Alcoholism in Native Americans:

A Halfway House Intervention on the Crow Creek Indian Reservation

Abby Bacon, Melissa Kludt, Connie Tschetter, Jill ZuehlkeSouth Dakota State University

NURS 760

Introduction

• Alcoholism is a chronic health problem among the Native Americans on the Crow Creek Indian Reservation

• It has a major impact on the quality of life and productivity of the community members

• Introduction of a Halfway House on the Reservation may assist recovering addicts in their transition from inpatient treatment to home

Identifying an Underserved Population

• Crow Creek Indian Reservation• Located on east bank of Missouri River in

central South Dakota• Median income: approximately $12,070

per year• Unemployment rate is 57%• 56% of the Reservations population had an

income below the poverty line in 2000

(USDC, 2003)

Impact of Alcoholism on Quality of Life

• Native Americans have a high prevalence (12.1%) of

heavy drinking• 29.6% of Native Americans are binge drinkers• Problems associated with alcoholism

• Medical, Social & Economic Hardship (USDHHS, 2009)

•CDC (2008) estimates that 11.7% of all Native American/Alaska Native deaths from 2001-2005 were a direct result of alcohol use

• leading acute cause of death: motor-vehicle traffic crashes• leading chronic cause of death: alcoholic liver disease• age-adjusted alcohol-attributable deaths were the higher in the

Northern Plains region (including South Dakota) than any other region

Impact of Alcoholism on Quality of Life

• Negative societal impacts• Approximately 3 million violent crimes

occur annually in which the victims perceive the offender to have been drinking at the time of the crime.

• Two-thirds of intimate partner abuse cases cite alcohol as a contributing factor

(USDJ, 1998)

Interviews with Interdisciplinary Colleagues • Patty Juhnke, MSW

• Clinical social worker at Sanford Medical Center in Chamberlin, South Dakota

• Services consist of assessment, diagnosis, treatment, client-centered advocacy, consultation, evaluation, and prevention of mental illness, emotional, or behavioral disturbances

• Feels an important service missing for Native Americans is placement between in-patient alcohol treatment and home

• Key informants • the outpatient treatment facilities in the area • the physicians that she directly works with

(Personal interview, November 5, 2010)

Interviews with Interdisciplinary Colleagues • Patty states

• a half way house that the local community could easily access would provide many advantages

• A benefit of a half way house would be safety

• The average time period for which a person should stay at a halfway (or sober home) is three to six months at the most

• By living in a sober house, the recovering addict can continue to work effectively on his recovery process

(Personal interview, November 5, 2010)

Interviews with Interdisciplinary Colleagues • Michelle Carpenter

• Executive Director of Dakota Counseling Institute in Mitchell, South Dakota

• Also known as Stepping Stones in Chamberlain, South Dakota

• Services offered include a halfway house, adolescent/adult intensive outpatient treatment, detoxification unit, outpatient continued care/after care, DUI education program, intensive prevention education program, outreach program, and the recovery house.

• States that the Native Americans would directly benefit from inpatient care before going home

(Personal interview, November 12, 2010)

Interviews with Interdisciplinary Colleagues

• Michelle states• Would like to reduce the use of alcohol and other drugs,

forestall children using illegal substances for the first time, increase the perception of risk and harm of the use of illegal substances, and assist community groups, parents, churches, and school personnel in developing coalitions, which focus on reducing the risk of problem behaviors and develop protective factors for individuals, families, schools, and communities

• Stepping Stones Prevention Services acts as a catalyst to reinforce messages that promote positive behaviors for youth and adults

• Efforts are concentrated to gather community resources to combat substance abuse using asset building to promote healthy behaviors in students and role-modeling skills in adults

(Personal interview, November 12, 2010)

Interviews with Interdisciplinary Colleagues• Tolly Estes

• Program Director of Circles of Care• Short term program in Fort Thompson that has

been funded by a three-year grant from the Substance Abuse and Mental Health Services Administration

• The goal of the facility is to plan for the implementation of a community bases, family-focused system of care to support mental health for the Native American youth and families of the Crow Creek Reservation

• Main goals of the organization are to educate the local providers about their systems of care philosophy, to encourage more family involvement in the care system, and to reduce the stigma associated with mental health issues

(Personal interview, November 12, 2010)

Interviews with Interdisciplinary Colleagues• Sherry Lulf

• Managed-care director of the Indian Health Center in Fort Thompson, South Dakota

• Offers outpatient treatment for people with dependency problems of alcohol and other drugs

• No inpatient treatment is available to the members of the Crow Creek Indian Reservation within miles of the Reservation

(Personal interview, November 18, 2010)

Interviews with Interdisciplinary Colleagues• Sherry states

• IHS is sending some of their tribal members as far as California for inpatient treatment

• Two main issues with starting a halfway house on the Reservation are funding and someone to manage the facility 24 hours a day

• It will still be quite some time that Crow Creek members will continue to go to long term treatment off of the reservation

(Personal interview, November 18, 2010)

The Halfway House as an Intervention

• History and Development of Halfway Houses• Concept first appeared in the 1950’s

• Provide a stable environment until residents are able to make suitable arrangements for themselves

• Often fully staffed by recovered alcoholics (White,

2000a)

The Halfway House as an Intervention

• Halfway House: a group of recovering alcoholics living together & supporting each other in their recoveries• Possession or use of alcohol, drugs, and/or weapons as well as any

criminal activity including threats, violent behavior, and/or vandalism results in immediate eviction

• Residents must attend off-site counseling and/or a 12 step program as well as all house meetings

• After a period of time during which the resident must stay on-site (30 days is recommended), he must obtain full-time employment

• Each resident is responsible for keeping himself and his belongings clean, as well as completing assigned chores throughout the property

• Medications are kept and dispensed by the house manager, and each resident must agree to random urine drug testing at his own expense

(Murray, n.d.)

Health Promotion and Disease Prevention Model• The Transtheoretical Model of Health

Promotion describes how people move toward adopting and maintaining behavior change

• A person who is trying to make a health-related change moves through five stages1. Precontemplation2. Contemplation3. Planning or Preparation4. Action5. Maintenance

(Pender, Murdaugh, & Parsons, 2011)

Health Promotion and Disease Prevention Model

• The proposed halfway house intervention as a bridge between inpatient treatment and returning home fits into this model at the action and maintenance stages, during which the person is actively engaged in behavioral change and is sustaining the change over time

(Pender, Murdaugh, & Parsons, 2011)

Health Promotion and Disease Prevention Model• Model includes 10 processes of change

(strategies) • Experiential Strategies

• Including consciousness raising, dramatic relief, environmental reevaluation, and self-reevaluation• Most likely implemented during initial, inpatient

treatment for alcohol dependence• Behavioral Strategies for Change

• Including social liberation, counterconditioning, helping relationships, reinforcement management, and self-liberation• Introduced during inpatient treatment, and

continued in the halfway house environment (Pender, Murdaugh, &

Parsons, 2011)

Nursing Recommendations for Implementing Interventions• Open, culturally respectful communication

• Attentive listening skills• Respect personal space (Flowers, 2005)

• Don’t teach too much at once (Harrington-Dobinson & Blows, 2007)

• Culturally-sensitive treatment methods • Reduce cultural stress

• Encourage health promoting behaviors in future generations

• Involve family and community in recovery process• Use family as a potential resource and support• Create economic development programs (Milbrodt,

2002)

Plan for Implementation and Evaluation in Crow Creek• Plan for Implementation

• Funding • Sources would have to be secured, possibly

through Indian Health Services or a federal grant• Care

• Should be coordinated with the other agencies in the area to include the halfway house as an option in discharge planning

• Staff for the halfway house• Ideally come from the Crow Creek community,

providing an additional employer for the community

Plan for Implementation and Evaluation in Crow Creek

• Evaluation of Effectiveness of the halfway house intervention• Tracking all discharges from the area’s

treatment centers • Comparing the long-term outcomes of those

who visit the halfway house to those who return directly home after inpatient treatment

Conclusion

• The Native American community free from the dangers of alcohol is not in the near future. The process of implementing interventions for Natives abusing alcohol can be a very involved and complicated process. By utilizing effective, culturally appropriate communication, paying attention to cultural traditions, involving family and the community and by making more resources available, including education, the mission can continue to move toward success for future generations. For the people of the Crow Creek Reservation in South Dakota, a community-based halfway house may be a step toward overcoming the effects of alcohol abuse in their community.

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