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The American Indian/Alaska Native National Resource Center for Substance Abuse and Mental Health Services. An Approach to Evidence Based Practice: the Partnership of Traditional and Contemporary Medicine in Healing Wisconsin Teleconference January 25, 2007.

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The American Indian/Alaska Native National Resource Center for Substance Abuse and Mental Health Services

An Approach to Evidence Based Practice: the Partnership of Traditional and Contemporary Medicine in Healing

Wisconsin Teleconference

January 25, 2007

Dale Walker, MD Patricia Silk Walker, PhD Douglas Bigelow, PhD

Bentson McFarland, MD, PhD, Michelle Singer 0HSU – Portland, Oregon


Native Communities for Substance Abuse and Mental Health Services

Advisory Council / Steering Committee

One Sky Center


Program goals
Program Goals for Substance Abuse and Mental Health Services

  • 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


One sky center outreach
One Sky Center Outreach for Substance Abuse and Mental Health Services


Six missions impossible
Six Missions Impossible? for Substance Abuse and Mental Health Services

How do we:

  • Define ourselves?

  • Define health care?

  • Ask for help?

  • Get Federal and State agencies to work together and with us?

  • Build our communities?

  • Restore what is lost?


Overview
Overview for Substance Abuse and Mental Health Services

  • An Environmental Scan

  • Behavioral Health Care Issues

  • Fragmentation and Integration

  • Best Practice = Evidence-Based + Indigenous Knowledge

  • You do both


Scientifically based approaches to drug addiction treatment
Scientifically Based Approaches to Drug Addiction Treatment for Substance Abuse and Mental Health Services

  • Relapse Prevention

  • Matrix Model

  • Supportive-Expressive Psychotherapy

  • Individualized Drug Counseling

  • Motivational Enhancement Therapy

  • Behavioral Therapy for Adolescents

  • Multidimensional Family Therapy (MDFT) for Adolescents

  • Multisystemic Therapy (MST)

  • Combined Behavioral and Nicotine Replacement Therapy for Nicotine Addiction

  • Community Reinforcement Approach (CRA) Plus Vouchers

  • Voucher-Based Reinforcement Therapy in Methadone Maintenance Treatment

  • Day Treatment with Abstinence Contingencies and Vouchers

http://www.nida.nih.gov/PODAT/PODATindex.html


10 leading causes of disability in the world who 1997

Unipolar Depression for Substance Abuse and Mental Health Services

Iron-deficiency Anemia

Falls

Alcohol Use

COPD

Bipolar disorder

Congenital anomalies

Osteoarthritis

Schizophrenia

Obsessive-compulsive disorder

10.7%

4.7

4.6

3.3

3.1

3.0

2.9

2.8

2.6

2.2

10 Leading Causes of Disability in the World (WHO, 1997)


Health problems

Health Problems for Substance Abuse and Mental Health Services

Alcoholism 6X

Tuberculosis 6X

Diabetes 3.5 X

Accidents 3X

Physicians 72/100,000 (US 242)

60% Over 65 live in poverty (US 27%)


American indians
American for Substance Abuse and Mental Health ServicesIndians

  • Have same disorders as general population

  • Greater prevalence

  • Greater severity

  • Much less access to Tx

  • Cultural relevance more challenging

  • Social context disintegrated


Agencies involved in b h delivery
Agencies Involved in B.H. Delivery for Substance Abuse and Mental Health Services

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


Disconnect between addictions mental health
Disconnect Between Addictions / Mental Health for Substance Abuse and Mental Health Services

  • Professionals are undertrained in one of two domains

  • Patients are underdiagnosed

  • Patients are undertreated

  • Neither integrates well with medical and social service


Difficulties of program integration
Difficulties of Program Integration for Substance Abuse and Mental Health Services

  • 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


Different goals for Substance Abuse and Mental Health Services

Resource silos

One size fits all

Activity-driven

How are we functioning?

(Carl Bell, 7/03)


Best practice
Best Practice for Substance Abuse and Mental Health Services

Culturally Specific

Outcome Driven

Integrating

Resources

We need Synergy and an Integrated System (Carl Bell, 7/03)


Indigenous knowledge

Definitions: for Substance Abuse and Mental Health Services

Indigenous Knowledge

  • 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 life’s needs.


Traditional medicine

Definitions: for Substance Abuse and Mental Health Services

Traditional Medicine

  • The sum total of health knowledge, skills and practices based upon theories, beliefs and experiences indigenous to different cultures…used in the maintenance of health.

    WHO 2002


Evidence based practices

Definitions: for Substance Abuse and Mental Health Services

Evidence-based Practices

  • Interventions that show consistent scientific evidence of improving a person’s outcome of treatment and/or prevention in controlled settings.

    SAMHSA 2003


Best practices

Definitions: for Substance Abuse and Mental Health Services

Best Practices

  • 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


World conference on science
World Conference on Science for Substance Abuse and Mental Health Services

  • Recommended that scientific and indigenous knowledge be integrated in interdisciplinary projects dealing with culture, environment and chronic illness.

    1999

A partnership begins!


Id best practice
ID Best Practice for Substance Abuse and Mental Health Services

Best Practice

Clinical/services

Research

Mainstream

Practice

Traditional

Medicine


Circle of care
Circle of Care for Substance Abuse and Mental Health Services

Traditional

Healers

Child & Adolescent Programs

Primary Care

Best

Practices

A&D

Programs

Boarding

Schools

Colleges &

Universities

Prevention Programs

Emergency

Rooms


Traditional and complementary medicine is widely and increasingly used in all regions of the world

Ethiopia for Substance Abuse and Mental Health Services

Benin

Populations using traditional medicine for primary health care

India

Rwanda

Tanzania

Uganda

Canada

Populations in developed countries who have used complementary and alternative medicine at least once

Australia

France

USA

Belgium

Traditional and complementary medicine is widely and increasingly used in all regions of the world

Sources: Eisenberg DM et al. 1998; Fisher P & Ward A, 1994; Health Canada, 2001;

World Health Organization, 1998; and government reports submitted to WHO.


Cultural approach
Cultural Approach for Substance Abuse and Mental Health Services

  • Original Holistic Approach

  • Psychopharmacology Approach

  • The unconscious has always been there

  • Group Therapy

  • Network Therapy

  • Recreational / Outdoors

  • Traditional Interventions

  • Indian is...


Selected treatment prevention activities
Selected Treatment/Prevention Activities for Substance Abuse and Mental Health Services

  • The Talking Circle

  • Smudging

  • Story telling

  • Traditional healers

  • Medicine Person

  • Herbal remedies

  • Traditional ceremonies

  • Sweat Lodge

  • Traditional Experiences Preservation


What is integrative medicine
What Is Integrative Medicine? for Substance Abuse and Mental Health Services

Wellness

Basic

Science

CAM

literacy

Patient

Centered

Care

Evidence

Based

Medicine

Cultural

Sensitivity

Power

Of the

Mind


Principles of integrative medicine
Principles of Integrative Medicine for Substance Abuse and Mental Health Services

  • It is better to prevent than to treat later.

  • Recognition of the interaction between body, mind, spirit, and environment.

  • Integrate the best of conventional and traditional medicine.

  • Belief that bodies respond uniquely, so treatment must be customized.

  • Belief in innate healing powers of the body.


The intervention spectrum for behavioral disorders
The Intervention Spectrum for Substance Abuse and Mental Health Servicesfor Behavioral Disorders

T

r

e

a

t

m

e

n

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f

o

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K

n

o

w

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Indicated—

Diagnosed

Youth

M

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D

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o

r

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v

t

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r

e

P

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p

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a

Selective—

Health Risk

Groups

n

w

i

t

h

L

o

n

g

-

T

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c

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r

e

a

t

m

e

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t

(

G

o

a

l

:

R

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d

u

c

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o

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Universal—

General Population

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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.


Ecological model
Ecological Model for Substance Abuse and Mental Health Services

Society

Community/

Tribe

Peer/Family

Individual


Interpersonal for Substance Abuse and Mental Health Services

societal

Environmental

Stigma

Community

Tribal

attitudes

Parents

Peers

National

attitudes

Personality

Attitudes

beliefs

Genetics

Individual

Cultural

beliefs

Schools

Local

legal

Interpersonal

State

attitudes

Personal situations

Individual

Portrayal in media


Treatment settings social support
Treatment Settings - Social Support for Substance Abuse and Mental Health Services

  • Tribal

  • Community

  • Family

  • Sibs

  • Peers

  • Individual


Evidence based practices for alcohol treatment
Evidence-Based Practices for Substance Abuse and Mental Health Servicesfor 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.


Evidence based approaches to addiction treatment
Evidence-Based Approaches for Substance Abuse and Mental Health Servicesto Addiction Treatment

  • Cognitive–behavioral 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


Unified services plan
Unified Services Plan for Substance Abuse and Mental Health Services

  • Case management should address:

  • Mental health

  • Education/vocation

  • Leisure/social

  • Parenting/family

  • Housing

  • Financial

  • Daily living skills

  • Physical health


Partnered collaboration
Partnered Collaboration for Substance Abuse and Mental Health Services

Community-Based

Organizations

Grassroots Groups

Research-Education-Treatment


Contact us at for Substance Abuse and Mental Health Services

503-494-3703

E-mail

Dale Walker, MD

[email protected]

Or visit our website:

www.oneskycenter.org


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