Advancing American Indian and Alaska Native Substance Abuse Research: Current Science and Future Directions

Abstract

American Indians and Alaska Natives (AI/AN) have disproportionately high rates of substance abuse yet there is little empirical research addressing this significant public health problem. This paper is an introduction to a special issue that includes cutting edge science in this research area. We identify several areas that require consideration in this field and indicate how the papers in the special issue address these gaps. These overarching areas of need, which should be considered in any substantive research, include attention to heterogeneity within the population, research that has tangible health benefits, continued work on research methods and strategies, increased focus on strength based and community oriented approaches, and the need for strong research partnerships. The special issue marks a major step forward for AI/AN substance abuse research. However, articles also highlight where more work is need to improve public health in AI/AN communities by addressing identified gap areas.

Cannabis Use and Disorder From Childhood to Adulthood in a Longitudinal Community Sample With American Indians

“…The lack of race/ethnic differences is noteworthy because American Indians were exposed to substantially higher rates of poverty in our sample, and this risk factor is typically linked to substance use and disorders. 5, 6 Resilience in our American Indian study population has been reported previously (to ages 19 and 21) and is, in part, attributable to income supplements received by American Indian families and their community following casino openings in the late 1990s. 34 These findings are also consistent with correlational studies reporting that differences in substance use between American Indian and white participants are no longer significant when adjusting for annual family income and education level (and also sex, age, urbanicity, and region).…”

“…The longitudinal course of substance use is rarely documented among American Indian youth; this gap in research exists, in part, because of a lack of long-term longitudinal studies among this group. 5,6 On average, substance use among American Indians begins earlier than among other races/ethnicities, involves heavier use, and increases more steeply. 7,8 Notably, considerable tribal and regional variation in use exists.…”

Acceptability of a Web-Based Community Reinforcement Approach for Substance Use Disorders with Treatment-Seeking American Indians/Alaska Natives

“…Users might relate to the content more easily if video clips and voice-over narration are more representative of AI/AN culture. As others have noted, services for AI/AN that marry traditional or cultural practices, such as strengths-based cultural assets, with evidence-based addiction treatments produce better effects (Dickerson, 2011; Etz, Arroyo, Crump, Rosa, & Scott, 2012; Kropp et al, 2013). Adaptation of existing treatments, however, must take into account that AI/AN communities are diverse – with over 280 separate cultural groups representing 560 tribes (Gray, 2001; Bureau of Indian Affairs, 2010).…”

Fourth and Fifth Step Groups: A New and Growing Self-Help Organization for Underserved Latinos with Substance Use Disorders

“…In agreement with previous approaches for studying substance use in minority populations (Etz, Arroyo, Crump, Rosa, & Scott, 2012), our ongoing study of CQ aims to address these questions by continuing to attend to the heterogeneity of Latinos who participate in CQ; to employ mixedmethods that account for the unique cultural and socioeconomic contexts in which CQ operates; to develop a partnership with CQ groups to help direct the research; and ultimately to produce tangible health benefits for this community. Future research is needed to determine the prevalence of these groups throughout the United States and Mexico, the health and social needs of their members, the longitudinal effectiveness of CQ participation, and whether aspects of CQ, especially the therapeutic retreat, might be detrimental to particular individuals.…”