Transcript Document

The American Indian/Alaska Native National Resource Center
for Substance Abuse and Mental Health Services
Methamphetamine Problems:
Development of Native Prevention
Models
Dale Walker, MD Patricia Silk Walker, PhD Michelle Singer
Laura Loudon, MS Doug Bigelow, PhD
August 1, 2007
Sioux Falls, South Dakota
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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
One Sky
Center
Red Road
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
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Presentation Overview
• What’s the story on methamphetamine?
• Discuss prevention theory and models
• Integrated care approaches and interagency
coordination are best overall solutions
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Methamphetamine Abuse Eastward Movement
Based on Hospital Admissions
R. Dale Walker, M.D., 2003
Arizona Methamphetamine
Admissions
Governor’s Council on Addictions 2006
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S.D. METH LABS SEIZED
Meth admissions/100,000 (2003) =92
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Oregon Methamphetamine Admissions
Meth admissions by state
2003=257
1,800
1,600
1,400
1,200
1,000
OR
800
600
400
200
1
00
q
2
20
99
q
3
19
98
q
4
19
97
q
1
19
97
q
2
19
96
q
3
19
95
q
4
19
94
q
1
19
94
q
19
19
93
q
2
-
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OHSU Substance Abuse Clinic
Enrollees
Marijuana mixed
Marijuana only
Methadone/heroin
19982000
N= 108
25
8
23
30
20022004
percent N= 172
23%
22
7%
5
21%
38
28%
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Methamphetamine
Narcotics
Benzodiazepines
Hallucinogens
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5
2
3
31%
4%
2%
3%
Alcohol
84
6
6
1
percent
13%
3%
22%
27%
49%
3%
3%
1%
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National Methamphetamine
Initiative Survey
Mark Evans Tactical Intelligence Supervisor New Mexico Investigative Support Center 4-12-2006
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National Methamphetamine
Initiative Survey
Mark Evans Tactical Intelligence Supervisor New Mexico Investigative Support Center 4-12-2006
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Methamphetamine:
Epidemiology
Methamphetamine:
Epidemiology
Past Month Illicit Drug Use among Youths Aged 12 to 17, by
Race/Ethnicity: 2002
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Methamphetamine Use in 2004
Percentage
2.5
2.2
1.9
2
1.7
1.5
1
0.7
0.5
0.5
0.2
0.1
0
Native
Hawaiian
or Pacific
Islander
Two or
More
Races
AI/AN
White
Source: SAMHSA 2004 NSDUH.
Hispanic or
Lantino
Asian
Black or
African
American
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IHS-Wide Outpatient Encounters for
Amphetamine Related Visit by Calendar Year
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Lifetime, Past Year, and Past Month
Methamphetamine Use
Numbers of Users (in Thousands)
14,000
12,000
12,38312,303
11,726
2002
2003
2004
2005
10,357
10,000
8,000
6,000
4,000
1,5411,3151,4401,297
2,000
597 607 583 512
0
Lifetime
Past Year
Past Month
Richard Kopanda, CSAT
a = Significant change 2003 to 2004; b = Significant change 2002 to 2004
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Why is Methamphetamine
so Devastating?
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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
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Native Adolescents: Multiple Life Risks
Psychiatric Illness
& Stigma
-Edn,-Econ,-Rec
Cultural Distress
Impulsiveness
Substance
Use/Abuse
Hopelessness
Family Disruption
Domestic Violence
CHILD
Family History
Negative Boarding School
Historical Trauma
Douglas Jackobs 2003
R. Dale Walker, M.D., 2003
Psychodynamics/
Psychological Vulnerability
Suicidal
Behavior
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Adolescent Problems In Schools
Fighting
and
Gangs
Alcohol
Drug
Use
Weapon
Carrying
Bullying
School
Sale of
Alcohol
and Drugs
Sexual
Abuse
Environment
Unruly
Students
Truancy
Attacks
on Teachers
Staff
Drop
Outs
Domestic
Violence
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Methamphetamine, Why Now?
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•
•
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The Internet
Diffused local production, less reliance on imports
Multi-drug use – no one uses only crystal
National outbreak
Varied sub-populations
More smoking
Strong association with HIV, hepatitis C
Community level responses to AIDS deaths, 9/11,
war
• National discussion
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The Methamphetamine Effect
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Difficulties of System
Integration
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Separate funding streams and coverage gaps
Agency turf issues
Different philosophies
Lack of resources
Poor cross training
Consumer and family barriers
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Developmental Paths for Multi-Problem
Behavior
Dennis D. Embry
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The Intervention Spectrum
for Behavioral Disorders
Case
Identification Standard
Treatment
for Known
Indicated—
Disorders
Diagnosed
Youth
Selective—
Health Risk
Groups
Universal—
General Population
Compliance
with Long-Term
Treatment
(Goal:Reduction in
Relapse and Recurrence)
Aftercare
(Including
Rehabilitation)
Source: Mrazek, P.J. and Haggerty, R.J. (eds.), Reducing Risks for Mental Disorders, Institute of
Medicine, Washington, DC: National Academy Press, 1994.
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Prevention Theory
• Explains the causes and mechanisms of action
• Identifies the variables influencing these
mechanisms, including cultural
• Predict points to interrupt the course leading to
substance abuse; and
• Specifies the interventions to prevent the onset of
substance abuse.
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Theories of Prevention
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Cognitive-Affective
Social Learning
Intrapersonal
Comprehensive
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Cognitive-Affective:
Theory: The consequences of experimenting
with a drug contributes to decision to use.
Intervention: Increase beliefs about negative
consequences of drugs, highlight benefits of
not using drugs, and correct inflated
estimates or perceptions of drug use.
•
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Social Learning:
Theory: Adolescents acquire their beliefs
about substance use and other delinquent
behaviors from their role models, friends, and
parents.
Intervention: Provide adolescents with
positive role models, and to teach them
refusal skills and the belief that they can
resist drugs.
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Conventional Commitment and
Social Attachment:
Theory: Emotional attachments adolescents have with
peers who use substances is the cause of substance
use.
Intervention: Improve bonds between adolescents and
positive peer groups and prosocial institutions. Focus
on improving academic and career skills, provide
career opportunities, and teach parents how to
socialize and reinforce their children.
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Intrapersonal:
Theory: Examine how personality characteristics,
emotions, and behavioral skills contribute to
substance use. Examples; stress at school, selfesteem, social interaction skills, coping skills, and
emotional distress.
Interventions: Target many of the individual
characteristics of children rather than focusing on
their beliefs about specific drugs and behaviors.
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Comprehensive
Combines components from all of the other
theories. They attempt to account for how
adolescents' biology, personality,
relationships with peers and parents, and
culture or environment interact to cause drug
use.
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Conclusions: Before selecting an
approach, consider the following:
• Who are the people in the support system?
• Are they contributor to the adolescent's level of risk for
using substances?
• What are the adolescent's attitudes toward specific
substances?
• How might values communicated through an adolescent's
culture influence decisions to experiment with substances?
• What are the personality characteristics, emotional states,
and/or behavioral skills of adolescents at risk for using
substances?
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Ecological Model
Society
Community/
Tribe
Peer/Family Individual
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Individual Intervention
• Identify risk and protective factors
counseling
skill building
improve coping
support groups
• Increase community awareness
• Access to hotlines other help resources
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Effective Family Intervention
Strategies: Critical Role of Families
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Parent training
Family skills training
Family in-home support
Family therapy
Different types of family interventions are
used to modify different risk and
protective factors.
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Community Driven/School Based
Prevention Interventions
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Public awareness and media campaigns
Youth Development Services
Social Interaction Skills Training Approaches
Mentoring Programs
Tutoring Programs
Rites of Passage Programs
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Risk Factors
• Exist in multiple domains.
• The more risk factors present, the greater the
risk.
• Reducing the overall number can have a
significant impact on future problem behaviors.
• Show the same effect across different races,
cultures and classes.
• Can be buffered by protective factors.
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Protective Factors
Individual is given:
• the opportunity for involvement in productive, prosocial roles in family, friends, community, society
• the skills to be successfully involved in those roles
• recognition and reinforcement for their
involvement
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Prevention Programs Reduce
Risk Factors
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ineffective parenting
chaotic home environment
lack of mutual attachments/nurturing
inappropriate behavior in the classroom
failure in school performance
poor social coping skills
affiliations with deviant peers
perceptions of approval of drug-using behaviors
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Prevention Programs Enhance
Protective Factors
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strong family bonds
parental monitoring
parental involvement
success in school performance
pro social institutions (e.g. such as family,
school, and religious organizations)
• conventional norms about
drug use
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Prevention Programs Should . . . .
Target all Forms of Drug Use
. . .and be Culturally Sensitive
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WHAT ARE SOME PROMISING STRATEGIES?
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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.)
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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
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Treatment Approaches Effective with
Methamphetamine Use Disorder
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Motivational Interviewing - MI
Therapeutic Use of Urinalysis
Contingency Management (motivational incentives)
Community Reinforcement Approach
Cognitive Behavioral Therapy - CBT
Matrix Model (combination of above)
(Data show that methamphetamine treatment outcomes
are not very different than those for other addictive drugs)
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Partnered Collaboration
Grassroots
Groups
Community-Based
Organizations
Research-Education-Treatment
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Potential Organizational
Partners
• Education
• Law Enforcement
• Family Survivors
• Juvenile Justice
• Health/Public Health
• Medical Examiner
• Mental Health
• Faith-Based
• Substance Abuse
• County, State, and
Federal Agencies
• Elders, traditional
• Student Groups
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Contact us at
503-494-3703
E-mail
Dale Walker, MD
[email protected]
Or visit our website:
www.oneskycenter.org
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