Transcript Methamphetamine Interventions and Treatment

The American Indian/Alaska Native National Resource Center
for Substance Abuse and Mental Health Services
Methamphetamine Interventions
and Treatment
Dale Walker, MD Patricia Silk Walker, PhD
The Confederated Tribes of Warm Springs
June 26, 2006
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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
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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One Sky Center Outreach
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Presentation Overview
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One Sky Center introduction
What’s the story on methamphetamine?
Fragmentation and Integration of systems
Discuss prevention and treatment
Integrated care approaches and interagency
coordination are best overall solutions
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Indianz.com Methamphetamine Stories
1. Wyoming governor addresses meth at Wind River (06/01)
2. Upper Sioux Community adopts banishment policy (06/01)
3. Gila River women speak out against meth use (05/29)
4. Methamphetamine ring leads to charges against 53 (05/26)
5. Editorial: Northern Cheyenne Tribe fights meth (05/23)
6. Story on Crow Tribe and gangs draws most comments (05/19)
7. Domenici seeks special federal judge for meth cases (05/18)
8. Crow Tribe seeks help in combating gangs (05/18)
9. Couple sentenced for meth and drug ring on Wind River (05/17)
10.Northern Cheyenne Tribe rallies against meth use (05/15)
11.Pine Ridge meth task force proposes tougher laws (05/09)
12.Weapons cache seized on Soboba Reservation (05/05)
13.Rincon man convicted for meth-related murders (05/05)
14.Nisqually Tribe's law enforcement scrutinized (05/04)
15.Pine Ridge concert promoters tout 'Death to Meth' (05/02)
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Methamphetamine Associated
Hospital Admissions (2002)
R. Dale Walker, M.D., 2003
Oregon Methamphetamine Admissions
Meth admissions by state
1,800
1,600
1,400
1,200
1,000
OR
800
600
400
200
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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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Methamphetamine:
Epidemiology
Methamphetamine:
Epidemiology
Past Month Illicit Drug Use among Youths Aged 12 to 17, by
Race/Ethnicity: 2002
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IHS-Wide Outpatient Encounters for
Amphetamine Related Visit by Calendar Year
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Native Health/ Educational Problems
1. Alcoholism 6X
2. Tuberculosis 6X
3. Diabetes 3.5X
4. Accidents 3X
5. Suicide 1.7 to 4x
6. Health care access -3x
7. Poverty 3x
8. Poor educational achievement
9. Substandard housing
10. Methamphetamines?
Agencies Involved in Behavioral Health
1. Bureau of Indian Affairs (BIA)
A. Education
B. Vocational
C. Social Services
D. Police
2. Indian Health Service (IHS)
A. Mental Health
B. Primary Health
C. Alcoholism / Substance Abuse
3. Tribal Education/Health
4. Urban Indian Education/Health
5. State and Local Agencies
6. Federal Agencies: SAMHSA, Edn
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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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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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Methamphetamine Indicators
Meth indicators
40,000
35,000
30,000
Possession arrests
Treatment cases
ER admissions
ID theft cases
Purity*
25,000
20,000
15,000
10,000
5,000
1
2
00
q
20
19
99
q
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4
98
q
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97
q
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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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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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An Ideal Intervention
• Includes individual, family, community, tribe
and society
• Comprehensive:
Universal
Selective
Indicated
Treatment
Maintenance
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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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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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Evidence Based Cognitive
and/or Behavioral Treatments
Cognitive/Behavioral Therapy-CBT
Motivational Interviewing-MI
Contingency Management-CM
Community Reinforcement Approach-CRA
Matrix Model of Outpatient Treatment-MM
(Combination of above)
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Cognitive Behavioral Therapy
• Key Concepts
– Encouraging and reinforcing behavior
change
– Recognizing and avoiding high risk
settings
– Behavioral planning (scheduling)
– Coping skills
– Conditioned “triggers”
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Motivational Interviewing
• Key Concepts
Empathy and therapeutic alliance
Give feedback and reframe
Create dissonance
Focus of discrepancy of expected
and actual
Reinforce change
Roll with resistance
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Contingency Management
• Key concepts
Behavior to be modified must be objectively
measured
Behavior to be modified (eg urine test
results) must be monitored frequently
Reinforcement must be immediate
Penalties for unsuccessful behavior (eg
positive Ua) can reduce voucher amount
Vouchers may be applied to a wide range of
prosocial alternative behaviors
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Matrix Model
• Is a manualized, 16-week, non-residential, psychosocial
approach used for the treatment of drug dependence.
• Designed to integrate several interventions into a
comprehensive approach. Elements include:
– Individual counseling
– Cognitive behavioral therapy
– Motivational interviewing
– Family education groups
– Urine testing
– Participation in 12-step programs
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Matrix Model Treatment
Key Concept: Thought Stopping
Trigger
Thought
Continued Thoughts
Cravings
Use
•Prevents the thought from developing into an
overpowering craving
•Requires practice
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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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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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Treatment Outcomes
Myth
Clients addicted to Methamphetamine
have poorer treatment outcomes
Reality
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
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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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