EDUCATORS:

  This entire site is designed for you.  Whether it is human biology, health, or even economics, this information is ready to use in the classroom.

  Drug education or Drug-proofing, as I call it, is required by California state law on a yearly basis,  at the minimum.  If we don't give them the information, their friends will. 

  PLEASE USE AND SHARE THESE POWERPOINTS!

Major Points to Remember
    One time use of methamphetamine can result in addiction.
 

    There is very little “casual use” of methamphetamine. Addiction progresses rapidly with significant adverse results.

    Methamphetamine use over time causes permanent brain changes.
 

    Effects of long-term methamphetamine use can still be evident up to two years after discontinuing the drug.
 

Most methamphetamine users are poly-drug abusers (more than one).

Where is Meth Coming From?
 

  Major suppliers in the West and Southwest are Mexican criminal gangs cooking in superlabs and bringing the product over the border for distribution.

Local gangs and some private cookers are main suppliers in our community.

  Methamphetamine is a money maker for our local gangs and is often used in recruitment of members.

Signs of Possible Meth Use
Poor hygiene, chemical smell, tremors, Bruxism (teeth grinding), acne, scabs or scratches, especially on face and arms, sleeping in class or complaints of being tired, burnt fingertips, lowered grades/academics, attendance issues such as cutting class and truancy (Most policies are 5-6 days undocumented absences or 3 tardies= truancy), verbal expressions of inability to be with other students in class often with a push to move to home school or another alternative setting, drug language and paraphernalia such as pipes, burnt foil, small baggies, symptoms of depression, symptoms of anxiety, flushed look when high and poor color, wearing sunglasses indoors, dilated pupils, darting eyes, weight loss.

Problems Getting Students Into Treatment
Students under the influence of methamphetamine are not thinking clearly and are not motivated for treatment.

Parents who use: “What’s the problem?”

Parents in denial: “What’s the problem?”

Students who have been neglected or abused have trust issues. Students are used to running their own lives with no consistent reasonable limits set by adults.

These kids have trouble giving up control. They often fight moving to a shelter or foster home because of rules and fear of abandonment. Treatment is scary and perceived as loss of control.
 

Only outpatient treatment is available for adolescents who are substance abusers in our county. County Mental Health and New Morning have a 30-day wait for outpatient services.

Placement in group homes outside our county often means no reciprocity for the other county for mental health, medical, or recovery services.
 

Problems Getting Students Into Treatment
Teenage methamphetamine abusers typically enter treatment through the juvenile justice system. They are prosecuted for crimes related to their substance abuse such as possession of drugs and paraphernalia, sales, burglary, and assault.

Treatment is mandated as part of their probation. While incarceration in Juvenile Hall is not ideal, it is one way to insure a methamphetamine abusing child refrains from using meth.
 

Other Treatment Issues
Adolescence is a time of crisis with wide ranges of physical and emotional maturity levels.

Major mental illnesses such as schizophrenia and bipolar disorder often are first seen during adolescence. Meth use symptoms often mimic these disorders.

Shortage of health care providers and facilities designed to treat dual diagnoses in teens, especially in rural areas where meth use is most common.

Methamphetamine addiction requires intervention from a variety of health care providers such as medical, dental, psychiatric, and recovery providers.

Addicts often have legal issues, housing issues, and employment issues and require extensive social services assistance.

Practitioners with middle-class values are often very uncomfortable hearing about the life styles of substance abusing patients.

Many antidepressants are not ruled safe for use in teens. Use of antidepressants in teens associated with some risk for suicide.
 

One Girl’s Diagnoses Over a Two-Year Period:
    Major Depression
    Poly Drug Abuse
    Borderline Personality Disorder
    Conduct Disorder
    Reactive Attachment Disorder
    Anxiety Disorder
    Post Traumatic Stress Disorder
    Bipolar Disorder
    Dysthymic Disorder
    Antisocial Personality Disorder
    Psychotic Episode
    Schizophrenia
    ADHD
    Adjustment Disorder


Meth Can Cause Extreme Disorganization of Behavior
Young women getting into stranger’s cars for a hit of meth.

Prostitution for methamphetamine (whether for money or the drug).

Jumping out of a second story window to avoid talking to a family member.

Hanging around dangerous adults, some who carry weapons or are abusive because these adults will supply the drug.

Criminal behavior to earn money to purchase drugs.

Aggressive behavior. Family members assaulted.

Hallucinations and delusions that are very frightening. (Strangers perceived as FBI agents who are after the meth user. One young man peeked out of his blinds 7 hours straight as he was worried someone was after him.)

Running away from home, sometimes days at a time.
 

Unplanned pregnancy with lack of prenatal care. Continuing meth use during the pregnancy resulted in a positve tox baby.

There is a high risk of domestic violence and child abuse in households where meth is used. Parents who use often expose children to dangerous drugs, dangerous people, and dangerous situations.

Safety Issues
 

Tweakers are never seen at school. Kids who are binging on meth will do so away from school and sleep it off, sometimes for days.
 

Attendance records will show this pattern until the student stops coming to school.
 

A person who is tweaking can be very dangerous. He/she will often be paranoid and delusional.

Set up your office with your safety in mind. Sit closest to the door; bathrooms that lock should have a key to open them from outside. Hard chairs are easier to get out of than soft chairs.
 

Be observant to details.
 

Reduce stimuli any way possible: don’t stand too close, keep light low, lower voice, slow speech, move slowly, keep hands visible.
 

Keep the person talking. Silence may mean the person’s delusions have taken over and the current environment incorporated in the delusion.
 

Back-up help is always welcome!
 

Do not confront!
 

Adverse Childhood Experiences A Study By Vincent J. Felitti, MD and Robert Anda, MD
17,421 patients of Kaiser Permanente’s Department of Preventive Medicine in San Diego.

80% White, 10% Black, 10% Asian, generally in their fifties, middle class.

Detailed biomedical, psychological, and social evaluations done.

The study measured effects of adverse childhood experiences on adult health status a half century after they occurred.

ACE scores ran from 0-8.

Categories of Adverse Childhood Experiences
    Recurrent physical abuse
    Recurrent severe emotional abuse
    Contact sexual abuse
    Household member in prison
    Mother treated violently in household
    Alcoholic or drug abuser in household
    Household member chronically depressed, mentally ill, or suicidal
    Biological parent lost during childhood regardless of cause
 

Results of ACE Study
Adverse childhood experiences are more common than previously believed.

Adverse childhood experiences have a powerful relation to adult health.

Health risk behaviors such as smoking, overeating, and drug use are actually coping mechanisms to deal with ACE.

Slightly more than half experienced one or more categories of ACE.
 

One in four exposed to two categories of ACE.
 

One in sixteen exposed to four categories of ACE.
 

Exposure to one category increases likelihood of exposure to another category by 80%.

Physical diseases such as chronic obstructive pulmonary disease, hepatitis, sexually transmitted disease, tobacco use, and IV drug abuse all showed progressive dose response with every increase in ACE score.
 

Other diseases with a graded response to ACE score were heart disease, fractures, diabetes, obesity, unintended pregnancy, and alcoholism.
 

Depression and suicide attempts had a similar strong relationship to ACE score. A patient with an ACE score of 4 or more was 460% more likely to be depressed and 1,220% more likely to attempt suicide. Between 66% and 80% of all suicide attempts could be attributed to ACE.

22% of Kaiser patients were sexually abused (28% women and 16% men).
A male child with an ACE score of 6 has a 4,600% increase in likelihood to be an IV drug user compared to a male child with an ACE score of 0.
ACE scores above 4 had a 3000%-5,100% increase in attempted suicide over the group with an ACE core of 0.
 

Clinical Implications
It is important to ask questions routinely in intakes to elicit information about possible adverse childhood experiences.
 

Dr. Felitti recommends asking after an ACE is confirmed, “How do you think this experience affects your adult health?”
 

Dr. Felitti reported a 35% reduction in office visits after a biopsychosocial approach adopted at the clinic.
 

Prevention is of Prime Importance
Prevention of ACE is of great importance for optimum adult health.
5 million children a year are exposed to traumatic events.

Neuroarcheology
    Dr. Bruce Perry, M.D., Ph. D, a Fellow of the Child Trauma Academy uses the term “neuroarcheology” to describe how our experiences change our brains.
    His research on trauma and neglect in children demonstrates that the traumas we experience in childhood can permanently limit our ability to react appropriately to our environment.

Dr. Perry states:
“Childhood maltreatment has profound effect on the emotional, behavioral, cognitive, social, and physical functioning of children. Developmental experiences determine the organizational and functional status of the mature brain and, therefore, adverse events can have a tremendous negative impact on the development of the brain. In turn, these neurodevelopmental effects may result in significant cost to the individual, their family, community, and ultimately, society. In essence, childhood maltreatment alters the potential of a child and, thereby, robs us all.”
 

Main Principles of Brain Development
  We each have a set of genes that makes us unique; the full expression of our gene potential is through interaction with the environment.
  A brain develops in sequence and hierarchically from least to most complex (brainstem to limbic to cortex). Rapidly organizing brain systems are more sensitive to insults than slower organizing brain systems.

  The brain organizes in a use-dependent way; undeveloped neural systems are dependent upon environmental and micro-environmental cues to organize.
  There are windows of opportunity and vulnerability in brain development. There are times when a developing neural system is more sensitive to environment than others. The unique demands of the environment create from a broad genetic potential those characteristics that best fit the environment.
 

  “Hot zones” are sensitive periods when an area of the brain is rapidly organizing. The brainstem which controls basic body functions like breathing, must be developed by birth. The hot zone for the brainstem is the prenatal period. The neocortex which controls reasoning, problem-solving, abstraction, and sensory organization develops over a long period of time, from childhood to adulthood.
 

Neglect Affects Children’s Brain
  There is a shifting of the vulnerability of the brain to experience. An infant or child whose brain is more malleable to experience than an adult, is also more vulnerable.
  It is easier to influence the function of a developing brain system than to alter the functioning of a developed system. A baby’s development and ultimate ability to function is much more affected by lack of stimulation than an adult’s ability.   
  Permanent changes in the brain, i.e. lack of neural connections and pathways may permanently limit the child’s ability to develop normally.
 

Trauma Affects Children’s Brain Development
  Just as lack of sensory stimuli can permanently limit a brain’s development, so can traumatic stress such as the adverse childhood experiences in Felitti’s study.
  External threat is met by significant and persistent neurophysiologic systems designed to respond to the threat.
  The longer the activation of a threat response, the more likely a use-dependent change in neural systems will occur.
  It is adaptive for a child growing up in a chronically stressed environment to be hypersensitive to stimuli and hyper vigilant in an environment.
  Neural systems will adapt to this kind of state and literally organize around it.
  While adults with PTSD have cue-specific stimuli relating to a specific traumatic event that set off stress responses, children develop a generalized hypersensitivity to all cues that activate the stress-response.
 

Effects of Trauma on Children’s Behavior
  As Dr. Perry states about children exposed to chronic trauma: “These children are hyper vigilant; they do not have a core abnormality of their capacity to attend to a given task. These children have behavioral impulsivity, and cognitive distortions all of which result from a use-dependent organization of the brain.       During development, these children spent so much time in a low-level state of fear, that they consistently were focusing on non-verbal but not verbal cues.”
 

Recommendations

  Often these kids are not able to operate on a cognitive level. The hyper arousal of the brainstem and limbic system must be addressed.

  The child’s ability to participate in treatment must be assessed. A developmental assessment is most useful.

  Modalities such as dance therapy and a supportive positive environment are most effective initially.
 

The Big Problem
  As mentioned before, there is little casual use with methamphetamine. There comes a time with escalating use when behavior becomes more disorganized and the teenager is at high risk for terrible consequences yet does not qualify for commitment.

How do we keep these kids safe?

Where do we put them?

Who treats them?
 

Works Cited
 

California Healthy Kids Survey Most Recent Performance Indicators, El Dorado high School, 2004-2005.
 

CAPRI* Concerned Advocates for Perinatal Related Issues. Handout from Presentation for the Perinatal Council of El Dorado, EMS Conference Room, Placerville, California. February 17, 2004.
 

Dansie, Roberto. “Anger, Pain, and Healing in the Native American Indian Community.” February 24, 2006 <http://www.robertodansie.com/articles/anger.htm>.
 

Dube, Shanta R. MPH; Felitti, Vincent J. MD; Dong, Maxia, MD, PhD; Chapman, Daniel P., PhD; Giles, Wayne H., MD; Anda, Robert F. , MD. “Childhood Abuse, Neglect, and Household Dysfunction and the Risk of Illicit Drug Use: The Adverse Childhood Experiences Study.” Pediatrics. March 2003.

February 2, 2006 <http://pediatrics.aappublication.org/cgi/content/full/111/3/564>.
 

El Dorado County Meth Awareness and Prevention Project (MAPP). Handout.
 

Felitti, Vincent J. MD. Presentation Given to Healthy Start and After School Program Coordinators. Hilton Hotel. Napa, California. January 26,2006.
 

Felitti, VJ. English Translation of “Belastungen in der Kindheitund Gesundheit im Erwachsenenalter: die Verwandlung von Gold in Blei.” Z Psychom Med Psychother. 2002; 48(4): 359-369.
 

Perry, Bruce MD, PhD. “The Neuroarcheology of Childhood Mistreatment The Neurodevelopmental Costs of Adverse Childhood Events.” July 27, 2000. February 2, 2006 <http://www.ChildTrauma.org/>.
 

Perry, Bruce MD, PhD. Presentation “The Power of Community: How Healthy Communities Create Healthy Children.” Sponsored by Placer County Health and Human Services, California State Department of Health Services, and First Five Commission of Placer County. Sierra Bible Church. Sonora, California. March 31, 2005.
 

Perry, Bruce MD, PhD. Presentation “Working with Children Exposed to Trauma and Violence.” Sponsored by The Perinatal Multidisciplinary Team of Tuolumne County, The Tuolumne County YES Partnership, with support from the California Attorney General’s Office-Safe from the Start Initiative. Sierra Bible Church. Sonora, California. September 1, 2004.
 

Copyright 2006   Dr. Mitchell A. Goodis, DDS