Ibogaine Aotearoa/NZ A Path to Integration with

Considerations on Assessment & Risk By Tanea Paterson

Director/Provider Ibogaine Aotearoa Charitable Trust I.ACT Applied Addictions Practitioner DAPAANZ Registered

"E nga mana, e nga reo, e nga waka, e tau nei.”

To all the chiefs, all the dialects, all the waka that have gathered here.

Ko Tinana toku waka

Ko Hereweka toku mauka

Ko Mata-Au toku awa

Ko Tanea Paterson toku ikoa

No Otepoti ahau

No reira

Tena koutou, tena koutou, tena koutou katoa

Tanea Paterson

• Born in Otepoti/Dunedin

• Spanish, Scottish and English

• Two Sons, Josef 13 and Salem 8

• Solo Mum/Student for 13 years

• Methadone program for 7 years, 6 years free

• Qualified Addiction Practitioner

• 2008-09 Certificate in Health at Otago Polytechnic

• 2009 Ibogaine Fora North & South Island

• 2011 Set up Ibogaine Aotearoa Charitable Trust or I.ACT

• 2011 Attended Cutting Edge National Addiction Conference & won award for my poster

• 2011 Voluntary intern at Salvation Army ‘drop in centre’

• 2011 Registered as an Addiction Practitioner with DAPAANZ

• 2012 Completed Te Taketake Applied Addictions Practitioner Paper through Moana House

• Current - Work at DIVO Dunedin IV Organisation

• Comprehensive 1st aid and level 4 Resus Certification

Risk Management

What Risk?

• Provider

• Client

• Movement

• West Africa – culture & resources

Addiction Training and the Importance of Personal Growth

• Transference and Countertransference

• Self Disclosure “who is benefitting from it?”

• Supervision (not limited by geography)

• Naïve Benevolence – doing goodwill without considering potential risks. When it is ok to say no or not yet

• ‘Rescuing’ without proper assessment. (Karpman Drama Triangle, 1968)

Persecutor, Rescuer and Victim

Dance

Rescuers get caught up in enabling. Doing too much for someone else is rationalized because "I care so much." Rescuers are often unaware that pity and disrespect are the fuel for this role. "I know what's best for you.” (thus moving into the persecutor role) Backing up from the rescuer role means learning that indifference can be a useful tool. Wait and see if the person you’re trying to rescue steps forward for themselves, increasing self efficacy on the way.

So next time you feel that brief flash of irritation at the start of a conversation or are left with a negative feeling after a conversation just stop and ask yourself “Was I just sucked into a Drama Triangle?” and then consider the question ”And to what extend was I unconsciously colluding?”. The tactic to avoid the Drama Triangle is to learn to recognise the emotional “hook” that signals the invitation to play the Game; and to consciously deflect it before it embeds into your unconscious mind and triggers an unconscious, habitual, reflex reaction. Anyone able to “press your button” is hooking you into a game.

Priorities for Providers to Reduce Risk to Self and Others

• Education, research and self growth

‘having a baby does not make you a midwife’

• Bwiti Tikanga, respect and knowledge of West Africa and source of the medicine we use

• Negative thinking towards ‘the system’ slows progression

Anti-establishment thinking slows

progression

Ibogaine Therapy Integration NZ

• The Feb 2010 scheduling of ibogaine as a non-approved prescription medication allows integration into health services

• Prior to this ibogaine was ‘underground’ therefore often dismissed by healthcare providers

• Exposing clients to risk -uninformed primary health workers = unsupported clients

• Ibogaine is ONE part of a therapeutic plan

Developing and Maintaining Trust with Existing Health Services

Consistency of

• Provision

• Protocol

• Professionalism

Transparency of practice

Code of Ethics DAPAANZ Example

Drug and Alcohol Practitioners Association of Aotearoa/NZ

THE DAPAANZ CODE – THE MAIN ETHICAL PRINCIPLES

In the DAPAANZ Code there are 10 main principles and/or core values.

Structural and Core Elements DAPAANZ

1. Self responsibility and practitioner status 2. Responding to clients and community 3. Professional practice within agencies and organisations

Assessment – Why Do It

• Who is this person?

• How can we best serve their needs?

• How is their mind, body, spirit and social network.

• Minimum of 6 assessment/counselling/preparation sessions pre ibo

The Importance of Assessment • Builds therapeutic alliance

• A holistic picture of the client enables a more individualized therapy plan

• Identifies strengths and build on these for increased sense of self worth & efficacy

• Identifies history and extent of drug use and this also allows for opportunities to increase the clients’ awareness around substances

• Can be therapeutic in itself, allows for reflection and communication with whanau

Western Model vs Eastern Orthodox/Maori Model

Western - Humanity in control

• Relationship to the issue

• Scientific explanation

• Evidence based intervention

Scientia - Takes a Snapshot, Seeks Answers

Eastern - Humanity & our relationship with the universe

• Relationship to each other

• Spiritual explanation

• Nature of breach (imbalance)Realignment

Spirituality - Moving Model, Seeks questions

Te Whare Tapa Wha (Durie, 1982) • A model of Maori health

• Allowed Maori to reclaim a sense of ownership over health

• Shifted away from a focus on disease and medical expertise

• Recognised health as a balance between wairua, hinengaro, tinana, whanau, the four walls of a house

• Used within areas of health, education and social services in Aotearoa/NZ

Balancing Wellness

As in Te Whare Tapa Wha all four areas must be considered

Ibogaine alone has the capacity to heal physically, spiritually and psychologically to an extent.

It doesn’t change the person’s social/whanau interactions.

Taha Tinana - Body • Medical/physical exam

• Exercise

• Illness

• Supplements

• Diet

• Physiological sensitivity to ibogaine

• Mind body link

• Overdose, using during tx or directly after ‘Break up sex’

Taha Hinengaro - Mind • Psychiatric assessment/meds

• Counsellor/therapist engagement

• Fears listened to

• Hopes listened to

• Reassurance

• Cognition and thoughts

• Understanding and acceptance of process

• Motivational Interviewing & Relapse Prevention Plan

Taha Whanau – Family/Social

• Genogram/genetic predisposition

• Who know’s? Who cares?

• Work/education

• Whanau inclusive practice = support, education & therapy

• Communication

• Relationships, respect. Reduce stigma

• Aftercare & Social participation

Taha Wairua - Spirit • Beliefs and how they can be supported

throughout therapy

• Values

• Rituals

• Reassurance, Dignity and Respect

• Cultural identity

• Personal contentment

• Spirituality • Stages of Change, Prochaska & DiClemete

Considerations on Assessment and Alliance

• Surroundings, compliance more likely in a clinical setting – go for a walk

• Senses, Cognition – does the person really understand. Have they had enough time to ask questions?

• Negotiate access to substances during tx (inc cannabis, cigarettes, supplements)

• Paradoxical effect of medications i.e benzodiazapine

Honouring Origins by Assessment “initiatory process in addiction

therapy” • Spending the time with people prior to

therapy not only builds trust and truth, it also allows greater respect for iboga/ibogaine (minimum 6 weeks)

• I see assessment and therapy planning as a kind of initiatory process

• This time spent prior to ibogaine increases long term efficacy thus lessens the amount of ibogaine used – sustainability

Importance and Benefits of

Integrated Care

• Assessment and Therapy Planning

• Common language and synchronized therapy plans within sector

• Insight and understanding into existing services for individual needs when planning

• Legitimacy and availability of ibogaine therapy grows with awareness and commonality of care

• Best Practice

Why Follow Best Practice? Cui Bono?

To whose benefit? Who profits by it?

~50yrs on - Many ‘mistakes’ have been made, all with good intentions, to

honour those pioneers we should not be making the same mistakes.

We, and future generations of providers and healers, therefore

clients, all benefit from

Best Practice.

Creative Commons Potential

• Creative Commons for collective input from providers

• “Our vision is nothing less than realizing the full potential of the Internet — universal access to research and education, full participation in culture — to drive a new era of development, growth, and productivity.”

He aha te mea nui o te ao? He tangata! He tangata! He tangata!

Further Reading….

• DAPAANZ Code of Ethics

• Karpman Drama Triangle

• Te Whare Tapawha Maori Model, Durie

• Relapse Prevention Planning, Marlett & Gordon

• Motivational Interviewing, Miller & Rollnick

• Stages of Change, Prochaska & DiClemente