Transcript Substance Use Disorder_ME.

Drug and Alcohol
Implications for TVR
Counselors
MARC ESPINO, TOHONO O’ODHAM
SYCUAN INTER-TRIBAL VOCATIONAL REHABILITATION PROGRAM SAN DIEGO CA
IN COLLABORATION WITH JESSICA ELM, MSW ONEIDA / STOCKBRIDGE-MUNSEE, UNIVERSITY OF WA
Origins – Historically Traumatic Events
Boarding School Period 1879-1935 +

On and off-reservation boarding schools were developed after at Fort
Marion Prison in Florida (1872-1875) where Native prisoners of war were
held.

1879: “Kill the Indian, Save the Man” Policy
Proposed

forced removal at early age with no return until young adults
1909: 25 off-reservation boarding schools
More
than 100,000 Native children forced to attend these schools
Attendance mandatory or parents would be imprisoned
Relocation Era 1950’s – 1960’s

U.S. government promised jobs and resources in an effort
to encourage Native people to leave their Tribal lands and
relocate to large metropolitan areas (Los Angeles, Bay Area, Seattle…)
After arriving many were not provided what was promised.
Some did not have the financial means to return to their
Tribal homelands -either permanently or even for
ceremony.
 Video Clip: We Shall Remain

Origins –Trauma Response

Trauma response
 Historically
traumatic events
 Grief
 Sense
of Loss
 Anger
 Coping
 Ceremony,
 Alcohol
cultural practices
and Substance Abuse
Consequences: Life Course Problems
Consequences: Risk Factors
Hopelessness
Impulsivity
Behavioral Problems
Unemployment
Withdrawal
School Problems
Depression
Poor Interpersonal Communication
Limited Social Support
Stigma
Anxiety
Family History
Suicidal Behavior
Domestic Violence
Dual Diagnosis
Geographic Isolation
Child Abuse
Personal Losses
Suicide Clusters
Slide borrowed from Rose Weahkee, PhD at the Indian Health Service
Implications: Protective Factors
Life Skills
Hope
Access
Healthy Peer/Adult Modeling
Sense of Humor
Belonging
Resources Available
Interpersonal Competence
Social Support
Sense of Well-being
Self-Esteem
Strong Group Affiliation
Family Support
Good Health
Language
Cultural Identity
Acceptance
Help-Seeking Behavior
Safety/Security
Slide borrowed from Rose Weahkee, PhD at the Indian Health Service
Protective Factors

A 1999 study of risk and protective factors among AI/AN youth showed
that “adding protective factors was equally or more effective than
decreasing risk factors in terms of reducing suicidal risk.”

Protective factors, similar to risk factors, are cumulative and interrelated.

Enhancing the way in which people feel connected to community and
family and strengthening their ability to cope with life’s challenges will
help them achieve their full potential.
Video Clip: White Bison.Org
The Wellbriety Movement: Journey of Foregiveness

Slide borrowed from Rose Weahkee, PhD at the Indian Health Service
Implications: Living in Both Worlds


History and Values

Collective Communities

Trauma, Stress -> Substance Use as a symptom
Today’s Western Philosophy

Economics

Independence

WORK
Vocational Implications


Eligibility Determination:

Substance Use Disorders and diagnostic criteria; mild,
moderate, severe (Addictive Disorders: Gambling Disorder)

Comprehensive Evaluation: co-occurring disorders, history
and barriers to employment

AIVR as outpatient and aftercare services; length of
sobriety
IPE Development

Disability Management: Counseling, cultural support
groups/meetings, recovery coaches, ceremony

Spiritual, Family, Cultural Interconnectedness
Vocational Complications

Work History: job loss, lack of positive references

“Using behavior” and accountability

Barriers: drug screening, background checks, transportation, esteem issues

Transition to work phase: scheduling, decreased meetings and counseling,
onset of work related stress/anxiety

Lack of coping mechanisms: functional or dysfunctional coping skills

Disconnection to cultural, family, and ceremonial supports

Poor social support network

Relapse potential

Pathway from institutionalization: prison, jails, mental facilities,
Implications: Psychological Consequences

PTSD

Generalized Anxiety Disorder

Depression

Guilt/Grief

Attention problems

Impulsive Control Issues

Low Frustration Tolerance

Lack of Time Perception
Social Consequences

Lack of Social Skills

Loss of Activity of Daily Living (ADL) Skills: Self
care activities; independent living skills, skills
performed with others

Immersion in Drug Culture

Need for Positive Peer Supports
Spiritual Consequences

Hopelessness

Despair

Loss of Direction

Need for Values Clarification
Progression Cycle
What would you do?

Transparency in case management approach

Personal perspective and personal beliefs

Transparency in case management approach

Medical Marijuana/Methadone Maintenance

Relapse and recovery maintenance

“Payment of residential treatment”

Substance abuse counseling as employment outcome

Case Studies/Song/Q & A