Counselors and others trying to help face plethora of problems

Published 5:00 pm Tuesday, September 13, 2005

“Addiction is a funny business – it’s all about the psychological defenses people put up,” Pam Christianson said.

“I have had clients sit in this room, they’re spun out, they’ve just failed a (drug test), and they adamently deny that they’re using.”

Breaking an addiction to methamphetamine involves most of the same tools used to fight the abuse of other illegal drugs, prescription medications or alcohol.

But meth also presents unique problems that challenge the people trying to help addicts get free of the drug.

In Clatsop County, much of the substance-abuse treatment is provided by LifeWorks Northwest Inc., a private agency that provides service through contracts with the county Health and Human Services Department and Community Corrections Department.

Local manager Christianson and the other two full-time therapists in the agency’s Astoria office handle about 120 cases, who come to them through referrals from the Department of Human Services, schools, medical providers and in some cases on their own. Two other Lifeworks counselors work in the community corrections office in the Restored Hope program, which targets 70 substance abusers in the criminal justice system.

While LifeWorks handles every variety of substance abuse case, methamphetamine users are by far the most common clients in most of its programs, Christianson said – she herself handles a mom’s group of welfare clients she dubs her “I was doing meth and the state took my kids’ group” because four out of five clients are meth users.

In the Community Corrections Restored Hope program, the percentage is closer to 90 percent.

Some clients seek help on their own, weary of the toll the drug has taken on their lives. Others go reluctantly, refusing to face their addiction even after they’ve ended up behind bars or had their children taken by state authorities.

But all face a tough path trying to free themselves from a drug with a nasty grip.

Through a contract with Clatsop County, Lifeworks has 45 treatment slots available for low-income clients. The waiting list for that program is currently five weeks, and because it is responsible for drunk-driving clients and other substance abuse cases, the agency has to juggle its available slots and prioritize cases to provide services to everyone who needs them.

“I will beg my staff, and work 50 or 60 hours a week, and try to squeeze those folks in,” she said.

Timing is critical in dealing with meth users, who binge on the drug for several days or even a few weeks, then crash and spend a few days recuperating.

“The danger is that as soon as they feel better, they’re off on their next binge,” she said. “You have that little window of opportunity to get them in.”

The therapists use a 16-week program focused on Cognitive Behavioral Therapy, a standard treatment protocol that’s aimed at getting users to understand the thoughts and urges that drive their drug use, and, once they’re clean, to recognize the triggers that can spark a relapse.

Long-term, the recovery rates for meth addicts are roughly the same as for abusers of other drugs such as cocaine, Christianson said. But meth’s unique effects can present special challenges from the first time clients come in.

“They can’t sit still in a chair, they’re jumping up and down, they’re paranoid, almost delusionally at times,” she said. “It’s hard to treat them when they’re actively using.”

Meth’s unique physiological effects also cause other difficulties. Researchers believe the drug causes long-term damage to the terminals in the brain that release dopamine, the naturally occuring chemical linked to feelings of pleasure, leaving meth users lethargic, unable to feel joy or see any hope for the future.

That lethargy lasts much longer than for users of other drugs – Christianson described one client who still suffered from dopamine depletion two years after quitting.

And while recovering meth users don’t tend to relapse any more frequently than other addicts, their relapses tend to be more extreme, versus the ex-drinker who has one beer, Christianson said.

“People don’t have little slips with meth – once they start using again, it’s binge usage,” she said.

Treatment researchers describe a phenomenon unique to meth users called “the Wall” – a point about three months after the last use when cravings for the drug can become intense and put a person at high risk for relapse.

That can also be a period when the drug’s dopamine-suppressing effects are wearing off, and the person finally has to come to grips with all the havoc their drug use has wreaked, including the loss of job, family and home. “It’s a lot to face,” Christianson said.

There is also the other criminal behavior that often goes along with meth use, especially stealing to support a habit, that complicates recovery by driving away a user’s friends, leaving them surrounded only by other addicts, Christianson said.

Sara Fasoldt, the county’s new community corrections director, said meth was seen as a largely rural, although growing, problem in New York State, where she headed the state’s parole and probation services before coming to Clatsop County. Data for 2002 show New York’s rates for treatment of methamphetamine at just 3.4 cases per 100,000 population – versus 323 cases for Oregon.

The county’s growing emphasis on drug treatment, much of it promoted by Fasoldt’s predecessor, Danny Jordan, gives the department a powerful tool to help its clients break out of the criminal lifestyle, especially with those services now offered within the Community Corrections office, she said.

“It’s terrific that we have treatment on-site here,” she said. “There’s an instant rapport between the probation officers and the treatment staff, and that allows very little opportunity for the clients to use one against the other, and no opportunity for a lapse in communication.”