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Methamphetamine Problems: Development of Native Prevention Models

This presentation discusses the development of Native prevention models for addressing methamphetamine abuse in American Indian/Alaska Native communities. It explores the story of methamphetamine, prevention theory and models, and the integrated care approaches and interagency coordination that are effective solutions. The presentation also highlights the devastating effects of methamphetamine, particularly on Native adolescents who face multiple life risks. Additionally, it addresses the difficulties of system integration in addressing methamphetamine abuse and the developmental paths for multi-problem behavior. Prevention theories, such as cognitive-affective and social learning, are also discussed.

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Methamphetamine Problems: Development of Native Prevention Models

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  1. 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

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

  5. Methamphetamine Abuse Eastward Movement Based on Hospital Admissions

  6. Arizona Methamphetamine Admissions Governor’s Council on Addictions 2006

  7. S.D. METH LABS SEIZED Meth admissions/100,000 (2003) =92

  8. Oregon Methamphetamine Admissions 2003=257

  9. OHSU Substance Abuse Clinic Enrollees

  10. National Methamphetamine Initiative Survey Mark Evans Tactical Intelligence Supervisor New Mexico Investigative Support Center 4-12-2006

  11. National Methamphetamine Initiative Survey Mark Evans Tactical Intelligence Supervisor New Mexico Investigative Support Center 4-12-2006

  12. Methamphetamine: Epidemiology

  13. Methamphetamine Use in 2004 Percentage Source: SAMHSA 2004 NSDUH.

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

  15. Numbers of Users (in Thousands) Lifetime, Past Year, and Past Month Methamphetamine Use Richard Kopanda, CSAT a = Significant change 2003 to 2004; b = Significant change 2002 to 2004

  16. 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

  17. 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

  18. 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

  19. 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

  20. The Methamphetamine Effect

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

  23. 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.

  24. 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.

  25. Theories of Prevention • Cognitive-Affective • Social Learning • Intrapersonal • Comprehensive

  26. 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.

  27. 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.

  28. 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.

  29. 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.

  30. 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.

  31. 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?

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

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

  34. 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.

  35. 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

  36. 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.

  37. 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

  38. 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

  39. 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

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

  41. WHAT ARE SOME PROMISING STRATEGIES?

  42. 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.)

  43. 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

  44. Treatment Approaches Effective withMethamphetamine 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)

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

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

  47. 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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