This is an archived article that was published on sltrib.com in 2007, and information in the article may be outdated. It is provided only for personal research purposes and may not be reprinted.
Correction: Utah Gov. Jon Huntsman Jr. is seeking $4.5 million for addiction treatment and drug courts.
Correction: The name of 3rd District Judge is Mark Kouris.
TOOELE - As 28-year-old Tori Curran walks down a narrow hallway in the county courthouse, portraits of smiling Miss Tooele pageant princesses gaze down at her.
She steps into Judge Mark Kouris' courtroom, where the young women inside have led less than picture-perfect lives. Like Curran, many are single mothers who want to raise happy children but who struggle with addiction and relationships.
After working 18 months to beat a methamphetamine addiction and stay clean during her fourth pregnancy, Curran was graduating from a drug court, which gave her treatment rather than prison.
Only time will tell whether the skills Curran has learned will last a lifetime.
Despite efforts to combat it, Utah's meth problem continues to grow - especially for women.
For five years, meth has been the top illegal drug of choice for Utahns entering public treatment. For women it surpasses even alcohol, the traditional front-runner, making it the only drug in history to have its female users outnumber males. Nearly half the women in treatment statewide have children.
Gov. Jon Huntsman Jr. has proposed investing $4.2 million in Utah's drug courts and $2.5 million to build two residential clinics in northern and southern Utah to treat 600 women, giving priority to those involved with the child welfare system. But Huntsman will have to convince lawmakers it's a wise investment, no easy task considering the stigma attached to addiction and a dearth of data on treatment, including how patients and drug court graduates fare over the longer term.
Helping Utah's women poses another challenge: transforming a system that wasn't built for them.
"Substance abuse treatment has been historically geared for white, middle-aged male alcoholics," said Salt Lake County substance abuse Director Patrick Fleming. "We're a hell of a lot better at treating women than 10 years ago, but there's room for improvement."
A review by The Salt Lake Tribune of Salt Lake County data shows men are more likely to complete therapy than women; a difference of 10 percentage points. A second Tribune analysis of drug-court graduation numbers found the lowest success rate in family drug courts, which cater mostly to women with children.
Brent Kelsey, assistant state substance abuse and mental health director, disputes any gender gap in treatment success. He insists treatment works: "It has to. What choice do we have?"
How to treat a woman
Utah's publicly funded clinics provide about 79 percent of the state's addiction treatment - a tab for taxpayers of $37 million in 2006. These clinics are required to tell the federal government how many of their patients drop out of treatment and other details.
Results from all these clinics combined show how elusive success can be. Thousands of Utah addicts - and more women than men - drop out of treatment every year.
* Of the 9,699 Utahns discharged from public clinics in 2006, barely half completed treatment. Statewide, women are only slightly less likely to finish treatment than men.
* Of those who do finish treatment, not all have kicked drugs. At the time of discharge, 71 percent reported being abstinent. That compares to 54 percent nationally.
State officials say it's impossible to judge which clinics are the most successful because clinics report outcomes incorrectly - or not at all.
National research shows that for severe addicts - the type who populate Utah's drug courts and public clinics - relapse is in the range of 50 percent to 90 percent. But each dose of therapy improves a patient's chances of staying sober, said Fleming, the Salt Lake County substance abuse director. And it's cheaper than building prisons, he added.
To better help women succeed, treatment must be tailored to them, asserts Tooele social worker Terry Bates. She works in Tooele County's drug court and is doing research for her doctorate at the University of Utah.
"Anyone who thinks drug court is about keeping clean is kidding themselves. It's about changing an identity," Bates said.
Women use drugs for different reasons than men - often prompted by relationships, either social or romantic. To reroute a woman's life, Bates believes, a woman must come to view herself as a working single mother or as a student, as examples, instead of as an addict.
"I really believe if they can get a handle on [relationships], they can choose differently," she said. "If they feel empowered, I'm hoping they will think twice about going back to drugs and letting it all fall apart."
Building women up
This is Caroline Willey's 18th month of sobriety. A photograph of her youngest son will soon hang on a Tooele County courtroom wall, joining some 20 other pictures of children born drug-free.
Bates looked on with pride as Willey and Curran graduated from Tooele's small drug court in December. She's investigating how well drug courts work for women.
"I'm really asking the question: Does drug court, as a rehabilitative effort, do what we think we are doing?" Bates said. "Or does it put people through a program, but their lives don't get much better?"
The House of Hope in Salt Lake City, which treats women with children referred by courts across the state, uses strategies similar to those suggested by Bates, said administrator Ken Brown.
Instead of the more confrontational approach commonly used for men and teens, therapy aims to build up women's self-esteem. Teaching them to eat right and exercise helps remove toxins from their bodies and brains. Classes on parenting, having fun without taking drugs and choosing healthier relationships give them tools to avoid lapses, said Brown.
Residential treatment lasts four months. Children receive care - and help from child development experts - at on-site day care.
Having stable housing, keeping her 10-month-old son with her and the camaraderie of other women are what Tamara cites as key to kicking her three-year habit. Her last relapse was triggered by the removal of her son by child welfare workers.
"My whole world came crashing in," she recalled.
Like many women at the House of Hope, Tamara was introduced to meth by a man in her life, her husband. A staunch Mormon and returned missionary, she said "the drug world was completely foreign" to her. Still bristling from being branded an addict, she asked that only her first name be used.
At first, meth gave her confidence and energy; her low-self-esteem was tied to a poor body image, but also abuse as a child.
"Since I was 4 years old I struggled to lose weight, working out and starving myself," Tamara said. "With meth, I went from a size 18 to a size 7 and lost 100 pounds in nine months. But I lost everything else with it."
Tamara says she has recovered her "dignity and hope." Pregnant with her second child, the 30-year-old said she hasn't touched meth since July.
Pushing for change
The closest evidence of success might be found in drug court programs, which are the most popular and studied treatment models nationally. Started in 1989 in Florida, drug courts debuted in Utah in 1996.
There are now 32 drug courts in Utah, targeting felony or misdemeanor offenders, juveniles - and parents in danger of losing their children due to drugs.
One in two parents in treatment in family courts fails, creating the worst graduation rate among the state's drug courts. Comparing such rates is problematic because different courts serve different types of addicts and no two operate exactly the same.
Still, those who work in family courts say they aren't surprised by the results. Parents in drug court must do more, faster.
They must meet the demands of drug court while satisfying requirements from the Division of Child and Family Services. Also, federal timelines for reuniting families give parents dramatically shorter deadlines for change.
"It's just not as simple as saying they should be more motivated," said Davis County's family drug court coordinator, Kevin Koopmans. "If you're a single mom with no job skills, no license, and if to get your kids back, you need transportation and need a $7 an hour job that works around drug court and meetings and drug tests, I'm not so sure that in some cases we don't create more problems for people," he said.
Still, Koopmans and others point to financial benefits. A typical family of three in public treatment costs $28,000 to $35,000 a year. To keep a mother in jail and her two children in foster care for a year costs $100,000.
Even when a parent fails, "there are no losers here," he said. "If the parents want to be addicts, that's fine, but at least the kid is in a safe place. I think our impact is in the next generation."
'I did struggle'
In her family court in West Jordan, 3rd District Juvenile Court Judge Christine Decker walks the line between being a cheerleader helping a parent and a guardian charged with protecting children.
Before court, Decker talks about parents' progress with counselors, child protection officers, prosecutors and others. The group agrees one woman needs more support: Her husband is in another drug court; they have a history of domestic violence; and she feels isolated while trying to cope with the demands of rearing her four children.
"Drug treatment is complicated as it is, but you put on these other layers," she said. "We [scrutinize these cases] more intensely, because there is a lot at stake. It isn't sending them back out on the street; it's giving them their children back."
She wishes treatment were quickly available for all parents.
"I have cases in my regular caseload where we can't get them in. As the child welfare timelines go on, you don't get your kids back. Maybe you would fail in treatment, but it seems to me you never even had a fair chance," she said.
Waiting lists in Salt Lake County average four to five months, and much of rural Utah lacks in-patient services altogether. Kelsey, the assistant state substance abuse and mental health director, estimates annual unmet demand for treatment statewide exceeds 90,000 people.
Today, Curran is grateful for the chance drug court has given her. She thought she could control meth when she was introduced to it at age 19. Like many women, she liked the high and initial weight loss. But the addiction drained away her money, cars, a home; she lost custody of her three children and ended a marriage before she hit rock bottom.
After her second stint in jail, her parents helped her find a drug court. Now she has visitation with her three children and custody of her 1-year-old.
"Nineteen months ago, I was a huge mess," she told a courtroom packed with supporters. "I let my friends and family down, but most of all, I let my kids down.
"Today I stand here clean, happy with myself and my life. I did struggle in drug court, but I would not change it for anything."
Monday: An experiment tries to help longtime criminal addicts
Tuesday: Improving prevention: Halting addiction before it starts
Meth addiction: Effects and treatment
* Is it treatable? Methamphetamine addiction is treatable but challenging, said Glen Hanson of the University of Utah's Center for Addiction.
* Why is it so addictive? Meth enhances dopamine, a neurotransmitter related to pleasure and thinking. "Do well on a test or win recognition for something at work [and] you get a little squirt of dopamine," Hanson said.
* Why is it so dangerous? Prolonged use can damage dopamine receptors, making it harder to take joy in everyday life. It also creates free radicals in the brain, damaging critical thought. Users tend to be impulsive and struggle with early abstinence. "It can take six to eight months for the brain to sort itself out," he said.
- Kirsten Stewart