The American Indian/Alaska Native National Resource Center for Substance Abuse and Mental Health Services

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The American Indian/Alaska Native National
Resource Center for Substance Abuse and Mental
Health Services
Methamphetamine Problems Development of Native
Prevention Models
Dale Walker, MD Patricia Silk Walker, PhD
Michelle Singer Laura Loudon, MS Doug
Bigelow, PhD August 1, 2007
Sioux Falls, South
Dakota
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Native Communities
Advisory Council / Steering Committee
One Sky Center
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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
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Presentation Overview

• Whats the story on methamphetamine?
• Discuss prevention theory and models
• Integrated care approaches and interagency
  coordination are best overall solutions

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Methamphetamine Abuse Eastward Movement Based on
Hospital Admissions
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Arizona Methamphetamine Admissions
Governors Council on Addictions 2006
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S.D. METH LABS SEIZED
Meth admissions/100,000 (2003) 92
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Oregon Methamphetamine Admissions
2003257
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OHSU Substance Abuse Clinic Enrollees
1998-2000 2002-2004
N 108 percent N 172 percent
Alcohol 25 23 22 13
Marijuana mixed 8 7 5 3
Marijuana only 23 21 38 22
Methadone/heroin 30 28 47 27
Methamphetamine 34 31 84 49
Narcotics 5 4 6 3
Benzodiazepines 2 2 6 3
Hallucinogens 3 3 1 1
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National Methamphetamine Initiative Survey
Mark Evans Tactical Intelligence Supervisor New
Mexico Investigative Support Center 4-12-2006
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National Methamphetamine Initiative Survey
Mark Evans Tactical Intelligence Supervisor New
Mexico Investigative Support Center 4-12-2006
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Methamphetamine Epidemiology
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Methamphetamine Use in 2004
Percentage
Source SAMHSA 2004 NSDUH.
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IHS-Wide Outpatient Encounters for Amphetamine
Related Visit by Calendar Year
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Lifetime, Past Year, and Past Month
Methamphetamine Use
Richard Kopanda, CSAT
a Significant change 2003 to 2004 b
Significant change 2002 to 2004
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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

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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
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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
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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

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The Methamphetamine Effect
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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

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Developmental Paths for Multi-Problem Behavior
Dennis D. Embry
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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.
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Prevention Theory

• Explains the causes and mechanisms of
  action
• Identifies the variables influencing these
  
• mechanisms, including cultural
• Predict points to interrupt the course
  leading to
• substance abuse and Specifies the
  interventions to prevent the onset of
• substance abuse.

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Theories of Prevention

• Cognitive-Affective
• Social Learning
• Intrapersonal
• Comprehensive

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Cognitive-Affective

• Theory The consequences of experimenting with a
  drug contributes to decision to use.
• Intervention Increase beliefs about negative
  consequences of drugs, highlight benefits of not
  using drugs, and correct inflated estimates or
  perceptions of drug use.

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Social Learning

• Theory Adolescents acquire their beliefs
  about substance use and other delinquent
  behaviors from their role models, friends, and
  parents.
• Intervention Provide adolescents with
  positive role models, and to teach them refusal
  skills and the belief that they can resist drugs.

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Conventional Commitment and Social Attachment

• Theory Emotional attachments adolescents have
  with peers who use substances is the cause of
  substance use.
• Intervention Improve bonds between
  adolescents and positive peer groups and
  prosocial institutions. Focus on improving
  academic and career skills, provide career
  opportunities, and teach parents how to socialize
  and reinforce their children.

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Intrapersonal

• Theory Examine how personality
  characteristics, emotions, and behavioral skills
  contribute to substance use. Examples stress at
  school, self-esteem, social interaction skills,
  coping skills, and emotional distress.
• Interventions Target many of the individual
  characteristics of children rather than focusing
  on their beliefs about specific drugs and
  behaviors.

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Comprehensive

• Combines components from all of the other
  theories. They attempt to account for how
  adolescents' biology, personality, relationships
  with peers and parents, and culture or
  environment interact to cause drug use.

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Conclusions Before selecting an approach,
consider the following

• Who are the people in the support system?
• Are they contributor to the adolescent's level of
  risk for using substances?
• What are the adolescent's attitudes toward
  specific substances?
• How might values communicated through an
  adolescent's culture influence decisions to
  experiment with substances?
• What are the personality characteristics,
  emotional states, and/or behavioral skills of
  adolescents at risk for using substances?

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Ecological Model
Individual
Peer/Family
Society
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 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

• 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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Risk Factors

• Exist in multiple domains.
• The more risk factors present, the greater the
  risk.
• Reducing the overall number can have a
  significant impact on future problem behaviors.
• Show the same effect across different races,
  cultures and classes.
• Can be buffered by protective factors.

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Protective Factors
Individual is given

• the opportunity for involvement in productive,
  pro-social roles in family, friends, community,
  society
• the skills to be successfully involved in
  those roles
• recognition and reinforcement for their
  involvement

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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

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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

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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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Treatment Approaches Effective withMethamphetamin
e Use Disorder

• Motivational Interviewing - MI
• Therapeutic Use of Urinalysis
• Contingency Management (motivational incentives)
• Community Reinforcement Approach
• Cognitive Behavioral Therapy - CBT
• Matrix Model (combination of above)

(Data show that methamphetamine treatment
outcomes are not very different than those for
other addictive drugs)
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Partnered Collaboration

Community-Based Organizations
Grassroots Groups
Research-Education-Treatment
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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

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