Recovery Month in Indian Country
CSAT Director Dr. H. Westley Clark speaks to the Circles of Recovery Conference in Albuquerque in September, 2003

Dr. H. Westley Clark (L), receives a miniature Hoop honoring gift from White Bison Board member Henry Lozano

Recovery Month in Indian Country
Dr. H. Westley Clark, CSAT (Center for Substance Abuse Treatment) Director, Addresses the Fourth Annual Circles of Recovery Conference On September 20, 2003

Dr. Clark

It is important for us to celebrate Recovery Month in as many different settings as possible. Today’s observance is one of more than 215 community events scheduled around the country celebrating National Alcohol and Drug Addiction Recovery Month. This annual observance is important because many people have already been tried by the fire of addiction and it is important for the community to understand those trials, as well as the victory of recovery as a process. As Don has done with the Circle, communicating a culturally sensitive approach to recovery is also very important. It’s important for us to keep in mind that recovery is not just the absence of alcohol and drugs.

I want to salute all of you who have taken your time to sit in this room today. Your commitment to this process is what has motivated me to get on a plane and come here today. I thank White Bison for its role in convening the Fourth Annual Circles of Recovery Strengthening Our Nations Conference in Albuquerque. White Bison has been a pioneer in helping American Indians identify what works best to combat drug and alcohol addiction. Through these efforts and vital linkages, and advocacy, we can have a sustained strategy to assist and partner with American Indians and Alaska Natives. The reality of addiction and dependency is quite painful. Its costs are enormous. What you as advocates have accomplished is critical to helping even greater numbers of Indian people feel the power of recovery.

Presidential Proclamation
The Department of Health and Human Services is committed to working with the tribes and with Indian people, but that requires your leadership. We are your partners, not your leaders. We need your guidance, your insight, and your wisdom. We cannot permit those who reside in Indian country to be less than full players in the dialogue on substance abuse prevention and treatment. As a federal agency charged with improving the quality and availability of substance abuse disorder services, SAMHSA (the Substance Abuse and Mental Health Services Administration) is committed to changing things for the better through every means available. Treatment and recovery, and the power of each, are recognized at our nation’s highest level. I’m pleased to report that a Presidential Proclamation recognizing Recovery Month 2003 was issued by President Bush on September 1.

That Proclamation states, “During National Alcohol and Drug Addiction Recovery Month we seek to remind all Americans, particularly those who struggle with alcohol and drug addictions, that recovery is possible. This year’s theme, Join the Voices of Recovery—Celebrating Health, salutes the thousands of Americans currently striving to address their alcohol and drug addiction, and the many professionals, volunteers, clergy, community groups, and friends and family members who support others in overcoming addiction. For the addicted, the fight is an ongoing struggle for their own lives. The process of treatment and recovery is personal, and each individual’s needs are different. As a result, treatment programs must address a wide range of physical, mental, emotional and spiritual needs. When properly tailored, alcohol and drug addiction treatment can be very effective.”

The key issue for this Gathering is the recognition that there are many pathways to recovery. You are the architects and engineers of the pathways of the American Indian community. The President’s message, our message, is getting out. It is reflected most impressively by the Administration’s treatment initiative. The Administration has made a commitment not only to reduce drug abuse disorders by 25% among adults and youth in the next five years, but also to build treatment capacity and to increase access to services that promote recovery. This includes not just illicit drugs but also alcohol. We know that a large number of people in the United States need treatment. We know that a small number of people in the United States get treatment.

By the Numbers
It’s estimated that about 22 million people need treatment. It’s also estimated that about 4.5 million get treatment. New data provides a snapshot of the situation here in New Mexico. It’s estimated that 14,000 New Mexico youth ages 12 to 17 are dependent on alcohol and drugs. Approximately 16% of high school students ages 18 and older reported using marijuana 20 or more days within the past month. Local authorities consistently rank cocaine and crack cocaine use a major problem. Powder and crack cocaine continue to saturate Albuquerque. Pharmaceutical substances, particularly oxycodone and hydrocodone are being diverted and abused in Albuquerque. Heroin abuse has shown a steady increase in New Mexico over the past five years. And of course, marijuana is the most readily available and commonly abused drug in New Mexico. Methamphetamine is an increasing drug threat in New Mexico. Law enforcement officials report that most of the methamphetamine available in New Mexico originates in Mexico. But there is also an increased availability of locally produced methamphetamine. The perception of some that methamphetamine is not as dangerous as cocaine or heroin has led some people to begin using meth instead.

National surveys show that American Indian and Alaska Natives have the highest rate of lifetime use of any illicit drug. American Indian and Alaska Natives have the second highest rate of current use of any illicit drug. American Indian and Alaska Natives have the highest rate of past-year drug dependence, and second in alcohol dependence. In light of these findings, the Administration is committed to addressing the needs of those who need treatment and seek it, and those who are in denial of the need for treatment.

The Access to Recovery Initiative
Most recently the President has proposed a three year, 600 million dollar Access to Recovery initiative to help people find needed treatment from the most effective organization, including community-based organizations at all levels. The first 200 million dollar installment is included in the President’s proposed FY 04 budget for SAMHSA. The Access to Recovery initiative would make available needed treatment for substance abuse problems by providing vouchers to individuals identified in their communities as needing treatment. With a voucher, people in need of addictions treatment and recovery support will have the choice to select a program from a provider that help them the most. Payment to providers will be linked to demonstration of treatment effectiveness and recovery, measured by outcomes such as abstinence from drugs and alcohol, no involvement in the criminal justice system, attainment of employment or enrollment in school, and stable housing. The initial phase of Access to Recovery will support the treatment of approximately 100,000 people per year and expand the array of services, including medical detoxification, inpatient/outpatient treatment modalities, residential treatment, peer support, relapse prevention, case management, and other recovery promoting services.

The initiative underscores the Administration’s understanding of what everyone here knows: addictions treatment works in recovery. But a key issue for this particular community is that while Access to Recovery is targeted to states, Tribal governments will be able to apply to Access to Recovery. American Indians will be able to offer their community in a competitive way the same type of voucher initiative that the states will be able to offer. But it’s competitive—not all states, and not all tribes will get a piece of the action. The fact of the matter is that tribes are included in the schema.

The President wants many pathways to recovery. We know from addiction that people report many pathways to recovery. Some people argue spontaneous recovery. They spontaneously stop using. Other people went to 12 Step programs. Some will do sweat lodges. Some will work with their Elders in the community. What we’re really interested in is the cessation of alcohol and drug abuse. We need to work with people in the community, Tribal governing councils, states, cities and counties, so that we can address the issue of addiction.

Dr. Clark speaking at the conference

SAMHSA’S Commitment
Access to Recovery is an example of the President’s commitment to recovery. The Department of Health and Human Services also supports a commitment to recovery through SAMHSA’s Administrator, Mr. Charles Curie. Not only does the President talk about recovery, but Mr. Curie does too as he articulates our mission, building resilience and facilitating recovery, and not just in substance abuse, but in mental health and physical health. The Recovery Month theme this year, Celebrating Health, is really important. This is our 14^th year for this month-long observance that unites public and private sector partners, municipalities and corporations, from employee groups to treatment providers, from urban Indians to Tribal governments, from state legislatures to Governors. Together we are united in an effort to highlight the human, social, organizational, and economic benefits of drug and alcohol treatment. And we should always throw prevention in there. Always. But where prevention does not reach, treatment works.

Recovery Month aims to reduce the stigmas associated with substance abuse disorder treatment, empowering individuals in recovery and those who love them and serve them. Henry Lozano in his talk to this Conference (please see Vol 4, #22 of Wellbriety! Magazine) talked about love across the generations. It is important for us to empower people to be able to recover. I’m here not only to honor and celebrate the joy that is recovery but I want to be able to share again and again that addiction is treatable and that recovery is possible.

SAMHSA wants the public to know that substance abuse disorder treatment is effective. I was on a Reservation where the program director said that it’s such a shame to have an alcohol and drug problem. But the whole community knows who has an alcohol and drug problem. It’s not like no one knows—that is the nature of alcohol and drug addiction. The community has to say that the person who recovers has a special place in its heart. The community is paying the price for, the tribe is paying the price for, the reservation pays the price for…addiction. The person in recovery not only helps his or herself, but they help their family, they help their tribes, they help the communities in which they live and function. If we can’t say to that person, “That’s a good thing!” then we need to reflect on our mixed message. That mixed message might be, “We want you to recover spontaneously on your own and then don’t talk about it.” We know alcohol and drug addictions are more complex than that. It’s not the simple picking up of a bottle of beer or the smoking of a joint of marijuana. If a person can’t talk about the wonders of recovery, then we basically banish them to use. As the 12 Step programs will point out, and the Wellbriety Movement will point out, that’s not an excuse. But it is a lost opportunity for the community. What Don is doing, and what you are all doing is bringing to your respective communities an opportunity.

We at SAMHSA are identifying and applying effective substance abuse disorder prevention and treatment strategies. We are funding grants from American Indians and Alaska Natives. We do need outcome data. I’m fond of saying that I’m less concerned about what goes into the black box of treatment since there are many pathways to recovery. If I can count the numbers of people who are in recovery, I can say that treatment works. We already know that. If you’ve got a culturally effective treatment strategy, you need to be able to demonstrate that. Not only to me, but also to the community, because it is the community that is silent on this issue—the community that is filled with shame. We need to be able to say to the community that with recovery, the individual need not be ashamed. The family need not be ashamed. The tribe need not be ashamed. We need to embrace recovery. What we do saves lives and saves our community.

More Sobering Numbers
Recovery month is an excellent opportunity to consider our individual and collective obligation to respond to a national health crisis and to a local health crisis—a community health crisis. Our data continue to show an overwhelming prevalence of alcohol and drug abuse in this country. We recently reconfigured our national household survey. We now estimate there are 19.5 million Americans who are current illicit drug users. That’s just illicit drugs. Among youth aged 12 to 17, 11.6% are current illicit drug users. The highest rate among young adults aged 18-25 is at 20.2%. Marijuana remains the most commonly used illicit drug across categories with 14.6% past month marijuana users. Hallucinogens are used by 1.2 million people. We now have more people who are current users of ecstasy (676,000) than we have as current users of heroin. Heroin is one of those old drugs. We have 6.2 million people, or 2.6% of the population aged 12 and older who are current users of psychotherapeutic medications, including pain relievers, non-medically. In emergency room visits, those people who are addicted to, or have problems with narcotic pain relievers, are showing up more often than those people who have heroin related problems. We need to know that because as we celebrate health and we advise people to get treatment for health problems, they also come in contact with new substances of abuse.

We also know that we have a significant number of heavy drinkers in this country. One in seven Americans age 12 or older drove under the influence of alcohol at least once in the 12 months prior to the survey in 2002. I was in Arizona on the Tohono Odam Reservation where there are long stretches of dark road with many crosses along those roads. I’m told this is duplicated on other reservations. Alcohol plays a major role in the untimely death of many of our youth.

It’s important that we celebrate recovery. It’s important that we give people permission to recover. In communities where family, heritage, and ancestors play an important role, recovery needs to be part of the fabric of the community.

We know at SAMHSA that we also have a major problem with mental illness in this country. In 2002, an estimated 17.5 million adults age 18 and older had a serious mental illness. We know that of this group, 8.4 million received mental health treatment in the 12 months prior to the interview. 30.5% perceived that they had an unmet need. Among adults with a serious mental illness, 23.2% were dependent on alcohol or illicit drugs. An estimated 4 million people had both serious mental illness and a substance abuse disorder. We are dealing with complex problems, and complex solutions are necessary. But they have to be culturally sensitive, culturally responsive, and that’s why this Gathering is important.

The One Sky Center
In July, SAMHSA awarded one million dollars in a cooperative agreement with the Oregon Health Sciences University to operate the One Sky Center, an American Indian and Alaska Native national resource center. This resource center will focus on the identification and fostering of effective and culturally appropriate prevention and treatment programs and systems to support American Indian and Alaska Native populations. It will be jointly administered by SAMHSA’s Center For Substance Abuse Prevention (CSAP), and the Center for Substance Abuse Treatment (CSAT). Working together with stakeholders from across the country, the Center will provide a blueprint for comprehensive services that honor the traditional ways of living and healing among American Indians. The new Center reflects the strong collaboration between our agency and our colleagues with the Indian Health Service. The objectives include

We have our ATTC’s (Addiction Technology Transfer Centers), which will be working in partnership with this resource center.

We felt that the American Indian and Alaska Native community needed a resource center devoted to its own unique needs. And so we are funding that. Our hope is that whatever strategy a community chooses to employ, the community can say to those who seek those treatments that their treatment works, whatever the method. It is those people who come to us to whom we have that obligation. We can’t simply say, “Come to us and we hope things will get better.”

Partners For Recovery
Mr. Curie believes that we need to help individuals in need reclaim their lives and realize the power of recovery. He’s promulgated an organizing principle for SAMHSA in the form of a matrix. This matrix includes focusing our budget on certain areas:

Our approach is to work with you and your communities on our priorities. We see these issues as applying to each and every community. It is the partnership that will help us navigate this process.

Our newest effort beyond co occurring disorders is our Partners for Recovery strategy, which recognizes that recovery is very much a personal process. This includes collaborations involving community and faith-based approaches to treatment; data and evidence-based outcomes; financing strategies and cost effectiveness; refocusing the conversation to reduce stigma and barriers to treatment; and working with a wide range of communities, including the American Indian and Alaska Native communities. Our Partners for Recovery effort is the next evolution of our National Treatment Plan.

Finally, we want to talk about our Peers Helping Peers. This program focuses on providing an array of services to persons in recovery to help sustain the benefits of treatment. A person returns to their community, whether the treatment program is in the community, or away from the community. It’s important that peers help peers. If we can sustain recovery then we reduce criminal justice, child welfare, economic costs, social costs, and health costs of relapse. We recognize the importance of professionally driven treatment, but it is peer-to-peer support linked with the professional delivery system that we believe will sustain our treatment efforts. The data shows that the longer you are in treatment the better off you are. These data make a lot of sense. But you don’t need PhD’s, MD’s, LCSW’s to provide support. You do need a community that says, Welcome back and we’ll work with you to stay back. You do need that. That’s our peer-to-peer support system. We want to facilitate that. That helps with the issue of stigma, it helps with the issue of shame. When Tribal Elders are involved with that it makes it a lot easier. When the faith community is involved in that, it makes it a lot easier. We are saving our communities by utilizing this kind of partnership.

You Are the Heart of Recovery Month
Recovery helps families, friends, and our society. Individually and collectively, we are infused by the spirit that makes Recovery Month what it is. By joining our voices, thousands of people, professionals, lay people, faith healers, providers, those in recovery, and friends and families of those in recovery can make our communities healthier and safer.

This observance, the Fourth Annual Circles of Recovery Conference, joined with other observances, allows us to join the voices of recovery and to celebrate health. You are messengers of hope and change. Your voice joins with the other messages of hope and change. We can have a nation that provides alcohol and drug treatment services to anybody who needs it. We can have a nation where being in recovery is not stigmatized. The person sitting next to the person in recovery will have a voice saying, “You can make this, what can I do to help?” The 12 Step programs have known this, the tribes have known this—by helping each other you help yourself because you are reminded. Our goals are a call to action. Let us work together, all of us, for recovery.

You can find information about SAMHSA’s programs at www.samhsa.gov

You can call us at 1-800-662-HELP

At the end of the day it is your commitment, your imagination, and your involvement that will make the difference. At the end of the day, we can only be your partners—but what a partnership it will be. Thank you!

Dr. H. Westley Clark, MD Dr. Clark is the Director of the Center for Substance Abuse Treatment (CSAT) under the Substance Abuse and Mental Health Services Administration (SAMHSA), U.S. Department of Health and Human Services. He leads the agency's national effort to provide effective and accessible treatment to all Americans with addictive disorders. His areas of expertise include substance abuse treatment, methadone maintenance, pain management, dual diagnosis, psychopharmacology, anger management, and medical and legal issues. Dr. Clark is a noted published author in the area of substance abuse and has received numerous awards for his contribution to the field of substance abuse treatment. Dr. Clark and Don Coyhis