Methamphetamine South Dakota Day 2 Methamphetamine Treatment Contingency Management Matrix Model.
Our Native Methamphetamine Crisis: An Integrated Care Solution
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Transcript of Our Native Methamphetamine Crisis: An Integrated Care Solution
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The American Indian/Alaska Native National Resource Center for Substance Abuse and Mental Health Services
Our Native Methamphetamine Crisis:
An Integrated Care SolutionDale Walker, MD Patricia Silk Walker, PhD Michelle Singer
Affiliated Tribes of Northwest Indians Portland, Oregon February 14, 2006
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One Sky Center
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One Sky Center Partners
Jack Brown Adolescent Treatment Center
Alaska Native Tribal Health Consortium
United American Indian Involvement
Northwest Portland Area Indian Health Board
Na'nizhoozhi Center
Tribal Colleges and Universities
National Indian Youth Leadership Project
Cook Inlet Tribal Council
Tri-Ethnic Center for Prevention Research
Red Road
Prairielands ATTC
Harvard Native Health Program
One Sky Center
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Presentation Overview
• One Sky Center introduction• What’s the story on methamphetamine?• Fragmentation and Integration of systems• Discuss prevention and treatment • Integrated care approaches and interagency
coordination are best overall solutions
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R. Dale Walker, M.D., 2003
Methamphetamine AssociatedHospital Admissions (2002)
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Meth admissions by state
-
200
400
600
800
1,000
1,200
1,400
1,600
1,800
OR
Oregon Methamphetamine Admissions
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OHSU Substance Abuse Clinic Enrollees
1998-2000
2002-2004
N= 108 percent N= 172 percent
Alcohol 25 23% 22 13%
Marijuana mixed 8 7% 5 3%
Marijuana only 23 21% 38 22%
Methadone/heroin 30 28% 47 27%
Methamphetamine 34 31% 84 49%
Narcotics 5 4% 6 3%
Benzodiazepines 2 2% 6 3%
Hallucinogens 3 3% 1 1%
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National Methamphetamine Initiative Survey
Mark Evans Tactical Intelligence Supervisor New Mexico Investigative Support Center 4-12-2006
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Methamphetamine: Epidemiology
Past Month Illicit Drug Use among Youths Aged 12 to 17, by Race/Ethnicity: 2002
Methamphetamine: Epidemiology
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IHS-Wide Outpatient Encounters for Amphetamine Related Visit by Calendar
Year
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Meth indicators
-
5,000
10,000
15,000
20,000
25,000
30,000
35,000
40,000
Possession arrestsTreatment casesER admissionsID theft casesPurity*
Methamphetamine Indicators
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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
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Douglas Jackobs 2003 R. Dale Walker, M.D., 2003
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Native Adolescents: Multiple Life Risks
-Edn,-Econ,-Rec-Edn,-Econ,-Rec
Family DisruptionDomestic ViolenceFamily DisruptionDomestic Violence
ImpulsivenessImpulsiveness
Negative Boarding SchoolNegative Boarding School
HopelessnessHopelessness
Historical TraumaHistorical Trauma
Family HistoryFamily History
SuicidalBehaviorSuicidal
Behavior
Cultural DistressCultural Distress
Psychiatric Illness& StigmaPsychiatric Illness& Stigma
Psychodynamics/Psychological VulnerabilityPsychodynamics/Psychological Vulnerability
Substance Use/AbuseSubstance
Use/Abuse
CHILD
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Adolescent Problems In Schools
School
Environment
Bullying
Fighting and
Gangs
Alcohol Drug Use
Weapon Carrying
Sexual Abuse
Truancy
Domestic Violence
Drop Outs
Attacks
on Teachers
Staff
Unruly Students
Sale of Alcohol
and Drugs
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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
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Native Health/ Educational Problems
1. Alcoholism 6X
2. Tuberculosis 6X
3. Diabetes 3.5X
4. Accidents 3X
5. Suicide 1.7 to 4x
6. Health care access -3x
7. Poverty 3x
8. Poor educational achievement
9. Substandard housing
10.Methamphetamines?
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Agencies Involved in Behavioral Health
1. Bureau of Indian Affairs (BIA)A. EducationB. VocationalC. Social ServicesD. Police
2. Indian Health Service (IHS)A. Mental HealthB. Primary HealthC. Alcoholism / Substance
Abuse3. Tribal Education/Health4. Urban Indian Education/Health5. State and Local Agencies6. Federal Agencies: SAMHSA, Edn
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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
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How are we functioning?(Carl Bell, 7/03)
One size fits allOne size fits all
Different goals Different goals Resource silosResource silos
Activity-drivenActivity-driven
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We need Synergy and an Integrated System (Carl Bell, 7/03)
Culturally Specific
Culturally Specific
Best Practice
Best Practice
IntegratingResources
IntegratingResources
Outcome Driven
Outcome Driven
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The Intervention Spectrum for Behavioral Disorders
CaseIdentification Standard
Treatmentfor KnownDisorders
Compliancewith Long-TermTreatment(Goal: Reduction inRelapse and Recurrence)
Aftercare(Including
Rehabilitation)
Prev
entio
n
TreatmentM
aintenance
Source: Mrazek, P.J. and Haggerty, R.J. (eds.), Reducing Risks for Mental Disorders, Institute of Medicine, Washington, DC: National Academy Press, 1994.
Indicated—Diagnosed Youth
Selective—Health RiskGroups
Universal—General Population
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An Ideal Intervention
• Includes individual, family, community, tribe and society
• Comprehensive:
Universal
Selective
Indicated
Treatment
Maintenance
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Ecological Model
IndividualPeer/FamilySociety Community/Tribe
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Individual Intervention
• Identify risk and protective factors counseling skill building improve coping support groups • Increase community awareness• Access to hotlines other help resources
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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.
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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
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• 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
Prevention Programs Reduce Risk Factors
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Prevention Programs Enhance 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
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Target all Forms of Drug Use
. . .and be Culturally Sensitive
Prevention Programs Should . . . .
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WHAT ARE SOME PROMISING STRATEGIES?
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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.)
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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
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Evidence Based Cognitive and/or Behavioral
Treatments
Cognitive/Behavioral Therapy-CBT
Motivational Interviewing-MI
Contingency Management-CM
Community Reinforcement Approach-CRA
Matrix Model of Outpatient Treatment-MM (Combination of above)
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Matrix Model• Is a manualized, 16-week, non-residential, psychosocial
approach used for the treatment of drug dependence.
• Designed to integrate several interventions into a comprehensive approach. Elements include:– Individual counseling– Cognitive behavioral therapy– Motivational interviewing– Family education groups– Urine testing– Participation in 12-step programs
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Contingency Management
• Key concepts
Behavior to be modified must be objectively measured
Behavior to be modified (eg urine test results) must be monitored frequently
Reinforcement must be immediate
Penalties for unsuccessful behavior (eg positive UA) can reduce voucher amount
Vouchers may be applied to a wide range of prosocial alternative behaviors
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Is Treatment for Methamphetamine Effective?
Analysis of:• Drop out rates• Retention in treatment rates• Re-incarceration rates• Other measures of outcome
All these measures indicate that MA users respond in an equivalent manner as do individuals admitted for other drug abuse problems.
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Youth Treatment Completion: WA State
50%
62%
52%46%
55% 50%
0%
10%
20%
30%
40%
50%
60%
70%
Alcohol Cocaine Marijuana Meth Heroin Other
Youth
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Study Says Incentive-Based Meth Treatment Works
• The contingency management (CM) program gave patients who had drug-free urine tests plastic chips that could be exchanged for prizes; those who did not follow program rules could lose chips.
• John Roll of Washington State University
AmJP, November 3, 2006
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44AmJP, November 3, 2006
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Study Says Incentive-Based Meth Treatment Works
• "The Matrix Model of psychosocial treatment currently is thought to be the most effective therapy for methamphetamine addiction, and CM has shown itself to increase the therapeutic effectiveness of treatments for other drug abuse disorders. Combining these two treatments gives us an even more powerful weapon against methamphetamine abuse."
NIDA Director Dr. Nora D. Volkow November 3, 2006
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Treatment Outcomes
Myth
Clients addicted to Methamphetamine
have poorer treatment outcomes
Reality Data show that methamphetamine treatment
outcomes are not very different than those for other addictive drugs
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Partnered Collaboration
Research-Education-Treatment
Grassroots Groups
Community-BasedOrganizations
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Potential Organizational Partners
• 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
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Contact us at503-494-3703E-mailDale Walker, [email protected] visit our website:www.oneskycenter.org