Effective Community – Based Treatment for Methamphetamine Addiction

Communities

The topic of this book is treatment of methamphetamine addiction, and more specifically, what families and communities can do to be an important part of the treatment process. The obvious answer to how families and communities can help people addicted to methamphetamine would probably entail support. However, the concept of support simply for the sake of supporting is actually quite risky. When it comes to methamphetamine addiction, often users become quite adept at taking advantage of other people around them, especially those who unconditionally support them with no accountability. Deception and manipulation often become paramount, and the loved one or the concerned community member showing them support often has feelings of his or her being used and perhaps even preyed upon. Take the example of Janice:

Janice was 29 and was a master at getting what she wanted out of other people, which was that they help her to get meth, to use it, to take on her responsibilities, or help her avoid the negative consequences because of her methamphetamine use. More than once, her parents had lied to the police about her whereabouts and her activities because she had them convinced that the police only wanted to catch her doing something wrong, since they had been paid off by her ex-husband who was trying to frame her and get sole custody of their children. She had also convinced the pastor from her church to give her housing assistance in the form of cash as opposed to a check made out to the landlord, by saying that her landlord was an immigrant and did not have a way of cashing a check. She was eventually evicted out of her apartment for nonpayment of rent. She used the money she had received from the pastor to buy drugs.

The principles and strategies discussed in this book are for community and family members to become productively involved in the treatment process of those addicted to methamphetamine. They go far beyond the simple idea of support and are designed to provide a systematic way to think about methamphetamine addiction; to consider the change needed if they are going to stop; and most important of all, to be actively involved in the treatment with other people and agencies from the community to help bring about the most promising outcome centered on recovery and long-term sobriety.

A brief discussion regarding the effect that methamphetamine has on users’ relationships with their sober community is warranted at this point. While addiction to methamphetamine may develop quickly, especially when compared to other substances of abuse, the alienation of methamphetamine users from their sober communities is not something that develops simply overnight. Often people who start using methamphetamine are not, or were not, always the most stellar members of the community. In most communities, people addicted to methamphetamine tend to be poor Caucasian adults who have worked primarily in blue-collar jobs. They may have had addiction problems before methamphetamine use, including addiction to alcohol. Before using meth, they may have already developed legal problems, such as underage drinking or being a minor in possession of marijuana. As was previously mentioned, methamphetamine not only creates almost orgasmic sensations of pleasure but also fabricates a community of close users who are often enmeshed. Needless to say, then, that people who are addicted to methamphetamine are a tight-knit community. Many in their community were never very meaningfully integrated into their sober community because of their own attitudes, actions, and choices.

From the sober community, many people see very little reason to try to rehabilitate meth-using people let alone try to integrate them into a community that they may have already rejected. Furthermore, since becoming methamphetamine addicts, individuals have unlikely been law abiding and more likely been lying, manipulating, stealing, and basically taking advantage of anyone in their path to get meth, use it, and not get caught. Their crimes and misdeeds certainly have not been without negative effects on many innocent people. Users selfishly put their addiction above all else in their life. From this perspective, it seems obvious that the best treatment approach for people addicted to methamphetamine is long-term incarceration.

The lay understanding of methamphetamine addiction is primarily through the media. This understanding is that once people are addicted to meth, they can never stop using it and very few of them are ever able to get into treatment. Even those who do go to treatment are so severely changed that treatment seldom works. So it would appear that there is a population of people addicted to meth, who are likely to continue in their path of addiction with all of the antisocial and criminal acts that go along with it. There is little that can be done to help them.

The idea that treatment for methamphetamine addiction is not possible is really incorrect. Although research does support that it may take more than one treatment attempt before individuals are able to be successful. Nonetheless, if the general opinion is that people addicted to methamphetamine are drug-using and criminally minded monsters who prey on innocent members of their community, then the idea that this book proposes, that treatment should be community based, is quite hopeless. It is hopeless because the sober community would just as soon have the meth-using people be gone permanently. In some communities, this approach is known as “greyhound therapy” or “geographical therapy,” which means that in some cases the best approach is to try everything to help meth-using individuals to decide, that they need to leave the community and never return. This can be done by convincing them to relocate, sending them away involuntarily, such as incarceration, or simply by buying them a one-way bus ticket so that they just keep moving through town without stopping or staying in the community. For example,

Jack worked as an on-call mental health technician employed by the local community mental health center. His responsibility was to respond to mental health emergencies involving members of his community as well as people who may just be visiting or passing through the community. The town where Jack lived was right off of a major freeway and many transient people, who were “just passing through,” would often stop in the town if they had run out of resources. A big reason why many transient people would stay was that the town had the unfortunate reputation of being an easy place to get methamphetamine. This meant that Jack was often called to respond to what appeared to be mental health emergencies involving transient visitors who seemed to be in acute states of psychiatric illnesses. Many times Jack would find out that the person did not have a serious mental illness but was under the influence of methamphetamine. Unable to arrange for psychiatric care to be provided to people under the influence of drugs, Jack’s only option was to hope that they would just “move on down the line.” That meant that sometimes, once a meth-using patient was determined not to be a risk to self or others, Jack helped them purchase a bus ticket to travel to whatever destination the person may have described for themselves.

Before visiting whether these options work, it would be helpful to consider if members of a community would feel different if a meth-using person was a member of their family. Most likely if that were the case, then the sober family members may be tired of the using and abuse they have had to put up with because of their loved one’s addiction to methamphetamine. They may even be at a point that they are ready to give up entirely on their loved one and to wash their hands completely of them and their addiction. However, it is more likely that while the family members may still be very tired of the addiction and the things their loved one does while addicted to meth, they are not ever entirely ready to wash their hands completely of their loved one, especially if there is a small glimmer of hope.

In some cases, the family, including members of the extended family of the addicted person, may have been methamphetamine users, alcoholics, or other drug users themselves. Chronic methamphetamine use has become a part of mainstream American culture, especially in rural midwestern and western communities. There are many cases of transgenerational methamphetamine use, meaning that the addiction to methamphetamine is something that is handed down, parent to child. In site, this was the case of Sasha’s best friend and fellow methamphetamine user, Kimberly. Kimberly’s name has been changed, but her story is the actual experience of a young woman who started to use methamphetamine because her mother and all of her mother’s friends were methamphetamine addicts.

Kimberly was the oldest of four children and was essentially burdened with entire responsibility of raising her younger siblings alone from the time she was about eight years old. It started off as simply an unwritten expectation that part of Kimberly’s responsibilities in her home were to watch after her younger brother and sisters. This was especially during the time that her mom was either sleeping or using methamphetamine in a back bedroom of their small trailer/mobile home, or completely gone from the residence for days at a time. Later, it became a direct mandate from her mother that Kimberly was to take care of the children. Her mother made it clear that if her siblings were found misbehaving, then the siblings and Kimberly were punished. Kimberly’s punishment was often more severe, since it was expected that she should have prevented the incident from occurring in the first place. After all, she was the oldest and the one her mother had made responsible for the care of the other children. Her punishment was always abusive, mostly verbal, although frequently physical as well.

At the age of 13, Kimberly started using methamphetamine. She was introduced to it by a male “friend” of her mother’s who actually was a small-time dealer. It was never established whether or not Kimberly’s mother had traded methamphetamine for her permission for this 18-year-old man to rape Kimberly. Nonetheless, that is what had happened, from Kimberly’s account of things. After forced sex with the young man became more frequent, Kimberly learned that if she agreed to use methamphetamine with him before having sex, it made the experience not only more tolerable but even, occasionally, somewhat enjoyable. However, what Kimberly noticed more was that when she would use methamphetamine with him, after having sex and he would leave, she would have what seemed to be almost unlimited energy. She could use this energy to clean up the house, take care of her younger brother and sisters and then be able to go to school and pretend to her friends that she came from a functional and non-drug-using home. Her mother was always very pleased with Kimberly after she used meth, because of the chores Kim was able to get done around their home and because her mother was usually given a fresh supply of methamphetamine from the young man who was having sex with Kimberly. Inappropriate as it may sound, her mother’s approval was all that really mattered to Kimberly. When she got it, she felt like she was on top of the world. So, Kimberly’s addiction to meth, starting when she was 13 years old, was interwoven with so many of her core psychological processes, including pleasure gaining, energy maintaining, and approval seeking.

At age 15, Kimberly was already a full-fledged methamphetamine addict who was quickly becoming less and less concerned about the care of her younger siblings and angry with her mother. She had also become more interested in Sasha and her other friends, including much older men, with whom she would use methamphetamine.

In Kimberly’s case, it really was not safe to assume that there was a sober home that she had actively rejected to seek after methamphetamine and the meth-using community. In fact, it was Kimberly’s home and her mother’s addiction to methamphetamine that was primarily responsible for her addiction. The “loved ones” who really cared about Kim and the possibility of her getting off of methamphetamine and getting meaningfully integrated into a sober community were not her immediate family members. With the possible exception of an out-of-state aunt whom she barely knew, there really was not anyone from Kimberly’s family who could be considered a healthy representative of a sober community with which she could become meaningfully integrated. Instead, the sober community that worked with her was made up of the many child welfare workers, foster parents, treatment providers, teachers, law enforcement officers, school counselors, and others who knew about her situation at home and the bad decisions she was making. Because she had been so responsible in caring for her younger siblings for so long, many of these people knew her, liked her, and saw her use of methamphetamine as an anomaly in her character and as something they were invested in helping her discontinue.

The First Step

Community Defined

It is important to note that the term “community” is being used in its broadest sense. A community can be friends, professionals, family, neighbors, employers, and caring individuals. The definition of a community that is being used in this book is “a social group of any size with a shared purpose and investment in a common good.” Communities are started by connection, which can be geographical, such as when two people live next door to one another. Connection also can be relational, such as when people are meaningfully connected because they belong to the same family or because they are coworkers. The community can be as broad as an entire town, city, or county. It also can be as narrow as the dyad relationship between siblings. Inclusion in the methamphetamine community is really determined by two simple criteria: shared use of methamphetamine and agreement not to tell anybody about it. That is it. All other connections within meth-using circles are really appendages to these two shared criteria (values). For example, take the story of Robbie:

Robbie became a methamphetamine addict so quickly it was a shock to his family and other people who knew him. During high school, he had always been a quiet young man who was more interested in playing online fantasy role-playing games than he was in doing his school work. He was smart enough to at least pass his classes, and he graduated from high school as something of a cipher. Robbie started working at a late night fast-food restaurant after high school, and there he met the first girl to ever show much interest in him. She seemed energetic and fun and not at all shy and awkward like Robbie felt most of the time. His first sexual experience happened with her late one night after the restaurant had closed, and that was when he was also first introduced to methamphetamine. Robbie was more than willing to use methamphetamine with his new girlfriend and her mefh-using friends. This is because not only did it take him out of a shell he felt had held him trapped for most of his life, but it also gave him instant friends. All he had to do to keep his newfound friends was not tell anybody what they were doing.

What Is Effective Treatment?

Effective treatment is not just an important part of interventions attempted by community members for people they know, such as family members or friends. Effective treatment is also critically important to general community responses to the issues of methamphetamine abuse because it lies directly at the foundation of these efforts. Effective treatment means treatment that works, creates, or helps addicted people produce actual, lasting changes in their drug-using behaviors. Perhaps the only thing more important to community responses to methamphetamine than effective treatment for methamphetamine addiction is prevention. Prevention, or keeping people from trying methamphetamine in the first place, is critical in turning the tide of increasing numbers of people addicted to methamphetamine. However, unless starting out new before a problem has grown into anything significant, prevention does very little about existing cases. To handle those currently addicted to meth, communities must have effective treatment. If effective treatment is not in place, then it becomes very difficult for people to maintain momentum and avoid feelings of hopelessness when they see people they care about continue to use methamphetamine. For these reasons, effective treatment must be at the foundation of community responses to methamphetamine addiction.

The issue becomes how to distinguish effective and less effective treatment approaches. These distinctions are made through outcome research. For a particular model to be researched, the model under investigation must be rigidly specific; otherwise, it cannot be concluded that the exact model has affected the change. For research, treatment models to be investigated need to have very specific programmatic guidelines, which are often manualized. Difficulties arise, however, in the application of these very specific models into “real community” settings. Staff limitations, service restrictions, and funding often prevent the “full” implementation of these evidence-based treatment models. This situation introduces the concept of fidelity. Programs that cannot apply the model in full, and only partially implement it, are awarded various levels of fidelity based on their exact use of the model. The problem with this is that there is no evidence supporting the partial use of the model. Therefore, evidence-based models that have been proved effective are seldom implemented in full fidelity. Instead, programs relying on partial models that have no evidence supporting their use are implemented.

The solution to this situation begins at the level of program development. Rather than designing and then researching very specific programmatic guidelines, program staff can carefully define and develop parameters for effective treatment. They can test those parameters. Program staff can research parameters with the same degree of scrutiny as a specific program. Then, they can assure communities at implementation that all of the evidence supporting the parameters applies to their specific, individualized community response to methamphetamine addiction. They can make this assurance as long as the community designs a response within the parameters. The following are descriptions of these parameters.

Parameters For Treatment

Theory And Practice

Case Management

Focus On Outpatient Success

Treatment Versus Counseling

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