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									                         Community Crisis:
     Public Health’s Role in the Methamphetamine Epidemic—
                 Partnering to Confront the Issue

               Maternal and Child Health (MCH) Federal/State
                             Partnership Meeting
                “Building Blocks 4 Promising Practic Models”
                        Hilton Alexandria Mark Center
                             5000 Seminary Road
                            Alexandria, VA 22311
                              October 16, 2007

Wilbur Woodis M.A.
IHS Division of Behavioral Health

  What is the "fight or flight response?"

This fundamental physiologic response forms
the foundation of modern day stress medicine.
The "fight or flight response" is our body's
primitive, automatic, inborn response that
prepares the body to "fight" or "flee" from
perceived attack, harm or threat to our
   What are the signs that our fight or flight response
           has been stimulated (activated)?

We become prepared—physically and
psychologically—for fight or flight. We scan and
search our environment, "looking for the enemy."

We tend to perceive everything in our environment as
a possible threat to our survival. By its very nature,
the fight or flight system bypasses our rational mind—
where our more well thought out beliefs exist—and
moves us into "attack" mode
Disrupts all relations
 ―Meth is not a drug that gets you drunk like
   alcohol or stoned like pot…
 The thing that Meth does…
 Is it makes you feel bright, awake, and
 You feel good about yourself, no matter how
 things may be…Meth is a drug of deception.‖

Roger Curtiss, Clinical Manager
Gateway Community Services
Great Falls, MT
Testimony senate panel
         At Risk Populations
 Traditionally considered a ―Caucasian
  drug‖—considered a blue collar drug
 Increased use among the Hispanic/Latino
  and Asian populations
 Reports of increased use among Native
  American Populations
 High rate of use among Women
 High rate of use in the Gay Community
            Methamphetamine –

What We’re Doing to Address the Problem

Meth use is an increasing problem in Indian
Country. This session will highlight what
programs are in place to address this problem
and share resources that are available to Tribes
battling this epidemic.
                       Taking action
                  Legislative approaches

   S 430, Arrest Methamphetamine Act of 2005
    (addresses production, sale, and use)

   HR 13, CLEAN-UP (Clean, Learn, Educate, Abolish,
    Neutralize, and Undermine Production) environmentally

   S 103, Combat Meth Act of 2005 (proposed
    solutions through criminal justice system and treatment
    community (abuse, manufacturing and treatment)
S 103, Combat Meth Act of 2005 (proposed solutions
  through criminal justice system and treatment
  community (abuse, manufacturing and treatment)

Methamphetamine distribution – passaged (2006)
Known as the ―Combat Methamphetamine Epidemic Act,‖
the law (P.L. 109-177) (2006)

• to make it harder for ―meth cookers‖ to obtain supplies/
ingredients from cough and cold drugs sold in drug stores.
     Indian Health Response
IHS Director’s three initiatives address:

Chronic Disease
Behavioral Health
Health Promotion/Disease Prevention

                            Director’s Initiatives
           System-Wide Effort
   Change approach from crisis orientation to ongoing
    behavioral health promotion

   Seek new and sustainable resources: multiple
    funding sources

   Maximize current program effectiveness:
    collaborations, data-driven models

   Technology and clinically sound behavioral
    approaches integrated with traditions and healing
    practices of the community.

                              Director’s Initiatives, 2005
           I/T/U Taking action
   HHS roundtables – OMH, NIH, SAMHSA, NIDA,
    HRSA, OJP, etc
   Intra/Interagency MOUs/IAAs
   Friendship House NA matrix model
HHS Indian County Methamphetamine Initiative – Public Health
OMH and NIH - Indian Country Methamphetamine Initiative (ICMI).

Nearly $1.2 million was awarded to the American Association of Indian
Physicians (AAIP) and its partners to address:

• outreach
• education needs of Native American communities on (meth) abuse

The partners will develop:

• national information and outreach campaign
• a culturally specific meth abuse education kit
• document and evaluate promising practices in education on meth use
• create meth awareness multi-disciplinary education teams

This project brings federal, tribal, state, and local resources together to
reach urban and rural Native American communities and families.
HHS Indian County Methamphetamine Initiative – Public Health

The AAIP, of Oklahoma City, OK, will partner with:
The Oregon Health and Science University-One Sky Center,
Portland, OR will serve as the principal expert for behavioral health,
mental health and substance abuse regarding methamphetamine
The National Congress of American Indians, Washington, DC will
provide technical assistance on a national scale in Indian country.
The United South and Eastern Tribes, Nashville, TN and the
Northwest Portland Area Indian Health Board, Portland, OR will
contribute regional expertise and will track data and trends within their
respective regions.
The five tribal sites include:
The Winnebago Tribe, Navajo Nation, Northern Arapaho Tribe,
Crow Tribe and Choctaw Nation
HHS Provides $98 Million in Access to Recovery Grants –
Program Expands Client Choice in Substance Abuse Treatment Services
to provide people seeking alcohol/drug/substance abuse TX with vouchers allowing them a greater range
of choice in selecting the services most appropriate for their needs.

Tribal Organization Awards:

Alaska Southcentral Foundation – “Circle of Recovery‖

California Rural Indian Health Board, Inc -- (CRIHB),
lead California American Indian Recovery (CAIR) program,
collaborate with the Northwest Portland Area Indian Health Board
to extend access to 43 additional tribes across California, Oregon, Washington, and Idaho.

Cherokee Nation of Oklahoma – “Many Paths Project”
Approximately 30 percent of its clients served will be methamphetamine users
and will build upon three SAMHSA planning grants that have been funded in the region.

Inter-Tribal Council of Michigan, Inc. -- The goal of the Anishnabe ATR is to increase
the eligible population on or near reservations by and members of other tribes living in the area;
expanding from outpatient only to a full continuum of clinical treatment
and recovery support by recruiting providers into the network;
increasing the overall capacity of the tribal network system collaborating with unrepresented providers

Montana-Wyoming Tribal Leaders Council -- The Rocky Mountain Tribal (RMT-ATR) program is a
collaboration of Montana and Wyoming Tribal and Urban Indian SA treatment and recovery support services
The goal of RMTAR is to increase access through client choice from an array of clinical
and recovery support services, reaching at least (½) of the unmet need for methamphetamine
and other substance use disorders within the three years of the grant.
                           Returns on the Investment
                            in Behavioral Health Care
                Reductions in other health care costs
                Reductions in criminal behavior
                Reductions in substance involved motor
                vehicle crashes ($64 of next premium payment)
                Improvements in vocational functioning
                Recovering individuals are tax payers, not
                recipients of public funding

Norman G. Hoffmann, Ph.D.
Evince Clinical Assessments
29 Peregrine Place
Waynesville, NC 28786
Tel: 828-454-9960; Fax: 828-454-9961; Cell: 401-374-0375
                       The Intervention Spectrum
                        for Behavioral Disorders

                                                     Identification Standard
                                           Indicated—               for Known
                                           Diagnosed                Disorders

                                  Selective—                             Compliance
                                  Health Risk                            with Long-Term
                                  Groups                                 Treatment
                                                                         (Goal:Reduction in
                                                                         Relapse and Recurrence)

                             Universal—                                                Aftercare
                             General Population                                       (Including

      Source: Mrazek, P.J. and Haggerty, R.J. (eds.), Reducing Risks for Mental Disorders, Institute of
      Medicine, Washington, DC: National Academy Press, 1994.

Dale Walker, MD
                           Ecological Model

               Society   Community/   Peer/Family Individual

Dale Walker, MD
    ASAM Six Assessment Dimensions

1. Acute Intoxication and/or Withdrawal
2. Biomedical Conditions and Complications
3. Emotional, Behavioral or Cognitive
   Conditions and Complications
4. Readiness to Change
5. Relapse/Continued Use, Continued
   Problem Potential
6. Recovery Environment
                       Individual Intervention

       Identify risk and protective factors
            skill building
            improve coping
            support groups
       Increase community awareness
       Access to hotlines other help resources

Dale Walker, MD
   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.

Dale Walker, MD
             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

Dale Walker, MD
                       Prevention Programs Reduce
                             …Risk Factors…

     - ineffective parenting
     • chaotic home environment
     - ineffective parenting
     • lack of mutual attachments/nurturing
     - chaotic home environment
     • inappropriate behavior in the classroom
     - lack of mutual attachments/nurturing
     • failure in school performance classroom
     - inappropriate behavior in the
     • poor social coping skills
     - failure in school performance
     • affiliations with deviant peers
     - poor social coping skills
     • perceptionswith deviant peers
     - affiliations of approval of drug-using behaviors
     • perceptions of approval of drug-using behaviors
Dale Walker, MD
                   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

Dale Walker, MD
      Components of Comprehensive
         Drug Abuse Treatment
                                       Child Care
                 Family                                          Vocational
                 Services             Intake Processing /         Services

  Housing /
                     Behavioral         Detoxification                         Mental Health
Transportation      Therapy and
                                                            Substance Use
                                                             Monitoring          Services
   Services          Counseling
                                        Treatment Plan
                  Clinical and Case                         Self-Help / Peer
                    Management                              Support Groups
   Financial                          Pharmacotherapy                            Medical
   Services                                                                      Services
                                       Continuing Care

                  Legal                                         Educational
                 Services              AIDS / HIV                Services
               Native Adolescents: Multiple Life Risks

                                    Psychiatric Illness
                                        & Stigma

              Cultural Distress                             Economics


 Family Disruption                     CHILD
 Domestic Violence                                                      Family History

Negative Boarding School
                                                              Psychological Vulnerability

                       Historical Trauma         Suicidal
Dale Walker, MD
  Adolescent Problems In Schools
                                      Fighting     Alcohol
                                        and         Drug
                                       Gangs         Use
                       Bullying                                 Carrying

                Sale of
                                            School                         Sexual
               and Drugs
                   Unruly                                               Truancy
                             on Teachers         Drop        Domestic
                                                 Outs        Violence

Dale Walker, MD
             Treatment Approaches Found
               Effective in Working with
            Methamphetamine Use Disorder
         Motivational Interviewing - MI
         Therapeutic Use of Urinalysis
         Contingency Management (AKA motivational
         Community Reinforcement Approach
         Cognitive Behavioral Therapy - CBT
         Matrix Model (combination of above)

Dale Walker, MD
                          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
Dale Walker, MD
     Key Concept: Thought Stopping
                  Thought Stopping

Trigger      Thought

      Continued Thoughts           Cravings       Use

  •Prevents the thought from developing into an
  overpowering craving
  •Requires practice
                               Guide to Recovery from Meth                                             Draft
                                            Stay Healthy

Access to Support                                                                   Access to Health

                        Rehabilitation              Relapse Prevention

                           3—9 Months                      Rest of your life

Stay Clean                                                                                Get Started

                       Alliance                                 Engagement

                    2nd Week—12 Week                                     1st Week

                      Get Medical care & Exercise    Sleep, Eat & Drink Water         Access to Hope
Access to Help
Outpatient or

                                             Get Clean
                                                                                  Billings Area
                                                                                Behavioral Health
                       Contingency Management
     Key concepts

             Behavior to be modified must be objectively
             Behavior to be modified (e.g. urine test results) must
              be monitored frequently
             Reinforcement must be immediate
             Penalties for unsuccessful behavior (e.g. positive UA)
              can reduce voucher amount
             Vouchers may be applied to a wide range of prosocial
              alternative behaviors

Dale Walker, MD
Some helpful Resources

This powerful one-hour documentary examines the effect of crystal
Methamphetamine use on the Navajo Nation and exposes the viewer to the
shattered lives of those affected by the highly addictive drug. Throughout the film,
candid interviewers of Navajo Meth addicts as well as individuals in recovery
reveal insight into the emotions, sacrifices and life altering impact of the drug.

TCRHCC Health Promotion Program
167 North Main St.
P.O. Box 600
Tuba City, Arizona 86045
(928) 283-1300/2404

Price Each DVD-$30.00
Price Each VHS-$25.00

Produced & Sponsored By:
Tuba City Regional Health Care Corporation
Health Promotion Program
Working Together to Combat Meth in Indian Country
A journal for health professionals working with American Indians
and Alaska Natives
December 2006 Volume 31 Number 12

Taking Control of Methamphetamine in Our Communities:
An Opportunity of Necessity
A journal for health professionals working with American Indians
and Alaska Natives
January 2007 Volume 32 Number 1

Treatment for Methamphetamine Abuse and Dependence: The Matrix Mo
A journal for health professionals working with American Indians and Ala
April 2007 Volume 32 Number 4
                 Aberdeen Area

 For more information on the
  training and DVD contact:
 Bobbi Bruce
 Mental Health Program
 Aberdeen Area Indian Health
 605-226-7342 (Phone).
Helen Waukazoo, Director
Orlando Nakai, Assistant Director

The Friendship House Association of
American Indians, Inc.
56 Julian Ave
San Francisco, CA 94103

(SAMHSA) has awarded $49.3 million in FY 2006 grant funding
 for 14 new, and one supplemental, discretionary grants
to tribal organizations for:
 prevention
 treatment and
 recovery support services

            SAMHSA, is a public health agency within the
             Department of Health and Human Services.

      The agency is responsible for improving the accountability,
              capacity, And effectiveness of the nation‘s
                    substance abuse prevention,
                        Addictions, treatment,
             and Mental health services delivery system.
Treatment Improvement
Protocols (TIP)
   – Best Practice Guidelines
     for Treatment of
     Substance Abuse
   – Researched, Drafted, and
     Reviewed by Substance
     Use Disorder Professionals
Companion Publications for TIP 33

                  KAP Keys & Quick Guide
                   – Developed to
                     accompany the TIP
                   – Based entirely on TIP
                   – Designed to meet the
                     needs of busy
                     clinicians for concise,
                     easily accessed ―how-
                     to‖ information
 SAMHSA’s Addiction
  Technology Transfer
  Centers (ATTC)
 Pacific Southwest ATTC
 Methamphetamine 101
   – Etiology and Physiology
     of an Epidemic
ATTC’s Introduction to Evidence-Based
  Treatments for Methamphetamine
 CD-ROM Learning Tools
 DVD Training Module
 Produced by: Applied
  Behavioral Health Policy
  at the University of
  Arizona for the Pacific
  Southwest ATTC
 web
Center for Substance Abuse Prevention ―Meth:
   What’s Cooking in Your Neighborhood?‖

   Available as booklet, video
    tape, and PowerPoint
    presentation.                                               Meth:
                                                    What’s Cooking in
   Useful information on what                     Your Neighborhood?
    methamphetamine is, what it
    does, why it seems appealing,
    and is dangerous.                                U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES
                                                     Substance Abuse and Mental Health Services Administration
                                                     Center for Substance Abuse Prevention

   Includes many additional
    resources and where to get
             Video and booklet are available at NCADI, 1-800-729-6686, and
             the PowerPoint version from SAMHSA at
Methamphetamine Publications

– Project web site:

– Journal of Psychoactive Drugs
    Special Issue- April-June 2000

– Journal of Addiction, June 2004
    A Multi-Site Comparison of Psychosocial Approaches for the
     Treatment of Methamphetamine Dependence
      SAMHSA/CSAT Information
 SHIN 1-800-729-6686 for publication
  ordering or information on funding
    – 800-487-4889 – TDD line
   1-800-662-HELP – SAMHSA’s National
    Helpline (average # of tx calls per mo.- 24,000)
State Profiles & Partners
 • DEA Assessment:
 • Methamphetamine Use among State Population (2002-2005):
 • Methamphetamine Use among High School Students (2005):
 • Drug Offenses:
 • Lab Incidents:
 • Treatment Admissions for Methamphetamine Abuse:
 • State Laws Pertaining to Precursor Chemicals:

1 2006 DEA State Fact Sheets.
2 Prevalence Estimates for 2002-2004. NSDUH. SAMHSA
3 Prevalence Estimates for 2002-2005. NSDUH. SAMHSA
5 Federal Sentencing Stats. U.S. Sentencing Commission.
6 Maps of Methamphetamine Lab Incidents. DEA.
7 TEDS. Drug and Alcohol Services Information System. SAMHSA.
8 Methamphetamine Precursor Laws. National Association of Chain Drug Stores.

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