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

Origins – Historically Traumatic Events

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” PolicyProposed forced removal at early age with no return until young adults

1909: 25 off-reservation boarding schoolsMore than 100,000 Native children forced to attend these schoolsAttendance mandatory or parents would be imprisoned

Boarding School Period 1879-1935 +

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

Origins –Trauma Response

Trauma response Historically traumatic events Grief Sense of Loss Anger

Coping Ceremony, cultural practices Alcohol and Substance Abuse

Consequences: Life Course Problems

Substance Abuse

Psychiatric Disorders

Poverty

Antisocial Behavior

Cultural Distress

Family Dysfunction

Historical TraumaStressful Life

Events

Impulsivity Unemployment

School Problems

Depression Anxiety

Suicidal Behavior

Personal Losses

Geographic IsolationDual 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

Implications: Protective Factors

Traditional Healing

Practices

Cultural Pride

Self-Determination S

piritual Beliefs

Strong Traditional

Culture

Healthy Attachments

Elder InvolvementYouth Involvement

Access Sense of Humor

Resources Available

Life Skills

Self-EsteemStrong Group Affiliation

Help-Seeking Behavior

LanguageCultural 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

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

Implications: Living in Both Worlds

History and Values

Collective Communities

Trauma, Stress -> Substance Use as a symptom

Today’s Western Philosophy

Economics

Independence

WORK

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

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,

Implications: Psychological Consequences

PTSD

Generalized Anxiety Disorder

Depression

Guilt/Grief

Attention problems

Impulsive Control Issues

Low Frustration Tolerance

Lack of Time Perception

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

Spiritual Consequences

Hopelessness Despair Loss of Direction Need for Values Clarification

Progression Cycle

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