Methamphetamine abuse and manufacture: the child welfare response.

Hohman, Melinda ; Oliver, Rhonda ; Wright, Wendy 等

Methamphetamine abuse is on the increase, particularly by females of childbearing age. In California from 1992 to 1998, methamphetamine as a primary drug rose from 11.2 percent to 22.4 percent of all alcohol and other drug (AOD) treatment admissions for females, and from 6.8 percent to 13.5 percent for males (Hohman & Clapp, 1999). Initially limited to western states and Hawaii, research suggests that methamphetamine abuse and its clandestine manufacture is spreading to the southern, northwestern, and midwestern United States (Greenblatt & Gfroerer, 1997; U.S. Department of Justice, Office of Justice Programs, Office of National Drug Control Policy, 1997). Once a drug primarily used by white males, methamphetamine use is increasing among Hispanics and Asian Americans, and among gay males (Hohman & Clapp; Maglione, Chao, & Anglin, 1998; Reback & Grella, 1999).

In addition to having an effect on the AOD treatment system, methamphetamine use and the problems associated with its manufacture affect the child welfare system. In a recent study of mothers entering San Diego County's AOD treatment system (N = 6,023), 60 percent of those active with child protective services (CPS) described methamphetamine as their primary drug of abuse (Shillington, Hohman, & Jones, 2002). Many of these parents manufactured methamphetamine in their homes; the directions can be obtained from the Internet, and the chemicals used are fairly easy and inexpensive to obtain (Center for Substance Abuse Treatment [CSAT], 1997). Such manufacturing places children at risk of environmental exposure to dangerous chemicals, toxic fumes, and possibly explosions (Irvine & Chin, 1997). >From 1997 to 1999, 472 children in California were found in 176 homes during methamphetamine laboratory seizures and were removed by child welfare officials. More than one-third of these children tested positive for illicit drugs because of environmental exposure. Of these children, 386 had dependency petitions filed and sustained in juvenile court (Drug Endangered Children's Resource Center, 2000).

This article describes how the use and production of methamphetamine affects adults and children. We also discuss the drug-endangered children's (DEC) program, a pilot program that integrates child welfare, legal, medical, and law enforcement personnel regarding methamphetamine-exposed children (DEC Resource Center, 2000). A case study of children found at a home during a methamphetamine laboratory seizure demonstrates how a DEC unit operates, with particular emphasis on the role of the child welfare worker. As the use and production of methamphetamine spread, such programs may be important for social workers, particularly those involved with child protection.

History of Methamphetamine

Methamphetamine, or crystal, crank, or speed, is a synthetic stimulant that can be smoked, inhaled, or injected. The drug is commonly sold as a white powder that is dissolvable in water but can also be produced in rock form (CSAT, 1997). It was first produced in the 1930s to treat asthma, schizophrenia, and narcolepsy, among other conditions (Miller, 1997). During World War II, Americans, Japanese, Germans, and British used methamphetamine to fight fatigue in soldiers. By the 1950s, students and truck drivers used the drug to stay awake (CSAT, 1999; Miller; Suwaki, Fukui, & Konuma, 1997). Initially thought to be a relatively benign drug, problems from its use in the 1960s and 1970s led to federal legislation that severely restricted legal production, which caused an increase in illegal methamphetamine production laboratories. Most of these laboratories were in the rural western and southwestern United States, because the chemicals used in methamphetamine's production (precursors)--ephedrine and pseudoephedrine--were easy to obtain in Mexico. Such laboratories were located in rural areas to avoid detection of the powerful fumes emitted during the manufacturing or "cooking" process. During the 1980s, ice, a more potent smokable form of methamphetamine, appeared in Hawaii; its use, however, has been limited in the mainland United States. As the prevalence of methamphetamine use and its many social consequences spread in the 1990s, researchers and lawmakers' interest in the drug increased (CSAT, 1997; Miller).

Effects of Methamphetamine Use

Abuse of methamphetamine outpaced cocaine abuse in the 1990s, especially in California. By 1996 the National Household Survey on Drug Abuse estimated that about 4.8 million people had used methamphetamine at least once (Substance Abuse and Mental Health Services Administration [SAMSHA], 1997). Compared with cocaine, methamphetamine is inexpensive and easily available, and its effects last much longer--hours, not minutes. It is similar to amphetamine in its chemical structure but has more intense effects (National Institute on Drug Abuse, 1998). Methamphetamine releases dopamine--a neurotransmitter--in the brain, which enhances mood, feelings of pleasure, satisfaction, and energy, while decreasing appetite (CSAT, 1999). A study of 37 female methamphetamine abusers found that friends, boyfriends, or relatives introduced them to the drug. Many of these women used the drug as an appetite suppressant and enjoyed the energy it provided, particularly for doing housework and taking care of small children (Joe, 1995, 1996).

Addiction to methamphetamine can occur quickly, as repeated use lowers the brain's ability to manufacture dopamine, leading to increased cravings for the drug. Withdrawal from methamphetamine can include depression and apathy, particularly if the individual has used alcohol or barbiturates to promote sleep (CSAT, 1997). More severe medical effects include coronary heart disease, brain hemorrhage, malnutrition, stroke, and short- or long-term psychosis with a potential for violent behavior (Buffenstein, Heaster, & Ko, 1999; Karch, Stephens, & Ho, 1999; Perez, Arsura, & Strategos, 1999).

Given the behavioral and physiological effects of methamphetamine abuse, social workers can assess clients who might be using the drug by looking for several indicators. First, methamphetamine abusers tend to have an abundance of energy and may participate in repetitive activities, such as continuously cleaning their kitchen or vacuuming. Social workers may observe anxiety, paranoia, mood swings, irritability, hypervigilance, confusion, violent threats or actions, and possibly psychosis. Methamphetamine abusers have a diminished need to eat or sleep. Other indicators include pupil dilation and the smell of ammonia or stale urine. Chronic use can cause skin abscesses, particularly on the face, that abusers may pick, and users can exhibit weight loss, poor hygiene, and dental problems. Methamphetamine abusers have been known to go for as many as three weeks without sleeping (Joe, 1995; Stalcup, 2000).

Joe (1996) interviewed 37 Asian Pacific women who were methamphetamine (ice) abusers. The participants in the study reported that they used methamphetamine about 15 days per month, and more than one-half reported going from five days to eight days without sleep during their use. The women reported the following drug-related symptoms: weight loss (89 percent), depression (70 percent), anxiety (54 percent), paranoia (51 percent), and relationship problems with their spouse or partner (65 percent). About one-fourth of the group indicated having been hospitalized for mental health problems, and two-thirds of the women reported financial problems because of their use of methamphetamine. Fifteen of the participants reported living with children, and 22 of those who had children had an average of two each.

No studies have examined the effects of methamphetamine abuse on parenting. Earlier studies have found, however, that abuse of illicit drugs is more likely to be linked to child neglect than to physical abuse (U.S. Department of Health and Human Services, National Center on Child Abuse and Neglect, 1993). Most drug-using parents, unfortunately, do not come to the attention of child welfare authorities (Huang, Cerbone, & Gfroerer, 1998). Furthermore, determining the effect of drug use on parenting is confounded by users' problems with economic deprivation, unstable lifestyles and living situations; and their own histories of abuse or neglect (Magura & Laudet, 1996). Given the serious physical, emotional, and social consequences of methamphetamine use, children living with methamphetamine-abusing parents are at a higher risk of neglect (Stalcup, 2000).

Treatment for Methamphetamine Abuse

The recommended treatment for methamphetamine abuse is a cognitive-behavioral intervention in an intensive outpatient setting (CSAT, 1999). This type of treatment educates clients to understand the cues that lead to methamphetamine use and the subsequent cravings these cues produce. Once clients understand and identify their personal cues, they practice alternative ways to cope. Extensive relapse-prevention work, participation in 12-step programs, urine testing, individual therapy, family therapy, and social support groups are included in this model (Obert et al., 2000). Herrell and colleagues (2000) conducted a federally funded seven-site clinical trial using the model as the experimental condition and "treatment as usual" as the comparison condition. The results of that study should greatly enhance our understanding of the efficacy of methamphetamine treatment.

Few studies have examined treatment for methamphetamine abuse by women. Huber and colleagues (1997) compared 500 methamphetamine abusers with 224 cocaine abusers in treatment; both were receiving a cognitive-behavioral model of intervention. Compared with the cocaine users in the study, the methamphetamine clients were more likely to be white, female, younger, never married, and unemployed. Methamphetamine users also started using drugs at a younger age, were more likely to use on a daily basis, and had no prior treatment. Both groups remained in treatment the same length of time and had comparable outcomes.

Similarly, in a study of female clients in San Diego's public AOD treatment system (N = 15,003), Hohman and colleagues (2001) found that the women treated for methamphetamine addiction were more likely to be white, younger, less educated, and had fewer children than their cocaine-abusing counterparts. Methamphetamine-abusing women, however, were more likely than cocaine-abusing women to be involved with CPS and mandated into treatment. Both groups had similar lengths of stay in treatment, but the methamphetamine abusers were more likely to be treated in an outpatient or day treatment setting and receive a "dissatisfactory" discharge status (Hohman et al.).

Exposure to Methamphetamine during Pregnancy

Most methamphetamine abusers tend to be polysubstance users, who commonly use tobacco, alcohol, and marijuana (Joe, 1996). Therefore, it is difficult to tease out the impact of methamphetamine use on the developing fetus (CSAT, 1997). Like those exposed to cocaine prenatally, infants exposed to methamphetamine during pregnancy have been found to have low birthweights, premature births, small head circumference, cerebral infarctions, and congenital anomalies. Exposure to methamphetamine in utero causes increased heart rate and blood pressure in both the fetus and the mother and may cause premature separation of the placenta from the uterine wall, resulting in a spontaneous abortion or premature delivery (Stewart & Meeker, 1997). In a follow-up study of methamphetamine-exposed infants compared with cocaine-exposed and nonexposed infants (N= 86), methamphetamine-exposed children at one year appeared less impaired than those exposed to cocaine, but were still found to be lethargic, with poor eating and alertness. About 59 percent of the infants in this study, either methamphetamine or cocaine exposed, were placed in foster care at birth (Dixon, 1989).

In a small qualitative study of nine women who used methamphetamine during pregnancy, the participants reported a general lack of knowledge regarding how methamphetamine would affect their infants (Irwin, 1995). These women also reported difficulty obtaining appropriate treatment. Whatever the problems might be, the women felt their methamphetamine use enabled them to work an extra job, maintain a household, provide child care, and so forth. For them, the benefits of using methamphetamine outweighed the risks. Irwin suggested that the lack of public attention to methamphetamine abuse allowed participants to "interpret and define their drug use and pregnancy experiences for themselves without outside pressures. On the other hand, lack of knowledge about speed use and pregnancy robs these women of valuable health information that would better inform their pregnancy decisions and harm-reduction strategies" (pp. 630-631).

Exposure to Methamphetamine during Manufacturing

Although the majority of home-based methamphetamine laboratories tend to be located in the western and southwestern United States, laboratories have also been seized in rural areas of the midwestern states, such as Illinois, Iowa, Kansas, and Missouri (CSAT, 1997). Although few in number, methamphetamine laboratories were found for the first time in Delaware, Massachusetts, and New Jersey in 1998. Total Drug Enforcement Administration (2000) methamphetamine laboratory seizures in the United States rose from 549 in 1990 to 2,155 in 1999.

Manufacturing of methamphetamine can expose adults and their children to toxic chemicals and fumes through absorption, inhalation, or ingestion. Acute health effects of exposure to methamphetamine production can include burning of the eyes and skin, headaches, dizziness, nausea, and respiratory distress (Haddad & Winchester, 1990). The long-term effects of breathing of contact with the chemicals used in manufacturing methamphetamine are not known. Reported side effects from the precursor chemicals include liver and kidney disease, cancers such as lymphomas and leukemias, bone marrow suppression resulting in anemia, and increased risks of infection (Irvine & Chin, 1997). In addition, there have been reports of severe lung disease in police officers involved in methamphetamine laboratory raids (Burgess, Barnhart, & Checkoway, 1996). Such disease is a function of the toxic effect on the lungs of the acid chemicals used in methamphetamine production. Some of the catalysts used in the making of methamphetamine include heavy metals that can cause severe kidney and neurologic damage if ingested in sufficient quantities (Haddad & Winchester). Last, methamphetamine, if ingested, can be extremely dangerous to children, causing irritability, seizures, cardiac arrhythmias, and death. A small study of 18 pediatric patients who had been inadvertently poisoned with methamphetamine found that they experienced tachycardia (100 percent), agitation (50 percent), vomiting (33 percent), and inconsolable crying and irritability (33 percent). The patients required an average of three days of hospitalization (Kolecki, 1999).

Children living in homes where methamphetamine is produced are exposed to other risks of physical problems in addition to the chemicals used to make methamphetamine. These children are often in homes with no running water, limited and unsafe electrical power, and extremely poor sanitation; often the toilets do not flush, and buckets are used instead. This leads to hygiene problems for the children, chronic rashes, poor dental care, and bites from insects, such as roaches and flies. Children's nutritional needs are often ignored. As the stimulation for these children's development is often lacking, they have a high incidence of developmental delays, especially in their speech and language skills (Wright, 2000).

Environmental effects are also a concern, as the chemicals and by-products from manufacturing are toxic and flammable and are often discarded in or around home-based laboratories. Often police and social workers working with laboratory seizures are required to be certified in hazardous materials (HAZMAT) handling. HAZMAT removal companies are often required to clean up seized laboratories, at a cost of about $5,000 per laboratory. The Bureau of Narcotics Enforcement spent $2.4 million for methamphetamine laboratory cleanup in 1995 (CSAT, 1997).

Recognition of Home Laboratories

Social workers who make home visits, particularly those in the child welfare system, are often the first to stumble on a home methamphetamine laboratory. Signs to look for include strong odors, similar to paint, ether, or rotten eggs; large quantities of over-the-counter cold medications that contain ephedrine or pseudoephedrine; and chemical containers of drain cleaner, battery acid, lye, lantern fuel, acetone, denatured alcohol, iodine, muriatic acid, or antifreeze. Glass cookware, hot plates, chemical flasks, soda bottles, tubing, and kitty litter are used in the manufacturing process. Kitty litter is used as an absorbent for fumes. Red phosphorous, commonly found in matches, road flares, and fireworks, is often used. Red phosphorous may leave red or purple stains on the manufacturer's hands or face or be seen in red puddles or stains on the floor. Fifty-gallon drums with the labels removed may be used in the cooking process (CSAT, 1997).

If social workers suspect that they are in a methamphetamine laboratory, they are advised to not touch anything and leave immediately. They should then follow their agency's protocol for notifying local law enforcement officials (Manning, 2000).

Drug-Endangered Children's Units

Before 1995 little thought was given to prosecuting the parent for child endangerment if children were present during a laboratory seizure. This changed in 1995 after a home laboratory exploded in Riverside, CA, killing three children. Their mother was convicted of second-degree murder, and this conviction was upheld under appeal. Exposing children to methamphetamine production was ruled "an inherently dangerous felony" (People v. James, 1998) by the Fourth Circuit Court of Appeals in 1998 (West, 1999). Subsequent California legislation (Penal Code Section 273(a) felony child endangerment) has provided for prison enhancement for those caught manufacturing methamphetamine in the presence of children younger than 16 (up to two years per child), with a five-year enhancement for those who injure children because of manufacturing. Parents are not charged with exposing children to methamphetamine per se, but with permitting children to be placed in situations that endanger their person of health (Manning, 1999).

Before 1997 if children were present during a laboratory seizure, they were almost treated as an afterthought by law enforcement. The police, after their initial work was completed, had to contact CPS or try to find a relative to pick up the children and often had to transport the children themselves. There was no official protocol on how to respond in these circumstances, including no provisions for medical testing or interviewing (Manning, 1999).

In response to these problems and to the strengthened legislation, the Governor's Office of Criminal Justice Planning in California awarded $3.2 million to seven counties to establish drug-endangered children's units, for a three-year period beginning in FY 1997-1998. These DEC units are overseen by their county district attorney's office. The units function as a multidisciplinary collaboration among the district attorney, law enforcement, medical personnel, environment health agency, and child protective services. Each unit has a clearly designated protocol for handling children found during methamphetamine laboratory seizures, and members have clearly defined roles and responsibilities. The award also provided for the DEC Resource Center, which provides training and materials for professionals across the state (West, 1999).

When a methamphetamine laboratory is to be seized, the CPS worker attends a briefing with members of the DEC response team and then proceeds to the site. The CPS role is to assess child safety by interviewing the children and parents and documenting home conditions, including accessibility to drugs or weapons. Children may be given a change of clothing, with their own clothing taken as evidence to be tested for chemical exposure. The CPS worker then notifies the medical personnel of the DEC team and transports the child for a medical evaluation, held either at a shelter or hospital emergency room. The CPS worker provides medical personnel a list of chemicals found at the site, ensures that a medical exam is completed, including blood and urine tests, and obtains hospital releases to transport the children to the local shelter. The CPS worker is expected to assist with evidence collection procedures and with the prosecution of child endangerment charges by making available reports of interviews with neighbors, school personnel, and so forth, as well as the results of the medical exams (Orange County DEC Team, n.d.).

Case Study

An anonymous referral to a child abuse hotline reported that children ages two, seven, and nine years were unsupervised and dirty. The report noted that there were strange people frequently visiting the house. As the emergency response CPS worker approached the door of the home, she noticed a great deal of garbage strewn in front of the house. This garbage included several cartons of camping fuel and pill blister packs from cold medication. At the door, she identified herself to the mother and inquired about the whereabouts other children. The mother stated that the two older children were in school and that the toddler was home with her. When asked about the fuel containers and cold medication, the mother replied that the family went camping frequently and had been sick recently. Although the CPS worker did not smell any strange odors, she was suspicious regarding possible methamphetamine production. She decided not to enter the home and immediately called her supervisor, who in turn notified the DEC social worker.

As the emergency response CPS worker proceeded to the school to interview the children, over the telephone the DEC CPS worker advised the emergency response worker to ask the children about recent camping trips, illnesses, adults smoking in the house (tobacco and drugs), unusual odors, drugs in the house, lots of people coming and going, and breathing or asthma problems. She was also advised to check the children for burns or staining on their feet and hands and chemical burns on their clothing (resembling bleach stains).

The DEC CPS worker then notified DEC detectives to look up the parents' names and previous addresses to determine any criminal history. It was found that the mother had no previous criminal history; her boyfriend, however, who rented the property, was on probation for an earlier drug conviction for possession of methamphetamine. He was under what is called a Fourth Waiver (no search warrant required), meaning that no reasonable cause was needed for a search of his property or belongings.

The emergency response CPS worker interviewed the two children at school. The children stated that the family never went camping and no one had been sick recently, other than asthma in the oldest child. They indicated that sometimes their mother's boyfriend smoked drugs in a glass pipe. He had "lots of friends" who came over, and sometimes they all smoked together along with their mother. The children described their mother's boyfriend putting cold pills into a "smelly" liquid and cooking it. They said their mother was at home when he did this and that she sometimes helped him take the pills out of the packets and put them in the liquid. The children said that they had last seen the boyfriend cook the "stuff" two days ago. This information was relayed to the DEC CPS worker, who immediately met with DEC detectives and the district attorney assigned to the DEC unit. The decision was made to search the premises under the Fourth Waiver. The emergency response CPS worker was advised to stay at the school and wait to hear from the DEC CPS worker.

The DEC CPS worker followed the detectives to the home and remained outside until the detectives indicated the home was secure. Both the mother and her boyfriend were handcuffed and sitting on the living room couch. In the home were indications of methamphetamine manufacture. The detectives found fuel cans, more blister packs, soda bottles with tubing attached, kitty litter bags, and spaghetti jars filled with an unknown liquid in the kitchen and dining area. Also found were 12 small packets believed to be methamphetamine bundled for sale. Several weapons were confiscated as was pornographic material and sexual toys, all of which were accessible to the children.

The CPS worker and a detective inspected the home for neglect. The house was cluttered with dirty clothes, debris, and dirty dishes. Dog feces were found in the children's bedroom. One bathroom had a toilet that was broken, and dirty clothes were piled in the bathtub. The CPS worker directed the detective to photograph the evidence of neglect and manufacturing, particularly when the various chemicals and cooking items were accessible to the children. The CPS worker also directed the detective searching the home to look for the children's medical records should they be needed later.

After the home inspection, the CPS worker interviewed the adults to determine their identifying information, relationship to the children, next of kin who could take custody of the children, and medical information. Although the police had already interviewed the parents, the CPS worker also asked the parents about their drug use and discussed the implications of using and manufacturing drugs in the presence of children. After a telephone call to her supervisor, the CPS worker was given permission to remove all of the children. The two-year-old child was given a change of clothes; his clothes were taken as evidence to be tested for exposure; and the CPS worker placed the toddler in her car. She went directly to the school, where she briefed the emergency response CPS worker and removed the two older children. All of the children were then taken to the shelter.

Once at the shelter, a pediatrician familiar with DEC medical protocols saw the children for a comprehensive medical exam and developmental screening and also processed blood and urine screening samples. Results indicated that the two-year-old child tested positive for exposure to methamphetamine and was developmentally delayed. The seven-year-old child was diagnosed with attention deficit disorder, and the nine-year-old child required treatment for asthma. Both older children needed dental work. Using this information, as well as supplemental information from the school and neighbors, the DEC CPS worker had 48 hours to complete her investigation and file petitions regarding neglect and parental incapacitation in juvenile court on both the mother and her boyfriend, because he was the father of the two-year-old child. When the DEC CPS worker had interviewed the mother, she indicated that she would prefer that her sister provide care for her children while she was in jail. The CPS worker checked records that indicated that the sister had no history with either the criminal courts or child welfare, and the sister agreed to allow the children to be detained in her home. Once there, all three children thrived, with the oldest one having no apparent symptoms of asthma after 10 weeks.

After the juvenile court petitions were filed and heard, the case was transferred to a court intervention CPS worker. The DEC CPS worker, however, maintained secondary responsibility for the lifetime of the case, working as a liaison with the police, district attorney, and the child welfare agency regarding the criminal outcomes. The DEC CPS worker was also responsible for filling out victims of crime applications that are filed with the district attorney's office. This can provide funding for any costs related to the crime of child endangerment, such as counseling or medical care.

The mother and her boyfriend were arrested for methamphetamine possession and manufacturing, weapons possession, and three counts of child endangerment (one count for each child), and taken to jail. Both plea-bargained, and the boyfriend received a seven-year prison sentence. He served three years and was released for time already served. He was subsequently rearrested three months after release for manufacturing methamphetamine.

The mother had no prior criminal history and was sentenced to four years in prison, which was stayed. She was placed on probation. The juvenile court found her guilty of neglect and parental incapacitation, and she was sent to the juvenile drug court for assessment and referral. The drug court case manager recommended to the court that she receive treatment in a residential recovery home and attend parenting classes. The mother entered the treatment program at the recovery home. After three months her youngest child was placed with her there. The two older children visited her on weekends. After six months she was able to secure and maintain housing and was discharged with requirements to attend Narcotics Anonymous meetings and maintain contact with the drug court case manager. Her other children were returned to her for a trial visit. After 14 months, the children were permanently reunified with her and the case was closed.

Discussion

The case example illustrates the various roles DEC CPS workers must fulfill. They serve as liaisons among the various agencies, including assisting police in the collection of evidence; they are responsible for quickly evaluating the needs of exposed children and securing appropriate treatment; and they must file petitions and other paperwork in a timely manner. Like most child welfare CPS workers, they must maintain dual roles, as both a representative of the system and as an advocate for their clients--the children and the parents. Multidisciplinary teams allow CPS workers--and other members of the team--to carry out their responsibilities while maximizing the protection of children.

Methamphetamine abuse and manufacture are dangerous to the adults involved and to their children. Because of methamphetamine's growing use, relative ease of manufacture, low cost, and long-lasting effects, CPS and other social workers need to be aware of its effects and the signs of abuse and manufacture to protect the children of clients and themselves. Social workers who work in substance abuse treatment or with treatment providers need to be aware of and use interventions for methamphetamine abuse that have shown empirically based positive outcomes. Health and counseling services may need to be provided for clients' children. Social workers may also want to influence policymakers regarding funding for intervention programs for children if methamphetamine manufacturing is a significant problem in their geographical area.

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Melinda Hohman, PhD, is associate professor, Center on Substance Abuse, School of Social Work, San Diego State University, 5500 Campanile Drive, San Diego, CA 92182-4119; e-mail: mhohman@mail. sdsu.edu. Rhonda Oliver, BA, is a deputy probation officer with San Diego County Probation. She was formerly a protective services worker II, Drug Endangered Children's Unit, Children's Services, Health and Human Services of San Diego County. Wendy Wright, MD, is a pediatrician and assistant director, Polinsky Children's Center, Children's Hospital of San Diego.

Original manuscript received January 1, 2001 Final revision received October 16, 2001 Accepted December 3, 2001