"KNOW METH" 2005 CALL TO ACTION

MONTANA/WYOMING Tribal Leaders Council and Billings Area I H S

NOV 16, 17, 2005

BILLINGS MT

Speakers take home messages:

Outsiders (drug cartels) are targeting reservation communities to sell
meth.

A whole generation of children are being neglected, abused, and started
on meth by their using parents.

.

Behavior of meth users can be understood as it is related to specific
brain damage, which is visible on brain scans.

Meth is not going to go away.

It keeps getting worse and worse.

Sending people off the reservation for 30 days of inpatient treatment
(or 60 or 90 days,) or to jail for 3 years, does not prevent their being
triggered to use immediately on their return to the location and people
where they used.

It's a brain thing.

Treatment implications:

Short term memory is one of brain functions most affected (along with
impulse control, reward center, and executive functioning.)

Treatment needs to be concrete, more like "coaching."

Reading assignments, or long group session, are not useful in early
stages of recovery.

Depression may require pharmacotherapy.

Urine drug testing is indicated for treatment purposes.

Paranoia is almost universal. Continuum from psychosis to suspicion.

Welcoming attitude is necessary by professionals.

Length of treatment is best predictor of success.

Intensive outpatient is the method of choice.

Confrontation of clients by treatment professionals is not indicated.
Accountability is.

Welcome the client back when he returns after relapse.

"Coach" needs to know what is the course of healing of the brain from
meth, just like basketball coach needs to know about course of healing
of knee injuries.

Stages of recovery refer to length of time since last use.

Relapse is common, should be expected.

Welcome client back to treatment after relapse. "Good for you, you came
back."

Do not kick client out of intensive outpatient group when they return
from relapse.

Research shows treatment outcomes similar to that for cocaine addiction.

Speakers/websites that indicate success for meth treatment is abysmal
have no data to support that.

Inpatient treatment more likely indicated for daily injection user,
adolescents, pregnant women, people with psychosis

E.D. needs to look for signs of hyperthermia in meth user. Can be fatal.
Check temp frequently.

Meth "speeds up" body processes.

Hypertension leading to heart failure and strokes are becoming more
prevalent in Hawaii where use has been more common for longer than in
the continental US.

Meth as a (non-traumatic) cause of death is increasing there.

Emergency Department assessment standard of care in the Southwest
includes social, psychological, not just medical.

"No wrong door" is needed for user when they decide they want to stop.
Short window of opportunity.

Dentists can deliver Screening and Brief Intervention (SBIRT.)

.

Positive (reward) or negative (dirty urine=go to jail if in Drug Court)
contingency management works. Accountability.

Spiritual treatment works.

Recovering people need a mentor/coach.

May need day treatment/ activities of daily living coaching.

When incarcerated, we should take the opportunity to teach them about
the effects of use and how to stay clean when they are released.

Community needs to make it known they will not tolerate drug use.

Counselors should be trained in meth treatment, and receive some kind of
certification.

12 step groups can be life saving.

Positive community activities necessary to prevent relapse.

Exercise is powerful treatment of meth-related depression.

Medical and Nursing Track Priorities/Needs:

1.  Protocols, Protocols, Protocols (for acute stabilization.,
    pregnancy, Drug Endangered Children, referrals to Substance Abuse)

2.  Training at each service unit

3.  Beds/Nursing staff/facilities for stabilization (24-48 hours)

4.  Secure psychiatric beds (CHS)

5.  Drop in centers

6.  Day treatment

7.  Substance abuse treatment programs (to refer to) that know how to
    treat meth

Tribal and Urban responses to questions:

1.  "What is working?'

> Drug Courts
>
> NA meetings
>
> Cultural healing/sweats
>
> Comprehensive wrap around services
>
> Education of individual programs
>
> Matrix Model
>
> Pulling together communities
>
> For individuals: Contingency management
>
> Accurate information
>
> Exercise

2.  "What tools, skills, and resources do you need?"

> Getting people involved
>
> Getting back to culture
>
> Building forces---colleges, students, admin, community
>
> Stable residential---treatment, halfway houses
>
> Public knowledge---Billboards, advertising
>
> Working with people in early addiction to meth
>
> Prevention education for youth
>
> Support for grandparents raising their children's children.
>
> They often do not get custody and the rights and resources that come
> with it.
>
> They request a hotline to call 24/7 when in crisis.
>
> Resources for women

3.  What relationships and partnerships are needed?

> Law enforcement and treatment with
>
> Community and public health with
>
> Schools and social services (Child protection) with
>
> I H S and Clinic
>
> Drug Courts
>
> Elected officials, Tribal leaders
>
> Training in Matrix model
>
> Adapt Matrix model for community
>
> "Ownership" of treatment model
>
> Before treatment can take place, have to address individuals' pyramid
> of needs. First: food and shelter
>
> Public safety: prevent elder abuse, threats, theft
>
> Update Tribal Code to include meth as illegal on reservation
>
> (One Tribe) Need Tribal Resolution: War on Meth
>
> (Another Tribe) Medicine Wheel: 7 Council Fires model

4.  How do we keep track of our efforts? Learn from our experiences?

> Set goals/frame work
>
> Quality reports
>
> Set plans, tracking: who what , where
>
> Seminars at school, elementary, HS , College