Body : Meth in the Body
Meth in the Body : Meth in the Body Meth mouth
Psychiatric Consequences : Psychiatric Consequences MA Psychiatric consequences
Paranoid reactions
Permanent memory loss
Depressive reactions
Hallucinations
Psychotic reactions
Panic disorders
Psychiatric Consequences : Psychiatric Consequences Rapid Addiction
ETOH first use to tx: average 7-10 years
MA first use to tx: average 5-7 years
Freese: duration of action makes it harder to control
Psychiatric Consequences : Psychiatric Consequences Acute MA psychosis
Extreme paranoid ideation
Well formed delusions
Hypersensitivity to environmental stimuli
Stereotyped behavior (tweaking)
Panic, extreme fearfulness
High potential for violence
Psychiatric Consequences : Psychiatric Consequences Treatment of MA Psychosis
Typical ER protocol:
Haloperidol 5mg
Clonazepam 1 mg
Cogentin 1 mg
Quiet, dimly lit room
Restraints
Meth and the Brain : Meth and the Brain
Meth and the Brain : Meth and the Brain MA causes a functional brain injury
Dopamine system
Meth and the Brain : Meth and the Brain
Meth and the Brain : Meth and the Brain Areas of brain affected by MA:
Judgment
Impulse control
Movement and balance
Reward center – reticular formation
Affective
Senses
Meth and the Brain : Meth and the Brain Dopamine passes from axon to dendrite through synapse via receptors
Meth and the Brain : Meth and the Brain Once released, dopamine is reabsorbed via an uptake pump
Meth and the Brain : Meth and the Brain MA (like cocaine) causes excessive release of dopamine resulting in great feelings of pleasure and well-being
Meth and the Brain : Meth and the Brain MA blocks reuptake of dopamine
MA destroys the uptake pump causing permanent damage
New reports propose that MA actually reabsorbed into axon causing further damage
Low dopamine transporter =
Decreased motor coordination
Decreased memory
Meth and the Brain : Meth and the Brain Desensitization can occur with ongoing use
Meth Withdrawal : Meth Withdrawal MA Withdrawal
Depression
Difficulty concentrating
Severe Cravings
Paranoia
Exhaustion
Confused
Meth and the Brain : Meth and the Brain Once dopamine depleted severe depression occurs
The brain must “rewire” the dopamine system. This can take up to 18 months but functioning does not return to baseline.
The brain of a meth user is similar to someone with severe Parkinsons Disease
Meth and the Brain : Meth and the Brain Dopamine levels in the brain
Meth and the Brain : Meth and the Brain
Meth and the Brain : Meth and the Brain Cognitive Impairment
Sara Simon – Matrix Institute
Stimulants and control group
Digit symbol
Trail making (judgment, problem solving)
Word recall
Picture recall
Meth and the Brain : Meth and the Brain Findings
In recovery verbal memory worse
In recovery visual memory improved
Important implications for treatment
Meth and HIV : Meth and HIV
Meth & HIV : Meth & HIV Semple, Patterson and Grant (2002)
Use of methamphetamine (among HIV positive men) was associated with high rates of anal sex, low rates of condom use, multiple sex partners, sexual marathons, and anonymous sex”
Meth & HIV : Meth & HIV Numerous studies document the association between increasing rates of HIV and methamphetamine
Meth & Sex : Meth & Sex Mansergh (2004)
Meth users were twice as likely as nonusers to engage in unprotected receptive anal intercourse and sildenafil users were 6.5 times more likely to report having had unprotected insertive anal intercourse.
Sexual Effects: Meth v Cocaine (Rawson, Washton, et.al. 2002) : Sexual Effects: Meth v Cocaine (Rawson, Washton, et.al. 2002)
Sexual Effects: Male v Female (Rawson, Washton, et.al. 2002) : Sexual Effects: Male v Female (Rawson, Washton, et.al. 2002)
Meth & Cognitive Escapism : Meth & Cognitive Escapism Escape from the emotional pain associated with
HIV+ status
Reduced sexual stamina
Reduced energy levels
Reduced self esteem
Other medical complications, and
Ravages of addiction itself.
Meth & HIV Meds: “an acceptable compromise” : Meth & HIV Meds: “an acceptable compromise” Reback, Larkins, Shoptaw (2003)
Unplanned nonadherence was associated with meth-related disruptions in eating and sleeping, while planned nonadherence was identified as a strategy in recognition that a rigorous medication schedule would not be maintained while using methamphetamine, or else was related to concerns about mixing methamphetamine and medications.
Meth & HIV : Meth & HIV Halkitis, Parsons, and Stirrat (2001)
The effect of methamphetamine [is] two or three times greater for individuals on combination therapy, especially combinations including ritonavir (Norvir)
Meth & HIV : Meth & HIV Urbina and Jones 2004
Simply stated, methamphetamine seems to impair the ability of the immune system to fight HIV following exposure, thus facilitating the establishment of infection.
Meth & HIV : Meth & HIV Rippeth et.al. 2004
They found that “HIV infection, methamphetamine dependence, and the combination of HIV infection and methamphetamine dependence are all associated with neuropsychological (NP) impairments... in several cognitive domains, including attention/working memory, learning, delayed recall, and motor skills.”
Meth & Sex : Meth & Sex
Meth & Sexual Desire : Meth & Sexual Desire Meth has been directly linked to increased impulsive sexual behavior.
In higher doses, meth is reported to increase sexual pleasure at the same time that its physiological effects preclude the ability to obtain a full erection, a phenomenon known as Crystal Dick.
Meth & Sex : Meth & Sex Anecdotal evidence also suggests increased anal sensation.
A direct result of this phenomenon the creation of instant bottoms.
Meth & Sex : Meth & Sex Because of the sensory effects and associated decrease in sexual inhibition, use of methamphetamine may also be directly linked to longer periods of continuous sexual intercourse.
Survey : Survey Web-based
Convenience Sample
368 responses
278 from US
42 states
18 other countries
Survey : Survey
Survey : Survey
Survey : Survey SEXUAL ORIENTATION OF RESPONDENTS EXCLUSIVELY GAY 72% MOSTLY GAY 15% BISEXUAL 8% MOSTLY HETEROSEXUAL 3% EXCLUSIVELY HETERO 2% June 2004
Survey : Survey HIV STATUS OF RESPONDENTS HIV+ 17% HIV- 83% June 2004
Survey : Survey 0 2 4 6 8 10 12 14 16 <6 MOS 6-12 MOS 1-5 Y 6-10 Y 11-15 Y 16-20 Y 20+ Y IF HIV POSITIVE, HOW LONG? June 2004
Survey : Survey 0% 10% 20% 30% 40% 50% 60% 70% 80% HIV + EVER + HIV - EVER + HIV + NOW + HIV- NOW + HIV STATUS AND METH USE
Survey : Survey 0 0.02 0.04 0.06 0.08 0.1 0.12 0.14 0.16 0.18 RARELY SOMETIMES MODERATELY MORE FREQ TOO MUCH FREQUENCY OF USE June 2004
Survey : Survey 0 0.1 0.2 0.3 0.4 0.5 0.6 SNORT SMOKE BUMP SLAM METHOD June 2004
Survey : Survey TRIED TO STOP YES 60% NO 40% June 2004
Motivation to Stop : Motivation to Stop Users became “selfish” in both social and sexual terms.
Physical problems
Psychiatric problems
Financial consequences
Occupational consequences
Legal consequences
Relationship problems
Problems with stopping : Problems with stopping Lack of intense sex
Inability to focus (perhaps underlying ADHD that was self-medicated)
Lack of energy
Constant cravings
Difficulty having sex unless their partner was PNP-friendly, where PNP stands for Party and Play.
Struggling : Struggling “I would mostly do crystal on weekends starting on Friday night and going all weekend having marathon sex. I got sick with my HIV in 96 and stopped using crystal completely.”
“I was sober for 2 years until just a few months ago in fact. On speed I hate my life. Off it - I had no life. It's a tough choice…”
Survey : Survey IMPACT ON SEX LIFE YES 50% NO 50% June 2004
Impact on Sex Life : Impact on Sex Life Careless in choice of partner
Not using condoms.
Desire
“it pushed my personal boundaries and changed preferences of the type of sex (rough, more adventurous, etc.)”
“I was a sex maniac on the drug…”
Impact on Sex Life : Impact on Sex Life “Use has increased my sex drive. While I have had [a few] good sexual experiences, I have not experienced the orgasm that I seem to think will be brought with meth use. Now after four years’ use the thought of sex without meth is uninteresting.”
“I was uninhibited, horny, insatiable.”
“I never fucked for 36 hours straight before using methamphetamine.”
Impact on Sex Life : Impact on Sex Life “I've become a bigger freak - a pig, a fetishist -- however you want to put it. And of course - I never want sex to end. Ever.”
“When I used it I found it impossible to obtain an erection. I would be impossibly horny but unable to cum unless I beat my dick to the point of blistering.”
“It made me more receptive to scenes outside my normal activities.”
Impact on Sex Life : Impact on Sex Life “I had more extreme sex. Wild fantasies. I was able to expand limits more.”
“Now that I have been clean for a year I find that my desire to have sex is not there because it reminds me of when [I] was using and too many memories of how I let myself down come back. So to prevent those feeling I have not had sex in nine months.”
Impact on Sex Life : Impact on Sex Life “Life has become foreplay for the ultimate sexual experience that never happens.”
“It opened Pandora's Box.”
“Since I used meth primarily as a sex drug I truly believe it has changed my perception of sex and has damaged my ability to enjoy normal sex.”
Impact on Relationships : Impact on Relationships “[I] had a multi-year relationship that ended because my partner became addicted to meth.”
“My boyfriend didn’t want to be with me unless I was doing the drug with him. After three years together he changed into a different person. He was the love of my life but he was essentially gone forever.”
“I have hurt and lied to my partner while using as it makes me sociopathic.”
Impact on Relationships : Impact on Relationships “My partner uses… unfortunately when he does it makes him insane. I have had to drive half way across the country to pick him up when he comes down. The last time he ended up in NY. Crystal allows him to live out his darkest fantasies of wanting to be a slave.”
“The few relationships I've tried in my long, [continuing meth] addiction have been volatile, shallow, violent, and insane.”
Impact on Relationships : Impact on Relationships “I have dated a couple of guys that used meth and found that sex with them was really kind of one sided--their side. When they weren't under the influence they were passionate lovers where mutual gratification was always achieved. [But on] meth they seemed to be so centered on themselves that they could care less whether I got any satisfaction.”
Meth & Sex : Meth & Sex Many MSM reported that they could not have sex unless they were high on methamphetamine. The fear of no longer being sexual was a major barrier to giving up methamphetamine.
Sex without Meth : Sex without Meth “I can't think of a way that sober sex could ever hope to be as passionate, as driven and hungry as speed sex. And please don't give me that ‘Oh it's so much more intense with someone you truly, deeply care for... crap. Gimme a break, huh? Save it for the greeting card companies.”
Sex without Meth : Sex without Meth “Since I've quit using I've been practically impotent. Sadly I don’t know [how sex could be better without crystal]. I am now fortunate enough to enjoy a relationship with a wonderful man that truly loves me. But that intensity of the high sex is never achievable.”
A different view? : A different view? “The few times that I have [tried crystal] I'd hardly call it mind blowing sex. Trying to get hard -- boring. Trying to stay hard -- boring. Trying to get my sexual partner hard -- even more boring. Trying to keep my sexual partner -- even more boring.”
“I find sex is unsatisfying on crystal because of the crystal dick problem - I guess if I was a total bottom whore I'd feel different about it?!?”
A different view? : A different view? “All I wanted was my hard-on back and quitting gave that to me.”
Implications for Sex Therapy : Implications for Sex Therapy
Can’t promise the total control, passion, and predictability of meth sex
Intimate sex is less driven, less powerful, less predicable, and not under the man’s total control
Intimate sex is qualitatively different than meth sex
Implications for Sex Therapy : Implications for Sex Therapy Emphasize pleasure-oriented, touch-oriented, and interactive sex.
Broaden fetish arousal pattern which is dominant and narrow, disconnected from part sex.
Broaden repertoire and shape fantasies which include interactive sexuality.
Implications for Sex Therapy : Implications for Sex Therapy Use cognitive behavioral methods to analyze cognitions, behavior, and feelings in sexual situations and for drug triggers.
Use motivational enhancement to increase sexual and social skills; to avoid using in the face of various triggers.
Best Practices : Best Practices
Best Practices : Best Practices Treatment approaches
Accepting
Non-judgmental
Empowering
Supportive
Understanding
Collaborative
Facilitative
Best Practices : Best Practices Stages of Change
Prochaska and DiClemente
Precontemplation
Contemplation
Determination
Action
Maintenance
Permanent Exit
Best Practices : Best Practices Harm reduction, abstinence, etc.
Positive change often occurs without formal treatment
Treatment can be viewed as facilitating what is a natural process of change
Perceived prognosis influences real outcomes
Best Practices : Best Practices Harmful assumptions
Someone who continues to use is “in denial”
The best way to break through the denial is direct confrontation
People change only when they have to
Best Practices : Best Practices Measures of denial are not clearly related to treatment or outcomes
Patient drug use, compliance, and outcome are powerfully influenced by therapist characteristics and environment
Direct confrontation yields poorer compliance and outcomes
Best Practices : Best Practices Most valuable modalities
Cognitive Behavioral Therapy
Motivational Enhancement
Contingency Management
Best Practices : Best Practices Best prognositic indicator of success
Retention
Best Practices : Best Practices Outpatient treatment for MA abuse
Less expensive than residential or inpatient
Easy to access
Can be combined with job or school
Can be delivered with varying intensities
Is often modified to treat concurrent medical or psychiatric disorders
Best Practices : Best Practices Matrix Model (UCLA/NIDA)
Freese: “provide information, guidance, support and coaching to help alter a chronic behavioral disorder and allow drug related brain modifications to remediate”
Best Practices : Best Practices Phases
Withdrawal Day 1-15
Honeymoon Day 16-45
The Wall Day 46 – 120
Adjustment Day 120-180
Resolution Day 180 +
Best Practices : Best Practices Empirically supported recommendations
Multiple weekly sessions for at least 90-120 days
Front loaded programs step down prior to “the Wall”
Can encompass more than one level of care
Should include strategies to engage and retain patients to avoid premature termination
Best Practices : Best Practices Group settings more effective than individual (Yalom)
3 visits per week minimum recommended
Reduces isolation
Provides interaction with and encouragement from people in similar situation
Provides opportunity to learn (relearn) communication skills
Best Practices : Best Practices Family involvement important
More effective when at least one supportive family member is engaged
12 step facilitation and participation valuable
Combination of CBT groups and self-help support most efficacious
Best Practices : Best Practices Adaptation of CBT
Not thinking clearly
Poor judgment
Poor verbal recall
20-30 minute sessions 3-4 x per week
Emphasis on visuals: handouts, “painting a picture”
Best Practices : Best Practices CBT Goals
Recognize high risk situations
Avoid high risk situations
Cope with problems and behaviors
2 critical components
Functional analysis
Skills training
Best Practices : Best Practices Motivational Interviewing
Increase motivation
Decrease resistance
Increase retention
Better outcomes
Best Practices : Best Practices Four principles of motivational interviewing
Express empathy
Develop discrepancy
Avoid argumentation
Support self-efficacy
Prevention and Community Awareness : Prevention and Community Awareness
Community Awareness : Community Awareness South Florida Methamphetamine Task Group
Therapists
Public health officials
Law enforcement
Educators
Since 2003
Over 1000 front line professionals attended community alert meetings
Prevention : Prevention tweaker.org
Prevention : Prevention
Prevention : Prevention
Prevention : Prevention
Prevention : Prevention
Gay Community Center, NYC
Prevention : Prevention Gay Community Center (NYC)
Prevention : Prevention Crystal Neon
(Seattle)
Contact : Contact David Fawcett, PhD, LCSW
1975 E. Sunrise Blvd, Suite 722
Ft. Lauderdale, FL 33304
954.764.6466
davidfawcett@earthlink.net
www.fortlauderdalecounseling.com