Meth Treatment

Pretty, blond, and poised, Jamie doesn't look like a meth addict. But she's been using for four years, since she was 19. She smoked some this morning. She smokes some every day.

She has to.

"I need it every morning to get started, and then on my lunch hour," she confesses. After her shift ends at the Phoenix call center where she works, she sometimes smokes again. "It depends on how much I have."

In some ways, Jamie is a meth success story: She has a job. She's never been arrested. She's not hideously pocked. Her teeth are straight and white.

But she knows full well the toll meth has taken on her: the cars repossessed, the jewelry pawned, the jobs lost.

Most of all, she hates that she's still under its power.

This is the most stable she's been in years. When she was with her boyfriend, the guy who got her started, things were crazy. He stole her mother's credit cards to buy meth.

They'd get spun on meth for days on end.

She didn't realize she was pregnant until she was almost six months along. He gave her stolen money orders to pay Planned Parenthood for the abortion. (She later repaid the money.)

A "friend" shot him, right in the gut. Still, they kept using.

She loved the high.

"I felt like I could do anything," she says. And she loved that it made her thin. She'd never been fat -- curvy, maybe. But her mom is a flight attendant, with the model-thin body that goes with the job. Jamie loved being just as skinny.

Her mother, Connie Irvine, was devastated.

She'd been a hands-on mom, even moving from Tempe to Ahwatukee because she thought the old neighborhood was going downhill. She wanted to shield her daughter from gangs and drugs.

Jamie, Irvine recalls, was a good kid who graduated high school a year early. Before she started using, her bedroom had prominently featured a "Tweakers Suck" poster.

"For all this to happen to my girl because of meth -- it was like she was bulletproof," Irvine says. "She was so ambitious. Everything was perfect for her. She was so determined. And then . . ."

There was hope for Jamie. She wanted to quit. With the right program, both mother and daughter are convinced she could have made it.

But both times Jamie packed her bags for rehab, the day ended in disappointment.

She never actually made it through the door.

At the first place, the director said they'd take her, but only if she tried Narcotics Anonymous first, and then outpatient therapy.

Jamie thought that was ridiculous. She knew she needed a total lifestyle change. She was smoking again later that day.

Later, mom and daughter went to the Salvation Army, which runs one of the few inpatient rehab centers for people who can't afford to pay.

But they wanted Jamie to pass a drug test before they'd admit her. And since she'd smoked that morning, she couldn't pass it.

That was on a Thursday. If she could stop using until Tuesday morning, they told her, they'd let her in.

Connie Irvine fretted.

"I'll call in sick," she told her daughter. "I'll be your shadow all weekend."

Jamie vowed she had it under control.

And so she did, through the weekend. She made plans to come to her mother's house Tuesday morning and they'd drive over together.

That morning, Connie Irvine got up and got ready to go.

She waited, and then, as her heart sank, she waited some more.

Jamie never showed up.

She was smoking again.

For the families caught in the middle, meth addiction can be a horrific roller coaster. Every promise to quit seems so sincere -- and maybe it is.

Often, though, it all ends in letdown.

"It's not even so much a matter of fun," says Mark, a construction worker who says he used meth "daily" from 1997 until a year ago. "Over a period of time, it's just impossible to get out of bed without it."

Politicians will tell you the drug is almost impossible to kick. "It's so highly addictive, you use it once, and you could be hooked," says Phoenix Councilman Dave Siebert.

Siebert's not alone. The idea of meth being a "super drug" that traps one-time users for life gets repeated again and again by lawmakers and their spokesmen. One oft-quoted statistic claims that no more than 1 to 5 percent of meth users manage to get clean.

It's one reason, perhaps, that politicians are so willing to ignore the treatment issue and instead focus on easier initiatives, like busting meth labs (see "Bad Medicine"). Treatment, the theory goes, is just a money pit.

The only problem?

It isn't true. Statistics overwhelmingly point to a more complex reality: Meth addiction is hard to treat, but can, in fact, be treated as successfully as drugs like cocaine and pot.

Which means that 5 percent figure is pure bunk.

"When asked about the source of numbers, speakers are uncertain about their origin," Richard Rawson, associate director of the UCLA Integrated Substance Abuse Programs, writes in a recent report on the topic. "In fact, no such data exist."

Rawson questions the motives of politicians who insist crystal meth can't be treated.

"The resulting conclusion is that spending money on treating methamphetamine users is futile and wasteful."

As treatment advocates point out, what Health and Human Services data actually show is that more than 12 million people have used crystal meth at least once. Only 5 percent of those 12 million -- fewer than 500,000 -- have used it in the last month.

How is that possible?

The others didn't get hooked after one snort. Or they managed to quit.

That's a better percentage than people who tried cigarettes, notes Reena Szczepanski, executive director of New Mexico's Drug Policy Alliance, which pushes for legalizing marijuana but not harder drugs like cocaine and meth. The group is committed to fighting all drug abuse through treatment rather than prosecution.

"It's not helpful to say meth is so powerful you can't treat it," she says. "We've been through this with cocaine, with crack. It's something we say with every drug that comes along and is suddenly popular.

"But we've talked to treatment providers. And overwhelmingly, they say, you can treat this."

For example: The Iowa Consortium for Substance Abuse Research and Evaluation surveyed 362 drug addicts who were treated in 2003. Six months after discharge, 65 percent of meth users were still clean.

That was higher than pot smokers (only 53 percent managed to stop completely) and alcoholics (43 percent).

That doesn't mean that it's easy to kick meth addiction -- or that there's even overwhelming research in support of the programs considered most successful.

Scientific studies of alcohol rehabilitation models are relatively common; studies that look solely at meth users are not. Some studies do measure how many meth addicts complete treatment, or how many pass drug tests at the end of the treatment period.

Few follow up with their subjects even a full year later.

There are some things that people in the treatment community, however, mostly agree on.

One is that meth addiction is, in fact, more difficult to treat than alcohol addiction.

Another is that it's more expensive.

And the third is that no one -- from insurance companies to taxpayers -- wants to foot the bill.

Like cocaine, crystal meth is not physically addictive. Someone who's coming off a bender will have to sleep, sometimes for days on end. But they won't be experiencing a heroin-style detox.

It should make things easier -- but in some ways, it doesn't.

Treatment workers say serious meth abusers alter their brain chemistry so much that they can feel "foggy" for as long as two years, even after quitting.

"You're not going to recover from meth overnight or even in a year," says Ken Lucas, a spokesman for Valley Hope Arizona, which runs four inpatient facilities in the Phoenix area. "You're rewiring the brain, much more so than with heroin or alcohol or cocaine."

Treatment providers believe inpatient therapy is key.

"It really takes a dramatic change in lifestyle," Lucas says.

"If you're addicted, outpatient therapy is like throwing money from a moving car," agrees Jeffrey Taylor, a counselor and program advocate for the Phoenix Rescue Mission.

But few insurance providers will fund lengthy inpatient treatment.

Many require addicts try outpatient first, to prove they're serious by attending meetings. Even if they manage to do that, and get into treatment, few insurance plans cover more than a one-month stay.

It's just not enough.

"A 28-day program is not going to do any good with a crystal meth addict doing 10 big lines a night," Taylor says. "You've got to have six months or even a year."

Taylor's program, the Phoenix Rescue Mission, is one of the rare inpatient programs for indigents -- and it's willing to house them for years at a time.

But Taylor's only got 20 beds.

Programs like Valley Hope Arizona, meanwhile, cost $10,000 a month. So when insurance runs out, many addicts have no choice but to leave, vowing to make it with outpatient therapy sessions.

Maybe they're on the road to recovery. But it's hard not to go back when their friends start calling again.

"A lot of people go right back to their old playpens," Lucas says.

And those are the ones who make it to inpatient treatment in the first place.

A big problem, on a practical level, is that meth addicts often hit rock bottom much more quickly than drunks. Don Nichols is CEO of the Arizona Treatment Institute in Casa Grande, which does intensive outpatient treatment.

Alcoholics who come for treatment are typically employed, Nichols says, which means they can opt for a month's stay covered by insurance.

That's not true of meth users.

"Most of them are not going to be working by the time they come to treatment," he says.

For the truly indigent, the Arizona Department of Health Services provides treatment -- in Maricopa County, there are about 400 meth addicts under the care of ValueOptions.

In recent years, the department has seen the number of meth users in its system explode, says Christina Dye, the clinical services division chief. It's now working to tailor treatment for those people.

But there just isn't money to do everything they'd like.

For example: Dye's division is devoting more than $2 million in 2006 to train its substance abuse providers under a system pioneered by the California-based Matrix Institute.

Thanks to its clinic in San Bernardino County, an area popular with bikers and thereby a longtime crystal meth hot spot, Matrix has carefully studied meth addiction. Its directors understand the challenges of keeping meth addicts coming to outpatient treatment.

Rehab depicted in the movies typically shows alcoholics working through family issues and confronting, say, their absent father. But Matrix associate director Michael McCann says his program determined that didn't work for outpatient therapy.

"If you take people this fragile and send them home after a session like that, more often than not, they're going to dive back into using again," McCann says.

Instead, the focus is on cognitive behavior skills. Learning to think differently. Learning to take control.

"The key," McCann says, "is often just making sure they come back the next time."

But despite the program's success, the health department won't be able to roll out training for it statewide in 2006, Dye says.

In fact, the division didn't receive any new funding to pay for it. It had to "find" the $2 million it plans to spend by cutting in other areas. And that's only enough for four pilot areas.

Maricopa and Pima counties were fortunate to be one of them. Addicts in Flagstaff aren't so lucky.

Alishia Hight used meth for the first time when she was 12, and by the time she should have graduated high school, she was a mess: Dating loser older guys because they had drugs. Staying up for days on end. Shooting the stuff straight into her veins.

"I didn't know how to drive, so I'd walk around people's neighborhoods and steal stuff from their cars," she admits.

A slender blonde with a quick smile, she's come far enough that brutal honesty is easy. "Every job I'd get, I'd lose because of drugs."

Then she got booked on a series of felonies -- all related to drug possession, but enough of them to be serious.

It wasn't her first brush with the law, but it was the first time the court gave her a choice: inpatient rehab or jail.

It was probably only because she was five months pregnant. (State health department guidelines give pregnant women priority for substance abuse treatment.)

But it worked.

She originally thought she'd be stuck in New Arizona Family for just 30 days. After she got there, though, they told her she was staying put until the baby was born. And so she did, and then she stayed for another five months.

In rehab, she learned the things she'd missed in her years of snorting and shooting. She learned how to live.

In jail, she'd heard other girls talking about getting their babies back from Child Protective Services. She thought about the kids she'd seen, hanging around, while she and her friends were snorting meth.

She decided that wouldn't be her kid.

"I wanted my little boy to have slumber parties, and perfect Christmases," she says. "He wasn't going to miss out.

"And so I decided I was done."

She's stayed clean. Two years after her son was born, she married a guy who had also stopped using meth.

Now they have another little boy. They're both going to school and working.

"I wanted a family," Hight says. "And I don't want to do anything to mess that up."

But the courts don't take every case as seriously as they took Hight's.

The system can't afford it.

New Arizona Family has just 30 beds. In Hight's case, having a baby made her eligible for the government assistance that helped finance her stay.

If she hadn't been pregnant, her best hope undoubtedly would have been outpatient treatment.

Studies suggest she would have had a much harder time making it.

A 2005 study from UCLA's Integrated Substance Abuse Programs, published in the American Journal of Drug and Alcohol Abuse, surveyed 350 meth users.

It found little statistical difference between patients who'd come to rehab because they were forced by court order and those who came willingly.

Overall, 70 percent of users relapsed within two years.

But 30 percent made it. And it's worth noting the factors that made a difference.

The study found a significant relationship between longer treatment times and success. "The strongest predictor," the authors reported, "is the number of months in treatment, with longer time in treatment associated with more positive outcomes."

Also significant: Addicts assigned to inpatient programs were 2.4 times greater to finish treatment.

It's obvious why courts don't mandate inpatient programs for everyone. With such programs being as expensive as they are, most defendants would probably just end up back in jail because they couldn't afford to comply.

It's much harder to understand why probation officers don't insist on longer stints in outpatient therapy.

Tammy Quarelli, a substance abuse counselor with Dynamic Living, gets most of her clients through court order.

She claims good success with meth users, even on an outpatient basis, if she can get patients who are mandated to see her for six months.

But many probation officers set the bar much lower, she says.

"I get so mad when I see a referral for two months," Quarelli says. "The physical part, you can get done with that in a few days. But the psychological part -- that just goes on and on."

At 21, Georganne Bickle's daughter has been using meth for five years. In the photograph Bickle carries in her wallet, the girl is fresh-faced and beaming at her high school graduation, a perky kid in white robes and a funny hat.

"She's a beautiful girl," Bickle says, and then hastily corrects herself.

"She was a beautiful girl." Now her skin is pocked with the sores that plague serious meth addicts: "She's got meth bites."

Bickle's daughter, whom Bickle asked New Times not to name, once dreamed of being an actress. Instead, she's working as a stripper.

She's been to the emergency room, after taking meth mixed with rat poison. She's dropped out of college and stopped acting. She's been arrested, for assaulting Bickle while in a meth-induced rage. She's been in three different psych wards.

Bickle has spent five years seesawing between hope and despair.

"Every time she's gotten up to 90 days clean and sober, she's said to me, 'Thank you for pushing me into rehab. I want to go to college. I want to study film,'" Bickle says, and her dark eyes are weary.

"And as soon as she picks up meth again, all these dreams die. Again."

Because Bickle was tired of feeling helpless, she made a flier announcing a new organization called "Fight Against Meth."

She faxed her flier to all the media outlets she could think of, but only one bothered to call her: the Ahwatukee Foothills News. Bickle lives in north Phoenix.

But the newspaper's short story drew immediate attention. Bickle started getting e-mails. And phone calls.

Her first meeting drew almost a dozen strangers, united by stories just like hers: Their daughters were meth addicts. Or their sons. Or their nieces.

They didn't understand why their kids couldn't stop. And, even more than that, they didn't understand why it was so hard to find treatment.

They returned to the topic, unsolicited, at their second meeting.

"It's like this underground thing," explained Paula, whose son is a meth addict. "Who to go to or how to find a psychiatrist or how to pay for it. No one explains anything."

Once, Paula got her son into rehab only to have her insurance company cut him off after 10 days.

And though Alice is thrilled that her son is about to finish a year at an inpatient center in Wickenburg, she's not so thrilled at the cost: $6,000 a month, without a dime from their insurance company.

The treatment problem is one of the big things that Fight Against Meth hopes to take on. It's something they've all lived with -- and something they can't believe no one else is talking about.

One woman, Adell, mentions that she saw an anti-meth commercial sponsored by County Attorney Andrew Thomas.

The commercial, called "Extreme Meth-Over," started airing in November. Using a game-show setup, it shows the nasty dental work and scabby skin associated with meth use.

It is, according to Thomas' office, the first time the county attorney has created an anti-drug commercial. But it's a smart spot, and it drew the women's praise.

"I thought, 'Somebody is doing something,'" Adell says, pleased.

"Finally, somebody is doing something," Paula says.

"Yeah," Adell agrees. "Finally somebody other than Georganne."

This past summer, Jamie made one more stab at changing her life. Heavily in debt, spun out, and dealing once more with a car repossession, she packed up her stuff and moved to Alaska to live with her dad.

She had no way of getting meth there. She didn't know anyone in Alaska, much less a dealer, and her dad was watching her like a hawk.

She got clean, and she felt stronger every day.

But then she started to gain weight. She remembered how much she'd hated feeling chubby.

"I got so fat," she moans. "I couldn't stand it."

Unbeknownst to her parents, Jamie persuaded a friend to book her a ticket home. And once she got home, she called up her old friends and jumped right back in.

She was awake for four days. Smoking. Getting spun.

She didn't call her mother for two months. She was too embarrassed.

"I had nothing good to tell her," she says.

Now she's stabilized, a bit, but Jamie will be the first to tell you that she's balanced in a precarious place. Meth isn't like pot, where you can use a little and everything works out okay.

One false move, one bad day . . .

She wants to meet a guy and get married and have kids. Go back to school, get a better job. Work as a drug counselor. Have a normal life.

But she just can't seem to stop smoking meth. Every morning, almost every lunch hour.

It's a pattern that could easily destroy her newfound balance, and she knows it. She wants to get into treatment -- but where?

She shows the scrapbook that she put together in Alaska. What she wrote then, in that period of new possibility, was simple, but hopeful.

I am now friendless, jobless, carless. The only thing I have now is my life and my freedom from something that controlled everything I thought, I did, and said. . . . TWEAK.

I may be carless, jobless, moneyless, and just have nothing at all, but I control my life and myself.

That was true, for a moment.

But then Jamie took that plane home to Phoenix. And then she picked up the meth pipe.

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Sarah Fenske
Contact: Sarah Fenske