Title: Addictions and Mental Health Approaches in Native Populations
1 Addictions and Mental Health Approaches in
Native Populations
R. Dale Walker, MD Patricia Silk Walker,
PhD Douglas Bigelow, PhD
Bentson McFarland, MD March 2,
2006 Phoenix, Arizona
2Native Communities
Advisory Council / Steering Committee
One Sky Center
3Program 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
4One Sky Center Outreach
5American Indians
- Have same disorders as general population
- Greater prevalence
- Greater severity
- Much less access to Tx
- Cultural relevance more challenging
- Social context disintegrated
6Percentage using any illicit drugs in the past
year
Total Female Male Total
11.9 9.8 14.1 Native American 19.8 23.3 15.6 N
on-Hispanic White 11.8 9.9 13.9 Non-Hispanic
Black 13.1 10.2 16.6 Hispanic Central
American 5.7 4.2 7.7 Hispanic Cuban
8.2 5.5 11.4 Hispanic Mexican 12.7 9.2 15.8
Source 1999 SAMHSA Treatment Episode Data Set
(TEDS).
7Percentage reporting dependence on alcohol
Total Female Male Total 3.5 2.1
4.9 Native American 5.6 6.8 4.3 Non-Hispanic
White 3.4 2.2 4.8 Non-Hispanic
Black 3.4 2.0 5.2 Hispanic Central
American 2.8 0.8 5.4 Hispanic
Cuban 0.9 0.5 1.3 Hispanic Mexican 5.6 2.6 8.
4
Source 1999 SAMHSA Treatment Episode Data Set
(TEDS).
8Lifetime 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
9Multiple Diagnoses Increases
- treatment seeking
- use of services
- poor outcome
- suicide risk
- likelihood of no services
- treatment costs
10(No Transcript)
11Different goals
Resource silos
One size fits all
Activity-driven
How is it working?
(Carl Bell, 7/03)
12Best Practice
Culturally specific
Outcome driven
Integrating resources
We need Collaboration, Integration, and Synergy
Community Mobilization
(Carl Bell, 7/03)
13Indigenous Knowledge
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.
14Traditional 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
15Evidence-based Practices
Definitions
- Interventions that show consistent scientific
evidence of improving a persons outcome of
treatment and/or prevention in controlled
settings. - SAMHSA 2003
16Best 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
17World Conference on Science
A partnership begins!
- Recommended that scientific and indigenous
knowledge be integrated in interdisciplinary
projects dealing with culture, environment and
chronic illness. - 1999
18ID Best Practice
Best Practice
Clinical/Services Research
Mainstream Practice
Traditional Healing
19Circle of Care
Traditional Healers
Child Adolescent Programs
Primary Care
Best Practices
AD Programs
Boarding Schools
Colleges Universities
Prevention Programs
Emergency Rooms
20The 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.
21Spectrum of Intervention Responses
Thresholds for Action
No Problems
Mild Problems
Severe Problems
Moderate Problems
22Ecological Model
Individual
Peer/Family
Society
Community/ Tribe
23Interpersonal 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
24Prevention
- 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
25Implications for Treatment
- Teach adolescents how to cope with difficulties
and adversity - Increase their repertoire of coping strategies
- Cognitive therapy is most effective approach
26Treatment Settings - Social Support
- Tribal
- Community
- Family
- Sibs
- Peers
- Individual
27Evidence-Based Practices for Alcohol Treatment
- Brief intervention
- Social skills training
- Motivational enhancement
- Community reinforcement
- Behavioral contracting
- Miller et al., (1995) What works A
methodological analysis of the alcohol treatment
outcome literature. In R. K. Hester W. R.
Miller (eds.) Handbook of Alcoholism Treatment
Approaches Effective Alternatives. (2nd ed., pp
12 44). Boston Allyn Bacon.
28Scientifically-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
29Alcohol/Drug Treatment Core Components and
Comprehensive Services
Medical
Mental Health
Financial
Vocational
Housing Transportation
Educational
Child Care
Legal
Family
AIDS / HIV Risks
Etheridge, Hubbard, Anderson, Craddock, Flynn,
1997 (PAB)
30Cultural Approach
- Original Holistic Approach
- Psychopharmacology Approach
- The unconscious has always been there
- Group Therapy
- Network Therapy
- Recreational / Outdoors
- Traditional Interventions
- Indian is...
31Unified Services Plan
- Case management should address
- Mental health
- Education/vocation
- Leisure/social
- Parenting/family
- Housing
- Financial
- Daily living skills
- Physical health
32Contact us at 503-494-3703 E-mail Dale Walker,
MD onesky_at_ohsu.edu Or visit our
website www.oneskycenter.org