PREVALENCE AND SYSTEMS PLANNING

Issues Affecting Tribes

This webpage identifies the major literature in the field of prevalence and systems planning: issues affecting tribes. The time frame is from January 2000 through December 2014.

Akins, S., Lanfear, C., Cline, S., & Mosher, C. (2013). Patterns and correlates of adult American Indian substance use. Journal of Drug Issues, 43(4), pp. 497-516. DOI: 10.1177/0022042613491100

There is substantial literature on the patterns and correlates of substance use across minority youth populations, but comparatively little attention has been directed to substance use among adults. This is particularly the case for adult American Indians, generally due to sampling challenges. This article provides multivariate analyses of the correlates of substance use across five racial/ethnic groups and highlights analyses focused on American Indian adults. In addition to marijuana use and binge drinking, our analyses consider hard drug use, which remains understudied in the literature, and include a first consideration of “bender drinking,” a form of alcohol consumption that is most likely to lead to health, social, and legal problems. Our results indicate that although American Indians report higher levels of substance use and abuse than do those from other racial/ethnic groups, these differences are attenuated when sociodemographic and individual-level/risk protective factors are taken into account.

Croff, R. L., Rieckmann, T. R., & Spence, J. D. (2014). Provider and state perspectives on implementing cultural-based models of care for American Indian and Alaska native patients with substance use disorders. The Journal of Behavioral Health Services & Research, 41(1), pp. 64-79.

This paper describes findings from interviews with 22 program directors and 18 representatives from Single State Authorities on substance abuse. Interviews assessed provider and state efforts to increase AI/A client engagement and to improve the quality of care through culturally relevant interventions. Results suggested that providers employed flexibility and originality to cultural-based programs by broadening established practices, adopting outside traditions, and creating new ones to fit client needs. However, gaps in state–tribal collaborations and inter-group complexities such as staff-based tensions, a widening generational divide, and blurred consensus of “tradition” affect service delivery. Overall, respondents underlined the critical role culturally relevant care plays in individual and community healing.

Crofoot, T. L., & Harris, M. S. (2012). An Indian child welfare perspective on disproportionality in child welfare. Children and Youth Services Review, 34(9), pp. 1667-1674.

American Indian and Alaska Native efforts to keep children in their families, communities and tribal nations have created an Indian Child Welfare perspective that is vital to understanding disparities and disproportionalities in child welfare. This article looks at 1) history of child welfare; 2) policies and practices continuing from that history; 3) police and practices continuing from that history and; 4) the child welfare process as a whole. From an Indian Child Welfare perspective this means that institutional racism and institutional bias are the primary causes of disparities and disproportionalities in child welfare. The implication for other communities is the need to do their own research and documentation of the participation of their children and families in child welfare.

Ehlers, C. L., Gizer, I. R., Gilder, D. A., Ellingson, J. M., & Yehuda, R. (2013). Measuring historical trauma in an American Indian community sample: Contributions of substance dependence, affective disorder, conduct disorder and PTSD. Drug and Alcohol Dependence, 133(1), pp. 180-187.

The aims of the present study were to evaluate the extent to which the frequency of thoughts of historical loss and associated symptoms are influenced by: current traumatic events, post-traumatic stress disorder (PTSD), cultural identification, percent Native American Heritage, substance dependence, affective/anxiety disorders, and conduct disorder/antisocial personality disorder (ASPD). Over half of the participants of the study indicated that they thought about historical losses at least occasionally, and that it caused them distress. Additionally, anxiety/affective disorders and substance dependence were correlated with historical loss associated symptoms. In this American Indian community, thoughts about historical losses and their associated symptomatology are common and the presence of these thoughts are associated with Native American Heritage, cultural identification, and substance dependence.

Neault, N., Mullany, B., Powers, J., Coho-Mescal, V., Parker, S., Walkup, J., & Barlow, A. (2012). Fatherhood roles and drug use among young American Indian men. The American Journal of Drug and Alcohol Abuse, 38(5), pp. 395-402.

The objective of this study was to describe substance use patterns among young American Indian (AI) fathers and examine the intersection of substance use with men’s fatherhood roles and responsibilities. Substance use was associated with history of alcohol abuse among participants’ fathers (but not mothers); participants’ poor relationships with their own fathers; unemployment status; and low involvement in child care. Drug and alcohol abuse may be obstructing ideal fatherhood roles among multiple generations of AI males. Targeting drug prevention among young AI men during early fatherhood may provide special opportunity to reduce substance use and improve parenting. Intergenerational approaches may hold special promise.

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