The Indian Country Methamphetamine Initiative: a Problem Uniquely Affecting Indian Country

1. 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, 2007 Nashville, Tennessee

2. Special Thanks and Recognition • AAIP and the Executive Board • Margaret Knight • Rachel Crawford • Heather Levi • Vincent Knight

3. Native Communities Advisory Council / Steering Committee One Sky Center

4. 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

5. One Sky Center Outreach

6. 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

7. 1491

11. Agencies Involved in B.H. Delivery 1. Indian Health Service (IHS) A. Mental Health B. Primary Health C. Alcoholism / Substance Abuse 2. Bureau of Indian Affairs (BIA) A. Education B. Vocational C. Social Services D. Police 3. Tribal Health 4. Urban Indian Health • State and Local Agencies • Federal Agencies: SAMHSA, VAMC, Justice

12. 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

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

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

15. Partnered Collaboration: AAIP Style State/Federal Community-Based Organizations Grassroots Groups Research-Education-Treatment

16. AmericanIndians • Have same disorders as general population • Greater prevalence • Greater severity • Much less access to Tx • Cultural relevance more challenging • Social context disintegrated

17. Native Health Problems Alcoholism 6X Tuberculosis 6X Diabetes 3.5 X Accidents 3X Poverty 3x Depression 3x Suicide 2x Violence? Methamphetamine?

18. 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!

19. Percentages of Young Adults Aged 18 to 25 Reporting Past Year Methamphetamine Use, by State: 2002, 2003, 2004, and 2005 Source: SAMHSA, 2002-2005 .

20. Methamphetamine: Epidemiology

21. Methamphetamine/Amphetamine Admissions, by Race/Ethnicity and Urbanization: 2004

22. 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)

23. The Methamphetamine Effect

24. 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.

25. “Tribal leaders unveil new meth Initiative” Indian Country Today NCAI President, Joe Garcia Anchorage, Alaska June 15, 2007

26. 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

27. 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.

28. The Indian Country Methamphetamine Initiative: Project Partners OMH HHS SAMHSA IHS AAIP USET NPAIHB OSC NCAI Choctaw Crow Navajo Northern Arapaho Winnebago

29. ICMI Partners

30. 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

31. 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

32. 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

33. ID Best Practice Best Practice Clinical/services Research Mainstream Practice Traditional Healing

34. Circle of Care Traditional Healers Child & Adolescent Programs Primary Care Best Practices A&D Programs Boarding Schools Colleges & Universities Prevention Programs Emergency Rooms

37. 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.

38. Treatment Brief Intervention Universal/Selective Prevention Spectrum of Intervention Responses Thresholds for Action No Problems Mild Problems Severe Problems Moderate Problems

39. Treatment Settings - Social Support: A Native Advantage • Tribal • Community • Family • Sibs • Peers • Individual

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

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

42. 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.

43. Sources of Strength Access to Mental Health Family Support Positive Friends Access to Medical Spirituality Caring Adults Positive Activities Generosity/Leadership

44. Recommended Behavioral Treatment Approaches • Cognitive Behavioral Therapy • Psychosocial Treatment • Community Reinforcement - Plus Vouchers • Contingency Management • Relapse Prevention • The Matrix Model

45. 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.

46. Relapse Rates Are Similar for Drug Dependence and Other Chronic Illnesses 50 to 70% 50 to 70% 40 to 60% 30 to 50% 100 90 80 70 60 Percent of Patients Who Relapse 50 40 30 20 10 0 Drug Dependence Type I Diabetes Hypertension Asthma Source: McLellan, A.T. et al., JAMA, Vol 284(13), October 4, 2000.

47. Youth Treatment Completion: WA State

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