A Healing Family. Reunited after both parents—Kirsten (far left) and John (far right)—recovered from methamphetamine abuse, the entire Smyrni family traveled to the recent conference in Washington, DC, to tell their story of healing and hope. The Smyrni children include (l to r) Lee, Zane, little Alex, Sophia, Quinn, and Nicki.

Methamphetamine Jeopardizes Children's Welfare

By Rebecca A. Clay

When Kirsten Smyrni first started using methamphetamine, it seemed like a wonder drug. The burst of productivity the drug provided helped her get more done in her roles as a chef and as the mother of five children. But that new power quickly proved illusory. By the time she hit bottom, she had lost her children, job, and home.

"This is a family disease," explained Ms. Smyrni, who was reunited with her children after she and her husband underwent substance abuse treatment. "People—and that includes my children—can count on me today."

According to SAMHSA's National Survey on Drug Use and Health, 1.4 million Americans age 12 and older in 2004 had used methamphetamine in the past year. But those methamphetamine users aren't just putting themselves at risk for physical and psychological problems like memory loss, psychosis, tremors, and hallucinations. If they're parents, they're also putting their children at risk of neglect and abuse.

Ensuring the safety of those children has become a priority for SAMHSA.

SAMHSA's Center for Substance Abuse Treatment (CSAT), along with the Administration for Children, Youth, and Families' Children's Bureau, funds the National Center on Substance Abuse and Child Welfare (NCSACW). And in May, the two agencies cosponsored a conference—"Methamphetamine: The Child Welfare Impact and Response"—that brought together representatives from the treatment, child welfare, and law enforcement fields as well as Ms. Smyrni and her family and others directly affected by methamphetamine.

"We acknowledge the impact this drug has on our families, specifically the long-term effects it has on our children," said CSAT Director H. Westley Clark, M.D., J.D., M.P.H. "We at SAMHSA have been closely monitoring and responding to the growing impact methamphetamine is having in our communities."

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Endangering Children

Like other kinds of substance abuse, methamphetamine use by parents puts children at risk.

Dr. Nancy K. Young, of the SAMHSA-funded National Center on Substance Abuse and Child Welfare, and Dr. H. Westley Clark, Director of SAMHSA's Center for Substance Abuse Treatment, presented recent data.

Prenatal exposure to methamphetamine can result in premature birth, birth defects, and low birth weight in the short term and learning disabilities, developmental disorders, and cognitive deficits in the long term, said Dr. Young.

Parents under the influence of methamphetamine are also likely to parent poorly, said Dr. Young, noting that methamphetamine use can result in poor judgment, confusion, irritability, and paranoia. Risks to children's health and well-being include inadequate supervision, inconsistent parenting, chaotic home lives, households without basics like food or utilities, lack of medical care, and abuse.

"Chronic neglect is what brings most kids to the attention of the child welfare system," explained Dr. Young.

Parents who manufacture methamphetamine create additional risks for their children. Even "cooking" small quantities of the drug can expose children to dangerous chemicals, toxic fumes, and fires and explosions, explained Dr. Young, noting that children's higher metabolic rates and developing bodies put them at higher risk than adults.

According to the U.S. Department of Justice National Drug Intelligence Center, there were 2,028 known cases of children present at seized methamphetamine laboratory sites in 2001. Of those, approximately 35 percent of the children tested positive for toxic levels of chemicals in their bodies.

If parents are selling methamphetamine, said Dr. Young, add the presence of weapons, the possibility of violence, the presence of strangers in the household, and the threat of incarceration to the list of dangers.

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Working Together

According to Cheryl J. Gallagher, a CSAT public health advisor, and Sharon Amatetti, a CSAT senior public health analyst, SAMHSA has had success treating parents with methamphetamine problems and reunifying them with their children.

Like the Smyrnis, parents who use methamphetamine can lose their children to foster care or even permanent adoption.

Fortunately, treatment for methamphetamine abuse works.

"We're having good success treating people with methamphetamine problems, and children are being reunified with parents as a result," said Cheryl J. Gallagher, M.A., a public health advisor at CSAT.

A treatment approach known as the Matrix Model—which relies on intensive cognitive behavioral therapy, family education, counseling, social support groups, and drug testing in outpatient settings—seems to work especially well.

A CSAT-funded study of nearly 1,000 methamphetamine users from 1999 to 2001—the largest randomized clinical trial of treatment for methamphetamine dependence—found that patients undergoing Matrix treatment attended more sessions, stayed in treatment longer, and had more drug-free urine samples during treatment than clients in the "treatment as usual" study group.

That "larger dose of treatment" is especially important for methamphetamine users, explained Ms. Gallagher, because the damage caused by methamphetamine takes longer to heal than that caused by other drugs.

But for parents to get the treatment they need, the substance abuse, child welfare, and law enforcement communities all need to work together. And that hasn't always happened. Law enforcement personnel, for example, may not be aware just how effective treatment is.

"Many don't think methamphetamine users can get well," said Ms. Gallagher. "But we're having exactly the same kind of results—59- to 69-percent success rates—with methamphetamine users going through treatment and getting into recovery as we do with other drugs."

Collaboration has become especially important since the Adoption and Safe Families Act of 1997, said Sharon Amatetti, M.P.H., a senior public health analyst at CSAT. The law speeds up the timeline for making decisions about whether children should be reunified with their parents or be put in permanent foster care or adoption, making it imperative to get parents into treatment as quickly as possible.

NCSACW aims to educate each field about the others. "There's still a lot of stigma about addiction and myths about the effectiveness of treatment, and child welfare workers sometimes feel it's hopeless," said Ms. Amatetti. "Through communication and collaboration, the child welfare field learns that's not necessarily true." Similarly, those in the treatment field need to know about the child welfare system and the pressures and rules child welfare workers face. Law enforcement and court personnel need to learn about both fields.

The center's resources and technical assistance can help. One free online curriculum teaches child welfare workers about addiction and treatment, for instance, and another teaches addiction professionals about child welfare. "To date, more than 5,000 people have completed these online trainings," said Ms. Amatetti.

For more information, visit the NCSACW Web site at www.ncsacw.samhsa.gov. The site includes a list of methamphetamine-related resources at www.ncsacw.samhsa.gov/MethamphetamineList.htm. 

Note: Photos by Meredith Hogan Pond for SAMHSA News.

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