1. MOD in New Mexico University of New Mexico Center on Alcoholism, Substance Abuse and Addiction Albuquerque, NM Na’Nizhoozhi Center Inc. Gallup, NM Totah Behavioral Health Authority Farmington, NM San Juan County Alternative Sentencing Division Farmington, NM

2. Who are we? WE ARE SPONSORED BY…

3. Project Partnerships AIAN MOD RESEARCH PROJECT Na’ Nizhoozhi Center Inc. Totah Behavioral Health Authority UNM CASAA San Juan County Alternative Sentencing Division

4. We want to thank everyone who assisted in this project Four Navajo chapters Char James Alberta Curley Navajo Nation Department of Behavioral Health Services Meth Project Patrick Lynch of Indian Health Services Health Promotion and Disease Prevention Department.

5. Study Overview  Aim One: COMPLETE Collect 300 ASIs at three treatment programs  Aim Two: COMPLETE Collect 100 Telephone Surveys across 26 counties  Aim Three: COMPLETE Conduct 9 Focus Groups in three cities  Treatment Providers, Clients/Relatives, Community Members (We originally intended to collect 400 ASIs and conduct focus groups at four sites. Also, the aim to conduct telephone surveys was added after initial collaboration with study partners. The N of aims one and two was modified based on study partners who were able to collaborate with us for this project.)

6. Study Data Collection  Addiction Severity Index Data Collection (pink) Farmington, Gallup Farmington, Gallup N=300 N=300 100/site 100/site  Focus Group Facilitation (blue) Albuquerque, Farmington, Gallup Albuquerque, Farmington, Gallup Providers, Community Members, Patients n=81 Three groups at each site  Phone Survey Collection (grey) n=100 Covers twenty-six counties in the Four Corners Region UT AZ CO NM

7. MOD in New Mexico FOCUS GROUPS

8. How much of a problem?  Gallup More of a problem five years ago than today The newness has worn off Still being used, especially in jobs requiring long shifts  Albuquerque All drug use on the rise, not just meth More prevalent in the ‘club scene’ and with the gay community Alcohol is still a larger problem than meth  Farmington Has become a very large problem in recent years Perceived as more problematic than in other regions Belief that use is resulting from occupational demands

9. Treatment Provider Themes  Treatment have an element of confrontation  Little knowledge of meth user signs Unable to differentiate a meth user vs. different stimulant  What should be done to decrease meth use Community involvement Education especially about heritage Control ingredients

10. Treatment Provider Themes  Most effective treatment methods Confrontational approaches best Incorporate traditional healing practices Some advocated western based practices

11. Treatment Provider Themes  Treatment providers felt education and confrontation most effective.  This contradicts evidence based practices  Confrontation and education are often ineffective  Can sometimes have a negative impact on treatment  see “Mesa Grande” article, Bill Miller, et al.)

12. Client/Relative Themes  Intrinsic motivation the key to recovery  Had the most knowledge Black stains on fingers/clothes Look older Terrible hygiene Pick at their face Steal pens Jitters

13. Client/Relative Themes  Effective treatments Tradition and spirituality Shared experience of recovery  What should be done to decrease meth use Intrinsic Motivation  Up to the individual  Individual motivation  Community support  Some early age education Shock value and scare tactics

14. Community Member Themes  Largely based on a media influence Integration of billboards Television commercials TV programs Radio advertisements Stronger law enforcement presence Harsher laws  Signs of meth use Picking, cleaning, ‘meth mouth’ Unable to distinguish between various stimulants use “You can’t [tell the difference] ‘cause they’re both the same, I mean, they’re both stimulants, speed…”

15. Community Member Themes  Decrease meth use? education of the community Especially focusing on anti-drug education with younger generations advertisements and billboards Without significant shock value or a scare tactic Strong advocates of increased law enforcement and stiffer penalties for drug users

16. Strengths  RehabJobs  Law enforcement Youth programs  Strong familyCompanion  TraditionsSpirituality/Religion  Active Community InvolvementFishing/Sports  Neighborhood WatchChapter House  Access to TreatmentFocus on strengths  Being in recovery Native American Culture

17. Strengths  Gallup “On the reservation, each community has a chapter house…it’s like a town hall. If they keep the chapter houses open…’til late…seven or eight for the kids…”  Albuquerque “The strengths of all addicts. They’re resilient. They’re still alive.” “…when you look at the Native American communities and consider…not having freedom of their own…We have so much to learn from them.”  Farmington “I think that if its our nature of our culture to be accepting and loving, and to stay as a family and work together, then teaching family members how reinforce that with loved ones that are trying to recover.”

18. MOD in New Mexico ADDICTION SEVERITY INDEX DATA

19. ASI Results  Three AIAN sites in New Mexico N=300  Descriptives: Age: Mean 34.2 (SD = 10.96) Gender:  Male: 58.2%  Female: 41.8% Education: Mean 11.6 (SD = 1.4)  10+ years: 93.1%  12+ years: 66.7% Amphetamine Use:  Past 30 days: 3.7% Primary Problem Substance:  Alcohol: 67.0% Site 1Site 2Site 3Aggregate Past 30 days – Composite Scores Mean SD Medical0.1880.1240.1220.1440.276 Employment0.8460.8810.8460.8570.213 Alcohol0.2620.1680.2170.2160.213 Drug0.0430.0080.0450.0330.078 Legal0.2000.0500.2590.1760.159 Psych0.2500.1530.1190.1720.219 Family0.1900.0840.1530.1440.167 Scale ranking 0 – 1; 0 = no problem, 1 = complete problem

20. ASI Results – Problem substance Substancef% Alcohol3820.2 Alcohol to intoxication12667.0 Amphetamine31.6 Cannabis42.1 Alcohol +Drugs115.9 Drugs –Alcohol52.7 Total188100 Self-reported major problem substance reported by number and percentage of participants

21. MOD in New Mexico TELEPHONE SURVEYS

22. Telephone Survey Trends  Conducted in Arizona, Colorado, New Mexico and Utah Each agency was asked to suggest most appropriate staff member to participate in phone surveys The participant was not required to be AI/AN, but we asked for the best person to answer our questions Agency Distribution Group 1 – San Juan (Utah), Coconino, Apache, Navajo Group 2 – Montezuma, La Plata, Archuleta Group 3 – San Juan (NM), Rio Arriba, Los Alamos, Santa Fe, Sandoval Group 4 – Taos, Colfax, Union, Guadalupe Group 5 – Socorro, Lincoln, Otero, Chaves, Lea Group 6 – McKinley, Cibola, Valencia, Bernalillo

23. Telephone Survey Trends Participant Characteristics (N = 100) Ethnicity White, non-Hisp. Hispanic Native American Navajo Apache Isleta Ute Mountain Other/Missing 54 22 10 5 2 1 13 County Group Group 1 Group 2 Group 3 Group 4 Group 5 Group 6 22 15 14 12 13 24 Gender Male Female Missing 49 50 1 Agency Type Medical Police/Jail School Treatment 13 23 28 36

24. Telephone Survey Trends  Respondents indicated the following* 100% alcohol is the biggest problem* 55.6% methamphetamine is “mild” problem 77.8% methamphetamine use increased in the past 5 years 25.0% “no” local production 37.5% “some” local production 44.4% methamphetamine “quite” or “extremely” available *In the telephone surveys, each participant indicated what they thought was true about their respective community

25.  Meth a significant community problem  Availability of meth community* significant  Alcohol ranked highest problem Second was marijuana, followed by meth  Meth use increased during the past five years  Alcohol remains most problematic substance *In the telephone surveys, each participant indicated what they thought was true about their respective community Telephone Survey Trends

26. Summary  Similar results among three methods** Substance users, treatment providers, community members differed  No unanimity with useful for treatment or prevention  Focus groups: The community members meth is a concerning problem, but not exclusive  Supported by ASI and Phone Survey  General non-hysterical response Meth use third most commonly used substance in lifetime **The telephone surveys include data that is representative of only a small portion of native community members in a large area, and therefore may not represent every perspective in these communities ***The ASI data were collected from three urban treatment centers

27. Summary  ASI high unemployment rates***  Local production shut down/economic shift  Alcohol most significant problem  Meth economically driven cheaper/easier  Future directions  Educational opportunities  Address confrontational approaches  Incorporate Native tradition