Transcript Native Communities Respond to

The American Indian/Alaska Native National Resource Center
for Substance Abuse and Mental Health Services
Native Communities Respond to
Methamphetamine Abuse:
Organize, Mobilize, and
Work Together
Dale Walker, MD Patricia Silk Walker, PhD Michelle Singer
September 13, 2007
Confederated Tribes of Grand Ronde
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One Sky
Center
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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
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One Sky Center Outreach
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Goals for Today
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Background: The environment and the system of care
The methamphetamine problem
The methamphetamine initiative
The toolkit
Treatment works!
Integrated care approaches are best for treatment of
these chronic illnesses
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A Major Reason People
Take a Drug is they Like
What It Does to Their Brains
The first use is usually voluntary
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Why do people take drugs?
To feel good
To have novel:
Feelings
Sensations
Experiences
AND
To share them
To feel
better
To lessen:
Anxiety
Worries
Fears
Depression
Hopelessness
Withdrawal
Effects of Drugs on Dopamine
Accumbens
AMPHETAMINE
% of Basal Release
1100
1000
900
800
700
600
500
400
300
200
100
0
% of Basal Release
Dopamine
Pathways
Principal
“Pleasure”
System of the
Brain
DA
0
1
2
3
4
5 hr
Time After Amphetamine
400
COCAINE
Accumbens
DA
300
200
100
0
0
1
2
3
4
Time After Cocaine
5 hr
Source: Di Chiara and Imperato
200
NAc shell
150
100
Empty
50 BoxFeeding
0
0
60
120
180
Time (min)
Di Chiara et al.
150
100
SEX
Copulation Frequency
nucleus
accumbens
FOOD
200
DA Concentration (% Baseline)
substantia
nigra/VTA
Natural Rewards Elevate Dopamine
% of Basal DA Output
frontal
cortex
striatum
hippocampus
15
10
5
0
ScrScr
Scr Scr
BasFemale 1 Present
Female 2 Present
1 2 3 4 5 6 7 8
9 101112131415 1617
Sample
Mounts
Number
Intromissions
Ejaculations
8 Phillips
Fiorino and
1491
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10
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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
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Difficulties of Program
Integration
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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
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Different goals
Resource silos
One size fits all
Activity-driven
How are we functioning?
(Carl Bell, 7/03)
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Culturally
Specific
Best
Practice
Outcome
Driven
Integrating
Resources
We need Synergy and an Integrated
System (Carl Bell, 7/03)
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Native Peoples: Multiple Life Risks
Psychiatric Illness
& Stigma
-Edn,-Econ,-Rec
Cultural Distress
Impulsiveness
Substance
Use/Abuse
Hopelessness
Family Disruption
Domestic Violence
CHILD/
ADULT
Negative Boarding School
Historical Trauma
Douglas Jackobs 2003
R. Dale Walker, M.D., 2003
Family History
Psychodynamics/
Psychological Vulnerability
Suicidal
Behavior
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American Indians
• Have same disorders as general
population
• Greater prevalence
• Greater severity
• Much less access to Tx
• Cultural relevance more challenging
• Social context disintegrated
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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?
Six Behaviors That Contribute
to Serious Health Problems:
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Tobacco use
Poor nutrition
Alcohol and other drug abuse –
Behaviors resulting in intentional or unintentional
injury
• Physical inactivity
• Risky sex
Methamphetamine!
Percentages of Young Adults Aged 18 to 25 Reporting Past Year
Methamphetamine Use, by State: 2002, 2003, 2004, and 2005
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Source: SAMHSA, 2002-2005 .
Methamphetamine:
Epidemiology
Methamphetamine:
Epidemiology
Past Month Illicit Drug Use among Youths Aged 12 to 17, by
Race/Ethnicity: 2002
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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/Ethnic
ity
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Source: 2003 SAMHSA Treatment Episode Data Set (TEDS).
Recent Methamphetamine Reports
Five arrested for drugs and meth in South Dakota (04/30)
Meth dealers targeted Wind River Reservation (04/30)
Crow students hold second walk against meth (04/30)
Belcourt: Indian Country takes path of healthy living (04/30)
Paiute Tribe of Utah cites increased meth use (04/26)
BIA ties violence against women to meth abuse (04/26)
HHS holds consultation session in Salt Lake City (04/25)
Fired U.S. Attorneys praised for Indian Country work (04/19)
Tribal methamphetamine bill clears House (04/17)
Coyote Valley Band on new track with new chairman (04/09)
Four await trial for meth-related triple homicide (04/04)
California court throws out search on reservation (04/03)
Artman ushers in leadership changes at BIA (04/02)
Pechanga man sentenced to 44 years for deaths (04/01)
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The Methamphetamine Effect
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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.
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“Tribal leaders unveil new meth Initiative”
Indian Country Today
NCAI President, Joe Garcia Anchorage, Alaska June 15, 2007
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HHS Indian Country
Methamphetamine Initiative
• $1.2 million awarded to Association of Indian Physician
(AAIP) its partners (National Congress of American
Indians, One Sky Center, South and Eastern Tribes, and
Northwest Portland Area Indian Health Board)
• Tribal Sites
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Navajo Nation
Winnebago Tribe
Northern Arapaho Tribe
Crow Nation
Choctaw Nation
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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.
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The Indian Country Methamphetamine
Initiative: Project Partners
SAMHSA
OMH
IHS
HHS
AAIP
USET
Choctaw
Crow
NPAIHB
OSC
NCAI
Navajo Northern Arapaho Winnebago
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ICMI Partners
OSC
Northern Arapaho
Crow
Winnebago
NCAI
NPAIHB
USET
Navajo
AAIP
Choctaw
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ICMI Major Project Deliverables
• Outreach/Education Kit for Tribes and other Groups
• Identification of Partners ( also Advisory Groups)
• Coordinated Federal-Tribal-State-Local Indian
Country Communication and Training Strategy
• Minimum 5 Tribal Specific Projects Identified and
Evaluated for Potential Transfer to Other NA
Communities
• Final Project Evaluation
• Year 3 - Promising Practices Transfer Kits
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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
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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ID Best Practice
Best Practice
Clinical/services
Research
Mainstream
Practice
Traditional
Healing
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Circle of Care
Traditional
Healers
Primary Care
A&D
Programs
Best
Practices
Child &
Adolescent
Programs
Boarding
Schools
Colleges &
Universities
Prevention
Programs
Emergency
Rooms
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Partnered Collaboration
State/Federal
Grassroots
Groups
Community-Based
Organizations
Research-Education-Treatment
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Ideas?
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Spectrum of Intervention Responses
Thresholds for Action
No
Problems
Mild
Problems
Moderate
Problems
Severe
Problems
Treatment
Brief Intervention
Universal/Selective
Prevention
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Treatment Settings - Social
Support: A Native Advantage
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Tribal
Community
Family
Sibs
Peers
Individual
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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
• 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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Sources of Strength
Access to Mental Health
Access to Medical
Spirituality
Generosity/Leadership
Family Support
Positive Friends
Caring Adults
Positive Activities
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Recommended Behavioral Treatment
Approaches
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Cognitive Behavioral Therapy
Psychosocial Treatment
Community Reinforcement - Plus Vouchers
Contingency Management
Relapse Prevention
The Matrix Model
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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.
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100
90
80
40
30
20
50 to 70%
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30 to 50%
60
50 to 70%
70
40 to 60%
Percent of Patients Who Relapse
Relapse Rates Are Similar for Drug
Dependence and Other Chronic
Illnesses
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0
Drug
Type I Hypertension Asthma
Dependence Diabetes
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Source: McLellan, A.T. et al., JAMA, Vol 284(13), October 4, 2000.
Youth Treatment Completion:
WA State
Youth
70%
62%
60%
55%
50%
50%
46%
52%
50%
40%
30%
20%
10%
0%
Alcohol
Cocaine
Marijuana
Meth
Heroin
Other
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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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