Transcript Document

The American Indian/Alaska Native National Resource Center
for Substance Abuse and Mental Health Services
Methamphetamine Abuse in American
Indian and Alaska Native Communities:
Restoring Harmony Through an Integrated
Treatment Model
Dale Walker, MD Patricia Silk Walker, PhD Michelle Singer
May 5, 2008
APA Annual Meeting. Washington, DC
1
One Sky
Center
2
One Sky Center Partners
Cook Inlet Tribal Council
Alaska Native Tribal
Health Consortium
Northwest Portland Area
Indian Health Board
Tribal Colleges
and Universities
Prairielands ATTC
Red Road
One Sky
Center
United American
Indian Involvement
Harvard Native
Health Program
Jack Brown
Adolescent
Treatment Center
National Indian Youth
Leadership Project
Tri-Ethnic Center for
Na'nizhoozhi Center Prevention Research
3
Goals for Today
• Background: The environment and the system
of care
• The methamphetamine problem
• The methamphetamine initiative
• Community treatment
• Integrated care approaches are useful
4
5
6
Agencies Involved in B.H. Delivery
1. Indian Health Service (IHS)
A. Mental Health
B. Primary Health
C. Alcoholism / Substance Abuse
2. Bureau of Indian Affairs (BIA)
A. Education
B. Vocational
C. Social Services
D. Police
3. Tribal Health
4. Urban Indian Health
5. State and Local Agencies
6. Federal Agencies: SAMHSA, VAMC,
Justice
7
Difficulties of Program
Integration
•
•
•
•
•
•
•
Separate funding streams and coverage gaps
Agency turf issues
Different treatment philosophies
Different training philosophies
Lack of resources
Poor cross training
Consumer and family barriers
8
Different goals
Resource silos
One size fits all
Activity-driven
How are we functioning?
(Carl Bell, Walker 7/03)
9
Culturally
Specific
Best
Practice
Outcome
Driven
Integrating
Resources
We need Synergy and an Integrated
System (Carl Bell, Walker 7/03)
10
Native Health Problems
1.
2.
3.
4.
5.
6.
7.
8.
9.
Alcoholism 6X
Tuberculosis 6X
Diabetes 3.5 X
Accidents 3X
Poverty 3x
Depression 3x
Suicide 2x
Violence?
Methamphetamine?
American Indians
• Have same disorders as general
population
• Greater prevalence
• Greater severity
• Much less access to Tx
• Cultural relevance more challenging
• Social context disintegrated
12
Native Peoples: Multiple Life Risks
Psychiatric Illness
& Stigma
-Edn,-Econ,-Rec
Cultural Distress
Impulsiveness
Substance
Use/Abuse
Hopelessness
Family Disruption
Domestic Violence
CHILD/
ADULT
Psychodynamics/
Psychological Vulnerability
Negative Boarding School
Historical Trauma
Douglas Jackobs 2003
R. Dale Walker, M.D., 2003
Family History
Suicidal
Behavior
13
Why is Methamphetamine
so Devastating?
•
•
•
•
•
•
•
•
Cheap, readily available
Stimulates, gives intense pleasure
Damages the user’s brain
Paranoid, delusional thoughts
Depression when stop using
Craving overwhelmingly powerful
Brain healing takes up to 2 years
We are not familiar with treating it
14
Young Adults Aged 18 to 25 Reporting Past Year
Methamphetamine Use: 2002 to 2005
15
Source: SAMHSA, 2002-2005 .
Methamphetamine:
Epidemiology
Methamphetamine:
Epidemiology
Past Month Illicit Drug Use among Youths Aged 12 to 17, by
Race/Ethnicity: 2002
16
Methamphetamine/Amphetamine Admissions,
by Race/Ethnicity and Urbanization: 2004
Large
Central
Metro
Large
Fringe
Metro
Small
Metro
Non-Metro
with City
Non-Metro
without City
White
56%
77%
78%
86%
87%
Black
5%
3%
2%
1%
1%
Hispanic
28%
14%
11%
6%
4%
American
Indian/
Alaska
Native
2%
1%
3%
4%
6%
Asian Pacific
Islander
3%
2%
3%
2%
1%
Other
6%
3%
3%
1%
1%
Race/Ethni
city
17
Source: 2003 SAMHSA Treatment Episode Data Set (TEDS).
IHS-Wide Outpatient Encounters for
Amphetamine Related Visit by Calendar Year
The Methamphetamine Effect
19
Methamphetamine Identified as the
Primary Health/Community Concern
• In 2006, Tribal Round Table sessions, HHS
Regional Tribal Consultations, and numerous
tribal community gatherings with SAMHSA, OMH,
and IHS identified Methamphetamine abuse as
the primary health concern in Indian Country.
20
“Tribal leaders unveil new meth
Initiative” Indian Country Today
• $3.5 million awarded to
Association of Indian
Physicians (AAIP) its
partners (National
Congress of American
Indians, One Sky
Center, South and
Eastern Tribes, and
Northwest Portland
Area Indian Health
Board)
NCAI President, Joe Garcia June 15, 2007
ICMI Partners
OSC
Northern Arapaho
Crow
Winnebago
NCAI
NPAIHB
USET
Navajo
AAIP
Choctaw
ICMI Project Description
• Create a National education and information
outreach campaign for all Native communities.
• Establish and transfer knowledge from community
based, promising practices for prevention,
intervention and treatment.
• Work across Federal agencies for a coordinated
and consistent outreach strategy.
WHAT ARE SOME PROMISING STRATEGIES?
24
Choctaw Nation of Oklahoma
•
•
•
•
•
“Natural Highs Program”
Transformation process
Experiential activities
Relationship building
Changing the way you live
and think
• Changing how you think
and you believe about life
and yourself
Meth Free Crow Walk: Youth as our
Warriors in Reclaiming our Nation
Dine Nation:
What Works
• Community Education
– Age-appropriate presentations,
brochures, ads
• Enforcement
– Arrest and detainment
for trafficking
• Caring members of the
community
• Partnerships
– Communities, chapters, private businesses
and tribal divisions and programs.
Northern Arapaho Tribe Works:
a Comprehensive Systems Plan
The Problem:
– “turf”
– gaps
– duplications
– crossed purposes
Fragmented
Service
System
The Solution:
– client-centered
– multi-agency
– comprehensive
– coordinated
– efficient
“Works”
Winnebago Meth Task Force
Goals and Objectives
• Develop/maintain a Comprehensive
Methamphetamine Prevention Strategy
• Collectively plan and implement
• Use Proactive measures
• Use available funds - take immediate
action
• Working together to determine what fits
for tribal members and the reservation
ID Best Practice
Best Practice
Clinical/services
Research
Mainstream
Practice
Traditional
Healing
30
Circle of Care
Traditional
Healers
Primary Care
A&D
Programs
Best
Practices
Child &
Adolescent
Programs
Boarding
Schools
Colleges &
Universities
Prevention
Programs
Emergency
Rooms
31
Ecological Model
Society
Community/
Tribe
Peer/Family Individual
32
Partnered Collaboration
State/Federal
Grassroots
Groups
Community-Based
Organizations
Research-Education-Treatment
33
Spectrum of Intervention Responses
Thresholds for Action
No
Problems
Mild
Problems
Moderate
Problems
Severe
Problems
Treatment
Brief Intervention
Universal/Selective
Prevention
34
Treatment Settings - Social
Support: A Native Advantage
•
•
•
•
•
•
Tribal
Community
Family
Sibs
Peers
Individual
35
Sources of Strength
Access to Mental Health
Access to Medical
Spirituality
Generosity/Leadership
Family Support
Positive Friends
Caring Adults
Positive Activities
36
Community Driven/School Based
Prevention Interventions
•
•
•
•
•
•
Public awareness and media campaigns
Youth Development Services
Social Interaction Skills Training Approaches
Mentoring Programs
Tutoring Programs
Rites of Passage Programs
37
Integrated Treatment
Premise: treatment at a single site, featuring
coordination of treatment philosophy,
services and timing of intervention will be
more effective than a mix of discrete and
loosely coordinated services
Findings:
• decrease in hospitalization
• lessening of psychiatric and substance abuse
severity
• better engagement and retention
(Rosenthal et al, 1992, 1995, 1997; Hellerstein et al 1995.)
38
Comprehensive School and
Behavioral Health Partnership
• Prevention and behavioral health
programs/services on site
• Handling behavioral health crises
• Responding appropriately and
effectively after an event occurs
39
Is Treatment for
Methamphetamine Effective?
Analysis of:
• Drop out rates
• Retention in treatment rates
• Re-incarceration rates
• Other measures of outcome
All these measures indicate that MA users respond
in an equivalent manner as do individuals
admitted for other drug abuse problems.
40
Contact us at
503-494-3703
E-mail
Dale Walker, MD
[email protected]
Or visit our website:
www.oneskycenter.org