Transcript The Indian Country Methamphetamine Initiative

The Indian Country
Methamphetamine Initiative:
Taking Interventions to Scale
Association of American Indian Physicians
39th Annual Meeting
R Dale Walker, MD Patricia Silk Walker, PhD Michelle Singer
August 9, 2010
Santa Ana Pueblo, New Mexico
Education
Mentorship
Opportunity,
Research
One Sky
Center
Training,
Consultation,
Technical
Assistance
Excellence
Tribal
Leadership
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Goals for Today
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The methamphetamine problem
The methamphetamine initiative
The Mission: Going-to-Scale
ICMI Tribal Sites
General Approaches
Logic Models
Examples
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Scope of the Meth Problem Worldwide
• The most widely used illicit drug in the world
except for cannabis.
• Worldwide it is estimated there are over 42
million regular users compared to approximately
15 million heroin users and 10 million cocaine
users
Meth use is increasing and expanding!
What is methamphetamine?
• A powerful stimulant drug, classified as a
psychostimulant
• A Schedule II drug (along with cocaine and
several other drugs) under the Federal
Controlled Substances Act
• A highly addictive drug
Why do people use meth?
• Initially, methamphetamine decreases fatigue
and appetite, heightens attention, and
increases activity and respiration, creating
feelings of high energy.
• Meth enables people to stay awake and be
physically (also sexually) active for long
periods.
Source: National Institute on Drug Abuse. April 1998, Reprinted January 2002. Research Report Series:
Methamphetamine Abuse and Addiction. www.nida.nih.gov/ResearchReports/methamph/methamph.html
How does meth work?
• Methamphetamine releases large amounts of
dopamine in the brain, causing feelings of
pleasure and euphoria.
Source: National Institute on Drug Abuse. April 1998, Reprinted January 2002. Research Report Series:
Methamphetamine Abuse and Addiction. www.nida.nih.gov/ResearchReports/methamph/methamph.html
• Withdrawal symptoms may include fatigue,
depression, anxiety, paranoia, aggression,
and an intense craving for more of the drug.
In some cases, psychotic symptoms may
persist for months or years following use.
Source: Office of National Drug Control Policy. November 2003. Fact Sheet: Methamphetamine.
www.whitehousedrugpolicy.gov/publications/factsht/methamph/
How is meth used?
• Injecting or smoking methamphetamine
produces a short but intense and pleasurable
“rush.”
• When taken orally or by snorting, meth
causes a less intense but much longer-lasting
high that persists for several hours.
Source: National Institute on Drug Abuse. April 1998, Reprinted January 2002. Research Report Series:
Methamphetamine Abuse and Addiction. www.nida.nih.gov/ResearchReports/methamph/methamph.html
Why is Meth 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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Young Adults (18 to 25) Reporting Past Year
Methamphetamine Use: 2002 to 2005
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Source: SAMHSA, 2002-2005 .
Methamphetamine Use in Past Year among
Persons Aged >11, by Percentage and by
Race/Ethnicity: 2002 - 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
Methamphetamine:
Epidemiology
Methamphetamine:
Epidemiology
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Past Month Illicit Drug Use among
Youths Aged 12 to 17, by
Race/Ethnicity: 2002
Methamphetamine Users (n= 1016)
LIFETIME SUICIDE ATTEMPTS and
BEHAVIOR PROBLEMS
Overall
Males
Females
Test
Statistic*
Attempted Suicide (%)
27%
13%
28%
35.42**
Violent behavior problems (%)
43%
40%
46%
3.29***
Assault Charges (mean number)
0.29
0.46
0.15
4.46**
Weapons charges (mean number)
0.13
0.21
0.07
4.09**
ASI Item
*Mantel-Haenszel chi-square was used to test differences in proportions by gender, df=1; Student’s
two-group t-test (two-sided) was used to test differences between males and females in continuous
dependent variables reflecting the number of charges, df=1013.
Zweben, et al., 2004
**p < 0.00001 ***0.1 < p <0.05
Clinical Challenges for Treatment
of Methamphetamine Addiction
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Poor treatment engagement rates
High dropout rates
Severe paranoia
High relapse rates
Ongoing episodes of psychosis
Severe craving
Protracted dysphoria
Many patients may require medical/psychiatric supervision and need
ongoing treatment with antipsychotic medications
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The Methamphetamine Effect
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“Tribal leaders unveil new meth
Initiative” Indian Country Today
NCAI President, Joe Garcia June 15, 2007
• Create a National
outreach campaign for all
Native communities.
• Establish and transfer
community based,
promising practices for
prevention and treatment.
• Work across Federal
agencies for coordinated
and consistent outreach
strategy.
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ICMI Partners
Yakama
OSC
Chippewa Cree
Northern Arapaho
Crow
Winnebago
NCAI
NPAIHB
Salt River
USET
Navajo
San Carlos
AAIP
Choctaw
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WHAT ARE SOME PROMISING
STRATEGIES?
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An Ideal Intervention
• Broadly based:
Includes individual, family,
community, tribe and society
• Comprehensive:
Prevention: Universal, Selective,
Indicated
Treatment
Maintenance
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Domains Influencing Drug Use Behavior:
A Native Ecological Model
Risk
Individual
Protection
Peers/Family Community/Tribe
Society/
Cultural
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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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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 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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Why Logic Models?
• Logic models are useful
– Clarification
– Group work
– Planning; project mgmt; evaluation
• Logic models are required
– Grant applications
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Logic Model
• Causes
– Social Determinants
– Risk and Protective Factors
• Target Populations
– Individuals; Families; Communities; Society
• Approach/Strategy
– Theory of Action
– Manualized Activity and Materials Details
• Outcomes (short; median; long)
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Fighting Meth, Healing Families:
Seven Promising Solutions
1. Media Campaigns
2. Expanding Permanency Options
3. Interagency Collaborations
4. New Supports for Grandfamilies
5. Enhancing Treatment Options
6. Family Drug Courts
7. Targeted Community Supports in Indian
Country
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ICMI Intervention Models
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Community Mobilization
Capacity Development
Information
Treatment
Law Enforcement and Justice
Cultural Renaissance
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Winnebago Tribe: Meth Task
Force Goals and Objectives
• Develop/maintain a Comprehensive Meth
Prevention Strategy
• Collectively plan and implement
• Use Proactive measures
• Use available funds - take immediate
action
• Working together to determine what fits
• Broad based, multi-agency, systematic,
family/community focused prevention-
Community Mobilization
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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
• Capacity development.
• Training for best, evidence based practice, integrated public health model.
• Experienced at mobilizing communities across large area for interventions.
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Northern Arapaho Tribe:
a Comprehensive Systems Plan
The Problem:
– “turf”
– gaps
– duplications
– crossed purposes
The Solution: “Works”
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client-centered
multi-agency
comprehensive
coordinated
Efficient
Fragmented Service
System
Implement Best Practice Treatment
1. Information
2. Multi-Systemic Family Therapy
3. Critical Incident Counseling
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Choctaw Nation of Oklahoma
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Adventure Therapy
“Natural Highs Program”
Transformation process
Experiential activities
Relationship building
Changing the way you live and think
Changing how you think and how
you believe about life and yourself
Treatment.
Creation of challenge in a safe
environment
Horses, Canoes, Tradition Camps
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Meth Free Crow Walk: Youth as
our Warriors in Reclaiming our
Nation
Meth Free Crowalition
• Establish a “War Against
Meth” Focus on
accountability, prevention,
intervention, and
treatment
• Combine forces for Unity.
• Diverse community
representation
• Youth and Community
Development: mentorship,
leadership, trust, establish
community norms. Law
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Cultural Renaissance
• All Sites
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Effective Treatment Approaches For
Methamphetamine Use Disorder
• Motivational Interviewing
• Therapeutic Use of Urine Testing
• Contingency Management ( motivational
incentive based)
• Cognitive Behavioral Therapy - CBT
• Community Reinforcement Approach
• Matrix Model (combination of above)
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Partnered Collaboration
State/Federal
Grassroots
Groups
Community-Based
Organizations
Research-Education-Treatment
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Problem is bigger, broader and more
complex than current solutions
• Broad-based, integrated, interagency changes
are needed.
• State, county, and city relationships to be
developed with tribes and communities
• Training and tribal leadership development.
• A Marshall Plan for all Native America that
effects: economics, housing, social services,
education, law/governance, and health.
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Six Key Principles
Evidence-based predictors of change
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Leadership
Mobilization Community driven
Public health approach
Strength based
Culturally informed
Proactive
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Contact us at
503-494-3703
E-mail
Dale Walker, MD
[email protected]
Or visit our website:
www.oneskycenter.org
How to Use the Toolkit
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Leadership and decision making
Overview of each module
Specific topics, issue pages
Promising Practice approaches
What the culture and science says
Training, technical assistance,
and consultation
• Reference documents
• Toolkit webpage
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Toolkit Essentials
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Leadership Information
Methamphetamine Basics
Tribal Code-Policy
Media
Educational Materials and Presentations
Prevention and Treatment
Educational for Students, Parents, Community
• Community Organizing
• Fun Youth Items
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• Additional Resources