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Tribal Healing to Wellness Courts: Treatment Guidelines, 2nd ed. (2017), is designed to provide tribal communities with an overview of Western substance abuse treatment strategies that have been developed by drug court programs over the past several years and that tribal programs might consider adapting, along with traditional healing practices. This guideline draws upon drug court standards and best practices, and the experiences of hundreds of tribal and state adult and juvenile drug court programs, operating in various environments and serving a wide range of individuals addicted to alcohol and/or other drugs. Tribal Healing to Wellness Courts: Treatment Guidelines for Adults and Juveniles (2002 draft)

  • A Technical Assistance Guide for Drug Court Judges on Drug Court Treatment Services, Jeffrey n. Kushner, Roger H. Peters, and Caroline S. Cooper, BJA Drug Court Technical Assistance Project, School of Public Affairs, Justice Programs Office, American University (2014).
    This guide has been prepared for judges newly assigned to preside over a drug court program to serve as a wuick primer to assist them in (a) becoming familiar with the key elements and evidence-based practices that should be reflected in the treatment services provided to drug court participants, and (b) working with local treatment provider(s) to ensure that these services are provided.
     
  • Quality Improvement for Drug Courts: Evidenced-Based Practices, Carolyn Hardin and Jeffrey N. Kushner, eds., Natonal Drug Court Institute, Mong. Series 9 (Apr. 2008).
    This document is inetned to be used by the drug court team to improve treatment practices. The document aims to provide “what works” approach based upon the science with recommendations to assist court in implementation of best practices to improve overall program operations.
     
  • Principles of Drug Abuse Treatment for Ciminal Justice Populations: A Research-Based Guide, National Institute on Drug Abuse, National Institutes of Health, U.S. Dep’t. of Health and Human Services (Sep. 2006).
    This booklet–a complement to NIDA’s Princples of Drug Addiction Treatment: A Research-Based Guide–is intended to describe the treatment principles and research findings that have particular relevance to the criminal justice community and to treatment professionals working with drug abusing offendeds. 
     
  • Principles of Drug Addiction Treatment: A Research-Based Guide, 3rd ed., National Institute of Drug Abuse, National Institutes of Health, U.S. Dep’t. of Health and Human Services (Dec. 2012).
    This update of the National Institute on Drug Abuse’s Principles of Drug Addiction Treatment is intended to address addiction to a wide variety of drugs, including nicotine, alcohol, and illicit and prescription drugs. It is designed to serve as a resource for healthcare providers, family members, and other stakeholders trying to address the myriad problems faced by patients in need of treatment for drug abuse or addiction. 


Presentations


Sample Treatment Program Requirements


Therapies and Interventions
Please note that these therapies are not specifically endorsed by TLPI, but rather are presented merely as available options. 

  • Moral Reconation Therapy (MRT), a cognitive-behavioral, evidenced-based treatment and a SAMHSA NREPP-registered program. MRT is a systematic treatment strategy that seeks to decrease recidivism by increasing moral reasoning. Its cognitive-behavioral approach combines elements from a variety of psychological traditions to progressively address ego, social, moral, and positive behavioral growth. MRT takes the form of group and individual counseling using structured group exercises and prescribed homework assignments. Participants meet in groups once or twice weekly and can complete all steps of the MRT program in a minimum of 3 to 6 months.
     
  • Seeking Safety, a model of counseling to help improve coping skills. It was originally developed for trauma, substance abuse, and/or posttraumatic stress disorder (PTSD). It is also applied broadly to increase coping and stabilization.
     
  • Native American Motivational Interviewing: Weaving Native American and Western Practices. Find other Motivational Interviewing materials here.
     
  • Find more at SAMHSA’s National Registry of Evidenced-Based Programs and Practices, a searchable online registry of more than 300 substance abuse and mental health interventions. NREPP was developed to help the public learn more about evidence-based interventions that are available for implementation. 


Trauma-Informed Care

  • National Center for Trauma-Informed Care and Alternatives to Seclusion and Restraint, Substance Abuse and Mental Health Services Administration (SAMHSA)
    NCTIC offers consultation and technical assistance, education and outreach, and resources to support a broad range of service systems, including systems providing mental health and substance abuse services, housing and homelessness services, HIV services, peer and family organizations, child welfare, criminal justice, and education.
     
  • Essential Components of Trauma-Informed Judicial Practice: A Guide for Judges in Treatment Courts, and Trauma 101: What Every Judge Needs to Know about Trauma, National Association of State Mental Health Program Directors (NASMHPD), HHSS2832007000201 (2013).
    Trauma awareness is an opportunity to make small adjustments that improve judicial outcomes while minimizing avoidable challenges and conflict during and after hearings. This issue brief provides information, specific strategies, and resources that many treatment court judges have found beneficial.
     
  • Engaging Women in Trauma-Informed Peer Support: A Guidebook, Andrea Blanch, Beth Filson, and Darby Penney, National Center on Trauma-Informed Care (2012)
    As a peer supporter, many of the women you work with will have experienced some form of violence or trauma in their lives. Perhaps you have experienced trauma in your own life. Whether you work in a mental health or substance abuse program, a homeless shelter, a correctional institute, a domestic violence shelter, an independent peer-run program, or any other setting, your relationships with the people you support may be profoundly affected by trauma. THis workbook will basic information on sources and impacts of trauma and will describe how behavioral health, human services, and other systems are becoming “traumainformed.” 
     


Co-Occurring Disorders

  • Six Steps to Improve Your Drug Court Outcomes for Adults with Co-Occurring Disorders, Henry J. Steadman, Roger H. Peters, Christine Carpenter, Kim T. Mueser, Norma D. Jaeger, Richard B. Gordon, Carol Fisher, Stephen Gross, Eric Olson, Fred C. Osher, Chanson D. Noether, and Caroyln Hardin; Drug Court Practitioner Fact Sheet Vol. VIII, No. 1, (2013).
    This article outlines strategies, in detail, for serving drug court participants with co-occuring disorders: 1) Identify the need; 2) adapt the court structure; 3) expand the treatment options; 4) target case management and community supervision; 5) expand mechanisms for collaboration; and 6) educate the team.
  • Co-Occurring Disorders: see the Appendix of the Quality Improvement for Drug Courts: Evidence Based Practices, NADCP Monograph Series 9 (2008), for a Checklist for Designing Problem-Solving Courts to Address Co-Occurring Disorders.
    Page 115 of this monograph provides a checklist, intended as a guide for problem-solving courts in developing services and community resources to meet the unique needs of participants with co-occurring mental health and substance abuse disorders.


Medically Assisted Treatnent (MAT)

  • Indian Health Service Pharamcists Engaged in Opioid Safety Initiatives and Expanding Access to Naloxone, Hillary Duvivier, Samantha Gustafson, Morgan Gruetman, Tenzin Jangchup, Ashlee Knapp Harden, Aimee Reinhard, Keith Warshany, 57 Journal of the American Pharmacists Association S135-S140 (2017).
    Deaths from prescription opioid overdoses among American Indians and Alaska Natives have increased nearly 4-fold from 1.3 per 100,000 in 1999 to 5.1 per 100,000 in 2013. The Indian Health Service has created the Prescription Drug Abuse Workgroup, charged with developing a series of policies and programs to prevent overdose deaths and reduce morbidity and mortality associated with opioid use disorders. These strategies include encouraging responsible prescribing of opioids in the management of pain, increasing access to naloxone, and increasing access to medication-assisted treatment for opioid use disorders. The Indian Health Service almost tripled the purchasing of naloxone in the first half of 2016 and significantly increased access to naloxone through direct patient and first responder initiatives.
  • National Overview of Medication-Assisted Treatment for American Indians and Alaska Natives with Substance Use Disorders, Traci Rieckmann, Ph.D., Laurie Moore, M.P.H., Calvin Croy, Ph.D., Gregory A. Aarons, Ph.D., Douglas K. Novins, M.D., 66:11 Psychiatric Services 1136-1143 (Nov. 2017).
    American Indians and Alaska Natives (AI/ANs) experience higher rates of substance use disorders and less access to high-quality care compared with other racialethnic groups. The objective of this study was to better understand the use of medication-assisted treatment (MAT) of substance use disorders for AI/ANs and barriers to broader implementation. Of the 192 programs, 28% reported implementing MAT. Staff that perceived MAT to be consistent with their program’s treatment approach and philosophy and programs reporting that MAT fit with staff expertise and training were more likely to implement MAT. Low rates of MAT implementation suggest racial disparities in access to MAT among AI/ANs, a population with historically high rates of substance use disorders. Study findings also highlight the important role of treatment culture and organizational fit in the implementation of MAT in treatment programs serving AI/AN populations. Results also speak to the importance of adapting existing EBTs in a culturally competent way to best serve the needs of the AI/AN community.
  • Evaluation of American Indian Health Service Training in Pain Management and Opioid Substance Use Disorder, Joanna G. Katzman, et. al., 106 Am. J. Oublic Health 1427-1429 (2016). 
    Examines the benefits of a collaboration between the Indian Health Service and an academic medical center to address the high rates of unintentional drug overdose in American Indians/Alaska Natives. In January 2015, the Indian Health Service became the first federal agency to mandate training in pain and opioid substance use disorder for all prescribing clinicians. More than 1300 Indian Health Service clinicians were trained in 7 possible 5-hour courses specific to pain and addiction. Positive changes in pre- and postcourse knowledge, self-efficacy, and attitudes were noted as well as thematic responses showing the trainings to be comprehensive, interactive, and convenient
  • Educating Drug Courts on Medication Assisted Treatment (MAT) Online Course
    The National Drug Court Institute (NDCI) with funding from the Office of National Drug Control Police, Executive Office of the White House in collaboration with American Academy of Addiction Psychiatry (AAAP) developed an online training curriculum designed to educate drug court professionals on medication assisted treatments (MAT) for substance use disorders with a major focus on opioid use disorders. Nine modules were developed.
  • Information Inquiry Regarding Use of Medication Assisted Treatment (MAT) by Drug Courts, American University Bureau of Justice Assistance (BJA) Drug Court Technical Assistance Clearinghouse, Frequently Asked  Questions Series (March 16, 2015) (April 23, 2015, rev.).
  • From the FY 2017 BJA Adult Drug Court Discretionary Grant Solicitation:Medication-Assisted Treatment (MAT) is an evidence-based substance use disorder treatment protocol, and BJA supports the right of individuals to have access to appropriate MAT under the care and prescription of a physician. BJA recognizes that not all communities may have access to MAT due to a lack of physicians who are able to prescribe and oversee clients using anti-alcohol and anti-opioid medications. This will not preclude the applicant from applying, but where and when available, BJA supports the client’s right to access MAT. This right extends to participation as a client in a BJA-funded drug court.Applicants must demonstrate that the drug court(s) for which funds are sought will not deny any eligible client for the drug court access to the program because of their use of FDA-approved medications for the treatment of substance use disorders (e.g., methadone, buprenorphine products including buprenorphine/naloxone combination formulations and buprenorphine monoproduct formulations, naltrexone products including extended-release and oral formulations, disulfiram, and acamprosate calcium). Specifically, methadone treatment rendered in accordance with current federal and state methadone dispensing regulations from an Opioid Treatment Program and ordered by a physician who has evaluated the client and determined that methadone is an appropriate medication treatment for the individual’s opioid use disorder must be permitted. Similarly, medications available by prescription must be permitted unless the judge determines the following conditions have not been met:·       The client is receiving those medications as part of treatment for a diagnosed substance use disorder.·       A licensed clinician, acting within their scope of practice, has examined the client and determined that the medication is an appropriate treatment for their substance use disorder.·       The medication was appropriately authorized through prescription by a licensed prescriber.In all cases, MAT must be permitted to be continued for as long as the prescriber determines that the medication is clinically beneficial. Grantees must assure that a drug court client will not be compelled to no longer use MAT as part of the conditions of the drug court if such a mandate is inconsistent with a licensed prescriber’s recommendation or valid prescription.Under no circumstances may a drug court judge, other judicial official, correctional supervision officer, or any other staff connected to the identified drug court deny the use of these medications when made available to the client under the care of a properly authorized physician and pursuant to regulations within an Opioid Treatment Program or through a valid prescription and under the conditions described above. A judge, however, retains judicial discretion to mitigate/reduce the risk of abuse, misuse, or diversion of these medications.

Webinar: Holistic Treatment of Substance Use Disorders: MAT and Beyond
This is the third session in a three-part on-demand webcast series entitled Medication Assisted Treatment in Context. Originally filmed on September 14, 2016 in Mt. Pleasant, Michigan. This final installment of the series focuses on using MAT within an integrated health treatment model and how to use MAT in regards to monitoring, pain management, and with other medications. Learning Objectives: 1. Describe the different MAT monitoring practices and why they are needed (CHES Area of Responsibility 1.6.1, 1.6.4) 2. Identify that MAT can be part of a holistic solution to substance use disorders (1.6.1, 2.1.1) 3. Define the challenges of managing pain for patients on MAT (1.6.4) Sponsors: This webcast was provided by the Michigan Public Health Training Center at the University of Michigan School of Public Health. The Michigan PHTC is a part of the Region V Great Lakes Public Health Training Collaborative and the Public Health Learning Network. This training was provided in partnership with the Saginaw Chippewa Tribal Court, Nimkee Memorial Wellness Center, Saginaw Chippewa Indian Tribe Behavioral Health, McLaren Central Michigan, and the Tribal Law and Policy Institute.

Webinar: Substance Use Disorders As A Public Health Issue
This is the second session in a three-part webcast series entitled Medication Assisted Treatment in Context, originating on August 24, 2016 at the Nimkee Memorial Wellness Center in Mt. Pleasant, MI. This session will include an overview of substance use disorders, specifically focusing on opioid misuse, and will provide a discussion of the need to approach prevention and treatment from multiple perspectives. Learning Objectives: 1. Describe how addiction affects the brain (CHES Area of Responsibility 1.4.1, 1.4.2) 2. Recognize the current issue of substance use disorders within tribal communities, specifically in Michigan (1.4.1, 1.4.2) 3. Identify opportunities and resources for action around substance use disorders in Michigan (2.1.3, 6.1.2) Sponsors: These activities are provided by the Michigan Public Health Training Center at the University of Michigan School of Public Health. The Michigan PHTC is a part of the Region V Great Lakes Public Health Training Collaborative and the Public Health Learning Network. This training is co-provided by the Saginaw Chippewa Tribal Court, Nimkee Memorial Wellness Center, Saginaw Chippewa Indian Tribe Behavioral Health, McLaren Central Michigan, and the Tribal Law and Policy Institute.

Webinar: Medication Assisted Treatment: An Evidence Based Treatment Option
This is the first session in a three-part webcast series entitled Medication Assisted Treatment in Context. This session originated on July 15, 2016 at the Nimkee Memorial Wellness Center in Mt. Pleasant, MI. This session will provide an introduction to the different MAT options, including a look at the advantages and disadvantages of MAT and the evidence-base supporting this treatment approach. Learning Objectives: 1. Describe MAT as an evidence-based treatment option for substance use disorders (CHES Area of Responsibility 1.6.1, 1.6.2) 2. List the advantages and disadvantages of MAT (CHES Area of Responsibility 1.6.1, 1.6.2) 3. Identify the difference between methadone, buprenorphine, naloxone, and naltrexone (CHES Area of Responsibility 1.6.1, 1.6.2) Sponsors: These activities are provided by the Michigan Public Health Training Center at the University of Michigan School of Public Health. The Michigan PHTC is a part of the Region V Great Lakes Public Health Training Collaborative and the Public Health Learning Network. This training is co-provided by the Saginaw Chippewa Tribal Court, Nimkee Memorial Wellness Center, Saginaw Chippewa Indian Tribe Behavioral Health, McLaren Central Michigan, and the Tribal Law and Policy Institute.


Other Articles

  • Acceptability of Web-based Community Reinforcement Approach of Substance Use Disorders with Treatment-seeking American Indians/Alaska Natives, Aimme N.C. Campbell, et. al., 51(4) Community Ment. Health J. 393-403 (May 2015)
    Longstanding disparities in substance use disorders and treatment access exist among American Indian/Alaska Natives (AI/AN). Computerized, web-delivered interventions have potential to increase access to quality treatment and improve patient outcomes. Prior research supports the efficacy of a web-based version (Therapeutic Education System [TES]) of the Community Reinforcement Approach to improve outcomes among outpatients in substance abuse treatment; however, TES has not been tested among AI/AN. The results from this mixed method acceptability study among a diverse sample of urban AI/AN (N=40) show that TES was acceptable across seven indices (range=7.8 to 9.4 on 0 to 10 scales with 10 indicating highest acceptability). Qualitative interviews suggest adaptation specific to AI/AN culture could improve adoption. Additional efforts to adapt TES and conduct a larger effectiveness study are warranted.
     
  • Promising Practices and Strategies to Reduce Alcohol and Substance Abuse Among American Indians and Alaska Natives, American Indian Decelopment Associates, Office of Justice Programs (2000).
    In 1986, Congress found that “alcohol and substance abuse are the most severe health and social problems facing Indian tribes and people today and nothing is more costly to Indian people than the consequences of alcohol and substance abuse measured in physical, mental, social, and economic terms.” This publication features promising practices from nine Tribes that highlight effective solutions that combine western and traditional approaches, building upon the strengths of the respective Indian communities.
  • The Treatment of Persons with Mental Illness in Prisons and Jails: A State Survey (Abridged), Treatment Advocacy Center (2014).
    This national study surveys treatment practices within jails and prisons. It focuses on the problem of treatment of seriously mentally ill individuals who refuse treatment, usually because they lack awareness of their own illness and do not think they are sick. What are the treatment practices for these individuals in prisons and jails in each state? What are the consequences is such individuals are not treated?
     
  • Practice-Informed Approaches to Addressing Substance Abuse and Trauma Exposure in Urban Native Families Involved with Child Welfare, Lucero, N.M., & Bussey, M., 94(4), Child Welfare League of America, 97-117 (2015).
    Practice-based evidence indicates that the trauma-informed and culturally responsive model developed by the Denver Indian Family Resource Center (DIFRC) shows promise in reducing out-of-home placements and re-referrals in urban Native families with substance abuse and child welfare concerns, while also increasing caregiver capabilities, family safety, and child well-being. This article provides strategies from the DIFRC approach that non-Native caseworkers and supervisors can utilize to create an environment in their own agencies that supports culturally based practice with Native families while incorporating a trauma-informed understanding of service needs of these families.
     
  • Treatment Professionals’ Basic Beliefs About Alcohol Use Disorders: The Impact of Different Cultural Contexts, Anja Koski-Jaennes, Marjo Pennonen, and Laurence Simmat-Durand, Substance Use & Misuse, DOI: 10.3109/10826084.2015.1126736 (Mar. 4, 2016).
    The treatment of alcohol abusers in different cultural contexts does not depend only on the methods used but also on the ways in which treatment providers perceive the problem and relate to their clients. This study compares treatment professionals’ basic beliefs about alcohol use disorders in two culturally different European countries to find out to what extent these ideas are shaped by the respondents’ socio-cultural context, profession, and other background variables. Cultural factors shape the ways in which alcohol use disorders are perceived more pervasively than the other background variables. The French professionals’ low trust in treatment and the Finnish professionals’ lack of concern for the addiction potential of alcohol and stronger tendency to regard the person as responsible for the problem could be seen as potential impediments to effective ways of helping alcohol abusers in these countries.The treatment of alcohol abusers in different cultural contexts does not depend only onthe methods used but also on the ways in which treatment providers perceive the problem and relateto their clients. Objectives: This study compares treatment professionals’ basic beliefs about alcoholuse disorders in two culturally different European countries to find out to what extent these ideasare shaped by the respondents’ socio-cultural context, profession, and other background variables.Methods: Similar postal surveys were conducted amongprofessionals working in specialized addictiontreatment units in Finland (n = 520) and France (n = 472). The data were analyzed by descriptive statisticalmethods and logistic regression analysis. Results: Consistent cultural differences were found inalmost all the questions asked and they remained significant even after controlling for the other backgroundfactors. The French professionals emphasized the addictiveness of alcohol more than theirFinnish colleagues. They also believed less in the chances of recovery and attributed more responsibilityfor the problem to external factors, while the Finns emphasized individual responsibility. Profession,gender and some other background variables also modified beliefs about specific questions.Conclusions: Cultural factors shape the ways in which alcohol use disorders are perceived more pervasivelythan the other background variables. The French professionals’ low trust in treatment and theFinnish professionals’ lack of concern for the addiction potential of alcohol and stronger tendency toregard the person as responsible for the problem could be seen as potential impediments to effectiveways of helping alcohol abusers in these countries.

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