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Addictions Treatment Technical Assistance in Native Populations

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. Native Communities.

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Addictions Treatment Technical Assistance in Native Populations

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

  5. One Sky Center Outreach

  6. AI/AN HEALTH DISPARITIES Alcoholism 6X Tuberculosis 6X Diabetes 3.5X Accidents 3X Suicide 1.7 to 4x 60% Over 65 live in poverty (US 27%)

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

  8. 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

  9. Multiple Diagnoses Increases: • treatment seeking • use of services • poor outcome • suicide risk • likelihood of no services • treatment costs

  10. 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

  11. Different goals Resource silos One size fits all Activity-driven How is it working? (Carl Bell and Dale Walker, 7/03)

  12. Best Practice Culturally specific Outcome driven Integrating resources We need Collaboration, Integration, and Synergy : Community Mobilization (Carl Bell and Dale Walker, 7/03)

  13. Definitions: Indigenous Knowledge (IK) • 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.

  14. Definitions: 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

  15. Definitions: Evidence-Based Practices (EB) • Interventions that show consistent scientific evidence of improving a person’s outcome of treatment and/or prevention in controlled settings. SAMHSA 2003

  16. Definitions: 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

  17. Best Practice = IK + EB Best Practice Clinical/Services Research EB Mainstream Practice Traditional Healing IK

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

  19. 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 t v 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.

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

  21. Prevention • Secondary • Prevent kids who use from continuing • Prevent kids who misuse from experiencing use related problems or dependency • Primary • Risk factors • Protective factors • Prevent 1st use

  22. Ecological Model Society Community Tribe Peer/Family Individual

  23. Interpersonal 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

  24. Treatment Settings - Social Support • Tribal • Community • Family • Sibs • Peers • Individual

  25. Evidence-Based Approaches to 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

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

  27. Selected Treatment/Prevention Activities • The Talking Circle • Smudging • Story telling • Traditional healers • Medicine Person • Herbal remedies • Traditional ceremonies • Sweat Lodge • Traditional Experiences Preservation

  28. Unified Treatment Plan Addresses • Mental health • Education/vocation • Culture • Leisure/social • Parenting/family • Community • Housing • Financial • Daily living skills • Physical health

  29. Alaska Native Tribal Health Consortium Tribal Colleges and Universities Northwest Portland Area Indian Health Board One Sky Center Eastern U.S. Tribal Consortium United American Indian Involvement National Indian Youth Leadership Project Jack Brown Adolescent Treatment Center One Sky Center Partners

  30. 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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