Addictions Treatment Technical Assistance in Native Populations

1
Addictions Treatment Technical Assistance in
Native Populations
R. Dale Walker, MD Patricia Silk Walker,
PhD Douglas Bigelow, PhD
Bentson McFarland, MD National Webcast May
10, 2006 Rockville, Maryland
2
Native Communities
Advisory Council / Steering Committee
One Sky Center
3
One Sky Center Program Goals

• Promote and nurture effective and culturally
  appropriate prevention and treatment
• Identify and disseminate evidence-based
  prevention and treatment practices
• Provide training and technical assistance
• Help to expand capacity

4
Technical Assistance and Consultation Approach

• Individually focused, supportive
• Establish study groups for emerging issues
• Expand by developing national partners
• Establish Association of First Nations Behavioral
  Health Professionals

5
(No Transcript)
6
One Sky Center Outreach
7
AI/AN HEALTH DISPARITIES

1. Alcoholism 6X
2. Tuberculosis 6X
3. Diabetes 3.5X
4. Accidents 3X
5. Suicide 1.7 to 4x
6. 60 Over 65 live in poverty
   (US 27)

8
American Indians

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

9
Lifetime History
Mental Disorder 22.5 Comorbidity 29 3.1
1.5 1.7 1.1
Alcohol Disorder 13.5 Comorbidity 45
Drug Disorder 6.1 Comorbidity 72
Regier, 1990
10
Multiple Diagnoses Increases

• treatment seeking
• use of services
• poor outcome
• suicide risk
• likelihood of no services
• treatment costs

11
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

12
Different goals
Resource silos
One size fits all
Activity-driven
How is it working?
(Carl Bell and Dale Walker, 7/03)
13
Best Practice
Culturally specific
Outcome driven
Integrating resources
We need Collaboration, Integration, and Synergy
Community Mobilization
(Carl Bell and Dale Walker, 7/03)
14
Indigenous Knowledge (IK)
Definitions

• Is local knowledge unique to a given culture or
  society it has its own theory, philosophy,
  scientific and logical validity, which is used as
  a basis for decision-making for all of lifes
  needs.

15
Traditional Medicine
Definitions

• The sum total of health knowledge, skills and
  practices based upon theories, beliefs and
  experiences indigenous to different culturesused
  in the maintenance of health.
• WHO 2002

16
Evidence-Based Practices (EB)
Definitions

• Interventions that show consistent scientific
  evidence of improving a persons outcome of
  treatment and/or prevention in controlled
  settings.
• SAMHSA 2003

17
Best Practices
Definitions

• Examples and cases that illustrate the use of
  community knowledge and science in developing
  cost effective and sustainable survival
  strategies to overcome a chronic illness.
• WHO 2002

18
Best Practice IK EB
Best Practice
Clinical/Services Research EB
Mainstream Practice
Traditional Healing IK
19
Circle of Care
Traditional Healers
Child Adolescent Programs
Primary Care
Best Practices
AD Programs
Boarding Schools
Colleges Universities
Prevention Programs
Emergency Rooms
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
f
o
r

K
n
o
w
n
o
M
Indicated Diagnosed Youth
i
t
a
D
i
s
o
r
d
e
r
s
n
i
e
n
v
t
e
e
r
n
P
a
C
o
m
p
l
i
a
n
c
e
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
Spectrum of Intervention Responses
Thresholds for Action
No Problems
Mild Problems
Severe Problems
Moderate Problems
22
Prevention

• Primary
• Risk factors
• Protective factors
• Prevent 1st use

• Secondary
• Prevent kids who use from continuing
• Prevent kids who misuse from experiencing use
  related problems or dependency

23
Ecological Model
Society
Individual
Peer/Family
Community Tribe
24
Interpersonal societal
Environmental
Stigma
Community
Tribal attitudes
Parents
Peers
National attitudes
Personality
Attitudes beliefs
Individual
Genetics
Cultural beliefs
Schools
Local legal
Interpersonal
State attitudes
Personal situations
Individual
Portrayal in media
25
Treatment Settings - Social Support

• Tribal
• Community
• Family
• Sibs
• Peers
• Individual

26
Evidence-Based Approaches to Addiction Treatment

• Cognitivebehavioral interventions
• Community reinforcement
• Motivational enhancement therapy
• 12-step facilitation
• Contingency management
• Pharmacological therapies
• Systems treatment
• L. Onken (2002). Personal Communication.
  National Institute on Drug Abuse.
• Principles of Drug Addiction Treatment A
  research-based guide (1999). National Institute
  on Drug Abuse

27
Cultural Approach

• Original Holistic Approach
• Psychopharmacology Approach
• The unconscious has always been there
• Group Therapy
• Network Therapy
• Recreational / Outdoors
• Traditional Interventions
• Indian is...

28
Selected Treatment/Prevention Activities

• The Talking Circle
• Smudging
• Story telling
• Traditional healers
• Medicine Person
• Herbal remedies
• Traditional ceremonies
• Sweat Lodge
• Traditional Experiences Preservation

29
Unified Treatment Plan Addresses

• Mental health
• Education/vocation
• Culture
• Leisure/social
• Parenting/family
• Community
• Housing
• Financial
• Daily living skills
• Physical health

30
One Sky Center Partners
31
Contact us at 503-494-3703 E-mail Dale Walker,
MD onesky_at_ohsu.edu Or visit our
website www.oneskycenter.org