May 2024 Regional Newsletter: South Southwest Prevention Technology Transfer Center

A Focus on Tribal Behavioral Health Providers: A Need to Advocate for the Wellbeing of Generations

By Sindy Bolaños-Sacoman, Owner & CEO, SBS Evaluation & Program Development Specialists, Director and Co-Founder, New Mexico Tribal Behavioral Health Providers Association

“…I can say that alcohol misuse has plagued our lives. Alcohol addiction has stunted the growth of my people for many generations. Culture and my people never reach the surface due to the cycle and social trauma contributed by this epidemic. My people have been targeted for so long by alcohol industries through cheap alcohol and accessibility within five miles from my dry reservation. With humility, I ask that you please help my people walk towards resiliency and healing.” Name withheld, Tribal Behavioral Heath Advocate

The New Mexico Tribal Behavioral Health Providers Association (NMTBHPA) was formed out of a need to provide a voice for Tribal behavioral health providers in our state and a need to bridge communication between the State departments and Tribal providers. Our mission statement is: Advocate as a united tribal voice for a quality behavioral health system accessible and responsive to tribal matters that affect the collective. Through engagement with state departments, the NMTBHPA seeks to amplify important behavioral health concerns faced by Tribal nations while fostering an environment where providers can positively impact the communities they serve. Indian Affairs Bureau Cabinet Secretary Lynn Trujillo endorsed the NMTBHPA, which held its first meeting in 2021 during the pandemic when the demand for behavioral health services was at an all-time high, regulations were changing due to pandemic restrictions- all while tribal shutdowns were in effect. 

Although Native Americans account for approximately 1.7% of the US population, they experience much higher rates of substance misuse compared to other racial and ethnic groups in the nation7. Alcohol use in tribes is so prevalent that nearly all native families have been affected directly or indirectly8. Thus, the voice of Tribal providers who treat those facing alcohol disorder, alcohol misuse, and alcohol related harms is crucial. But where are these voices and why are they not resonating in halls demanding change?

New Mexico is home to 23 separate and distinct Tribal nations which include 19 Pueblos; Jicarilla, Mescalero and Ft. Sill Apache Nations; and Navajo Nation. New Mexico has long suffered the nation’s highest rate of alcohol-related deaths and in 2021, reached an all-time high with 2,276 lives lost1,2 and in 2022, again, lost over 2,000 lives. Since 1981, NM has ranked 1st, 2nd, or 3rd in the nation for alcohol-related deaths3. Moreover, Native Americans in NM die of alcohol-induced causes at four times the state rate4,5,6. Thus, in a state that is home to many Tribal nations, it is vital to ensure, encourage, elicit, and listen to the needs and suggestions of those who provide mental health services. 

In 2022 and again in 2023, legislation was introduced to increase the liquor excise tax, which has not been increased in 30 years, by 25 cents generating approximately $250 million dollars in an Alcohol Harms Alleviation Fund to fund prevention, treatment, and recovery services9 statewide. The excise tax also included funding for Tribes to address the devastating impact of the alcohol crisis on tribal land. Although this evidence-based strategy is recommended by the Center for Disease Control10, the World Health Organization11, and the New Mexico Department of Health12, most tribal behavioral health providers were unaware of this effective strategy or that it was being proposed.

The NMTBHPA worked to build capacity amongst its membership around evidence-based strategies known to decrease alcohol-related harms, including liquor excise tax, and mobilized its membership to raise awareness about the alcohol initiatives proposed. Armed with information, knowledgeable about the proposed alcohol related initiatives, professional and life experiences, and years of seeing the negative impact alcohol has had on tribal communities, Association members verbalized their support for action to be taken. Several members stepped foot at the state capital for the first time, provided public comment, and participated in a process that had the potential to generate statewide change and address the alcohol epidemic that has plagued their communities and state for generations.

It is vital for Tribal behavioral health providers to understand the legislative initiatives proposed that could affect them or have a negative impact on Tribal Nations. Although it is rare for Tribal clinicians or preventionists to participate in a legislative process, especially when it comes to alcohol, many now have a heightened interest in increasing their capacity, educating the masses, actively participating during Behavioral Health Day, and raising awareness of the many tribal behavioral health needs across their state. Although behavioral health providers are extremely busy addressing community needs due to substance misuse, abuse and related harms, there has been an enormous increase in the willingness to learn, get involved and have their voices heard.

The accomplishments of the New Mexico Tribal Behavioral Health Providers Association have been many as they have brought awareness to the state behavioral health department, tribal liaisons, local behavioral health associations, law enforcement, and stakeholders statewide in order to reduce inequities.

Although the Association has not been funded for two years, the director and an active long-term core team have voluntarily guided and given direction to the group. If you are aware of funding sources for such initiatives, please contact [email protected]

You can learn more about the New Mexico Tribal Behavioral Health Providers Association at https://nmtribalbehavioralhealth.org

  1. https://www.nmhealth.org/publication/view/marketing/8331/ Centers for Disease Control and Prevention, National Center for Health Statistics.
  2. Underlying Cause of Death 1999-2020 on CDC WONDER Online Database, released in 2021. Multiple Causes of Death Files 1999-2020.
  3. https://ibis.doh.nm.gov/indicator/summary/AlcoholRelatedDth.html
  4. https://nmindepth.com/2022/an-emergency-hiding-in-plain-sight/
  5. https://ibis.doh.nm.gov/indicator/view/AlcoholRelatedDthInjury.RacEth.html
  6. https://www.lcsun-news.com/story/news/2022/07/27/new-mexico-nm-alcohol-residents-drinking-themselves-to-death-high-rate/65379663007/
  7. https://americanaddictioncenters.org/addiction-statistics/native-americans
  8. Hawkins EH, Cummins LH, & Marlatt GA (2004). Preventing substance abuse in American Indian and Alaska Native youth: Promising strategies for healthier communities. Psychological Bulletin, 130(2), 304–323. doi: 10.1037/0033-2909.130.2.304
  9. Alcohol Harms Alleviation https://www.ahacoalition.org/
  10. The Community Guide (2023). https://www.thecommunityguide.org/pages/about-community-preventive-services-task-force.html
  11. World Health Organization. Excise tax on alcoholic beverages (2024). https://www.who.int/data/gho/data/indicators/indicator-details/GHO/excise-tax-on-alcoholic-beverages
  12. https://www.nmhealth.org/publication/view/marketing/8331/

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Resources to Support Those Impacted by Tornadoes

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Building Resilience in Military Families

By Iris Smith, Ph.D.

In 2022, the total number of military personnel was estimated to be 2,071,451, 63% of whom were active duty and 37% Reserve members. Active-Duty personnel include members of the Army, Marine Corps, Navy, Air Force, and Reserve components comprised of the Coast Guard, Army, Navy, and Marine Corps Reserves, the Air National Guard, and Air Force Reserve. Across the Departments of Defense 50.9% are members of family units having spouses, children, or other adult dependents.1 Results from the 2021 Active-Duty Spouse Survey (ADSS) found that while average financial well-being score among active-duty spouses was 58 (slightly higher than the US. Average score of 55 in 2020), one in four active-duty spouses experienced low or very low food security and only 30% of respondents reported no financial distress.2

Military families often face unique challenges due to frequent relocation, extended absences of parents due to deployment and other stresses associated with military life. Deployment of a parent or family member is a significant stressor for children, particularly when they are deployed to locations of ongoing conflicts. The impact of deployment varies depending on the duration of the separation and the developmental age of children. Some studies have found increased anxiety and other behavioral health issues in young children whose parents have been deployed. Other studies have found an increased risk of child neglect and maltreatment.3 Family-based interventions that increase resilience and mitigate stress have been found to be effective.4

Alcohol use disorder (AUD) is also more prevalent in veterans compared to the general population.  A 2021 study of 4,069 veterans found that the prevalence of lifetime and past year AUD was 40.8%.5  The study found that being younger, male, white, unmarried, and retired were independently correlated with increased lifetime prevalence of AUD. This study highlights the importance of screening veterans and recently separated military personnel for AUD. It is also important to connect children and other family members with support and resources.  Special attention also needs to be paid to families with children. There is extensive research on the emotional, psychological, and social impact of parental alcoholism and drug use which adds an additional layer of family stress.

Despite the challenges, studies have also found that being part of the military culture is also a protective factor for children. Living in proximity to other families facing many of the same challenges creates opportunities for shared experiences, social connections, and support. One study found that although school-aged children had increased psychosocial morbidity during parental wartime deployment, they had lower baseline psychosocial symptoms than their civilian peers.6 There are also numerous government sponsored resources available to military families including the Department of Defense employee sponsored childcare system, a global health care delivery system, and an education system that serves 7,200 children in 7 states, 11 countries, and 2 territories. However, roughly half of military families receive health care through civilian providers who may not be familiar with aspects of military life and culture or available resources. Providing training and resources to mental and physical health providers should be an important part of any prevention strategy for military families.

Resources

Cramm, Heidi; Godfrey, Christina M.; Murphy, Susanne; McKeown, Sandra; Dekel, Rachel. Experiences of children growing up with a parent who has military-related post-traumatic stress disorder: a qualitative systematic review. JBI Evidence Synthesis 20(7):p 1638-1740, July 2022. | DOI: 10.11124/JBIES-20-00229

Muir, C., Adams, E. A., Evans, V., Geijer-Simpson, E., Kaner, E., Phillips, S. M., Salonen, D., Smart, D., Winstone, L., & McGovern, R. (2023). A Systematic Review of Qualitative Studies Exploring Lived Experiences, Perceived Impact, and Coping Strategies of Children and Young People Whose Parents Use Substances. Trauma, violence & abuse24(5), 3629–3646. https://doi.org/10.1177/15248380221134297

National Academies of Sciences, Engineering, and Medicine; Division of Behavioral and Social Sciences and Education; Board on Children, Youth, and Families; Committee on the Well-Being of Military Families, Le Menestrel, S., & Kizer, K. W. (Eds.). (2019). Strengthening the Military Family Readiness System for a Changing American Society. National Academies Press (US).

Rossiter, A. G., & Ling, C. G. (2022). Building resilience in US military families: why it matters. BMJ military health168(1), 91–94. https://doi.org/10.1136/bmjmilitary-2020-001735

Solomon, N., Gribble, R., Dighton, G., Evans, S., Taylor-Beirne, S., Chesnokov, M., & Fear, N. T. (2022). The Mental Health and Well-Being Among Partners and Children of Military Personnel and Veterans with a Combat-Related Physical Injury: A Scoping Review of the Quantitative Research. Disability and Health journal15(3), 101283. https://doi.org/10.1016/j.dhjo.2022.101283

Tetlow, S., Wallace, C., Thomas, M., Filipponi, T., Pontin, D., & Livingstone, A. (2024). A systematic review of the use of the concept family resilience in interventions with families with children and young people. Public Health Nursing (Boston, Mass.)41(2), 346–355. https://doi.org/10.1111/phn.13287


[1] Department of Defense Demographics (2022) Demographics Profile.

[2] Office of People Analytics (2023) 2021 Active-Duty Spouse Survey

[3] Hubner CR, AAP Section on Uniformed Services AAP Committee on Psychosocial Aspects of Child and Family Health (2019).  Health and Mental Health Needs of Children in U.S. Military Families.  Pediatrics 143(1); e20183258.

[4] Ibid.

[5] Panza Ke, Kline AC, Na PJ, Potenza MN, Norman SB, Pietrzak RH (2021) Epidemiology of DSM 5 Alcohol Use Disorder in U.S. Military Veterans:  Results from the National Health and Resilience in Veterans Study.  Drug and Alcohol Dependence 231; pg. 19240.

[6] Aranda MC, Middleton LlS, Flake E, Davis BE (2011).k  Psychosocial Screening in Children with Wartime-Deployed parents.  Mil Med 176(4); pg. 402-407. Cited in Hubner (2019)

A Focus on Tribal Behavioral Health Providers: The Need to Advocate for the Wellbeing of Generations

By Sindy Bolaños-Sacoman, Owner & CEO, SBS Evaluation & Program Development Specialists, Director and Co-Founder, New Mexico Tribal Behavioral Health Providers Association

“…My people have been targeted for so long by alcohol industries through cheap alcohol and accessibility within five miles from my dry reservation. With humility, I ask that you please help my people walk towards resiliency and healing.”

The New Mexico Tribal Behavioral Health Providers Association (NMTBHPA) was formed out of a need to provide a voice for Tribal behavioral health providers in our state and a need to bridge communication between the State departments and Tribal providers. Our mission statement is: Advocate as a united tribal voice for a quality behavioral health system accessible and responsive to tribal matters that affect the collective. Through engagement with state departments, the NMTBHPA seeks to amplify important behavioral health concerns faced by Tribal nations while fostering an environment where providers can positively impact the communities they serve. Indian Affairs Bureau Cabinet Secretary Lynn Trujillo endorsed the NMTBHPA, which held its first meeting in 2021 during the pandemic when the demand for behavioral health services was at an all-time high, regulations were changing due to pandemic restrictions- all while tribal shutdowns were in effect. 

Although Native Americans account for approximately 1.7% of the US population, they experience much higher rates of substance misuse compared to other racial and ethnic groups in the nation7. Alcohol use in tribes is so prevalent that nearly all native families have been affected directly or indirectly8. Thus, the voice of Tribal providers who treat those facing alcohol disorder, alcohol misuse, and alcohol related harms is crucial. But where are these voices and why are they not resonating in halls demanding change?

New Mexico is home to 23 separate and distinct Tribal nations which include 19 Pueblos; Jicarilla, Mescalero and Ft. Sill Apache Nations; and Navajo Nation. New Mexico has long suffered the nation’s highest rate of alcohol-related deaths and in 2021, reached an all-time high with 2,276 lives lost1,2 and in 2022, again, lost over 2,000 lives. Since 1981, NM has ranked 1st, 2nd, or 3rd in the nation for alcohol-related deaths3. Moreover, Native Americans in NM die of alcohol-induced causes at four times the state rate4,5,6. Thus, in a state that is home to many Tribal nations, it is vital to ensure, encourage, elicit, and listen to the needs and suggestions of those who provide mental health services. 

In 2022 and again in 2023, legislation was introduced to increase the liquor excise tax, which has not been increased in 30 years, by 25 cents generating approximately $250 million dollars in an Alcohol Harms Alleviation Fund to fund prevention, treatment, and recovery services9 statewide. The excise tax also included funding for Tribes to address the devastating impact of the alcohol crisis on tribal land. Although this evidence-based strategy is recommended by the Center for Disease Control10, the World Health Organization11, and the New Mexico Department of Health12, most tribal behavioral health providers were unaware of this effective strategy or that it was being proposed.

The NMTBHPA worked to build capacity amongst its membership around evidence-based strategies known to decrease alcohol-related harms, including liquor excise tax, and mobilized its membership to raise awareness about the alcohol initiatives proposed. Armed with information, knowledgeable about the proposed alcohol related initiatives, professional and life experiences, and years of seeing the negative impact alcohol has had on tribal communities, Association members verbalized their support for action to be taken. Several members stepped foot at the state capital for the first time, provided public comment, and participated in a process that had the potential to generate statewide change and address the alcohol epidemic that has plagued their communities and state for generations.

It is vital for Tribal behavioral health providers to understand the legislative initiatives proposed that could affect them or have a negative impact on Tribal Nations. Although it is rare for Tribal clinicians or preventionists to participate in a legislative process, especially when it comes to alcohol, many now have a heightened interest in increasing their capacity, educating the masses, actively participating during Behavioral Health Day, and raising awareness of the many tribal behavioral health needs across their state. Although behavioral health providers are extremely busy addressing community needs due to substance misuse, abuse and related harms, there has been an enormous increase in the willingness to learn, get involved and have their voices heard.

The accomplishments of the New Mexico Tribal Behavioral Health Providers Association have been many as they have brought awareness to the state behavioral health department, tribal liaisons, local behavioral health associations, law enforcement, and stakeholders statewide in order to reduce inequities.

Although the Association has not been funded for two years, the director and an active long-term core team have voluntarily guided and given direction to the group. If you are aware of funding sources for such initiatives, please contact [email protected]

You can learn more about the New Mexico Tribal Behavioral Health Providers Association at https://nmtribalbehavioralhealth.org

  1. https://www.nmhealth.org/publication/view/marketing/8331/ Centers for Disease Control and Prevention, National Center for Health Statistics.
  2. Underlying Cause of Death 1999-2020 on CDC WONDER Online Database, released in 2021. Multiple Causes of Death Files 1999-2020.
  3. https://ibis.doh.nm.gov/indicator/summary/AlcoholRelatedDth.html
  4. https://nmindepth.com/2022/an-emergency-hiding-in-plain-sight/
  5. https://ibis.doh.nm.gov/indicator/view/AlcoholRelatedDthInjury.RacEth.html
  6. https://www.lcsun-news.com/story/news/2022/07/27/new-mexico-nm-alcohol-residents-drinking-themselves-to-death-high-rate/65379663007/
  7. https://americanaddictioncenters.org/addiction-statistics/native-americans
  8. Hawkins EH, Cummins LH, & Marlatt GA (2004). Preventing substance abuse in American Indian and Alaska Native youth: Promising strategies for healthier communities. Psychological Bulletin, 130(2), 304–323. doi: 10.1037/0033-2909.130.2.304
  9. Alcohol Harms Alleviation https://www.ahacoalition.org/
  10. The Community Guide (2023). https://www.thecommunityguide.org/pages/about-community-preventive-services-task-force.html
  11. World Health Organization. Excise tax on alcoholic beverages (2024). https://www.who.int/data/gho/data/indicators/indicator-details/GHO/excise-tax-on-alcoholic-beverages
  12. https://www.nmhealth.org/publication/view/marketing/8331/

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Charting Paths to Prevention: Mapping Social Vulnerability and Alcohol-Related Deaths

Evidence-Based Strategies to Decrease Alcohol Consumption

By Sindy Bolaños-Sacoman, Owner & CEO, SBS Evaluation & Program Development Specialists

Why did the alcohol conversation stop twenty years ago?  The focus of prevention has turned to opioids and fentanyl, but more people in the U.S. die of alcohol-related causes than from opioids and other drugs1.

Community organizations and coalitions can start having these much-needed conversations to raise awareness and uncover this silent epidemic. There are several benefits to community education (e.g. town halls) and advocacy including, alcohol focused data presentations, sharing information about evidence-based strategies known to effectively decrease alcohol consumption, and increasing awareness of alcohol related harms. The more community members know, the better equipped they will be to counter the pressure from the alcohol industry, to address policy initiatives, and to implement local strategies.

Important data topics include how a specific state compares to the nation, local rates for alcohol related harms (e.g. cancer, homicide, poisoning, alcohol use disorder, suicide, heart disease, and motor vehicle crashes), and rates for excessive drinking including heavy drinking, binge drinking, underage drinking, and drinking while pregnant. Vital to the conversation are topics on equity, social determinants of health, and trauma (including historical trauma) and their impact on alcohol misuse. Consider how different populations or sub-populations are impacted by alcohol; this can include Tribal communities, the unhoused, LGBTQI people, a specific gender, rural communities, etc. Ensure that you have a variety of people at the table representing local populations; different opinions shed light on different community needs.

There are some recommended evidence-based-strategies known to successfully decrease alcohol-related harms. The top recommended strategies include4:

References

  1. Weir, K. (2023) More People in the U.S. die of alcohol-related causes than from opioids and other drugs. Psychologists are working to change that: cultural beliefs paint alcohol use disorder as black and white, a mindset that often means too few people get help for problematic drinking. Monitor on Psychology Vol 54 No.4
  2. Daley J.I., Stahre MA, Chaloupka FJ, Naimi TS. The impact of a 25-cent-per drink alcohol tax increase. Am J Prev Med. 2012; 42:382-389.
  3. Woodall W.G, Starling R, Saltz RF, Buller DB, Stanghetta P. Results of a Randomized Trial of Web-based Retail Onsite Responsible Beverage Service Training: WayToServe. J Stud Alcohol Drugs. 2018; 79: 672-679.
  4. The Community Guide (2023). https://www.thecommunityguide.org/pages/about-community-preventive-services-task-force.html
  5. World Health Organization. Excise tax on alcoholic beverages (2024). https://www.who.int/data/gho/data/indicators/indicator-details/GHO/excise-tax-on-alcoholic-beverages
  6. The Community Guide. Alcohol Excessive Consumption: Electronic Screening and Brief Interventions (e-SBI). (2021). https://www.thecommunityguide.org/findings/alcohol-excessive-consumption-electronic-screening-and-brief-interventions-e-sbi.html
  7. The Community Guide. Alcohol Excessive Consumption: Maintaining Limits on Hours of Sale. (2021) https://www.thecommunityguide.org/findings/alcohol-excessive-consumption-maintaining-limits-hours-sale.html
  8. The Community Guide. Preventing Excessive Alcohol Consumption: Dram Shop Liability (2013). https://www.thecommunityguide.org/media/pdf/Alcohol-Dram-Shop.pdf
  9. Alaska Mental Health Trust Authority. Does an Increase in Alcohol Tax Reduce Alcohol Misuse. (2020). https://alaskamentalhealthtrust.org/wp-content/uploads/2020/03/Trust-Whitepaper_-Alcohol-Taxes-and-Alcohol-Misuse_March-2020.pdf
  10. Change Lab Solutions. (2019) Alcohol Tax Revenues, Social and Health Costs, & Government Expenditures. http://alcohol-psr.changelabsolutions.org/alcohol-psr-faqs/alcohol-taxes-faq/alcohol-tax-revenues-social-and-health-costs-government-expenditures/
  11. Alcohol Harms Alleviation. (2023). https://www.ahacoalition.org/
  12. Guide to Community Preventive Services. (2010). Alcohol - Excessive consumption: Dram shop liability. Retrieved from https://www.thecommunityguide.org

Sindy Bolaños-Sacoman is the owner and CEO of SBS Evaluation & Program Development Specialists, the Founder and Director of the New Mexico Tribal Behavioral Health Provider’s Association and a Core Team Member of the Alcohol Harms Alleviation Coalition. Sindy serves as a consultant, trainer, technical advisor, and evaluator to communities across New Mexico. She is also a Program Evaluation Advisory Council Member with the Substance Abuse and Mental Health Services Administration (SAMHSA). She has expertise in program development, program evaluation, community mobilizing, alcohol policy, strategic planning, grant writing, Medicaid, crisis intervention, behavioral health treatment, substance use prevention, and evidence-based strategies to reduce substance use consumption.

April 2024 Regional Newsletter: South Southwest Prevention Technology Transfer Center - Evidence Based Strategies to Decrease Alcohol Consumption

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Strategies to Disrupt the Proliferation of Emerging Drugs: A Community Approach

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Military Prevention Alliance Directory

Welcome to the Military Prevention Alliance information page. Here, you will find contact information for military connected preventionists from Region 6 (Arkansas, Louisiana, New Mexico, Oklahoma, and Texas). They support our states, counties, and cities in reducing substance misuse by promoting and implementing effective prevention practices. Many of them are Drug Demand Reduction and Outreach Officers, a team of military service members (Civil Operators).

Connect with them to help you further cultivate a resilient and prevention prepared community.

Methamphetamine Use: What are the Data Telling Us?