The American IndianAlaska Native National Resource Center for Substance Abuse and Mental Health Serv

1
The American Indian/Alaska Native National
Resource Center for Substance Abuse and Mental
Health Services
Our Native Methamphetamine Crisis An
Integrated Care Solution
Dale Walker, MD Patricia Silk Walker, PhD
Michelle Singer Regional Methamphetamine
Conference
Portland, Oregon November 7, 2006
2
Native Communities
Advisory Council / Steering Committee
One Sky Center
3
One Sky Center Partners
Tribal Colleges and Universities
Cook Inlet Tribal Council
Alaska Native Tribal Health Consortium
Prairielands ATTC
Red Road
Northwest Portland Area Indian Health Board
One Sky Center
Harvard Native Health Program
United American Indian Involvement
Jack Brown Adolescent Treatment Center
National Indian Youth Leadership Project
Tri-Ethnic Center for Prevention Research
Na'nizhoozhi Center
4
Presentation Overview

• One Sky Center introduction
• Whats the story on methamphetamine?
• Fragmentation and Integration of systems
• Discuss prevention and treatment
• Integrated care approaches and interagency
  coordination are best overall solutions

5
Methamphetamine AssociatedHospital Admissions
(2002)
6
Oregon Methamphetamine Admissions
7
OHSU Substance Abuse Clinic Enrollees
8
National Methamphetamine Initiative Survey
Mark Evans Tactical Intelligence Supervisor New
Mexico Investigative Support Center 4-12-2006
9
National Methamphetamine Initiative Survey
Mark Evans Tactical Intelligence Supervisor New
Mexico Investigative Support Center 4-12-2006
10
National Methamphetamine Initiative Survey
Mark Evans Tactical Intelligence Supervisor New
Mexico Investigative Support Center 4-12-2006
11
Methamphetamine Epidemiology
12
IHS-Wide Outpatient Encounters for Amphetamine
Related Visit by Calendar Year
13
Methamphetamine Indicators
14
Why is Methamphetamine so Devastating?

• Cheap, readily available
• Stimulates, gives intense pleasure
• Damages the users 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

15
Native Adolescents Multiple Life Risks
Psychiatric Illness Stigma
-Edn,-Econ,-Rec
Cultural Distress
Impulsiveness
Substance Use/Abuse
Hopelessness
Family Disruption Domestic Violence
CHILD
Family History
Negative Boarding School
Psychodynamics/ Psychological Vulnerability
Historical Trauma
Suicidal Behavior
16
Adolescent Problems In Schools
Alcohol Drug Use
Fighting and Gangs
Bullying
Weapon Carrying
School Environment
Sale of Alcohol and Drugs
Sexual Abuse
Unruly Students
Truancy
Attacks on Teachers Staff
Domestic Violence
Drop Outs
12
17
Methamphetamine, Why Now?

• The Internet
• Diffused local production, less reliance on
  imports
• Multi-drug use no one uses only crystal
• National outbreak
• Varied sub-populations
• More smoking
• Strong association with HIV, hepatitis C
• Community level responses to AIDS deaths, 9/11,
  war
• National discussion

18
Native Health/ Educational Problems

• Alcoholism 6X
• Tuberculosis 6X
• Diabetes 3.5X
• Accidents 3X
• Suicide 1.7 to 4x
• Health care access -3x
• Poverty 3x
• Poor educational achievement
• Substandard housing
• Methamphetamines?

19
(No Transcript)
20
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
• State and Local Agencies
• Federal Agencies SAMHSA, Edn

21
Difficulties of System Integration

• Separate funding streams and coverage gaps
• Agency turf issues
• Different philosophies
• Lack of resources
• Poor cross training
• Consumer and family barriers

22
Different goals
Resource silos
One size fits all
Activity-driven
How are we functioning? (Carl Bell, 7/03)
23
Best Practice
Culturally Specific
Outcome Driven
Integrating Resources
We need Synergy and an Integrated System (Carl
Bell, 7/03)
24
(No Transcript)
25
The Intervention Spectrum for Behavioral
Disorders
T
r
e
a
t
m
e
n
t
C
a
s
e
I
d
e
n
t
i
f
i
c
a
t
i
o
n
S
t
a
n
d
a
r
d
T
r
e
a
t
m
e
n
t
n
o
f
o
r

K
n
o
w
n
i
Indicated Diagnosed Youth
M
t
D
i
s
o
r
d
e
r
s
n
a
e
i
v
n
e
t
r
e
P
n
C
o
m
p
l
i
a
n
c
e
a
Selective Health Risk Groups
n
w
i
t
h

L
o
n
g
-
T
e
r
m
c
e
T
r
e
a
t
m
e
n
t
(
G
o
a
l


R
e
d
u
c
t
i
o
n

i
n
R
e
l
a
p
s
e

a
n
d

R
e
c
u
r
r
e
n
c
e
)
A
f
t
e
r
c
a
r
e
Universal General Population
(
I
n
c
l
u
d
i
n
g
R
e
h
a
b
i
l
i
t
a
t
i
o
n
)
Source Mrazek, P.J. and Haggerty, R.J. (eds.),
Reducing Risks for Mental Disorders, Institute of
Medicine, Washington, DC National Academy
Press, 1994.
26
An Ideal Intervention

• Includes individual, family, community, tribe and
  society
• Comprehensive
• Universal
• Selective
• Indicated
• Treatment
• Maintenance

27
Ecological Model
Individual
Peer/Family
Society
Community/Tribe
28
Individual Intervention

• Identify risk and protective factors
• counseling
• skill building
• improve coping
• support groups
• Increase community awareness
• Access to hotlines other help resources

29
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.
30
Community Driven/School Based Prevention
Interventions

• Public awareness and media campaigns
• Youth Development Services
• Social Interaction Skills Training Approaches
• Mentoring Programs
• Tutoring Programs
• Rites of Passage Programs

31
Prevention Programs Reduce Risk Factors

• 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

32
Prevention Programs Enhance Protective Factors

• 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

33
Prevention Programs Should . . . .
Target all Forms of Drug Use
. . .and be Culturally Sensitive
34
WHAT ARE SOME PROMISING STRATEGIES?
35
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.)

36
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

37
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)

38
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

39
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

40
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.

41
Youth Treatment Completion WA State
42
Study Says Incentive-Based Meth Treatment Works

• The contingency management (CM) program gave
  patients who had drug-free urine tests plastic
  chips that could be exchanged for prizes those
  who did not follow program rules could lose
  chips.
• John Roll of Washington State University

AmJP, November 3, 2006
43
AmJP, November 3, 2006
44
Study Says Incentive-Based Meth Treatment Works

• "The Matrix Model of psychosocial treatment
  currently is thought to be the most effective
  therapy for methamphetamine addiction, and CM has
  shown itself to increase the therapeutic
  effectiveness of treatments for other drug abuse
  disorders. Combining these two treatments gives
  us an even more powerful weapon against
  methamphetamine abuse."

NIDA Director Dr. Nora D. Volkow November 3,
2006
45
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

46
Partnered Collaboration

Community-Based Organizations
Grassroots Groups
Research-Education-Treatment
47
Potential Organizational Partners

• Law Enforcement
• Juvenile Justice
• Medical Examiner
• Faith-Based
• County, State, and Federal Agencies
• Student Groups

• Education
• Family Survivors
• Health/Public Health
• Mental Health
• Substance Abuse
• Elders, traditional

48
Contact us at 503-494-3703 E-mail Dale Walker,
MD onesky_at_ohsu.edu Or visit our
website www.oneskycenter.org