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

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Title: 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
Methamphetamine Interventions and Treatment
Dale Walker, MD Patricia Silk Walker, PhD
San
Diego, California
June 8, 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
One Sky Center Outreach
5
(No Transcript)
6
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

7
Indianz.com Methamphetamine Stories
  • Wyoming governor addresses meth at Wind River
    (06/01)
  • Upper Sioux Community adopts banishment policy
    (06/01)
  • Gila River women speak out against meth use
    (05/29)
  • Methamphetamine ring leads to charges against 53
    (05/26)
  • Editorial Northern Cheyenne Tribe fights meth
    (05/23)
  • Story on Crow Tribe and gangs draws most comments
    (05/19)
  • Domenici seeks special federal judge for meth
    cases (05/18)
  • Crow Tribe seeks help in combating gangs (05/18)
  • Couple sentenced for meth and drug ring on Wind
    River (05/17)
  • Northern Cheyenne Tribe rallies against meth use
    (05/15)
  • Pine Ridge meth task force proposes tougher laws
    (05/09)
  • Weapons cache seized on Soboba Reservation
    (05/05)
  • Rincon man convicted for meth-related murders
    (05/05)
  • Nisqually Tribe's law enforcement scrutinized
    (05/04)
  • Pine Ridge concert promoters tout 'Death to Meth'
    (05/02)

8
Methamphetamine AssociatedHospital Admissions
(2002)
9
Oregon Methamphetamine Admissions
10
OHSU Substance Abuse Clinic Enrollees
11
Methamphetamine Epidemiology
12
IHS-Wide Outpatient Encounters for Amphetamine
Related Visit by Calendar Year
13
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?

14
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

15
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

16
Methamphetamine Indicators
17
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

18
The Intervention Spectrum for Behavioral
Disorders
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Source Mrazek, P.J. and Haggerty, R.J. (eds.),
Reducing Risks for Mental Disorders, Institute of
Medicine, Washington, DC National Academy
Press, 1994.
19
An Ideal Intervention
  • Includes individual, family, community, tribe and
    society
  • Comprehensive
  • Universal
  • Selective
  • Indicated
  • Treatment
  • Maintenance

20
Ecological Model
Individual
Peer/Family
Society
Community/Tribe
21
Individual Intervention
  • Identify risk and protective factors
  • counseling
  • skill building
  • improve coping
  • support groups
  • Increase community awareness
  • Access to hotlines other help resources

22
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.
23
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

24
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

25
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

26
Prevention Programs Should . . . .
Target all Forms of Drug Use
. . .and be Culturally Sensitive
27
WHAT ARE SOME PROMISING STRATEGIES?
28
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.)

29
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

30
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)

31
Cognitive Behavioral Therapy
  • Key Concepts
  • Encouraging and reinforcing behavior change
  • Recognizing and avoiding high risk settings
  • Behavioral planning (scheduling)
  • Coping skills
  • Conditioned triggers

32
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

33
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

34
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

35
Matrix Model Treatment Key Concept Thought
Stopping
Trigger
Thought
Continued Thoughts
Use
Cravings
  • Prevents the thought from developing into an
    overpowering craving
  • Requires practice

36
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.

37
Youth Treatment Completion WA State
38
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

39
Partnered Collaboration

Community-Based Organizations
Grassroots Groups
Research-Education-Treatment
40
Potential Organizational Partners
  • Education
  • Family Survivors
  • Health/Public Health
  • Mental Health
  • Substance Abuse
  • Law Enforcement
  • Juvenile Justice
  • Medical Examiner
  • Faith-Based
  • County, State, and Federal Agencies

41
Contact us at 503-494-3703 E-mail Dale Walker,
MD onesky_at_ohsu.edu Or visit our
website www.oneskycenter.org
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