1. Drug and Alcohol Implications for TVR Counselors MARC ESPINO, TOHONO O’ODHAM SYCUAN INTER-TRIBAL VOCATIONAL REHABILITATION PROGRAM SAN DIEGO CA IN COLLABORATION WITH JESSICA ELM, MSW ONEIDA / STOCKBRIDGE-MUNSEE, UNIVERSITY OF WA

2. Origins – Historically Traumatic Events

3.  On and off-reservation boarding schools were developed after at Fort Marion Prison in Florida (1872-1875) where Native prisoners of war were held.  1879: “Kill the Indian, Save the Man” Policy  Proposed forced removal at early age with no return until young adults  1909: 25 off-reservation boarding schools  More than 100,000 Native children forced to attend these schools  Attendance mandatory or parents would be imprisoned Boarding School Period 1879-1935 +

5. Relocation Era 1950’s – 1960’s  U.S. government promised jobs and resources in an effort to encourage Native people to leave their Tribal lands and relocate to large metropolitan areas (Los Angeles, Bay Area, Seattle…)  After arriving many were not provided what was promised. Some did not have the financial means to return to their Tribal homelands -either permanently or even for ceremony.  Video Clip: We Shall Remain

6. Origins –Trauma Response  Trauma response  Historically traumatic events  Grief  Sense of Loss  Anger  Coping  Ceremony, cultural practices  Alcohol and Substance Abuse

7. Consequences: Life Course Problems

8. Substance Abuse Psychiatric Disorders Poverty Antisocial Behavior Cultural Distress Family Dysfunction Historical Trauma Stressful Life Events ImpulsivityUnemployment School Problems Depression Anxiety Suicidal Behavior Personal Losses Geographic Isolation Dual Diagnosis Stigma Hopelessness Poor Interpersonal Communication Behavioral Problems Withdrawal Family History Limited Social Support Domestic Violence Child Abuse Suicide Clusters Slide borrowed from Rose Weahkee, PhD at the Indian Health Service Consequences: Risk Factors

9. Implications: Protective Factors Traditional Healing Practices Cultural Pride Self-Determination Spiritual Beliefs Strong Traditional Culture Healthy Attachments Elder Involvement Youth Involvement AccessSense of Humor Resources Available Life Skills Self-Esteem Strong Group Affiliation Help-Seeking Behavior Language Cultural Identity Sense of Well-being Hope Interpersonal Competence Healthy Peer/Adult Modeling Belonging Family Support Social Support Good Health Acceptance Safety/Security Slide borrowed from Rose Weahkee, PhD at the Indian Health Service

10. Protective Factors  A 1999 study of risk and protective factors among AI/AN youth showed that “adding protective factors was equally or more effective than decreasing risk factors in terms of reducing suicidal risk.”  Protective factors, similar to risk factors, are cumulative and interrelated.  Enhancing the way in which people feel connected to community and family and strengthening their ability to cope with life’s challenges will help them achieve their full potential.  Video Clip: White Bison.Org The Wellbriety Movement: Journey of Foregiveness Slide borrowed from Rose Weahkee, PhD at the Indian Health Service

11. Implications: Living in Both Worlds  History and Values  Collective Communities  Trauma, Stress -> Substance Use as a symptom  Today’s Western Philosophy  Economics  Independence  WORK

12. Vocational Implications  Eligibility Determination:  Substance Use Disorders and diagnostic criteria; mild, moderate, severe (Addictive Disorders: Gambling Disorder)  Comprehensive Evaluation: co-occurring disorders, history and barriers to employment  AIVR as outpatient and aftercare services; length of sobriety  IPE Development  Disability Management: Counseling, cultural support groups/meetings, recovery coaches, ceremony  Spiritual, Family, Cultural Interconnectedness

13. Vocational Complications  Work History: job loss, lack of positive references  “Using behavior” and accountability  Barriers: drug screening, background checks, transportation, esteem issues  Transition to work phase: scheduling, decreased meetings and counseling, onset of work related stress/anxiety  Lack of coping mechanisms: functional or dysfunctional coping skills  Disconnection to cultural, family, and ceremonial supports  Poor social support network  Relapse potential  Pathway from institutionalization: prison, jails, mental facilities,

14. Implications: Psychological Consequences  PTSD  Generalized Anxiety Disorder  Depression  Guilt/Grief  Attention problems  Impulsive Control Issues  Low Frustration Tolerance  Lack of Time Perception

15. Social Consequences  Lack of Social Skills  Loss of Activity of Daily Living (ADL) Skills: Self care activities; independent living skills, skills performed with others  Immersion in Drug Culture  Need for Positive Peer Supports

16. Spiritual Consequences  Hopelessness  Despair  Loss of Direction  Need for Values Clarification

17. Progression Cycle

18. What would you do?  Transparency in case management approach  Personal perspective and personal beliefs  Transparency in case management approach  Medical Marijuana/Methadone Maintenance  Relapse and recovery maintenance  “Payment of residential treatment”  Substance abuse counseling as employment outcome  Case Studies/Song/Q & A