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The American Indian/Alaska Native National Resource Center for Substance Abuse and Mental Health Services The American Indian/Alaska Native National Resource Center for Substance Abuse and Mental Health Services The Indian Country Methamphetamine Initiative: Addressing a Problem Uniquely Affecting Indian Country Dale Walker, MD Michelle Singer Patricia Silk Walker, Ph. D Douglas Bigelow, Ph. D ATNI Winter Conference: January 24, 2008 Yakima, Washington

Six Behaviors That Contribute to Serious Health Problems: • Tobacco use • Poor nutrition Six Behaviors That Contribute to Serious Health Problems: • Tobacco use • Poor nutrition • Behaviors resulting in intentional or unintentional injury • Physical inactivity • Risky sex • Alcohol and other drug abuse – Methamphetamine! 2

Methamphetamine Use, by State in Young Adults (18 to 25) 3 Source: SAMHSA, 2002 Methamphetamine Use, by State in Young Adults (18 to 25) 3 Source: SAMHSA, 2002 -2005.

Methamphetamine: Epidemiology Methamphetamine: Epidemiology

Methamphetamine/Amphetamine Admissions by Ethnicity and Urbanization: 2004 Large Central Metro Large Fringe Metro White Methamphetamine/Amphetamine Admissions by Ethnicity and Urbanization: 2004 Large Central Metro Large Fringe Metro White 56% Black Race/Ethnic ity Small Metro Non-Metro with City Non-Metro without City 77% 78% 86% 87% 5% 3% 2% 1% 1% Hispanic 28% 14% 11% 6% 4% American Indian/ Alaska Native 2% 1% 3% 4% 6% Asian Pacific Islander 3% 2% 1% Other 6% 3% 3% 1% 1% Source: 2003 SAMHSA Treatment Episode Data Set (TEDS).

The Methamphetamine Effect 6 The Methamphetamine Effect 6

Methamphetamine Identified as the Primary Health/Community Concern • In 2006, Tribal Round Table sessions, Methamphetamine Identified as the Primary Health/Community Concern • In 2006, Tribal Round Table sessions, HHS Regional Tribal Consultations, and numerous tribal community gatherings with SAMHSA, OMH, and IHS identified Methamphetamine abuse as the primary health concern in Indian Country. 7

“Tribal leaders unveil new meth Initiative” Indian Country Today NCAI President, Joe Garcia Anchorage, “Tribal leaders unveil new meth Initiative” Indian Country Today NCAI President, Joe Garcia Anchorage, Alaska June 15, 2007 8

 Indian Country Methamphetamine Initiative (ICMI) • $1. 75 million awarded to Association of Indian Country Methamphetamine Initiative (ICMI) • $1. 75 million awarded to Association of Indian Physician (AAIP) its partners (National Congress of American Indians, One Sky Center, South and Eastern Tribes, and Northwest Portland Area Indian Health Board) • Tribal Sites – – – Navajo Nation Winnebago Tribe Northern Arapaho Tribe Crow Nation Choctaw Nation 9

ICMI Project Description • Create a National education and information outreach campaign for all ICMI Project Description • Create a National education and information outreach campaign for all Native communities. • Establish and transfer knowledge from community based, promising practices for prevention, intervention and treatment. • Work across Federal agencies for a coordinated and consistent outreach strategy. 10

The Indian Country Methamphetamine Initiative: Project Partners SAMHSA OMH IHS HHS AAIP USET Choctaw The Indian Country Methamphetamine Initiative: Project Partners SAMHSA OMH IHS HHS AAIP USET Choctaw Crow NPAIHB OSC NCAI Navajo Northern Arapaho Winnebago 11

ICMI Partners 12 ICMI Partners 12

ICMI Major Project Deliverables • Outreach/Education Kit for Tribes and others • Identification of ICMI Major Project Deliverables • Outreach/Education Kit for Tribes and others • Identification of Partners/Advisory Groups • Coordinated Federal-Tribal-State-Local Indian Country Communication and Training • Minimum 5 Tribal Specific Projects Identified and Evaluated for Potential Transfer to Other NA Communities • Final Project Evaluation • Year 3 - Promising Practices Transfer Kits 13

Toolkit Essentials • Leadership Information • Methamphetamine Basics • Tribal Code-Policy • Media • Toolkit Essentials • Leadership Information • Methamphetamine Basics • Tribal Code-Policy • Media • Educational Materials and Presentations Prevention and Treatment Educational for Students, Parents, Community • Community Organizing • Fun Youth Items 14 • Additional Resources

How to Use the Toolkit • Leadership and decision making • Overview of each How to Use the Toolkit • Leadership and decision making • Overview of each module • Specific topics, issue pages • Promising Practice approaches • What the culture and science says • Training, technical assistance, and consultation • Reference documents • Toolkit webpage 15

ID Best Practice Clinical/services Research Mainstream Practice Traditional Healing 16 ID Best Practice Clinical/services Research Mainstream Practice Traditional Healing 16

 Choctaw Nation of Oklahoma • • • “Natural Highs Program” Transformation process Experiential Choctaw Nation of Oklahoma • • • “Natural Highs Program” Transformation process Experiential activities Relationship building Changing the way you live and think • Changing how you think and you believe about life and yourself 17

METH FREE CROWALITON Unity in Our “War Against Meth” 18 METH FREE CROWALITON Unity in Our “War Against Meth” 18

Meth Free Crow Walk: Youth as our Warriors in Reclaiming our Nation Meth Free Crow Walk: Youth as our Warriors in Reclaiming our Nation

Dine Nation Methamphetamine Initiative Dine Nation Methamphetamine Initiative

What Works • Community Education – Age-appropriate presentations, brochures, ads • Enforcement (NLE Drug What Works • Community Education – Age-appropriate presentations, brochures, ads • Enforcement (NLE Drug Unit) – Arrest and detainment for trafficking • Caring members of the community • Partnerships – Communities, chapters, private businesses and tribal divisions and programs. 21

Northern Arapaho Tribe Methamphetamine Initiative A System of “Works” 22 Northern Arapaho Tribe Methamphetamine Initiative A System of “Works” 22

The concept of “Works” in a Comprehensive Systems Plan The Problem: – – “turf” The concept of “Works” in a Comprehensive Systems Plan The Problem: – – “turf” gaps duplications crossed purposes Fragmented Service System The Solution: – – – client-centered multi-agency comprehensive coordinated efficient “Works” Works 23

Winnebago Tribe Together, WE Make A Difference: Methamphetamine Prevention on the Winnebago Reservation Tipi Winnebago Tribe Together, WE Make A Difference: Methamphetamine Prevention on the Winnebago Reservation Tipi Means, Tribal Health Educator 24

Goals and Objectives Winnebago Meth Task Force • Develop/maintain a Comprehensive Methamphetamine Prevention Strategy Goals and Objectives Winnebago Meth Task Force • Develop/maintain a Comprehensive Methamphetamine Prevention Strategy • Collectively plan and implement • Use Proactive measures • Use available funds - take immediate action • Working together to determine what fits for tribal members and the reservation 25

Next Steps • Add two additional Tribes • NCAI provide PSAs and house the Next Steps • Add two additional Tribes • NCAI provide PSAs and house the Tribal Meth Taskforce • USET and NPAIHB will gather baseline data on methamphetamine use • One Sky Center: – TA for writing best practices – Create a training curriculum – Train additional tribes in ICMI best practices – Develop a cultural methamphetamine abuse education kit

Contact us at 503 -494 -3703 E-mail Dale Walker, MD onesky@ohsu. edu Or visit Contact us at 503 -494 -3703 E-mail Dale Walker, MD [email protected] edu Or visit our website: www. oneskycenter. org




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