Post on 22-Jan-2016
description
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The American Indian/Alaska Native National Resource Center for Substance Abuse and Mental Health Services
The Indian Country Methamphetamine Initiative: a Problem Uniquely Affecting
Indian Country
Dale Walker, MD Patricia Silk Walker, PhD Michelle Singer
July 29, 2007Nashville, Tennessee
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Special Thanks and Recognition
• AAIP and the Executive Board• Margaret Knight• Rachel Crawford• Heather Levi• Vincent Knight
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One Sky Center
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Jack Brown Adolescent Treatment Center
Alaska Native Tribal Health Consortium
United American Indian Involvement
Northwest Portland Area Indian Health Board
Na'nizhoozhi Center
Tribal Colleges and Universities
One Sky Center
National Indian Youth Leadership Project
Cook Inlet Tribal Council
Tri-Ethnic Center for Prevention Research
Red Road
Prairielands ATTC
Harvard Native Health Program
One Sky Center Partners
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One Sky Center Outreach
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Goals for Today
• 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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1491
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Agencies Involved in B.H. Delivery
1. Indian Health Service (IHS)A. Mental HealthB. Primary HealthC. Alcoholism / Substance Abuse
2. Bureau of Indian Affairs (BIA)A. EducationB. VocationalC. Social ServicesD. Police
3. Tribal Health4. Urban Indian Health5. State and Local Agencies6. Federal Agencies: SAMHSA, VAMC,
Justice
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Difficulties of Program Integration
• 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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How are we functioning?(Carl Bell, 7/03)
One size fits allOne size fits all
Different goals Different goals Resource silosResource silos
Activity-drivenActivity-driven
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We need Synergy and an Integrated System (Carl Bell, 7/03)
Culturally Specific
Culturally Specific
Best Practice
Best Practice
IntegratingResources
IntegratingResources
Outcome Driven
Outcome Driven
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Partnered Collaboration: AAIP Style
Research-Education-Treatment
Grassroots Groups
Community-BasedOrganizations
State/Federal
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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
Native Health Problems1. Alcoholism 6X
2. Tuberculosis 6X
3. Diabetes 3.5 X
4. Accidents 3X
5. Poverty 3x
6. Depression 3x
7. Suicide 2x
8. Violence?
9. Methamphetamine?
Six Behaviors That Contribute to Serious Health
Problems:• Tobacco use• Poor nutrition• Alcohol and other drug abuse – • Behaviors resulting in intentional or unintentional
injury• Physical inactivity• Risky sex
Methamphetamine!
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Percentages of Young Adults Aged 18 to 25 Reporting Past Year Methamphetamine Use, by State: 2002, 2003, 2004, and 2005
Source: SAMHSA, 2002-2005 .
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Methamphetamine: Epidemiology
Past Month Illicit Drug Use among Youths Aged 12 to 17, by Race/Ethnicity: 2002
Methamphetamine: Epidemiology
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Methamphetamine/Amphetamine Admissions, by Race/Ethnicity and
Urbanization: 2004 Race/
Ethnicity
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%
Source: 2003 SAMHSA Treatment Episode Data Set (TEDS).
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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– 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 to 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
AAIP
USET NPAIHB OSC NCAI
Choctaw Crow Navajo Northern Arapaho Winnebago
IHS OMH HHS
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Winnebago
Navajo
Choctaw
Crow
Northern Arapaho
NPAIHB
AAIP
USET
OSC
NCAI
ICMI Partners
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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
• 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• Additional Resources
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How to Use the Toolkit
• 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/servicesResearch
TraditionalHealing
MainstreamPractice
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Circle of Care
Best Practices
Child & Adolescent Programs
Prevention Programs
Primary Care
EmergencyRooms
TraditionalHealers
A&D Programs
Colleges & Universities
Boarding Schools
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The Intervention Spectrum for Behavioral Disorders
CaseIdentification Standard
Treatmentfor KnownDisorders
Compliancewith Long-TermTreatment(Goal: Reduction inRelapse and Recurrence)
Aftercare(Including
Rehabilitation)
Prev
entio
n
TreatmentM
aintenance
Source: Mrazek, P.J. and Haggerty, R.J. (eds.), Reducing Risks for Mental Disorders, Institute of Medicine, Washington, DC: National Academy Press, 1994.
Indicated—Diagnosed Youth
Selective—Health RiskGroups
Universal—General Population
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No No ProblemsProblems
Universal/Selective Universal/Selective PreventionPrevention
Brief InterventionBrief Intervention
TreatmentTreatment
Mild Mild ProblemsProblems
Moderate Moderate ProblemsProblems
Severe Severe ProblemsProblems
Thresholds for ActionThresholds for Action
Spectrum of Intervention Responses
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Treatment Settings - Social Support: A Native Advantage
• Tribal
• Community
• Family
• Sibs
• Peers
• Individual
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Ecological Model
IndividualPeer/FamilySociety Community/Tribe
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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 therapyDifferent types of family interventions are used
to modify different risk and protective factors.
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Sources of Strength
Family Support
Positive Friends
Caring Adults
Positive ActivitiesGenerosity/Leadership
Spirituality
Access to Medical
Access to Mental Health
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Recommended Behavioral Treatment Approaches
• 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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Relapse Rates Are Similar for Drug Dependence and Other Chronic
Illnesses
Relapse Rates Are Similar for Drug Dependence and Other Chronic
Illnesses
00
1010
2020
3030
4040
5050
6060
7070
8080
9090
100100
Drug Dependence
Drug Dependence
Type I DiabetesType I
DiabetesHypertensionHypertensionAsthmaAsthma
40 t
o 60
%40
to
60%
30 t
o 50
%30
to
50% 50
to
70%
50 t
o 70
%
50 t
o 70
%50
to
70%
Source: McLellan, A.T. et al., JAMA, Vol 284(13), October 4, 2000.Source: McLellan, A.T. et al., JAMA, Vol 284(13), October 4, 2000.
Per
cen
t of
Pat
ien
ts W
ho
Rel
apse
Per
cen
t of
Pat
ien
ts W
ho
Rel
apse
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Youth Treatment Completion: WA State
50%
62%
52%46%
55% 50%
0%
10%
20%
30%
40%
50%
60%
70%
Alcohol Cocaine Marijuana Meth Heroin Other
Youth
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Contact us at503-494-3703E-mailDale Walker, MDonesky@ohsu.eduOr visit our website:www.oneskycenter.org