Nancy K. Young, Ph.D., Director

1
Methamphetamine Use and the Impact on Child
Welfare
Nancy K. Young, Ph.D., Director National Center
on Substance Abuse and Child Welfare Jay
Wurscher, Director Oregon Child Welfare Addiction
Services Presented at CWLA Methamphetamine
Teleconference September 22, 2005
2
Overview, Treatment and Risks to Children
3
Overview, Treatment and Risks to Children

• 1. NCSACW
• 2. Scope of the Problem
• 3. Patterns of Use
• 4. Effects of Meth Addiction
• 5. Risks to Children
• 6. Treatment for Meth

4

• A Program of the
• Substance Abuse and Mental Health
• Services Administration
• Center for Substance Abuse Treatment
• and the
• Administration on Children, Youth and Families
• Childrens Bureau
• Office on Child Abuse and Neglect

5
NCSACW Mission

• To improve outcomes for families by promoting
  effective practice, and organizational and system
  changes at the local, state, and national levels
• Developing and implementing a comprehensive
  program of information gathering and
  dissemination
• Providing technical assistance

6
NCSACW Consortium

• American Public Human Services Association
  (APHSA)
• Child Welfare League of America (CWLA)
• National Association of State Alcohol and Drug
  Abuse Directors (NASADAD)
• National Council of Juvenile and Family Court
  Judges (NCJFCJ)
• National Indian Child Welfare Association (NICWA)

7
Recent NCSACW Products

• Understanding Substance Abuse and Facilitating
  Recovery A Guide for Child Welfare Workers
• (A short monograph for front-line workers)
• On-Line Training Now Available
• Understanding Child Welfare and the Dependency
  Court A Guide for Substance Abuse Treatment
  Professionals
• Understanding Substance Use Disorders, Treatment
  and Family Recovery A Guide for Child Welfare
  Professionals

8
Scope of the Problem
9
Scope of the Problem

• Meth use has increased
• Use has spread from the West
• Accounts for a small percentage of the total
  number of people affected by drug and alcohol
  problems
• The impact of meth use on child welfare varies
  widely among States and among Counties

10
Meth/Amphetamine Treatment Admission Rate Per
100,000 Population Aged 12 or Older - 1993-2003
Source Treatment Episode Data Set (TEDS)
11
Eastward Spread of Methamphetamine
Admissions per 100,000 population
12
Eastward Spread of Methamphetamine
Admissions per 100,000 population
13
Treatment Admissions by Primary Substance - 2003

• Alcohol 42
• Heroin/Other Opiates 18
• Marijuana 15
• Cocaine 14
• Meth/Amphetamine and 7
• Other Stimulants

Source Treatment Episode Data Set (TEDS)
14
Impact of Increasing Methamphetamine Use

• Methamphetamine is affecting communities that
  have not experienced prior stimulant drug
  problems
• Child welfare agencies are dealing with more
  cases involving methamphetamine

15
Smoked Cocaine/Crack and Meth/Amphetamine
Treatment Admissions by Race/Ethnicity
Source Treatment Episode Data Set (TEDS)
16
Meth/Amphetamine Cocaine Treatment Admissions
According to Census Division 2003
RATE per 100,000
Rate per 100,000
Source Treatment Episode Data Set (TEDS)
17
Gender Differences

• 47 of admissions are women
• Since women are often caretakers of children,
  more children are likely affected.

Source Vaughn, C. (2003)
18
Treatment Admissions Meth/Amphetamine as Primary
Substance by Gender
Source Treatment Episode Data Set (TEDS)
19
Meth/Amphetamine Admissions By Gender - 2003
Source Treatment Episode Data Set (TEDS)
20
Female Treatment Admissions States with Highest
of Meth/Amphetamine as Primary Substance
Source Treatment Episode Data Set (TEDS)
21
Trends in Primary Substance UseTreatment
Admissions for Pregnant Females by Primary
Substance 1995-2003
Percent of Womens Admissions for
Meth/Amphetamine and Marijuana Nearly Doubled
over 8 Years
Source Treatment Episode Data Set (TEDS)
22
Foster Care Population and Persons Who First Used
Crack or Methamphetamine in Prior Year
23
Effects of Methamphetamine Addiction
24
Short-Term Effects of Methamphetamine

• PHYSICAL
• Heart rate
• Respiration
• Blood pressure
• Pupil size
• Sensory acuity
• Energy
• Appetite
• Sleep
• Reaction time

• PSYCHOLOGICAL
• Confidence
• Alertness
• Mood
• Sex drive
• Energy
• Talkativeness
• Boredom
• Loneliness
• Timidity

Source Judith Cohen, Ph.D., Presentation to
NASADAD, June 2005
25
Methamphetamine Chronic Physical Effects

• Tremors
• Weakness
• Headaches
• Sweating
• Coughing

• Dry Mouth
• Oily skin/complextion
• Burned lips/sore nose
• Dental
• Weight Loss/Anorexia

26
MethamphetamineChronic Psychological Effects

• - Confusion -
  Irritability
• - Concentration - Paranoia
• - Hallucinations - Panic
  reactions
• - Fatigue -
  Depression
• - Memory loss - Anger
• - Insomnia - Psychosis

Source Richard Rawson, Ph.D., Presentation to
SAMHSA, August 2005
27
Cognitive Effects

• Decreased ability to
• Recognize and recall words and pictures
• Make inferences
• Manipulate information
• Ignore irrelevant information
• Learn from experience
• Users and people in early recovery may find it
  difficult to
• Pay attention
• Comprehend spoken and written information
• Remember information

Source Simon (1999)
28
Cognitive Effects

• Abilities that improve after 12 weeks abstinence
• Manipulate information
• Ignore irrelevant information

• Abilities that do note improve after 12 weeks
  abstinence
• Recognize and recall words
• Recognize and recall pictures (declines less than
  word recognition and recall)

Source Obert et al. (2002)
29
Cognitive Effects

• Rate of recovery is associated with severity of
  abuse and days of abstinence.
• Study documented significant recovery with Meth
  abusers who were able to stay drug free for at
  least 9 months.
• After 4 years of abstinence, no deficits in
• Memory
• Learning
• Attention
• Executive function
• Motor function

Sources Lundahl et al. (2004) Volkow et al.
(2001)
30
Risks to Children When Parents Use Meth
31
Six Different Situations for Children

• Parent uses or abuses methamphetamine
• Parent is dependent on methamphetamine
• Mother uses meth while pregnant
• Parent cooks small quantities of meth
• Parent involved in trafficking
• Parent involved in super lab

Source Nancy Young, Ph.D., Testimony before the
U.S. House of Representatives Government Reform
Subcommittee on Criminal Justice, Drug Policy,
and Human Resources, July 26, 2005
32
Six Different Situations for Children

• Each situation poses different risks and requires
  different responses
• Child welfare workers need to know the different
  responses required
• The greatest number of children are exposed
  through a parent who uses or is dependent on the
  drug
• Relatively few parents cook the drug

Source Nancy Young, Ph.D., Testimony before the
U.S. House of Representatives Government Reform
Subcommittee on Criminal Justice, Drug Policy,
and Human Resources, July 26, 2005
33
Parent Uses or Abuses Meth

• Risks to safety and well-being of children
• Parental behavior under the influence poor
  judgment, confusion, irritability, paranoia,
  violence
• Inadequate supervision
• Inconsistent parenting
• Chaotic home life
• Exposure to second-hand smoke
• Accidental ingestion of drug
• Possibility of abuse
• HIV exposure from needle use by parent

Source Nancy Young, Ph.D., Testimony before the
U.S. House of Representatives Government Reform
Subcommittee on Criminal Justice, Drug Policy,
and Human Resources, July 26, 2005
34
Parent Is Dependent on Meth

• Risks to safety and well-being of children
• All the risks of parents who use or abuse, but
  the child may be exposed more often and for
  longer periods
• Chronic neglect is more likely
• Household may lack food, water, utilities
• Chaotic home life
• Children may lack medical care, dental care,
  immunizations
• Greater risk of abuse
• Greater risk of sexual abuse if parent has
  multiple partners

Source Nancy Young, Ph.D., Testimony before the
U.S. House of Representatives Government Reform
Subcommittee on Criminal Justice, Drug Policy,
and Human Resources, July 26, 2005
35
Mother Uses Meth While Pregnant

• Risk to child depends on frequency and intensity
  of use, and the stage of pregnancy
• Risks include birth defects, growth retardation,
  premature birth, low birth weight, brain lesions
• Problems at birth may include difficulty sucking
  and swallowing, hypersensitivity to touch,
  excessive muscle tension (hypertonia)
• Long term risks may include developmental
  disorders, cognitive deficits, learning
  disabilities, poor social adjustment, language
  deficits

Sources Anglin et al. (2000) Oro Dixon,
(1987) Rawson Anglin (1999) Dixon Bejar
(1989) Smith et al. (2003) Shah (2002)
36
Mother Uses Meth While Pregnant

• Observed effects may be due to other substances,
  or combination of substances, used by the mother
• For example, if the mother also smokes, growth
  retardation may be significant
• Observed effects may be complicated by other
  conditions, such as the health, environmental, or
  nutritional status of the mother

Source Nancy Young, Ph.D., Testimony before the
U.S. House of Representatives Government Reform
Subcommittee on Criminal Justice, Drug Policy,
and Human Resources, July 26, 2005
37
Mother Uses While Pregnant

• Scope of the problem
• An estimated 10 to 11 of all newborns are
  prenatally exposed to drugs or alcohol this
  amounts to 400,000 to 480,000 newborns per year
• Only about 5 of prenatally exposed newborns are
  placed in out-of-home care the rest go home
  without assessment and services

Sources Vega SAMHSA, OAS, National Survey of
Alcohol and Drug Use During Pregnancy, 2002 and
2003
38
Mother Uses While Pregnant
Home environment is the critical factor in the
childs outcome Consequences can be mediated
Shah, R. (2005, June). From NASADAD presentation
39
Parent Cooks Small Quantities of Meth

• All the risks of parents who use or are dependent
  on meth, with added risks of manufacturing the
  drug
• Chemical exposure
• Toxic fumes
• Risk of fire and explosion

Source Nancy Young, Ph.D., Testimony before the
U.S. House of Representatives Government Reform
Subcommittee on Criminal Justice, Drug Policy,
and Human Resources, July 26, 2005
40
Environmental Methamphetamine Exposure and Risks

• Toxic effects of manufacturing
• Children more at risk
• Higher metabolic rates
• Developing bone and nervous systems
• Thinner skin than adults which absorbs chemicals
  faster
• Children tend to put things in their mouth and
  use touch to explore

Source Mason (2004)
41
Parent Involved in Trafficking

• Presence of weapons
• Possibility of violence
• Possibility of physical or sexual abuse by
  persons visiting the household

Source Nancy Young, Ph.D., Testimony before the
U.S. House of Representatives Government Reform
Subcommittee on Criminal Justice, Drug Policy,
and Human Resources, July 26, 2005
42
Parent Involved in Super Lab

• Lower likelihood of children on the site

Source Nancy Young, Ph.D., Testimony before the
U.S. House of Representatives Government Reform
Subcommittee on Criminal Justice, Drug Policy,
and Human Resources, July 26, 2005
43
Number of Children in Meth Labs
4 years 2,881 all children 1,200,000
Source El Paso Intelligence Center
44
Medical Interventions for Children

• Field medical assessment
• Immediate care protocol
• Baseline assessment protocol
• Initial follow-up care protocol
• Long-term follow-up care protocol

Source Colorado DEC
45
Treatment for Methamphetamine
46
CSATs Methamphetamine Treatment Project

• Largest randomized clinical trial of treatment
  for meth dependence
• Compared the MATRIX manualized treatment model
  developed at UCLA to treatment as usual
• 8 study sites site in HI was all women

47
Matrix Model

• Intensive outpatient setting
• Three to five visits per week of comprehensive
  counseling for at least the first three months
• Cognitive behavioral approach
• Contingency management

48
Urinalysis Results

• Results of UA tests at discharge, 6 months
• and 12 months post admission
• Matrix Group TAU Group
• D/C 66 MA-free 65 MA-free
• 6 mo 69 MA-free 67 MA-free
• 12 mo 59 MA-free 55 MA-free
• Over 80 follow-up rate in both groups at all
  points

Source Richard Rawson, Ph.D., Presentation to
SAMHSA, August 2005
49
Similar Outcomes

• Treatment outcomes do not differ from other drugs
  of abuse
• Treatment outcomes have more to do with the
  quantity and quality of treatment than type of
  drug abused

50
Treatment Outcomes for Women

• Of 10 MA-abusing women entering treatment

After treatment 1mo.
12mo. 24mo.
48mo.
Still MA-abstinent 6
4 3
3
3 still MA-abstinent 48 months after treatment
Source M.L. Brecht, Ph.D. (2004)
51
Gender Differences and Implications for Treatment

• Co-occurring mental health problems
• Trauma
• Body image

52
Behavior Symptom Inventory (BSI) Scores at
Baseline
Richard Rawson, Ph.D., Presentation to SAMHSA,
August 2005
53
Beck Depression Inventory (BDI) Scores at
Baseline
Richard Rawson, Ph.D., Presentation to SAMHSA,
August 2005
54
Self-Reported Reasons for Starting
Methamphetamine Use
Richard Rawson, Ph.D., Presentation to SAMHSA,
August 2005
55
Gender Differences and Implications for Treatment

• Co-occurring mental health issues complicate
  treatment and require longer duration for
  treatment
• Violence linked to meth use is related to trauma
  and safety needs which must be addressed in
  treatment
• Body image and nutrition need to be addressed

56
Gender Differences and Implications for
Treatment

• Threats of violence and reduced cognitive
  capacity to manage activities of daily living
  suggest that a period of residential treatment
  will most often be indicated for women with
  serious addiction to methamphetamine
• When residential care is not available, IOT may
  be indicated, with additional supports such as
  transportation, meals, child care, referral to
  safe houses or supervised housing

57
What Predicts Longer Abstinence?

• Longer abstinence following treatment for women
  with
• Longer time in treatment (e.g. those with 4 or
  more mo. of treatment have more than double the
  rate of 24-48 mo. abstinence)
• More sessions per month of individual counseling
  (or sexual recovery groups)
• Treatment, intervention and case planning need to
  account for short-term effects, especially
  cognitive deficits and verbal communication
• Drug Court involvement
• Family involvement

M.L. Brecht, Ph.D., et al. (2005)
58
Sacramento, California Model of Effective Child
Welfare and Substance Abuse Services

• Comprehensive trainingto understand substance
  abuse and dependence and acquire skills to
  intervene with parents
• Early Intervention SpecialistsSocial workers
  trained in motivational enhancement therapy are
  stationed at the family court to intervene and
  conduct preliminary assessments with ALL parents
  with substance abuse allegations at the first
  court hearing
• Improvements in Cross-System Information
  Systemsto ensure that communication across
  systems and methods to monitor outcomes are in
  place as well as management of the countys
  treatment capacity

59
Sacramento, California Model of Effective Child
Welfare and Substance Abuse Services

• Prioritization of Families in Child Protective
  ServicesCounty-wide policy to ensure priority
  access to substance abuse treatment services
• Specialized Treatment and Recovery Services
  (STARS)provides immediate access to substance
  abuse assessment and engagement strategies
  conducted by staff trained in motivational
  enhancement therapy. STARS provides intensive
  management of the recovery aspect of the child
  welfare case plan and routine monitoring and
  feedback to CPS and the court
• Dependency Drug Courtprovides more frequent
  court appearances for ALL parents with
  allegations of substance use.

60
Treatment Discharge Status by Primary Drug
Problem
61
18-Month Child Placement Outcomesby Parent
Primary Drug Problem
62
Methamphetamine Implications for Workers
63
MethamphetamineImplications for Workers

• Signs of Use and Warning Signs for Workers
• Oregons Response

64
Signs of Use and Warning Signs for Workers
65
Signs of Methamphetamine Use and Use of Other
Stimulants

• Euphoria
• Grinding of teeth
• Rapid breathing
• Sweating
• Hyperactivity
• Tremor - shaking hands
• Rapid or pressured speech
• Depression - when drug wears off
• Irritability, paranoia, suspiciousness
• Hallucinations
• Presence of drug paraphernalia

Source Crowell Webber (2001)
66
Warning Signs for Workers

• Client is extremely irritable, suspicious, or
  argumentative, or there is an escalation of
  irritability
• Regular client does not appear to know who worker
  is
• Evidence of paranoid thinking, delusions
• Client verbalizes implicit or explicit threat
  against worker

Source Crowell and Webber (2001)
67
Other Severe Signs of Meth Use

• Scratch marks or scabs, particularly on clients
  hands and arms - may be evidence of tactile
  hallucinations and indicate a prior episode of
  stimulant psychosis
• Severe damage to teeth and gums
• Drawn face and underweight
• Strong chemical odor - may indicate manufacturing
  of meth

Source Crowell and Webber (2001)
68
Natural Rewards Elevate Dopamine Levels
69
Effects of Drugs on Dopamine Levels
Source Di Chiara and Imperato
70
Denial Super-memory Imprinting

• Memory imprinting increases in power as dopamine
  activity increases.
• Addicts remember the good-times and fail to
  remember the bad-times.

71
Research on Cognitive Impairments of MA addicts

• Ability to manipulate information
  (multi-relational or synthesis).
• Ability to make inferences.
• Ability to ignore irrelevant information.
• Ability to learn new or recall information.

Hippocampus?
implications?
72
Methamphetamine Snapshot Phenomenon Wurscher
Martin
Doesn't want recovery
wants recovery
Sad-case
Criminal
Psycho-case
73
Oregons Response
74
Oregon 2004

• 9,500 CW cases (kids)
• 50 connected to Meth
• Up to 75 in some counties
• Usually exaggerated because they are the most
  Chaotic Cases
• Major Media coverage
• Major Crime issue Labs ID theft

75
Oregon CW Success

• CW - FIT Family Involvement Team
• CW - ART Addiction Recovery Teams

• CADCs
• Outreach Workers
• DHS Staff
• ASFA Video

76
Oregon Response

• Governors Meth Task Force
• Legislative Response Labs Crushed Drug Court
  TX increased
• Pseudo RX Drug as of July-2006
• DHS Meth Response Team

77
Summary
78
Summary

• Methamphetamine is a dangerous drug with serious
  physical, cognitive, and health consequences
• The effects of long-term use are reversible with
  prolonged abstinence
• Treatment for methamphetamine is as effective as
  treatment for other drugs

79
Summary

• A high percentage of methamphetamine users are
  women of child-bearing age
• Meth accounts for 7 of treatment admissions
  nationally, but in some States 30- 44 of women
  admitted were admitted for methamphetamine

80
Summary

• Scope of the problem
• The number of meth users is small compared to
  other drugs and alcohol
• Admissions increased through 2003
• Communities that have not experienced prior drug
  problems may lack the resources to handle a meth
  problem
• Meth use may be leveling off

81
Summary

• Parents use of methamphetamine puts their
  children at risk
• The best outcome for both child and parent is
  achieved when
• The parent receives immediate, effective
  treatment and comprehensive services
• The child receives immediate assessment and
  services, as well as follow-up services

82
Summary

• Child welfare workers must distinguish between
• Children whose parents use meth, and
• Children whose parents manufacture meth
• They must learn the established medical protocols
  for children present in meth labs

83
Summary

• We need early diagnosis and intervention for
  children affected by meth before and after birth
• We need comprehensive, timely, and
  state-of-the-art treatment for parents referred
  to treatment as a condition of keeping or
  reunifying with their children
• We need information systems that capture the
  necessary data to support effective approaches

84
For Further Information
85
SAMHSA Resources

• Treatment Improvement Protocols (TIP 33)
• Best Practice Guidelines for Treatment of
  Substance Abuse
• Researched, Drafted, and Reviewed by Substance
  Use Disorder Professionals

86
SAMHSA Resources

• KAP Keys Quick Guide
• Developed to accompany the TIP Series
• Based entirely on TIP 33
• Designed to meet the needs of busy clinicians for
  concise, easily accessed how-to information
• http//www.samhsa.gov

87
SAMHSA Resources

• SAMHSAs Addiction Technology Transfer Centers
  (ATTC)
• Pacific Southwest ATTC
• http//www.psattc.org/events/cates/I/presentation
  s/index.html
• Methamphetamine 101 Etiology and Physiology of
  an Epidemic

88
ATTCs Introduction to Evidence-Based Treatments
for Methamphetamine

• CD-ROM Learning Tools
• DVD Training Module
• Produced by Applied Behavioral Health Policy at
  the University of Arizona for the Pacific
  Southwest ATTC
• web www.psattc.org

89
Contact NCSACW

• www.ncsacw.samhsa.gov
• Project Director
• Nancy Young, Ph.D.
• 714-505-3525
• Government Project Officer
• Sharon Amatetti, SAMHSA/CSAT
• 240-276-1694
• sharon.amatetti_at_samhsa.hhs.gov

90
References

• Anglin, M., Burke, C., Perrochet, B., Stamper, E.
  Dawud-Noursi, S. (2000). History of the
  methamphetamine problem. Journal of Psychoactive
  Drugs, 32(2), 137-141.
• Brecht, M.-L., M. D. Anglin, et al. (2005).
  "Coerced Treatment for Methamphetamine Abuse
  Differential Patient Characteristics and
  Outcomes." The American Journal of Drug and
  Alcohol Abuse 31(2) 337.
• Brecht, M.L.(2004) Women and Methamphetamine
  Characteristics, Treatment Outcomes. Presentation
  to the Center
• For Substance Abuse Treatment, State
  Systems Development Conference. August 13.
• Cohen, Judith, Ph.D. Presentation to NASADAD,
  June 2005.
• Colorado DEC. Retrieved from www.colodec.org/decp
  apers/Documents/DEC20Medical20Protocol.pdf
• Crowell and Webber, 2004. Retrieved from
  www.drugfreeinfo.org/PDFs/strengthensupervision.pd
  f.
• Dixon, S.D., Bejar, R. (1989).
  Echoencephalographic findings in neonates
  associated with maternal cocaine and
  methamphetamine use Incidence and clinical
  correlates. Journal of Pediatrics, 115(5 Pt 1),
  770-778.
• Ferguson, T. (2001). Overview of medical
  toxicology and potential exposures to clandestine
  drug laboratories in California. Paper presented
  to the Minnesota Department of Health.
• Lundahl, L.H., Keenan, P., Schuster, C.R.,
  Johanson, C.E. (2004, June). Neurocognitive
  function in chronic high dose methamphetamine
  abusers following long term abstinence. Poster
  session presented at the 66th Annual Scientific
  Meeting of the College on Problems of Drug
  Dependence, San Juan, Puerto Rico.
• Mason, A. P. 2004. Methamphetamine labs.
  Presented at the annual conference of the North
  Carolina Family-Based, Services Association.
• Obert, J.L., London, E.D., Rawson, R.A. (2002).
  Incorporating brain research findings into
  standard treatment An example using the Matrix
  Model. Journal of Substance Abuse Treatment,
  23(2), 107-113.
• Office of Applied Studies, Substance Abuse and
  Mental Health Services Administration, Treatment
  Episode Data Set (TEDS).
• Office of Applied Studies, Substance Abuse and
  Mental Health Services Administration, National
  Survey of Alcohol and Drug Use During Pregnancy,
  2002 and 2003.

91
References
Oro, A.S., Dixon, S.D. (1987). Perinatal
cocaine and methamphetamine exposure Maternal
and neonatal correlates. Journal of Pediatrics,
571-578. Rawson, Richard, Ph.D., Presentation to
SAMHSA, August 2005. Rawson, R., Anglin, M.D.
(1999, June). Methamphetamine New knowledge, new
treatments. Retrieved April 2004, from the UCLA
Integrated Substance Abuse Programs Web site
http//www.uclaisap.org/slides/Index46/index.htm S
imon, S. (1999). Cognitive impairment in
individuals currently using methamphetamine.
Retrieved April 2004, from the UCLA Integrated
Substance Abuse Programs Web site
http//www.uclaisap.org/slides/Index46/sld034.htm
Smith, L., Yonekura, M.L., Wallace, T., Berman,
N., Kuo, J., Berkowitz, C. (2003). Effects of
prenatal methamphetamine exposure on fetal growth
and drug withdrawal symptoms in infants born at
term. Journal of Developmental and Behavioral
Pediatrics, 24(1)17-23. Shah, R. (2005, June).
From NASADAD presentation Thompson, P.M.,
Hayashi, K.M., Simon, S.L., Geaga, J.A., Hong,
M.S., Sui, Y., et al. (2004). Structural
abnormalities in the brains of human subjects who
use methamphetamine. Journal of Neuroscience,
24(26), 6028-6036. Vaughn, C. (2003). Get up to
speed on methamphetamine use. NCADI Reporter.
Retrieved from http//www.health.org/newsroom/rep/
215.aspx Vega et al (1993), Profile of Alcohol
and Drug Use During Pregnancy in California,
1992. Volkow, N.D., Chang, L, Wang, G.J.,
Fowler, J.S., Leonido-Yee, M., Franceschi, D., et
al. (2001b). Association of dopamine transporter
reduction with psychomotor impairment in
methamphetamine abusers. American Journal of
Psychiatry, 158, 377-382. Young, Nancy K., Ph.D.
Testimony before the U.S. House of
Representatives Government Reform Subcommittee on
Criminal Justice, Drug Policy, and Human
Resources, July 26, 2005. Zickler, P. (2000).
Brain imaging studies show long-term damage from
methamphetamine abuse. NIDA Notes, 15(3).