On Thursday, Nov. 12, the College of Public Health hosted the summit “Heroin and Opioids: A Community Crisis” that brought more than 200 experts together to address the heroin and prescription opioid abuse and overdose epidemic plaguing eastern Iowa. The event was sponsored by the United States Attorneys’ Offices for the Northern and Southern Districts of Iowa, and the University of Iowa Injury Prevention Research Center and College of Public Health.
Dreamland: The True Tale of America’s Opiate Epidemic
Wednesday, Nov. 11
Prairie Lights, 15 S. Dubuque St., Iowa City
In a special event sponsored by the University of Iowa’s Injury Prevention Research Center, Sam Quinones will read from Dreamland: The True Tale of America’s Opiate Epidemic.
The book chronicles how, over the past 15 years, communities all over the United States where heroin had never been seen before, found themselves overrun with it. Who was bringing it here, and why were so many people suddenly eager for the comparatively cheap high it offered?
Sam Quinones is a journalist and author whose two acclaimed books of narrative nonfiction about Mexico and Mexican immigration True Tales from Another Mexicoand Antonio’s Gun and Delfino’s Dreamhave made him, according to the San Francisco Chronicle Book Review, the most original writer on Mexico and the border.
Thursday, Nov. 12
8:30 a.m. to 4:30 p.m.
College of Public Health Building
University of Iowa
Please note: There is a waiting list to attend this conference.
This conference will bring together law enforcement, public health and health care professionals, and educators to exchange information and strategies to address the heroin and prescription opioid abuse and overdose epidemic plaguing eastern Iowa. Speakers will provide a national overview of the heroin problem and address issues specific to Iowa.
The National Heroin Threat
Opioid-Based Deaths in Iowa
Heroin in Iowa – Urban and Rural Communities
Heroin: Then and Now
Responding to Heroin and Other Opioid Addictions
Heroin Prevention Education in Schools and Iowa Communities
Heavy drinking among college students continues to be a serious problem. The risks are significant, including physical and sexual assault, unplanned sexual activity, and even injury or death. Although college parties are known to be high-risk environments, little is known about how specific characteristics of parties such as size, setting, and duration, as well as perception of other drunk partygoers influence student drinking.
Researchers including Miesha Marzell, assistant professor of community and behavioral health in the UI College of Public Health, conducted a study focused specifically on characteristics of parties across various college drinking settings and how those characteristics influenced students’ drinking behaviors.
Overall, they found that more than 50% of students reported drinking to intoxication the last time they attended a party at a Greek house, residence hall, on-campus event, or off-campus residence. The study was published online May 15, 2015, in the Journal of Primary Prevention.
Parties at fraternities and sororities (Greek settings) had the highest rate of drinking to intoxication (62.8%) and perception of others partygoers being intoxicated (68.8%). Greek parties were also most likely to have a keg available, and most unlikely to enforce a minimum drinking age or refuse an intoxicated partygoer more drinks.
As might be expected, the longer students remained at a party, the more likely they were to drink to intoxication. At bars, a cover charge or drink promotion was associated with higher odds of drinking to intoxication.
The study was conducted using data from the Safer California Universities Randomized Trial (Safer Trial), which conducts surveys in 14 public universities in California. Data from 6,903 students in the 2010 and 2011 fall surveys were analyzed.
A clearer picture of risk
“We now have a clearer picture of students’ risk of intoxication by setting and of the importance of peer influence on perceptions about drinking,” says Marzell.
She also believes the findings have important implications for prevention programming.
“An important element of these programs would be the development of refusal skills as it relates to serving intoxicated partygoers,” Marzell notes.
Furthermore, since drinking to intoxication was prevalent in all campus-related settings (Greek parties, residence halls, on-campus events), the researchers recommend stricter implementation of university alcohol policies, together with collaboration with local law enforcement to promote awareness.
In addition to Marzell, the study team included Niloofar Bavarian, California State University – Long Beach; Mallie J. Paschall and Robert F. Saltz with the Pacific Institute for Research and Evaluation; and Christina Mair, University of Pittsburgh.
The research was funded by the National Institute on Alcohol Abuse and Alcoholism.
What motivates someone to change is complex, particularly when it comes to addictive behaviors. Substance abuse programs in the U.S. reflect the disparity evident in the health care system as a whole—while Whites are twice as likely to report substance abuse problems as Blacks, Black clients are two times less likely to complete substance abuse treatment programs.
Race and referral sources
In an effort to investigate this paradox, a team of University of Iowa researchers, including Marizen Ramirez, associate professor of occupational and environmental health in the College of Public Health, considered how referral source might affect completion of treatment among racial groups. They found that Black clients were most likely to successfully complete treatment when referred by an employer, while for White clients, criminal justice referrals such as court orders were associated with the highest percentage of program completion.
The study, which was published online April 18, 2015, in the journal Addictive Behaviors, drew on the vast data sets collected by the national Substance Abuse and Mental Health Services Administration from the years 2006–2009. Clients were over 18 and had received no prior treatment; more than 2.5 million cases met these criteria. Overall, the study found a 44.2% successful treatment completion rate for all clients. The treatment completion rate was 47.1% for Whites and 34.9% for Blacks.
Referral sources included self-referral, drug abuse agency, health care professional, school, employer, community, and criminal justice agency. It was noted that several of these may include a certain amount of coercion, as failure to comply would result in consequences such as loss of freedom, employment, or education.
Although the researchers could not say definitively that this was where racial differences entered the equation, they suggest that Blacks may not have been as affected by the coercive nature of possible incarceration as Whites in that they may not have believed that their behavior would have an impact on whether or not they received jail time.
Criminal justice, employer, and student referral sources had the highest success rate for both White and Black clients. Interestingly, self-referrals and referrals from health care providers were associated with the lowest success rates for both Black and White clients.
The study makes a strong case for the argument that incentives for substance abuse treatment might benefit from a multicultural perspective.
“Health care providers need to learn better follow-up techniques to help their patients recover,” says corresponding author Stephan Arndt, director of the Iowa Consortium for Substance Abuse Research and Evaluation. “Making more of an effort to involve employers rather than the criminal justice system may reduce the disparities.” Arndt is also a professor in biostatistics and psychiatry.
The research team also included Ethan Sahker, graduate research assistant in the Iowa Consortium for Substance Abuse Research and Evaluation and the Department of Psychological and Quantitative Foundations; Maisha Toussaint, graduate research assistant in the Department of Epidemiology; and Saba Ali, associate professor in the Department of Psychological and Quantitative Foundations.
Many leaders of behavioral health programs in tribal communities have expressed concerns about the aging workforce, especially among leaders of substance abuse and mental health prevention and treatment programs.
To help develop future leaders in these professions, the National American Indian and Alaska Native Addiction Technology Transfer Center (ATTC) based in the UI College of Public Health recently launched a pilot training program called the American Indian & Alaska Native Leadership Academy for behavioral health professionals.
The Leadership Academy lasts about nine months and consists of three face-to-face events, webinars, regular conference calls, and mentor support. Over the course of their training, participants develop their personal leadership qualities, learn from their mentor, and develop a project to be implemented towards the end of the program. The mentees are also expected to present their projects and to enhance their public speaking skills.
The first Immersion Training session took place Aug. 11-15, 2014, in Tama, Iowa, and included five mentees and three mentors representing a number of different tribes from around the country.
The curriculum is based on content previously developed by the Southern Coast ATTC, often referred to as the ATTC Leadership Institute.
“As a regional center formerly called the Prairielands ATTC, we offered this program annually for close to 10 years,” notes Anne Helene Skinstad, the center’s program director and clinical associate professor of community and behavioral health. “However, after Prairielands ATTC became a National Focus Area ATTC, we embarked on a cultural adaptation together with American Indian and Alaska Native task force members.”
The adaption was made with the input of tribal leaders who convened at the University of Iowa in October 2013 for a two-day Leadership Academy Task Force Meeting (see photo above). The task force meeting was facilitated by the original author of the training program, Pam Waters. One significant overall change was to emphasize the role of mentoring in leadership development.
“The mentoring concept is much more in tune with the tribal culture than a top-down protégée model of leadership,” says Skinstad, who adds that the curriculum was re-tooled to fit broadly shared cultural aspects of American Indian and Alaska Native leadership styles and decision-making processes. “Face-to-face interaction is important as well,” Skinstad notes.
A diversity of cultures
Above all is a respect for the participants’ different cultures, and the program continues to be modified as necessary.
“It’s a consensus program that’s under continuous revision since we have people from many different tribal backgrounds,” Skinstad explains. “Also, the diversity of cultures across the country led us to require the mentees to do homework before they came to the training. Their assignment was to connect with tribal elders who had influence over the behavioral health initiatives in their community and to share their experiences with the other mentees and mentors.”
The center also makes an effort to integrate different symbols, rituals, and aspects from the various tribal cultures.
“We ask participants to share their cultural background,” says Skinstad. “And when we have an event such as a meeting, we hold it on tribal property. This gives a clear concept of the diversity in American Indian and Alaska Native cultures.”
At the end of the nine-month training, all the mentors and mentees will gather to acknowledge their accomplishments. Mentees will present their individual projects and participate in a special ceremony with current leaders in the field. Mentees also will be awarded a formalized certificate of proficiency.
“The goal is for the mentees to go on to leadership positions in behavioral health and in the tribal government,” says Skinstad. “Additionally, it’s important for the mentees to have an understanding of both worlds—tribal and non-tribal–to be successful as leaders. Our experiences from previous Leadership Institutes is that our participants really entered in leadership roles across the region. Time will tell if the cultural adaptation of the Leadership Academy yields similar results. The center is in the process of starting the evaluation process.”