Download Native Traditional Recovery In a Contemporary

The American Indian/Alaska Native National Resource Center
for Substance Abuse and Mental Health Services
Native Traditional Recovery In a
Contemporary Western Environment
Dale Walker, MD Patricia Silk Walker, PhD
Doug Bigelow, PhD Laura Loudon, MS Michelle Singer
Oregon Health and Science University
Clinical Update on Substance Abuse and Dependence
Portland, Oregon June 26, 2007
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One Sky
Center
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One Sky Center Partners
Cook Inlet Tribal Council
Alaska Native Tribal
Health Consortium
Northwest Portland Area
Indian Health Board
Tribal Colleges
and Universities
Prairielands ATTC
Red Road
One Sky
Center
United American
Indian Involvement
Harvard Native
Health Program
Jack Brown
Adolescent
Treatment Center
National Indian Youth
Leadership Project
Tri-Ethnic Center for
Na'nizhoozhi Center Prevention Research
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One Sky Center Outreach
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Goals for Today
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Background: The environment and the system of care
The problem
Contributing factors
Prevention strategies
Indigenous Knowledge + Evidence Based Knowledge
= Best Practice
• Promising programs
• Integrated care approaches are best for treatment of
these chronic illnesses
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Adolescent Problems In Schools
1. School Admin
Fighting
and
Gangs
2. Law
3. FBI
Alcohol
Drug
Use
Weapon
Carrying
Bullying
4. DEA
5. State MH
6. State A&D
Sexual
Abuse
Environment
7. Courts
8. Child Services
School
Sale of
Alcohol
and Drugs
Unruly
Students
Truancy
Attacks
on Teachers
Staff
Drop
Outs
Domestic
Violence
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Key Adolescent Risk Factors
Aggressive/Impulsive
Substance Abuse
Depression
Trauma
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Six behaviors that contribute to
serious health problems:
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Tobacco use
Poor nutrition
Alcohol and other drug abuse
Behaviors resulting in intentional or unintentional
injury
• Physical inactivity
• Risky sex
Native Health Problems
1.
2.
3.
4.
5.
6.
7.
8.
Alcoholism 6X
Tuberculosis 6X
Diabetes 3.5 X
Accidents 3X
Poverty 3x
Depression 3x
Suicide 2x
Violence?
American Indians
• Have same disorders as general
population
• Greater prevalence
• Greater severity
• Much less access to Tx
• Cultural relevance more challenging
• Social context disintegrated
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Percentage 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).
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Percentage 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
Non-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
12.7
9.2
15.8
Hispanic – Mexican
Source: 1999 SAMHSA Treatment Episode Data Set (TEDS).
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Lifetime History
Mental Disorder
22.5%
Comorbidity
29%
3.1%
1.5%
1.7%
Alcohol Disorder
13.5%
Comorbidity
45%
1.1%
Drug Disorder
6.1%
Comorbidity
72%
Regier, 1990
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Agencies Involved in B.H. Delivery
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
5. State and Local Agencies
6. Federal Agencies: SAMHSA, VAMC,
Justice
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Difficulties of Program
Integration
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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
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Different goals
Resource silos
One size fits all
Activity-driven
How are we functioning?
(Carl Bell, 7/03)
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Culturally
Specific
Best
Practice
Outcome
Driven
Integrating
Resources
We need Synergy and an Integrated
System (Carl Bell, 7/03)
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The Intervention Spectrum
for Behavioral Disorders
Case
Identification Standard
Treatment
for Known
Indicated—
Disorders
Diagnosed
Youth
Selective—
Health Risk
Groups
Universal—
General Population
Compliance
with Long-Term
Treatment
(Goal:Reduction in
Relapse and Recurrence)
Aftercare
(Including
Rehabilitation)
Source: Mrazek, P.J. and Haggerty, R.J. (eds.), Reducing Risks for Mental Disorders, Institute of
Medicine, Washington, DC: National Academy Press, 1994.
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Spectrum of Intervention Responses
Thresholds for Action
No
Problems
Mild
Problems
Moderate
Problems
Severe
Problems
Treatment
Brief Intervention
Universal/Selective
Prevention
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Ecological Model
Society
Community/
Tribe
Peer/Family Individual
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Environmental
Interpersonal
societal
Stigma
Community
Tribal
attitudes
Parents
Peers
Personality
National
attitudes
Genetics Individual Attitudes
beliefs
Cultural
beliefs
Schools
Interpersonal
Local
legal
State
attitudes
Personal situations
Individual
Portrayal in media
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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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Prevention Programs Reduce
Risk Factors
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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
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Prevention Programs Enhance
Protective Factors
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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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Sources of Strength
Access to Mental Health
Access to Medical
Spirituality
Generosity/Leadership
Family Support
Positive Friends
Caring Adults
Positive Activities
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Effective Interventions for Adults
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Cognitive/Behavioral Approaches
Motivational Interventions
Psychopharmacological Interventions
Modified Therapeutic Communities
Assertive Community Treatment
Vocational Services
Dual Recovery/Self-Help Programs
Consumer Involvement
Therapeutic Relationships
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Effective Interventions for Youth
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Family Therapy
Multisystemic Therapy
Case Management
Therapeutic Communities
Community Reinforcement
Circles of Care
Motivational Enhancement
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Treatment Settings - Social
Support: A Native Advantage
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Tribal
Community
Family
Sibs
Peers
Individual
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Cultural Approach
• Original Holistic Approach
• Psychopharmacology Approach
• The unconscious has always been
there
• Group Therapy
• Network Therapy
• Recreational / Outdoors
• Traditional Interventions
• Indian is...
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Possible Treatment/Prevention
Activities
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The Talking Circle
Smudging
Story telling
Traditional Healers
Medicine Person
Herbal remedies
Traditional ceremonies
Sweat Lodge
Traditional Experiences Preservation
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Use of Traditional Medicine
Forty-four percent of respondents used Traditional Healing
Services in past year.
When you have used
traditional healing
services, how have they
affected…
Physical wellbeing
Emotional
well-being
Spiritual
well-being
Not at all
34.2
34.15
34.15
Just a little
4.8
2.44
2.44
Somewhat
12.2
12.20
7.32
Significantly
12.2
7.32
9.76
Very Much
34.2
41.46
43.90
Kevin Foley, Ph.D.
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Definitions:
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.
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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
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Definitions:
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
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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
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ID Best Practice
Best Practice
Clinical/services
Research
Mainstream
Practice
Traditional
Healing
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Circle of Care
Traditional
Healers
Primary Care
A&D
Programs
Best
Practices
Child &
Adolescent
Programs
Boarding
Schools
Colleges &
Universities
Prevention
Programs
Emergency
Rooms
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WHAT ARE SOME PROMISING STRATEGIES?
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What Is Integrative Medicine?
Basic
Science
Wellness
CAM
literacy
Patient
Evidence Centered
Care
Based
Cultural
MedicinePower
Sensitivity
Of the
Mind
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Principles of Integrative
Medicine
1. It is better to prevent than to treat later.
2. Recognition of the interaction between
body, mind, spirit, and environment.
3. Integrate the best of conventional and
traditional medicine.
4. Belief that bodies respond uniquely, so
treatment must be customized.
5. Belief in innate healing powers of the
body.
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Healing Concepts 1
• Healing takes time and time is healing
• Healing occurs within the context of a
relationship
• Achieving energy of activation is necessary
• Biological systems behave similarly across all
levels
Lewis Mehl-Madrona 2002
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Healing Concepts 2
• Distractions of modern life “inactivate”
catalysts for change
• Modern culture teaches us to ignore emotions
• Physiological change requires a break in
usual daily rhythms
• Ceremony helps the spiritual dimension of
healing
Lewis Mehl-Madrona 2002
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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
planning
• Prevention and behavioral health
programs/services on site
• Handling behavioral health crises
• Responding appropriately and
effectively after an event occurs
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Potential Organizational
Partners
• Education
• Law Enforcement
• Family Survivors
• Juvenile Justice
• Health/Public Health
• Medical Examiner
• Mental Health
• Faith-Based
• Substance Abuse
• County, State, and
Federal Agencies
• Traditional Healers
• Elders
• Girls/Boys Clubs
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Partnered Collaboration
State/Federal
Grassroots
Groups
Community-Based
Organizations
Research-Education-Treatment
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Recommendations
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Develop interagency task forces
Bring in supportive/interested state partners
Reach out to bring in new resources
Be clear, positive, and direct
Remember what this effort is all about
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Recommendations - Recovery
Summit 2006
• Person-centered
• Family and other ally involvement
• Individualized and comprehensive services
across the lifespan
• Systems anchored in the community
• Continuity of care
• Partnership-consultant relationships
• Strength-based
• Adequately and flexibly financed
• Research based
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Recommendations - Recovery
Summit
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Culturally responsive
Responsiveness to personal belief systems
Commitment to peer recovery support services
Inclusion of voices and experiences of
recovering individuals and their families
Integrated services
System-wide education and training
Ongoing monitoring and outreach
Outcome driven
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“We cannot solve
problems by using
the same kind
of thinking we used
when we created
them.”
– Albert Einstein
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Contact us at
503-494-3703
E-mail
Dale Walker, MD
[email protected]
Or visit our website:
www.oneskycenter.org
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