VOF Professional2005

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Published on April 16, 2008

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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

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