Pubdate: Sat, 23 Apr 2005
Source: New Zealand Herald ( New Zealand )
Copyright: 2005 New Zealand Herald
Contact:  http://www.nzherald.co.nz/
Details: http://www.mapinc.org/media/300
Bookmark: http://www.mapinc.org/meth.htm (Methamphetamine)

DRUG BIZ: HOW THEY PICK UP THE PIECES

He was of average height, but by the time he tried to quit methamphetamine 
he was thin and his face was drawn in.  Those who saw him could see clearly 
that he had not been eating enough.

Addicted to the methamphetamine drug P, he joined the Odyssey House 
programme several months ago.

"He was just skin and bone," says the alcohol and drug programme's chief 
executive, Christine Kalin.  "He used P excessively.  Just seeing him eat 
and put some weight on, you wouldn't recognise him.  He looked drawn and 
terrible before.

"Nutrition is a big issue with P users.  They often don't eat and come in 
malnourished.  The basics, like giving them three meals a day, is 
important.  And they often have difficulty sleeping."

Kalin is describing the things that differentiate P users from those whose 
lives are damaged by other drugs.

The Herald's inquiry into the illegal drugs industry has shown that while 
the phase of spectacular growth in the use of P, a highly addictive drug, 
has ended, growth remains steady and is now supplemented by imported 
crystal methamphetamine, known as Ice.

For drug treatment services, alcohol and cannabis remain the biggest 
problem, but at Odyssey House, the percentage of clients who say 
methamphetamine is their drug of first choice has risen month by month to 
16 per cent in February.  At Auckland City Hospital, the number of patients 
at the emergency department who have overdosed on amphetamines is down to 
about one a week.

Asked to explain this apparently contrary trend, emergency physician Dr 
Lynn Theron says the typical P patients at the hospital tend to be 
experimental users, whereas the chronic users now seeking help from 
addiction treatment services may have started using two or three years 
earlier.

Methamphetamine has not presented particular problems for treatment 
services.  Everyone goes through the same kind of programme - but P 
addiction has its differences.

"They can have swings in moods and sometimes mental health characteristics, 
sometimes three weeks into the programme," says Major Ian Hutson, the 
director of the Salvation Army's Auckland Bridge Programme.

The Drug and Alcohol Practitioners Association's chairman, Tim Harding, 
says users' physical dependence and withdrawal problems with P are less 
than with with opiates such as heroin.

"But psychologically it's very habitual.  When you have the ability to go 
from boredom to excitement in two seconds you lose the ability to have fun 
without it.  The worst thing is the psychological craving for the 
excitement.  That's one of the most difficult things to deal with," says 
Harding, who is also the chief executive of Care NZ, a provider operating 
at more than a dozen sites, including prisons and schools.

Amphetamines cause the release of large amounts of dopamine, a 
neurotransmitter, in the brain.  The sudden euphoria, energy and 
concentration boosts and talkativeness are the kinds of effects that 
attract people back to P.  But they can also become confused, aggressive 
and suffer chest pain, psychosis and paranoid hallucinations.

Psychosis is more likely from abusing P than with other drugs, says 
Professor Doug Sellman, director of the National Addictions Centre at the 
Christchurch Medical School.  "Other drugs also produce mood problems - it 
just seems more highlighted by P."

Overseas research has found that 6 per cent of occasional users and about 
half of heavily dependent users are at risk of psychosis.

A treatment problem with P is that while drug therapies exist for some of 
the symptoms they may suffer - antipsychotics, antidepressants and 
sedatives - no medicines have proved effective in controlling dependence on 
psycho-stimulants, the class that includes amphetamines and 
cocaine.  Long-acting amphetamines have been used experimentally as a 
substitution therapy for amphetamine users, but not in New Zealand, and the 
results have ranged from "modest gains" to discouraging.

Despite this, about two-thirds of people who receive specialist help for 
drug and alcohol problems improve after treatment.  The trouble is finding 
enough help for those who need it.

Providers agree that more services are needed, especially in prisons - 80 
per cent of prisoners have substance abuse problems and less than half 
receive treatment.  More help is also needed for young people and those who 
also have a mental illness.  Some services have no waiting-lists, but for 
other services people may have to wait for months to get in.  For those 
facing long delays, an opportunity to address their addiction may be lost.

PEOPLE usually seek help only when their life starts to fall apart.  They 
may lose their job, their partner may leave or they get into trouble with 
the law.  They realise they're not coping.  They seek help, but if forced 
to wait too long for treatment, the crisis may pass and the motivation for 
change be lost.

"We find ways of seeing more people, which puts a lot of stress on 
counsellors," says Care NZ's Harding.  "We don't advertise.  We probably 
are missing opportunities for more people to get help but there's no point 
advertising.  The more people we get the longer the waiting list and we 
would miss their point of motivation.  My concern is that we only ever see 
a fraction of the people out there who are in quite serious trouble with 
substance abuse."

The Health Ministry says district health boards, the conduit of state 
funding for their own and non-government services, can meet demand in some 
areas and "in others they are working through these".

The Government is spending about $72 million on alcohol and drug services 
this year, well up from the $50 million in 1999/2000, but still less than 
10 per cent of the mental health budget.  Harding says the amount Australia 
spends on mental health is similar to its drug and alcohol treatment 
budget.  It is estimated that 9 per cent of New Zealand adults have a 
diagnosable drug or alcohol problem and that 3 per cent of the population 
have a severe problem.

With mental health, it is estimated that 3 per cent of the population need 
treatment for a severe illness.  Many are in both camps, with 60 per cent 
of mental health service patients having alcohol or drug difficulties.

The Mental Health Commission says only 0.3 per cent of the population was 
reported as being treated in alcohol and other drug services in the first 
half of 2004 - that is 384 clients fewer than in the same part of 2003 - 
but the true percentage would be higher as figures are not gathered from 
many non-government providers.  In the kinds of services provided, mental 
health and drug and alcohol services have followed the same path, swinging 
from costly residential services to those provided in the community and 
tailored to individuals - "de-institutionalisation".

The commission said that in 2003 the number of funded adult alcohol and 
drug treatment beds dipped to about 500, while the amount of community 
services on offer grew.

The ministry and health boards strongly support this shift, partly to 
stretch money further.  A key ministry document says: "Recently there has 
been a greater focus on non-residential alcohol and drug services, 
partially because non-residential treatment and assessment services offer a 
greater ability to reach an expanded and diverse clientele and they can 
often be more cost-effective."

Harding believes the pendulum has swung too far away from residential 
services, but for him it is not an either/or matter.  "We need more 
community-based treatment and we need more residential treatment."

The Salvation Army is grappling with the issue.  It plans to close its 
residential centre on Rotoroa Island in the Hauraki Gulf and open 
residential services in South Auckland and possibly West Auckland - but in 
a more flexible way and closer to clients' families.

"We are moving to a model which would see far more integration of people 
into their local community," says social policy national director Major 
Campbell Roberts.

"Sometimes people do need to come into residential treatment because the 
pressures on their lives are too great.  The residential in the past has 
taken people away to Rotoroa Island and it has majorly disrupted their lives."

Some people lose their homes while away and when they return are faced with 
the extra burden of finding somewhere to live.  "We want to cause the 
minimum disruption and keep their lives intact as much as possible, hence 
now we try and provide treatment at a community level."

* Alcohol and Drug Helpline 0800 787 797

Auckland's Community Alcohol and Drug Services ( 09 ) 8451818

Odyssey House

Drug of first choice:

* 29 per cent of clients say cannabis is their preference.
* 24 per cent alcohol.
* 16 per cent methamphetamine.
* 10 per cent nicotine.
* 4 per cent amphetamines.
- - February statistics

Services Available

Treatment services in Auckland include:

* Community Alcohol and Drug Services, six sites.  About 2800 clients at a 
time.  Outpatient therapy and counselling, methadone treatment, 10-bed 
detoxification unit, home detox service.  Waiting times one to four weeks 
for detox, four weeks to start methadone.  A 19 per cent readmission rate 
within 5 years.
* Salvation Army: six to eight-week residential programme, 40 assessment or 
treatment beds in Mt Eden, 35 beds on Rotoroa Island, community-based 
treatment.  Residential waiting times two to six weeks.  Based on community 
reinforcement and the 12-step concept of a spiritual or religious power.
* Odyssey House: 140 residential beds for adults, youths and families and 
non-residential programmes.  Residential stay averages four 
months.  Lifetime support for "graduates".  Residential waiting times six 
weeks.  Based on mutual self-help in a therapeutic community. 
- ---
MAP posted-by: Beth