Abby Bacon, Melissa Kludt, Connie Tschetter, Jill Zuehlke
South Dakota State University
NURS 760
Alcoholism in Native Americans:
A Halfway House Intervention
on the Crow Creek Indian Reservation
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, clientcentered 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 stages
1.
2.
3.
4.
5.
Precontemplation
Contemplation
Planning or Preparation
Action
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 selfliberation
• 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.
References
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http://www.nicd.us/howtoopenahalfwayhouseorhelpstartingahalfwayhouse.html
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