Methamphetamine Addiction, Mental Health, and Choices

 No Easy Answers – One Agency’s Approach

            Almost everyone has a friend, loved one, or knows of someone who struggles with drug/alcohol addiction. Only now, is our community realizing the impact of Crystal Methamphetamine (Meth) addiction. Crystal methamphetamine is a colorless, odorless and highly addictive synthetic (man-made) stimulant. It is abused because of the long-lasting euphoric effects it produces.  Families, neighborhoods, and children are all profoundly impacted by this drug. Drug and alcohol addiction is not new to Long Beach, but the physical/psychiatric damage of Meth usage is only now becoming clear. We had no idea that by moving to Long Beach we had moved to ground zero of this epidemic. 

Three years ago, my partner and I moved to Long Beach, and settled in the neighborhood around 7^th Street and Cherry Avenue. We saw this neighborhood as a good investment and decided to add our efforts to revitalizing Long Beach while providing much needed recovery services to the community. Initially, we operated and lived on site of a single (10 Bed) sober living home, Choices Sober Living I. 

A sober living home is defined as a congregate living environment operated on three basic principles: first, the residents make sure that a person who is in recovery lives in a place that is free from alcohol and drug use. Second, the residents themselves reinforce their recovery through support with other recovering persons. Finally, the residents are free to voluntarily pursue activities to support their recovery, either alone or with others.

Today Choices operates 8 properties serving a total of 126 residents. Six of these properties are in a centralized area in the Rose Park/Hellman neighborhoods in Long Beach, California. In addition to providing sober living homes, Choices Recovery Services provides residential Alcohol and Other Drug (AOD) recovery program services, offering a variety of recovery services including residential recovery housing as a sub-contractor of Phoenix House (15 months), enhanced sober living homes, three Residential Facilities under contract with the Department of Corrections and Rehabilitation-Division of Juvenile Justice, one home for men and one for women aged 18-23 who have been diagnosed with co-occurring disorders (mental/personality disorders combined with drug and alcohol disorders) (16 months), and a separate parole re-entry home for young men with “special supervision needs.”

Choices’ homes are a central component to our program. They are all clean, inviting, and non-institutional. All homes have at least one house pet, and all homes have multiple forms of on-site recreation. Our staff is well trained and we enjoy community support from our neighbors and over 400 referral sources. Each location was carefully researched and chosen due to its initial state of disrepair, proximity to recovery and social services, and transitional nature of it’s neighborhood. All of them had open city code violations, but now are often considered the best maintained on their blocks. The cleanup had a positive ripple effect at each location.

Choices staff worked with the Long Beach Police Department (keeping them informed of suspected neighborhood drug activity), the Long Beach PD’s Nuisance Abatement Office, the Long Beach City Council - Safety Committee, Our local Councilman’s office, Neighborhood Code Enforcement, Neighborhood Associations, and serve on the 10yr Plan to End Homelessness – Housing Subcommittee. These relationships have been established over the past four years and have provided us positive feedback and support. Additionally, we have excellent relationships and reputations with the social service community and neighbors.

Today, less drug traffic is seen in our neighborhood than in past years. It seems to that our neighborhood is cleaning up one block at a time. I firmly believe the drug use is very much still here, but it seems that with the community and law enforcement attention, it has been driven further underground or possibly out of the city.

Choices homes have provided housing services to over 950 recovering alcoholics and drug addicts during the past 3½ years. Over this same period, we have seen a steady increase in the frequency of crystal methamphetamine (Meth) as the drug of choice among residents. Crystal meth has decimated the local community and its use is a strong contributor to the increased incidence co-occurring disorders (mental/personality disorders combined with drug and alcohol disorders) and health issues including: HIV, Hepatitis C, and Staph infections. Psychiatric symptoms of paranoia, depression, and anxiety are common among Meth users.  These symptoms can be short lasting, but more and more we see these symptoms lasting extended periods requiring medical/psychiatric treatment. At Choices, our goal is to make a difference within this underserved “special needs” recovery population.

Our company vision is to provide recovery services that work.  The Choices Program Model (CPM) was developed with this in mind utilizing a common sense business approach. The development and implementation of this program produced efficient, cost-effective, scaleable program components. Fundamental business quality control and process evaluation principles are fundamental to CPM’s continued refinement. The comprehensive nature of this program has produced a growing, self-supporting, recovery community. The mentoring, peer support, and social rehabilitation within the residents/participants has been amazing and effective as you will see through our data analysis.  

            The need is clear within our community for programs that simultaneously address mental health, addiction, and other co-occurring disorders. Choices residents who address their recovery as a "whole person" do better than those who focus on the single issue of their addiction.

Our program, (CPM), an innovative and comprehensive treatment program was designed to serve the “special needs” recovery community.  CPM was specifically designed to focus on issues related to those with co-occurring disorders/mental health diagnoses, adult and juvenile parole re-entry, youth offenders, HIV concerns, people with physical disabilities, and the GLBT recovery community.  All of our programs utilize a wide range of modalities in varying levels of structure/supervision. CPM continues to utilize a solution-oriented, continuously adaptive process with the recovery goal of producing efficient, cost-effective, quantifiable program outcomes.

Our local community has been hit hard with the economic and social costs associated with drug and alcohol addiction and mental illness. Choices will shortly be one of only three programs within the State of California with licensing and/or certification from the CA State Departments of Alcohol and Drug Programs, CA State Department of Mental Health, and Community Care Licensing. Effectively addressing these co-occurring disorders in a treatment and rehabilitation environment is an innovative idea whose time has come.

While attending a conference almost a year ago, a study on treatment findings of those diagnosed with Co-Occurring Disorders (COD) was presented.  During this presentation, I realized that our resident population had a high COD incidence, and I was motivated by the idea of studying the information gathered on our past and present residents. For this purpose we developed a database that would allow us to view, add, and analyze our resident data for both academic and ongoing treatment purposes. As principal investigator, I submitted a research protocol to an Investigational Review Board (IRB) for approval. Once approved, we approached UCLA – ISAP Department for partnering. The resulting data has proven quite interesting and sometimes surprising.  

Choices Longitudinal Study Findings – Phase 1

To date, those Choices residents (past and present) claiming addiction to Meth is 40.34% of our total resident population. The State average in California is 30.30%, and the national average is 6.40%.  Choices serves a Meth population almost 35% greater than the state average and over 600% greater than the national average.

On a national level, of those who sought treatment for a drug or alcohol addiction, approximately 20.3% were categorized as co-occurring disordered. As of March 15^th, 2006 Choices has averaged 43.17% which is over 100% or twice the percentage of co-occurring disordered (COD) program participants on a national average.

While operating sober living homes, not a treatment program, we have achieved an average short-term completion rate of 58% for all residents and 55% for those with CO. The national average is 63%. Our long-term rates are closer to the national average of 33%; ours are 31% for all residents and 31% for those with co-occurring disorders. Our results for Methamphetamine users were identical in the short-term at 58%, but the long-term decreased slightly to 29%.

Since the beginning of this year, we increased the recovery support services at all of our homes. This enhanced sober living program has produced increased short-term results of 67%, which is almost 7% higher than the national average. These results are from the same resident population without providing typical “treatment” modalities. Note: National and state statistics provided by SAMHSA-TEDS Data Set 2002, 2003.

It has been documented that program participants with a COD have a statistically greater propensity for violence, medication noncompliance, and failure to respond to treatment than consumers with either substance abuse or a mental illness. These problems also extend out to these consumers’ families, friends and co-workers.

Over 43% of our resident population is diagnosed with at least two co-occurring disorders. Of the 57% of our residents not diagnosed with a COD requiring medication, many of them exhibit symptoms of mental illness and refuse treatment or deny symptoms as possibly mental health related. Primary co-occurring disorders are substance abuse and mental illness/personality disorder. Over time we developed systems and procedures for handling these and other disorders as they presented in our residents.

To effectively provide the best service possible, we developed a manual of our policies, procedures, and guidelines for staff and resident use, we have a staff training program, weekly staff team meetings, all staff have mobile phones and email addresses, and we adhere to strict ethical standards of professionalism. Our staff is cross-trained and most positions have dual staffing. We hire and promote most staff members from within Choices, which helps us to maintain our standards and culture. Technology also plays an important role at Choices. All staff and residents have access to computers, email, and the internet. We closely monitor and maintain our network for misuse. We developed a promotional DVD for use prospective residents and an orientation DVD that all Choices participants and staff view as an initial intake tool. Understanding the need for ADA (Americans with Disabilities Act) accessibility, we now have 3 units conforming to ADA standards. We have customized units for both older and younger adults, units with increased security, supervision, and safety depending on the needs of the program participant. All homes have 24/7 resident staff and our operations office is open 7 days per week with staff available by phone 24 hrs per day. Our program continues to develop on a daily basis.

Studies have shown, that having a simultaneous mental illness and a substance abuse disorder frequently leads to overall poorer functioning and a greater chance of relapse. We have worked hard developing an innovative program model effectively addressing this fact. Interestingly, in our population we have noted an “acceptance” process that needs to occur. Similar to one accepting their addiction, a substance abuser confronted with the sobering reality of a mental health diagnosis must learn to also accept this. Meth addiction provides for a unique dilemma since many of the symptoms of Meth usage mimic mental health disorders. Initially, it may be unclear if the behaviors are a symptom of mental illness or Meth. When this becomes difficult to determine, we utilize on site drug testing to rule out Meth usage from mental illness symptoms.  We refer many of our Meth residents to mental health clinics and many times, now sober; they must face the fact that they may have a condition requiring them to take psychotropic medication. Many residents, having great difficulty developing social relationships, some find themselves more easily accepted by groups whose social activity is based on drug use. We have repeatedly documented in young adults a belief that an identity based on drug addiction is more acceptable than one based on mental illness.

Our residents with co-occurring disorders are also much more likely to be homeless or jailed prior to coming to Choices. An estimated 50 percent of homeless adults with serious mental illnesses have a co-occurring substance abuse disorder. Meanwhile, 16% of jail and prison inmates are estimated to have severe mental and substance abuse disorders. Among detainees with mental disorders, 72 percent also have a co-occurring substance abuse disorder. Note: Statistics provided by NAMI

Despite much research that supports its success; integrated treatment is still not made widely available. We have seen those who simultaneously struggle with serious mental illness and substance abuse face problems of enormous proportions. Mental health services and most recovery agencies tend not to be well prepared to deal with patients having both afflictions. Often only one of the two problems is identified. If both are not recognized, the individual may bounce back and forth between services for mental illness and those for substance abuse, or they may be refused treatment by each of them. Fragmented and uncoordinated services create a service gap for persons with co-occurring disorders.

Our program strives to provide appropriate, integrated services for these consumers which not only allows for their recovery and improved overall health, but can ameliorate the effects their disorders have on their family, friends and society at large. By helping these consumers stay in treatment, find housing and jobs, and develop better social skills and judgment, we can potentially begin to substantially diminish some of the most sinister and costly societal problems: homelessness, institutionalization, crime, HIV/AIDS, domestic violence and more.

In December of 2006, Choices secured 6 Residential Alcohol and other Drug (AOD) Treatment/Detoxification Facility Licenses. We also received program certification for Residential Treatment, Residential Detoxification, Outpatient Treatment, Outpatient Detoxification, and a Day Treatment Program through CA Dept. of Alcohol and Drug Programs (ADP). We are in the process of securing an AOD Adolescent Treatment Waiver.

Additionally, Choices is also in the process of having three Social Rehabilitation Facility licenses approved by Community Care Licensing (CCL) and program certified by the Department of Mental Health (DMH).

Our belief is these new treatment ‘choices’ will help people and because of this, we are hopeful for the future.

Sean E Zullo CPRS, CCDC, NCRS, CAS, Director/Founder, Choices Recovery Services, seanzullo@yahoo.com