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Methamphetamine in Native Communities: Incidence, Interventions, and Treatment

This presentation provides an overview of the incidence, interventions, and treatment of methamphetamine use in Native communities. It discusses the fragmentation and integration of systems, prevention and treatment strategies, and the importance of integrated care approaches and interagency coordination. The presentation also includes information on the Methamphetamine Associated Hospital Admissions and the challenges of system integration.

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Methamphetamine in Native Communities: Incidence, Interventions, and Treatment

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  1. The American Indian/Alaska Native National Resource Center for Substance Abuse and Mental Health Services Methamphetamine in Native Communities: Incidence, Interventions, and Treatment Dale Walker, MD Patricia Silk Walker, PhD Michelle Singer InterTribal Council of Arizona October 24, 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. Presentation Overview • One Sky Center introduction • What’s the story on methamphetamine? • Fragmentation and Integration of systems • Discuss prevention and treatment • Integrated care approaches and interagency coordination are best overall solutions

  6. Indianz.com Methamphetamine Stories • Meth epidemic a top issue at NCAI annual conference (10/04) • Pine Ridge drug trafficking case sent to jury (10/04) • NCAI kicks off annual meeting in Sacramento (10/03) • Border fence will further divide Tohono O'odham Nation (09/25) • Tribes receive substance abuse prevention grants (09/21) • Task force recommends help for Native meth addicts (09/21) • Five on trial for trafficking cocaine to Pine Ridge (09/20) • Tohono O'odham Nation opposes border fence (09/20) • Conference to present models for meth treatment (09/18) • Tohono O'odham Nation caught in border battle (09/15) • Navajo Nation makes biggest drug seizure in it history (09/14) • Crow chairman testifies at Senate hearing on meth (09/13) • Elders hear dangers of meth at Oklahoma conference (09/07) • Indian mothers who use meth part of birth weight study (09/06) • Salt River Pima-Maricopa voters go to the polls (09/05)

  7. Methamphetamine AssociatedHospital Admissions (2002)

  8. Oregon Methamphetamine Admissions

  9. OHSU Substance Abuse Clinic Enrollees

  10. Methamphetamine: Epidemiology

  11. IHS-Wide Outpatient Encounters for Amphetamine Related Visit by Calendar Year

  12. 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?

  13. 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

  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. Different goals Resource silos One size fits all Activity-driven How are we functioning? (Carl Bell, 7/03)

  17. Best Practice Culturally Specific Outcome Driven Integrating Resources We need Synergy and an Integrated System (Carl Bell, 7/03)

  18. Methamphetamine Indicators

  19. Why is Methamphetamine so Devastating? • Cheap, readily available • Stimulates, gives intense pleasure • Damages the user’s 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

  20. 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 n v t e 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.

  21. An Ideal Intervention • Includes individual, family, community, tribe and society • Comprehensive: Universal Selective Indicated Treatment Maintenance

  22. Ecological Model Society Community/Tribe Peer/Family Individual

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

  24. 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.

  25. 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

  26. Prevention ProgramsReduce 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

  27. Prevention ProgramsEnhance 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

  28. PreventionPrograms Should . . . . Target all Forms of Drug Use . . .and be Culturally Sensitive

  29. WHAT ARE SOME PROMISING STRATEGIES?

  30. 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.)

  31. 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

  32. 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)

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

  34. 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

  35. 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

  36. 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

  37. Matrix Model TreatmentKey Concept: Thought Stopping Trigger Thought Continued Thoughts Cravings Use • Prevents the thought from developing into an overpowering craving • Requires practice

  38. 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.

  39. Youth Treatment Completion: WA State

  40. 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

  41. Partnered Collaboration Community-Based Organizations Grassroots Groups Research-Education-Treatment

  42. Education Family Survivors Health/Public Health Mental Health Substance Abuse Law Enforcement Juvenile Justice Medical Examiner Faith-Based County, State, and Federal Agencies Potential Organizational Partners

  43. American Indian and Alaska Native Substance Abuse Treatment The Native Programs Directory Prepared by: One Sky National Resource Center for American Indian and Alaska Native Substance Abuse Prevention and Treatment Services

  44. Contact us at 503-494-3703 E-mail Dale Walker, MD onesky@ohsu.edu Or visit our website: www.oneskycenter.org

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