Health and Psychiatric Issues in Children of Rural Methamphetamine Abusers and Manufacturers

Methamphetamine (also known as "crystal," "meth," "ice," or "speed") is a highly addictive form of amphetamine with strong effects on the CNS. Methamphetamine initially causes feelings of euphoria, decreases in fatigue and appetite, and increases in energy and alertness that last considerably longer than similar effects of cocaine.^1-4 Regular use, however, has serious effects on the brain, which may account for the behavioral and psychiatric symptoms often associated with methamphetamine abuse.⁵ Abusers may experience psychosis; depression; intense paranoia; visual and auditory hallucinations; rapid mood changes; irritability; out-of-control rages; and suicidal, repetitive, and violent behavior.^1,3,6 Methamphetamine's ability to disrupt normal brain functioning can be long lasting, and psychotic symptoms may persist for months or years after drug use has ended.^2,3,7 Prenatal exposure to methamphetamine is associated with a 3.5-fold increase in low birth weight and is often associated with neurodevelopmental results such as behavioral and cognitive deficits.⁸

Methamphetamine production and abuse has become a serious problem in many rural communities.^1,9 The production of methamphetamine takes place in "laboratories" that are often located in rural areas to avoid detection because powerful fumes are emitted during the manufacturing process; these areas also offer access to precursors used in methamphetamine production, such as anhydrous ammonia (a common fertilizer). Methamphetamine is relatively easy to produce, and instructions can even be downloaded from the Internet.

Many abusers of methamphetamine in rural areas manufacture the drug for their personal use. These "mom-and-pop cooks" produce methamphetamine in and around homes where children are also living.^6,9-13 This article provides an overview of the mental health of children whose parents abuse methamphetamine.

Health and safety consequences
The rise of methamphetamine production and abuse has taken a serious toll on children. Rural law enforcement officers and health, mental health, and child welfare professionals are encountering more children who live in homes where methamphetamine is produced and abused.^1,6,14

Children whose parents abuse methamphetamine are exposed to a variety of risks. They may be exposed to severe neglect from parents who are preoccupied with obtaining and using the drug and who may sleep for days after bingeing. Children living in these homes may have no running water, limited and unsafe electrical power, extremely poor sanitation, and little food.¹¹ Children may also be exposed to persons abusing a variety of other substances, such as alcohol and marijuana. Violence, including severe domestic violence, is common among methaphetamine abusers, and children understandably find such exposure particularly troubling.¹⁰ As parents become increasingly ill, children may also be exposed to criminal behaviors that are associated with their parents' drug seeking.^10,14 Children may also experience physical, sexual, and emotional abuse from their substance-abusing parents and other users who frequent the home.^6,9,11-13

In addition to these significant risk factors (which are similar to those experienced by many children whose parents abuse other illicit substances), children whose parents are abusing methamphetamine may experience some relatively unique risks because:

• Methamphetamine is highly addictive and parents may become rapidly disabled, for example, by developing psychosis. This can be both frightening and dangerous for children who may have little time to adapt to rapidly deteriorating parental functioning.^10,14
• Methamphetamine may be produced in homes, which exposes children to unique health and safety risks. Children may be exposed to dangerous conditions, such as toxic chemicals, explosions, and fire from the manufacturing of methamphetamine.^6,9,11-13
• Children may be exposed to relatively high levels of adult criminality in and around the home. Parents' drug production often involves other illegal behaviors, such as stealing ingredients to make methamphetamine. Children may be brought into these activities directly by being taught to steal or more indirectly as they witness their parents' illegal activities and arrests.¹⁴
• Children may face long-term or permanent separation from parents who are serving extended prison terms, experiencing serious illnesses, or deceased.¹⁴ Despite difficult and complex relationships, many children express love, longing, and concern for their parents.¹⁵

Psychiatric consequences
Children exposed to parental methamphetamine abuse can experience significant psychological stress. Mental health problems may include dissociative or other posttraumatic symptoms. Other significant emotional and behavioral problems may include thought and attention problems, rule-breaking, and aggressive behavior. In addition, many children report having emotional pain, few social resources for coping or understanding problems involving their families, and avoidant or passive coping strategies.¹⁵

There is, however, a substantial variation in children's mental health. Although additional research is necessary, case reports suggest that the variation may be attributed to factors such as the child's age, the length and severity of family dysfunction, and the presence of protective factors such as supportive extended family members, as illustrated in the following 2 vignettes.¹⁵

CASE VIGNETTE 1
D.C.'s mother was relatively healthy until he was 10 years old. While grieving a death in the family, she began to use methamphetamine. As their home life began to deteriorate, D.C. went to live with his grandmother because his mother was, as he expressed, "no longer acting like a mom should." The grandmother housed and nurtured her grandson and sought mental health care to help D.C. cope with the eventual death of his mother.

CASE VIGNETTE 2
J.H. is another 10-year-old whose parents are heavily involved in methamphetamine use. When his parents became incapacitated because of their addiction, J.H. had no outside relationships with adults who could provide emotional support, accurate information, and practical assistance. The child viewed substance abuse as normative and even accepted his father's interpretation that "the government was out to get" their family. J.H. and his siblings were eventually placed in foster care. Although J.H. was mentally unstable, he actively resisted mental health intervention.

Longitudinal data on the mental health of children from methamphetamine-involved families are currently lacking. However, evidence from the larger substance abuse literature suggests that multiple stressors experienced by children from methamphetamine-involved families place them at high risk for substance abuse and mental health disorders. In general, familial influences, such as a history of substance abuse by a parent, have been identified as major contributors to adolescents' drug use and abuse.^6,16 In addition, children raised in homes where drug use is common are at a higher risk for early pregnancy, dropping out of school, and involvement in criminal and other antisocial behavior.¹⁷

Treatment challenges andclinical implications
Addressing the mental health needs of children exposed to parental methamphetamine abuse will require an integrative, multidisciplinary approach. There are a number of challenges and clinical implications that need to be considered when treating the child of a methamphetamine abuser.

First, children of methamphetamine abusers may have significant medical and dental needs as a consequence of neglect and exposure to toxins; these needs must be attended to for optimal mental health intervention. It should be noted that more than one third of the children found in homes during methamphetamine laboratory seizures tested positive for illicit drugs because of environmental exposure.⁹

In addition, assessment of these children's mental health needs is complex. Multiple assessments and use of the best estimate technique are essential.¹⁸ For example, caregivers may report significant child trauma symptoms, but children may underreport trauma on standardized assessments or disclose trauma only during clinical interviews.¹⁵ There may also be a strong "no talk" rule that impedes both assessment and therapeutic progress. Many children from methamphetamine-involved families report being instructed by parents not to talk about their families and even being punished for doing so.¹⁰ Parents and kinship care providers may deny that the events the child experienced were traumatic.^15,16 Clinicians should pay special attention to building a rapport with adults so that they will support their children's participation in mental health treatment and the children will feel that they may safely disclose their experiences within their families.

Many children with parents who are methamphetamine abusers have multiple problems. Mental health intervention may need to address not only parent methamphetamine abuse and associated traumas, but also a range of socialization issues-such as following regular eating and sleeping schedules, regularly attending school, and trusting adults-as well as children's ongoing distress resulting from family disruptions.¹⁰ By the time children enter mental health care, most will be living away from one or both parents. An initial goal of treatment is likely to be the creation of a safe and stable home environment through the identification, education, and support of substitute caregivers.

Next, parents and substitute caregivers may hold a variety of beliefs regarding children's responses to and recovery from psychological trauma that may undermine mental health intervention. For example, caregivers may think it best for children to just forget the traumatic events and move on with their lives. Again, rapport building and communication with caregivers are vital to a successful mental health intervention with children.

Finally, accessing appropriate mental health care may be complex. Because many of these children reside in isolated rural areas, they may be a significant distance away from mental health services.¹⁴ Families and substitute care providers may have transportation needs that must be resolved in order to receive proper treatment.

Conclusion
Methamphetamine abuse affects not only the individual abusers. It may also have a pervasive effect on the experiences of their children. In the words of one articulate 13-year-old girl,

"You just grow up and you don't know anything better. You just know your family does drugs. And there's, like, nothing you can do about it . . . you're so used to hollering and screaming. . . . You're used to everything that you grew up around. . . . All the people I knew were drug addicts."¹⁰

Exposure to parental methamphetamine abuse places children at risk for the development of mental health and substance abuse disorders. Additional research is needed not only on the prevention and treatment of parents' methamphetamine addiction but also on the treatment of their children's traumatic experiences.

Dr Black is assistant professor in the department of psychiatry at Southern Illinois University School of Medicine in Springfield.

Drs Haight and Ostler are associate professors in the school of social work at the University of Illinois at Urbana-Champaign.

The authors report they have no conflicts of interest to disclose.

References:

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