Addiction awareness and education

1. The Medicine Wheel;The Medicine Wheel;
Multi-Discipline Treatment Planning andMulti-Discipline Treatment Planning and
ReferralReferral

2. O i aa dawojiihiO i aa dawojiihi
Hada Hazi Dawo BizigoHada Hazi Dawo Bizigo

3. Addiction the Faster Easier WayAddiction the Faster Easier Way
Long term pain/ Short term gainLong term pain/ Short term gain

4. SpeakersSpeakers
• Michele Keim MS,CRC,CDPT, LMHCAMichele Keim MS,CRC,CDPT, LMHCA
• Penny Wilson Pathway to HealingPenny Wilson Pathway to Healing
Advocate (DVSA)Advocate (DVSA)
• Savenia Falquist Pathway to HealingSavenia Falquist Pathway to Healing
Community CoordinatorCommunity Coordinator

5. Terminology you may hear todayTerminology you may hear today
• Traditionalist; people who live there lives in the old ways, followingTraditionalist; people who live there lives in the old ways, following
the natural laws to livethe natural laws to live
• Reservationist; people who live on the reservation but do not followReservationist; people who live on the reservation but do not follow
or may not even know the tribal ways.or may not even know the tribal ways.
• Intermediates; these are people who either live on the reservation orIntermediates; these are people who either live on the reservation or
in Urban setting passing back and forth with the traditionalist andin Urban setting passing back and forth with the traditionalist and
living as close to the old ways as they can.living as close to the old ways as they can.
• Modernist; these are people who live mainly in Urban setting andModernist; these are people who live mainly in Urban setting and
have been almost completely assimilated into main stream living.have been almost completely assimilated into main stream living.
• Hoop of life; is another way of talking about the Medicine wheel.Hoop of life; is another way of talking about the Medicine wheel.

6. Medicine Wheel from White Bison INC.Medicine Wheel from White Bison INC.

7. Tribal Medicine WheelsTribal Medicine Wheels

8. Medicine WheelMedicine Wheel
• There are seven hoops to the Medicine Wheel.There are seven hoops to the Medicine Wheel.
• First hoop; is the Great Mystery, (Spiritual/above)First hoop; is the Great Mystery, (Spiritual/above)
• Second hoop; is the Earth, (Past/ Center, below, 7Second hoop; is the Earth, (Past/ Center, below, 7
generation before)generation before)
• Third hoop; family, (Future/7 generation to come)Third hoop; family, (Future/7 generation to come)
• Fourth hoop; Social Society/Medicine Society (Duty)Fourth hoop; Social Society/Medicine Society (Duty)
• Fifth hoop; Community (Values)Fifth hoop; Community (Values)
• Sixth hoop; the world we live in (Honor)Sixth hoop; the world we live in (Honor)
• Seventh hoop; Is self (Integrity)Seventh hoop; Is self (Integrity)

10. Treatment Planning and ReferralsTreatment Planning and Referrals
• In the Native world all things are connected andIn the Native world all things are connected and
for a person to find balance and be whole thefor a person to find balance and be whole the
hoop must be mended and connectedhoop must be mended and connected
• Each direction will need to be looked at andEach direction will need to be looked at and
problems identified. This is not a new concept, itproblems identified. This is not a new concept, it
is done everyday in our work. However, in theis done everyday in our work. However, in the
Native view it needs to be in a circle not in aNative view it needs to be in a circle not in a
linear fashion. This creates an easierlinear fashion. This creates an easier
understanding for Native clients.understanding for Native clients.

11. Tradition Values (Tribal) compared toTradition Values (Tribal) compared to
Euro-American Contemporary ValuesEuro-American Contemporary Values
• Native American (Tribal) Euro-Native American (Tribal) Euro-
American (WesternAmerican (Western
• Cooperation………………….……………………………….CompetitionCooperation………………….……………………………….Competition
• Group Emphasis……………………………………………..IndividualGroup Emphasis……………………………………………..Individual
EmphasisEmphasis
• Modesty, Humility……………………………………………Self ImportanceModesty, Humility……………………………………………Self Importance
• IndividualIndividual
Autonomy……………………………………….Interference/InvolvementAutonomy……………………………………….Interference/Involvement
• Passivity/Calmness………………………………………….Activity/RestlessnePassivity/Calmness………………………………………….Activity/Restlessne
ssss
• Generosity………………………………………………………SavingGenerosity………………………………………………………Saving
• Patience………………………………………………………….ImpatiencePatience………………………………………………………….Impatience
• Non-materialism……………………………………………...MaterialismNon-materialism……………………………………………...Materialism
• Work to meet needs…………………………………………Puritan Work EthicWork to meet needs…………………………………………Puritan Work Ethic
• Time- always with us………………………………………..Time-Use everyTime- always with us………………………………………..Time-Use every
minuteminute
• Orientation to Present……………………………………….Orientation to theOrientation to Present……………………………………….Orientation to the
FutureFuture
• Pragmatic, Practical…………………………………………..TheoreticalPragmatic, Practical…………………………………………..Theoretical
• Respect for Age…………………………………………………Respect forRespect for Age…………………………………………………Respect for
YouthYouth

12. Values continuedValues continued
• PersonalPersonal Caution…………………………………………………..Personal OpennessCaution…………………………………………………..Personal Openness
• Listening/Observation Skills…………………………………Verbal SkillsListening/Observation Skills…………………………………Verbal Skills
• Indirect Criticism………………………………………………..Direct CriticismIndirect Criticism………………………………………………..Direct Criticism
• Extended Family…………………………………………………Nuclear FamilyExtended Family…………………………………………………Nuclear Family
• Cultural Pluralist…………………………………………………AssimilationistCultural Pluralist…………………………………………………Assimilationist
• No Eye-to-eye Contact………………………………………..Eye-to-eye ContactNo Eye-to-eye Contact………………………………………..Eye-to-eye Contact
ImportantImportant
• Self-Exploratory Child Rearing…………………………….Strict DisciplineSelf-Exploratory Child Rearing…………………………….Strict Discipline
• Restitution………………………………………………………..PunishmentRestitution………………………………………………………..Punishment
• Character=Source of Status………………………………..Degree=Source ofCharacter=Source of Status………………………………..Degree=Source of
StatusStatus
• Bilingualism……………………………………………………….MonolingualismBilingualism……………………………………………………….Monolingualism
• Illness=Imbalance's)………………………………Illness-PhysicalIllness=Imbalance's)………………………………Illness-Physical
IssueIssue
• Belief in the Unseen…………………………………………...Belief in the Seen/Belief in the Unseen…………………………………………...Belief in the Seen/
ProvenProven
• Respect for Tradition…………………………………………..Progress OrientedRespect for Tradition…………………………………………..Progress Oriented
• "This Conflict In Values Creates Stress, Anxiety And Frustration""This Conflict In Values Creates Stress, Anxiety And Frustration"
““From Understanding Native American Culture Second Edition Copyright 2009 “From Understanding Native American Culture Second Edition Copyright 2009 “

14. Medicine wheel and ASAMMedicine wheel and ASAM
• The Medicine Wheel is a way of viewing ASAMThe Medicine Wheel is a way of viewing ASAM
from a holistic (circular) view as apposed to afrom a holistic (circular) view as apposed to a
linear view.linear view.
• Illness=Imbalance's)………Illness-Physical IssueIllness=Imbalance's)………Illness-Physical Issue
• Dimensions 1 through 6 all fallDimensions 1 through 6 all fall
somewhere in the Hoop of lifesomewhere in the Hoop of life
• All Dimensions help to heal the peopleAll Dimensions help to heal the people
we are servingwe are serving

15. Needs ListNeeds List
• Dimension I:Dimension I:
• Pt. is in need of detoxification from Alcohol and Opiod Referred to LL DetoxPt. is in need of detoxification from Alcohol and Opiod Referred to LL Detox
• Dimension II:Dimension II:
• Medical Deferred at this timeMedical Deferred at this time
• Dimension III:Dimension III:
• Pt. reports un-dealt with child abuse and depression and loss of children due to drugPt. reports un-dealt with child abuse and depression and loss of children due to drug
abuse. Referred to CTMHabuse. Referred to CTMH
• Pt. reports not knowing about his tribe or Native culture. See open treatment planPt. reports not knowing about his tribe or Native culture. See open treatment plan
• Pt. has thinking errors that lead to self-defeating behaviors. Deferred to later datePt. has thinking errors that lead to self-defeating behaviors. Deferred to later date
• Dimension IV:Dimension IV:
• Pt. reports several Treatments with no clean time or change. See treatment plan.Pt. reports several Treatments with no clean time or change. See treatment plan.
• Pt. reports not liking to go to community support groups. See open treatment planPt. reports not liking to go to community support groups. See open treatment plan

16. Needs List continuedNeeds List continued
• Dimension V:Dimension V:
• Pt. lacks skills to combat relapse symptom and stop return to activePt. lacks skills to combat relapse symptom and stop return to active
addiction. See open treatment planaddiction. See open treatment plan
• Pt. lacks understanding how using friends helps contribute toPt. lacks understanding how using friends helps contribute to
relapse process. Treatment plan to be addressed at later date.relapse process. Treatment plan to be addressed at later date.
• Pt. needs to develop a personal plan of action to help preventPt. needs to develop a personal plan of action to help prevent
relapse. Treatment plan to be addressed at later date.relapse. Treatment plan to be addressed at later date.
• Dimension VI:Dimension VI:
• Pt. needs to build strong health support system.Pt. needs to build strong health support system.
• Pt will attend three different cultural events See open treatmentPt will attend three different cultural events See open treatment
plan.plan.
• Pt. will explore community based support. See open treatment planPt. will explore community based support. See open treatment plan

17. Lakota Medicine Wheel ANDLakota Medicine Wheel AND
DIMENSIONSDIMENSIONS
• Dim. 1 Start in the Direction of the WestDim. 1 Start in the Direction of the West
• Referral to medical or non-medical Detox.Referral to medical or non-medical Detox.
In the traditional Native way, Detox is needed. The needs of the physical body mustIn the traditional Native way, Detox is needed. The needs of the physical body must
be addressed and detoxed, as well as the mental, emotional and spirit that have beenbe addressed and detoxed, as well as the mental, emotional and spirit that have been
poisoned. Remember everything is connected. Mind, Emotion, body and Spirit needpoisoned. Remember everything is connected. Mind, Emotion, body and Spirit need
to be looked at. You may need to identify a Healer, Medicine person, or a Spiritualto be looked at. You may need to identify a Healer, Medicine person, or a Spiritual
Ceremonial person to help with detoxing.Ceremonial person to help with detoxing.
((Always get a Release of information).Always get a Release of information).
For the reservationist and the modernist, normal referrals to treatment modalities willFor the reservationist and the modernist, normal referrals to treatment modalities will
suffice. With Intermediates either normal referral or the traditionalist path is correct (Itsuffice. With Intermediates either normal referral or the traditionalist path is correct (It
is better to follow the traditional path)is better to follow the traditional path)
Note: Rarely will you see a traditionalist in your office. However due to economic needNote: Rarely will you see a traditionalist in your office. However due to economic need
younger people raised traditionally may become clients. Living in the modernyounger people raised traditionally may become clients. Living in the modern
world does create a loss of identity and purpose for many of these young people.world does create a loss of identity and purpose for many of these young people.
Confusion between traditional and modern value system creates stress. For theseConfusion between traditional and modern value system creates stress. For these
young people homelessness and addiction become the norm.young people homelessness and addiction become the norm.

18. Lakota Medicine Wheel andLakota Medicine Wheel and
DimensionsDimensions
• Dim 2 Direction of the EastDim 2 Direction of the East
• Many of the Natives that live in Urban settingsMany of the Natives that live in Urban settings
live well below the poverty levels and have notlive well below the poverty levels and have not
had needed medical exams.had needed medical exams.
Referral to an I.H.S. (Indian Health Services)Referral to an I.H.S. (Indian Health Services)
may be needed. Health issues can be a reasonmay be needed. Health issues can be a reason
for relapse, or failed treatment due to self-for relapse, or failed treatment due to self-
medicating and continued use.medicating and continued use.

19. I.H.S. Clinics in local AreaI.H.S. Clinics in local Area
• N.A.R.A Health Clinic Portland OR.N.A.R.A Health Clinic Portland OR.
• Cowlitz Tribal Health Clinic Longview WA.Cowlitz Tribal Health Clinic Longview WA.
• Chemawa Health Clinic Salem OR. (DentalChemawa Health Clinic Salem OR. (Dental
Services also available)Services also available)
• ““Always get a release”,Always get a release”, so you canso you can
communicate with health care providers forcommunicate with health care providers for
continuing treatment planning and other futurecontinuing treatment planning and other future
referrals.referrals.
Note: If Native Americans have cultural values as in Dim 1 you may need to contactNote: If Native Americans have cultural values as in Dim 1 you may need to contact
Healer, Medicine person, or a Spiritual Healer or Ceremonial person to help.Healer, Medicine person, or a Spiritual Healer or Ceremonial person to help.

20. Lakota Medicine Wheel ANDLakota Medicine Wheel AND
DIMENSIONSDIMENSIONS
• Dimension 3Dimension 3
• This Dimension covers an area that can have a majorThis Dimension covers an area that can have a major
impact on a persons ability for long-term recovery. Fromimpact on a persons ability for long-term recovery. From
abuse to mental health, these issues may needabuse to mental health, these issues may need
medication and medication management.medication and medication management.
• Many of theses problems are denied, minimized orMany of theses problems are denied, minimized or
suppressed at time of assessment or admission. Theysuppressed at time of assessment or admission. They
will start to arise the longer the person is in treatment.will start to arise the longer the person is in treatment.
Educational didactics and process can open manyEducational didactics and process can open many
suppressed wounds.suppressed wounds.
• As in Dim. 2 Abuse and Mental health issues can be aAs in Dim. 2 Abuse and Mental health issues can be a
reason for relapse, or failed treatment due to self-reason for relapse, or failed treatment due to self-
medicating and continued use.medicating and continued use.

21. Native Culture has some of theNative Culture has some of the
highest rates per capita of anyhighest rates per capita of any
other culture:other culture:
• Domestic ViolenceDomestic Violence
• Sexual AssaultSexual Assault
• Child AbuseChild Abuse
• SuicideSuicide
• AddictionAddiction
• Drop out rates from schoolDrop out rates from school
• unemploymentunemployment

22. ““WARNING”WARNING”
• Know your limitations, never go out side your educational andKnow your limitations, never go out side your educational and
certified bias.certified bias.
•Refer, Refer,Refer, Refer,
Refer, Refer,Refer, Refer,
Refer, ReferRefer, Refer

23. Abuse is a huge DIMENSIONS 3Abuse is a huge DIMENSIONS 3
issue that needs on going care,issue that needs on going care,
well past normal treatment limitswell past normal treatment limits
• Speakers: Penny Wilson Pathway toSpeakers: Penny Wilson Pathway to
Healing Advocate (DVSA) and SaveniaHealing Advocate (DVSA) and Savenia
Falquist Pathway to Healing CommunityFalquist Pathway to Healing Community
CoordinatorCoordinator

24. WarningWarning
• Our purpose is to help people recoverOur purpose is to help people recover
from a ‘Disease’ that destroys individuals,from a ‘Disease’ that destroys individuals,
families, and communities.families, and communities.
•To do no harm ‘refer’To do no harm ‘refer’

25. Progress NoteProgress Note
• 9/10/10 educational didactic was on9/10/10 educational didactic was on
emotional management and howemotional management and how
chemicals only provide short-term reliefchemicals only provide short-term relief
from feeling our feelings. Patient stated, “Ifrom feeling our feelings. Patient stated, “I
can’t recognize my feelings, I just don’tcan’t recognize my feelings, I just don’t
feel. A) Open about not being able to feel,feel. A) Open about not being able to feel,
block emotions, honest about wanting toblock emotions, honest about wanting to
feel. P) Refer to Mental Health.feel. P) Refer to Mental Health.

26. DIMENSIONS 3 TREATMENT PlanDIMENSIONS 3 TREATMENT Plan
• Young EagleYoung Eagle
• Young Eagle reports, not being able to identifyYoung Eagle reports, not being able to identify
feelings.feelings.
• Young Eagle stated, “I really don’t think I feel”.Young Eagle stated, “I really don’t think I feel”.
• A) Young Eagle agrees to make an appt. withA) Young Eagle agrees to make an appt. with
Mental Health clinic for assessment and needsMental Health clinic for assessment and needs
to be address. Report out come during nextto be address. Report out come during next
1x1.1x1.
• B) Young Eagle agrees to follow Mental HealthB) Young Eagle agrees to follow Mental Health
referrals, report problem to CDP.referrals, report problem to CDP.

27. Dimension 3 Issues that can effectDimension 3 Issues that can effect
Dimension 4 ProgressDimension 4 Progress
• Trust issues towards; authority, non-natives,Trust issues towards; authority, non-natives,
government/ the view of government includes police,government/ the view of government includes police,
DSHS, CPS.DSHS, CPS.
• Many of the Reservationist and Modernist will haveMany of the Reservationist and Modernist will have
feelings of not belonging or fitting in anywhere. Withfeelings of not belonging or fitting in anywhere. With
Modernist raised in an urban setting associating with theModernist raised in an urban setting associating with the
Mexican or Black population there is a loss of culture,Mexican or Black population there is a loss of culture,
language, and tradition family connectionslanguage, and tradition family connections
• Note: This is not new in our profession: we have been dealing with family dysfunctionNote: This is not new in our profession: we have been dealing with family dysfunction
for years (socialization). However with Native people this go far past just familyfor years (socialization). However with Native people this go far past just family
dysfunction to “Generational Trauma”dysfunction to “Generational Trauma”

28. NoteNote
• Treatment planning should followTreatment planning should follow
assessment to treatment plan to progressassessment to treatment plan to progress
note. Or progress note to treatment plan tonote. Or progress note to treatment plan to
assessment.assessment.
• Always update assessment with newAlways update assessment with new
information to make sure of the continuedinformation to make sure of the continued
flow of the chart.flow of the chart.

29. For all New Treatment PlansFor all New Treatment Plans
• Assessment to Treatment Plan to NotesAssessment to Treatment Plan to Notes
Then back toThen back to assessmentassessment and updateand update

30. The Medicine Wheel andThe Medicine Wheel and
Dimension 4Dimension 4
• Dimension 4 west, east, and southDimension 4 west, east, and south
• Always use the clients strengths when writing yourAlways use the clients strengths when writing your
treatment plan.treatment plan.
• Right Brain Orientation………………………………Left brainRight Brain Orientation………………………………Left brain
Orientation aesthetics linearOrientation aesthetics linear
• In a traditional view everything has a power.In a traditional view everything has a power.
• Identify what the substance did for them in the beginning an then how itIdentify what the substance did for them in the beginning an then how it
turned against them. By doing so you start gaining information for Dim 3, 5,turned against them. By doing so you start gaining information for Dim 3, 5,
and 6 treatment planning.and 6 treatment planning.
• Another treatment plan objective is to identify family and community norms,Another treatment plan objective is to identify family and community norms,
giving you a view of their socialization and personal norms and values.giving you a view of their socialization and personal norms and values.

31. The Medicine Wheel andThe Medicine Wheel and
Dimension 5Dimension 5
• Dimension 5 east, south and westDimension 5 east, south and west
• Many of the objectives should revolveMany of the objectives should revolve
around feelings management, negativearound feelings management, negative
thinking errors, and behaviors that leadthinking errors, and behaviors that lead
back to active addictionback to active addiction
• Once again use the clients strengths; art,Once again use the clients strengths; art,
music, dance, or story telling.music, dance, or story telling.

33. Dimension 5 issuesDimension 5 issues
• As in Dim. 3 these un-dealt with issues become stuck points in aAs in Dim. 3 these un-dealt with issues become stuck points in a
persons recovery.persons recovery.
• Domestic ViolenceDomestic Violence
• Sexual AssaultSexual Assault
• Child AbuseChild Abuse
• SuicideSuicide
• AddictionAddiction
• Drop out rates from schoolDrop out rates from school
• UnemploymentUnemployment
• Un-dealt with these issues may set clients up for a return to activeUn-dealt with these issues may set clients up for a return to active
addiction.addiction.

34. Dimension 6 encompasses allDimension 6 encompasses all
directionsdirections
• We all know support is needed but we canWe all know support is needed but we can
combine Native ways with Urban supportcombine Native ways with Urban support
• Ceremonies for HealingCeremonies for Healing
Sun DanceSun Dance
Ghost DanceGhost Dance
Mtn. DanceMtn. Dance
Naming CeremoniesNaming Ceremonies
Pipe CeremoniesPipe Ceremonies
Water CeremoniesWater Ceremonies
WeddingWedding
Crossing/PassingCrossing/Passing
Sweat LodgeSweat Lodge
WelcomingWelcoming
BlanketBlanket

35. Employment is a means to supportEmployment is a means to support
a clients growth, family, and healthya clients growth, family, and healthy
life style (recovery)life style (recovery)
Speaker: Michele Keim MS,CRC,CDPT,Speaker: Michele Keim MS,CRC,CDPT,
LMHCALMHCA

36. Hanandziihi godiyaa yee nahonlkidHanandziihi godiyaa yee nahonlkid
(Your healing starts by your(Your healing starts by your
asking)asking)

37. The Medicine WheelThe Medicine Wheel
• The Medicine Wheel allows us to see thatThe Medicine Wheel allows us to see that
all things, Individual, family, community,all things, Individual, family, community,
and earth are connected.and earth are connected.
• Thought, Emotion, Physical, and SpiritualThought, Emotion, Physical, and Spiritual
wellness are connected.wellness are connected.
• We can no longer work on just symptoms.We can no longer work on just symptoms.
We have to take a holistic approach toWe have to take a holistic approach to
healing.healing.

38. Canoe Journeys and Races:Canoe Journeys and Races: EventsEvents
like these are helping the healing for the Individual,like these are helping the healing for the Individual,
family, community, and earth.family, community, and earth.

39. Cultural Camps
• Bring Elders, Young, and families back together
• Teaching the old stories, songs, and building unity in the
Communities and families

40. Drum CirclesDrum Circles

41. Ceremonies to heal the pastCeremonies to heal the past
between different culturesbetween different cultures

42. Veterans Healing Ceremonies andVeterans Healing Ceremonies and
Pipe CeremoniesPipe Ceremonies

43. Alcohol and Drug free eventsAlcohol and Drug free events
Providing a safe healing placeProviding a safe healing place

44. Successes is Possible
Change is Possible
When you leave here think about what
you can do to adapt your programs to
help the Hole.
May You Walk in Beauty the Rest of
Your Days

45. ReferencesReferences
• Post-Colonial Psychology E. & B. DuranPost-Colonial Psychology E. & B. Duran
• Healing the Soul Wound DuranHealing the Soul Wound Duran
• Cowlitz Tribal Sexual Assault and Domestic ViolenceCowlitz Tribal Sexual Assault and Domestic Violence
ProgramProgram
• Center for Disease ControlCenter for Disease Control
• Red Road to WellbrityRed Road to Wellbrity
• Understanding Native American Culture Don L. CoyhisUnderstanding Native American Culture Don L. Coyhis
• ASAM Criteria (American Society of Addiction Medicine)ASAM Criteria (American Society of Addiction Medicine)
• Rethinking Columbus Bigelow and PetersonRethinking Columbus Bigelow and Peterson
• Alcohol Problems in Native America D. Coyhis and W.Alcohol Problems in Native America D. Coyhis and W.
WhiteWhite
• Personal Works JD AmburnPersonal Works JD Amburn

46. The Lakota Way By Joseph M Marshall IIIThe Lakota Way By Joseph M Marshall III
The Sixth Grandfather By Raymond J DemallieThe Sixth Grandfather By Raymond J Demallie
The Sacred PipeThe Sacred Pipe
The Seven Sacred CeremoniesThe Seven Sacred Ceremonies
Black Elk Speaks By Joseph Epes BrownBlack Elk Speaks By Joseph Epes Brown
Tunkashila By Gerald HausmanTunkashila By Gerald Hausman
Myths and Tales of the Jicarilla Apache IndiansMyths and Tales of the Jicarilla Apache Indians
By Edward Morris OplerBy Edward Morris Opler
White Eagle Medicine Wheel By Wa-Na-Nee-White Eagle Medicine Wheel By Wa-Na-Nee-
CheChe
Night Flying Woman By Ignatia BrokerNight Flying Woman By Ignatia Broker
Kill the Indian Save the Man By Ward ChurchillKill the Indian Save the Man By Ward Churchill