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CORK Bibliography: Native Americans

64 citations. January 2007 to present

Prepared: September 2009

Abbott PJ. Co-morbid alcohol/other drug abuse and psychiatric disorders in adult American Indian and Alaska Natives: A critique. Alcoholism Treatment Quarterly 26(3): 275-293, 2008

The American Indian and Alaska Native population is a heterogeneous population with significant social, psychological, and alcohol/other drug use risk factors. This article reviews the adult research to date that has examined the overlap between alcohol/other drug abuse and mental disorders. In the adult community and treatment seeking clinical populations, the co-occurrence of alcohol/other drug abuse and mental disorders is particularly high. Some studies among Native American populations have shown higher rates of affective disorders, post-traumatic stress disorders, organic brain disorders, and lower rates of drug abuse/dependence.

Angstman S; Harris KJ; Golbeck A; Swaney G. Cultural identification and smoking among American Indian adults in an urban setting. Ethnicity & Health 14(3): 289-302, 2009. (51 refs.)

Objectives. Among American Indians (AIs), an important relationship has been theorized between cultural identification and substance abuse, including smoking. We investigated the relationship between cultural identification and smoking among AI adults. Design. Using the Orthogonal Cultural Identification Scale (OCIS), we examined the relationship between AI and White cultural identification and cigarette use in a sample of AI recruited at an urban Indian center (n=217). Results. We found that high AIs identification predicted smoker status and high White identification predicted non-smoker status when controlling for age and reservation residence. Orthogonal cultural identification status (categorized as high White/high AI, high White/low AI, low White/high AI, or low White/low AI) did not predict smoker status when controlling for age and reservation residence. OCIS item analysis revealed that positive responses to the individual OCIS items 'My family lives by the American Indian way of life,' 'I live by the American Indian way of life,' and 'I am a success in the American Indian way of life' predicted smoker status when controlling for age and reservation residence. Conclusions. Our data suggest that, among some groups of urban AIs, recreational smoking is associated with AI cultural identification.

Beauvais F; Jumper-Thurman P; Burnside M. The changing patterns of drug use among American Indian students over the past thirty years. American Indian and Alaska Native Mental Health Research 15(2): 15-24, 2008. (13 refs.)

Drug use among American Indian (Al) youth continues at higher levels than those found among other youth. While the rates are higher, the patterns of increases and decreases over the past 30-year period have been similar, indicating that AI youth are part of the larger adolescent culture. There is a set of secular influences that affect the rates of drug use in both groups in the same manner. The major implication of these findings is that effective interventions in non-Al groups may also be effective among AI adolescents. Intervention activities, however, must be adapted to be culturally congruent. Despite rising concern over methamphetamine use on reservations, the data presented here indicate that, with the exception of two points in time, the rates have not increased substantially for AI youth who remain in school. School dropouts and young adults/adults may be more vulnerable to the abuse of methamphetamines and the rates of use may be higher in these groups.

Beebe LA; Vesely SK; Oman RF; Tolma E; Aspy CB; Rodine S. Protective assets for non-use of alcohol, tobacco and other drugs among urban American Indian youth in Oklahoma. Maternal and Child Health Journal 12(Supplement 1): S82-S90, 2008. (34 refs.)

Objective This study explored associations between nine youth assets and tobacco, alcohol and other drug non-use among participating American Indian adolescents. Methods Data from 134 American Indians, ages 13-19 years, participating in an inner-city youth asset study, were analyzed. Individual logistic regression analyses were conducted, controlling for demographic variables, with nine youth assets as the independent variables and alcohol, tobacco and other drug non-use as the dependent variables. Results: Among American Indian youth, nearly 79% reported not using alcohol in the past 30 days. The prevalence of tobacco non-use was somewhat lower than that of alcohol, with 71% reporting not using tobacco in the past 30 days. For other drug non-use, 87% reported not using other drugs in the past 30 days. The non-parental adult role models asset was significantly associated with non-use of alcohol (OR = 4.4, 95% CI 1.5-13.3), tobacco (OR = 7.5, 95% CI 2.2-25.6), and other drugs (OR = 5.0, 95% CI 1.5-16.8). The use of time (religion) asset was also significantly associated with alcohol non-use (OR = 2.8, 95% CI 1.1-7.2). The family communication asset was associated only with other drug non-use (OR = 3.1, 95% CI 1.02-9.4). For tobacco non-use, an interaction was observed between family structure and the good health practices (exercise/nutrition) asset. Among youth in single-parent households, the odds of tobacco nonuse were 4.4 times greater among those who possessed the good health practices (exercise/nutrition) asset. Conclusions Despite the relatively small sample size of American Indian youth, these results suggest an important role for specific youth assets in the prevention of substance abuse among American Indian youth.

Carter TL; Morse KL; Giraud DW; Driskell JA. Few differences in diet and health behaviors and perceptions were observed in adult urban Native American Indians by tribal association, gender, and age grouping. (editorial). Nutrition Research 28(12): 834-841, 2008. (45 refs.)

Diet and health behaviors and perceptions of adult urban Native American Indians in a large Midwestern city were evaluated for differences by tribal association, gender, and age grouping. The hypothesis was that human behavior is influenced by tribal association, gender, and age grouping in the subject population. The subjects included 33 men and 32 women, with 26 being Sioux; 22 Omaha; and 17 a combination of other tribes. The descriptive survey included two interviewer-administered 24-hour recalls. The majority of subjects were overweight or obese. Significant differences (P < .05) were observed in vitamin A and calcium intakes by tribal association. Men reported consuming significantly more (P < .05) kilocalories, vitamin C, and sodium. Over half the subjects consumed more than the recommended 20% to 35% kcal from fat, >= 10% kcal from saturated fat, and >= 300 mg cholesterol/d. Less than Estimated Average Requirements for vitamin A, vitamin C, and iron were consumed by 31%, 59%, and 6%, respectively; 79% consumed less than Adequate Intakes for calcium. Ninety-two percent consumed more than the Tolerable Upper Intake Level for sodium. Few differences were observed in the kilocalorie, vitamin A, vitamin C, calcium, and sodium intakes of these Native American Indians by tribal association, gender, or age grouping. Significant differences in percentages consuming alcohol were observed by gender (P < .05) and by age grouping (P <. 01). A significant difference (P < .01) was observed by gender regarding the subjects' perceptions of their being alcoholics. Overall, few differences were observed in diet and health behaviors and perceptions of adult urban Native American Indians by tribal association, gender, and age grouping.

Chong J; Lopez D. Predictors of relapse for American Indian women after substance abuse treatment. American Indian and Alaska Native Mental Health Research 14(3): 24-48, 2008. (58 refs.)

The objective of this study was to describe the predictors of substance use relapse of American Indian (AI) women up to one year following substance abuse treatment. Relapse is defined as any use of alcohol or drugs in the past 30 days at the follow-up points. Data were collected from AI women in a 45-day residential substance abuse treatment program. Predictors include distal (in time) proximal (recent), and intrapersonal factors. Results indicated that intrapersonal factors showed the strongest relationship with relapse, followed by proximal and distal factors. Negative messages about using alcohol or drugs from the client's father while growing up may have had an impact on whether the client used alcohol at 6 months. Conflicts with other people and being in the company of alcohol or drug users were highly predictive of relapse. While craving was highly predictive of substance use at follow up, self-efficacy was highly predictive of no substance use. Knowledge about predictors of relapse among this population should be used as a guide toward individual treatment planning.

Clarimon J; Gray RR; Williams LN; Enoch MA; Robin RW; Albaugh B; Singleton A et al. Linkage disequilibrium and association analysis of alpha-synuclein and alcohol and drug dependence in two American Indian populations. Alcoholism: Clinical and Experimental Research 31(4): 546-554, 2007. (43 refs.)

Background: alpha-Synuclein is involved in dopaminergic neurotransmission and has been implicated in a number of neurodegenerative disorders, such as Parkinson's disease. Recent studies, in humans and in rat and monkey models, have suggested that alpha-synuclein may play a role in the development and maintenance of certain addictive disorders. Methods: Fifteen single-nucleotide polymorphisms (SNPs) in the alpha-synuclein gene (SNCA) and 1 upstream microsatellite repeat (NACP-REP1) were assayed in Southwest (SW; n=514) and Plains (n=420) American Indian populations. Patterns of linkage disequilibrium (LD) at SNCA were determined for the 2 populations and compared with Caucasian, African, and Asian populations in the HapMap database (http: www.hapmap.org). Assayed alleles and constructed haplotypes in the study populations were tested for association with 4 clinical phenotypes [alcohol dependence, alcohol use disorders, drug dependence, and drug use disorders (lifetime diagnoses)] as well as with 2 symptom count phenotypes (all 18 questions and the 8 questions diagnostic for alcohol dependence). Results: Patterns of LD at SNCA were similar in both Indian populations and were consistent with the LD structure in other populations as reflected in the HapMap database. Single allele tests revealed significant associations between 4 SNPs and drug dependence in the SW population and between 2 of those SNPs plus 2 other SNPs and drug dependence in SW males only. In the Plains population, a significant association was detected only in males between 2 SNPs and alcohol use disorders and between 1 SNP and alcohol dependence. In the SW population, 1 SNP was marginally significant with the total symptom count. However, in all cases, the support was modest and disappeared with correction for multiple comparisons. No association was found between constructed haplotypes and any of the phenotypes in either population. Conclusions: Despite modest support for association between multiple SNCA SNPs and several of the addictive disorders tested in this study, statistical significance disappeared after correction for multiple testing. Thus, our data do not support a role for a variant in the SNCA gene that contributes to alcohol or drug addiction in the 2 studied American Indian populations. Future research may focus on variants in the promoter region that could cause the changes in mRNA and protein levels observed in previous studies.

Coyhis D; Simonelli R. The Native American healing experience. Substance Use & Misuse 43(12-13): 1927-1949, 2008. (35 refs.)

Recovery from addiction to alcohol and other drugs is taking place with the assistance of culture-specific methods in American Indian and Alaska Native communities in North America. These communities utilize many of the recovery approaches that make up today's best practices, but they also use their own cultural and ethnic strengths as an important part of their addictions recovery. The Wellbriety Movement among Native people is one such expression of culture-specific healing for North Americans having the heritage of indigenous peoples. The rallying call, Our culture is prevention, expresses an approach unique in addictions recovery processes anywhere.

Criado JR; Ehlers CL. Electrophysiological responses to affective stimuli in southwest California Indians: Relationship to alcohol dependence. Journal of Studies on Alcohol and Drugs 68(6): 813-823, 2007. (97 refs.)

Objective: Native Americans have some of the highest rates of alcohol abuse and dependence, yet potential risk factors associated with the problem drinking seen in some tribes remain relatively unknown. The present investigation evaluated associations between the P350 and P450 components of the event-related potential (ERP) elicited by affective stimuli and potential vulnerability factors associated with risk of alcohol dependence in Southwest California (SWC) Indian adults. Method: Data from 517 Native American SWC Indian adults between the ages of 18 and 70 were used in the analyses. ERPs were collected using a task that required discrimination among faces with neutral, sad, and happy facial expressions. Results: P450 amplitudes were significantly reduced in participants who met lifetime Diagnostic and Statistical Manual of Mental Disorders, Third Edition, Revised, criteria for alcohol dependence in centroparietal leads. In contrast, participants who met personal lifetime criteria for affective disorder were found to have higher P350 and P450 amplitudes in frontal leads. Neither P350 nor P450 component amplitudes were significantly altered based on a family history of alcohol dependence, a personal history of antisocial personality disorder/conduct disorder, or the presence of drug dependence other than alcohol. Conclusions: These findings suggest, in this select population, that P450 amplitudes are selectively affected by both alcohol dependence and affective disorder. However, reductions in P450 amplitude were restricted to those participants with alcohol dependence, confirming that it may be an important putative endophenotype for genetic studies of that disorder in this high-risk population.

Dickerson DL; O'Malley SS; Canive J; Thuras P; Westermeyer J. Nicotine dependence and psychiatric and substance use comorbidities in a sample of American Indian male veterans. Drug and Alcohol Dependence 99(1-3): 169-175, 2009. (30 refs.)

Background: American Indians and Alaska Natives have the highest rates of nicotine dependence in the U.S. However, studies analyzing associations between nicotine dependence and psychiatric and substance use disorders in these groups have been limited. Methods: This study analyzes the co-occurrence current and lifetime DSM-III-R nicotine dependence with psychiatric and substance use disorders ill a Community sample of 490 American Indian male veterans. Results: Lifetime nicotine dependence (23.3%) was associated with all lifetime disorders studied, including alcohol use and drug use disorders, and anxiety disorders, PTSD, pathological gambling and antisocial personality disorder. Current nicotine dependence was present in 19% affective, of the sample and significantly associated with current affective aid gambling disorder. Conclusions: Substantial co-morbidity exists between nicotine dependence and other Substance abuse and psychiatric disorders among this sample of American Indian male veterans, particularly for lifetime diagnoses. Screening for all psychiatric disorders among American Indian/Alaska Native smokers may be warranted. Although these results are similar to those observed among the general U.S. population, unique risk factors exist among American Indians/Alaska Natives which may require further attention. Specific public health and clinical interventions to reduce the rate of nicotine dependence among American Indians/Alaska Natives are recommended.

Duran B; Oetzel J; Parker T; Malcoe LH; Lucero J; Jiang YZ. Intimate partner violence and alcohol, drug, and mental disorders among American Indian women from southwest tribes in primary care. American Indian And Alaska Native Mental Health Research 16(2): 11-27, 2009. (57 refs.)

The relationship of intimate partner violence (IPV) with mental disorders was investigated among 234 American Indian/Alaska Native female primary care patients. Results indicated that unadjusted prevalence ratios for severe physical or sexual abuse (relative to no IPV) were significant for anxiety, PTSD, mood, and any mental disorder. Adjusted prevalence ratios showed severe physical or sexual IPV to be associated with any mood disorder. Patterns of IPV and mental health have implications for detection and service utilization.

Duran BG; Wallerstein N; Miller WR. New approaches to alcohol interventions among American Indian and Latino communities: The experience of the Southwest Addictions Research Group. Alcoholism Treatment Quarterly 25(4): 1-10, 2007

This introduction presents a bi-directional approach to developing alcohol interventions for American Indians, Latinos, and rural populations, which recognizes the need to translate knowledge from evidence-based practice to diverse minority communities, as well as to learn from the healing knowledge that emerges from the communities themselves. The overarching paradigm of Community Based Participatory Research is presented which emphasizes addressing health disparities through partnering with communities and building on their strengths. The articles in this volume are an outgrowth of the Southwest Addictions Research Group (SARG), which was founded to promote interventions with these populations through supporting the career development of investigators of color. Articles discuss investigator-piloted interventions and other cultural dimensions which support effective behavioral and preventive services for diverse populations.

Ehlers CL. Variations in ADH and ALDH in southwest California Indians. Alcohol Research & Health 30(1): 14-17, 2007. (17 refs.)

Native Americans as a group have the highest rates of alcohol-related deaths of all ethnicities in the United States, however, it remains unclear how and why a greater proportion of individuals in some Native American communities develop alcohol-related problems and alcohol use disorders (AUDs). One potential factor that can influence responses to alcohol are variations in alcohol-metabolizing enzymes. Researchers have analyzed the frequencies of variants in the alcohol-metabolizing enzymes alcohol dehydrogenase (ADH) and aldehyde dehydrogenase (ALDH) in some Native American populations. So far the studies have yielded no evidence that an ALDH2 variant, which has shown protective effects in other populations, is found in either American Indians or Alaska Natives. A variant of the ALDH1 enzyme that is encoded by the ALDH1A1 *2 allele, however, was found in a small proportion of a group of Southwest California Indians and had a protective effect against alcoholism in that population. Furthermore, a variant of the ADH1B enzyme that is encoded by the ADH1B *3 allele was found in a similar proportion of Southwest California Indians and also was associated with a protective effect. However, these findings do not explain the high prevalence of alcoholism in the tribes investigated.

Public Domain

Ehlers CL; Gilder DA; Gizer IR; Wilhelmsen KC. Heritability and a genome-wide linkage analysis of a Type II/B cluster construct for cannabis dependence in an American Indian community. Addiction Biology 14(3): 338-348, 2009. (85 refs.)

Subtyping of substance dependence disorders holds promise for a number of important research areas including phenotyping for genetic studies. characterizing clinical course, and matching treatment and prevention strategies. This study sought to investigate whether a dichotomous construct similar to Babor's Types A/B and Cloninger's Types I/II for alcohol dependence can be identified for cannabis dependence in a Native American sample. In addition, heritability of this construct and its behavior in a genetic linkage analyses were evaluated. Information on cannabis use and dependence symptoms and other psychiatric disorders was obtained using the Semi-Structured Assessment for the Genetics of Alcoholism from a community sample of 606 American Indians. Hierarchical average linkage and K means cluster analysis was used, and a three-cluster solution was found to generate the best separation of variables. Ninety-one per cent of cannabis-dependent participants fell into one of the two subtypes: Type A/I cluster (n = 114, 56%) and Type B/II cluster (n = 70, 35%). Heritability (estimated using Sequential Oligogenic Linkage Analysis Routines) was only significant for the Type B/II cluster (h(2) = 0.44, SE = 0.18. P < 0.01). Evidence for linkage was found for the Type B/II cluster (versus no diagnosis) on chromosome 1.6 [at 139 centimorgans (cM), Log of the Odds (LOD) score = 4.4], and on chromosome 19 (at 74 cM. LOD score = 6.4). Regions of interest for this phenotype (LOD > 1.5) were also located on chromosomes 14, 21, 22. These findings suggest that a Type B/II cannabis dependence phenotype can be identified in this population and that it is in part heritable and linked to areas of the genome identified previously for drug dependence phenotypes in this population as well as in other studies.

Ehlers CL; Gilder DA; Phillips E. P3 components of the event-related potential and marijuana dependence in Southwest California Indians. (review). Addiction Biology 13(1): 130-142, 2008. (111 refs.)

Native Americans have some of the highest rates of marijuana use and abuse, yet neurobiological measures associated with addiction to marijuana in this population remain unknown. The present investigation evaluated associations between the P350 and P450 components of the event-related potential (ERP) elicited by affective stimuli, and marijuana dependence in a population of Southwest California (SWC) Indian adults. Three hundred and seventeen participants with a mean age of 30 years who were free of major Axis I and psychiatric diagnoses and antisocial personality disorder were categorized as: (1) no marijuana use disorders or other drug dependence diagnoses; (2) marijuana dependence and no other drug dependence diagnoses; and (3) marijuana dependence and other drug dependence diagnoses. ERPs were collected using a facial discrimination task that generated a late positive component with two peaks at approximately P350 and P450 milliseconds. Multivariate analyses of variance was used to detect associations between the two component peaks and the three participant groups taking into consideration age, gender and the presence of a lifetime diagnosis of alcohol dependence. Increases in the latency of both the P350 and P450 component peaks were found to be associated with the diagnosis of marijuana dependence and marijuana dependence co-morbid with other drug dependence. Women appeared to be more impacted than men are. A diagnosis of marijuana dependence was not associated with any changes in late component amplitudes. Taken together these studies suggest that marijuana dependence may be associated with delays in the evaluation and identification of emotional stimuli in SWC Indians.

Ehlers CL; Gilder DA; Slutske WS; Lind PA; Wilhelmsen KC. Externalizing disorders in American Indians: Comorbidity and a genome wide linkage analysis. American Journal of Medical Genetics. Part B: Neuropsychiatric Genetics 147B(6): 690-698, 2008. (98 refs.)

Alcohol dependence is one of the leading causes of morbidity and mortality in Native Americans. Externalizing disorders such as conduct disorder (CD) and antisocial personality disorder (ASPD) have been demonstrated to have significant comorbidity with alcohol dependence in the general population. This study's aims were to: assess the comorbidity of DSM-III-R ASPD and CD with alcohol dependence, to map susceptibility loci for ASPD and CD, and to see if there is overlap with loci previously mapped for alcohol dependence phenotypes in 587 American Indians. Alcohol dependence was found to be comorbid with DSM-III-R ASPD but not CD. However, the amount of alcohol dependence in the population attributable to ASPD and/or CD is low. ASPD and the combined phenotype of participants with ASPD or CD were both found to have significant heritability, whereas no significant evidence was found for CD alone. Genotypes were determined for a panel of 791 micro-satellite polymorphisms in 251 of the participants. Analyses of multipoint variance component LOD scores, for ASPD and ASPD/CD, revealed six locations that had a LOD score of 2.0 or above: on chromosome 13 for ASPD and on chromosomes 1, 3,4,14,17, and 20 for ASPD/CD. These results corroborate the importance of several chromosomal regions highlighted in prior segregation studies for externalizing diagnoses. These results also further identify new regions of the genome, that do not overlap with alcohol dependence phenotypes previously identified in this population, that may be unique to either the phenotypes evaluated or this population of American Indians

Ehlers CL; Slutske WS; Gilder DA; Lau P. Age of first marijuana use and the occurrence of marijuana use disorders in Southwest California Indians. Pharmacology, Biochemistry and Behavior 86(2): 290-296, 2007. (82 refs.)

in several national surveys a younger age of substance usage has been associated with a higher likelihood of the development of dependence. Some studies have suggested that age at first use is primarily an environmentally driven variable, whereas others suggest that it may be partially mediated by a general vulnerability to exhibit problem behaviors. Although Native Americans, overall, have the highest prevalence of substance dependence of any US ethnic group, the relationship of age of first marijuana use on the development of dependence in Native American populations is relatively unknown. Demographic information and DSM-III-R diagnoses were obtained from 525 Southwest California Indian adults residing on contiguous reservations. Multinomial logistic regression was used to investigate the relationship between age of first use and marijuana use disorders. Early marijuana use was found to be strongly associated with abuse and dependence in this population, even in the presence of several other risk factors including externalizing diagnoses. These data suggest that effective environmental prevention efforts at reducing early marijuana use may be an important strategy to lower the prevalence of use disorders in this high risk population.

Ehlers CL; Wall TL; Corey L; Lau P; Gilder DA; Wilhelmsen K. Heritability of illicit drug use and transition to dependence in Southwest California Indians. Psychiatric Genetics 17(3): 171-176, 2007. (56 refs.)

Objective: Native Americans have high rates of drug use and dependence yet little is known concerning its etiology or clinical course. These analyses were conducted to describe the heritability of the use of a variety of illicit drugs, as well as the conditional probability of transitioning from use to dependence for each drug class in a community sample of Native American men and women. Methods: The sample included 460 participants (1190 men and 270 women), recruited through community effort, from eight contiguous Indian reservations in Southern California. Participants were assessed using the Semi-Structured Assessment for the Genetics of Alcoholism. The Semi-Structured Assessment for the Genetics of Alcoholism interview retrospectively asks about the initial use and drug dependence of the following illicit drug classes: marijuana, cocaine, stimulants, sedatives, opiates, hallucinogens, and solvents. Heritability of initial use was determined using SOLAR (http: www.sfbr.orglsolarl). Results: Ninety-one percent of this select Indian population had tried at least one of the illicit drug classes. The most commonly tried substance was marijuana (88%), followed by stimulants (60%), cocaine (44%), hallucinogens (34%), and solvents (20%). The heritability of initiation of drug use ranged from 0.14 for cocaine to 0.59 for marijuana. The conditional probability of transition from initiation to drug dependence ranged from 0.66 for stimulants to 0.06 for hallucinogens. Conclusions: These findings suggest that heritability of the initiation of substance use, in Southwest California Indians, may be similar to other population samples. In this population, however, high rates of dependence on marijuana, opiates, and stimulants are seen once initiation of the use of the substance has occurred.

Ehlers CL; Wilhelmsen KC. Genomic screen for substance dependence and body mass index in southwest California Indians. Genes, Brain and Behavior 6(2): 184-191, 2007. (69 refs.)

Substance abuse and obesity are health disparities that may afflict Native Americans more than some other ethnic groups. One theoretical assumption concerning Native people is that the long history of dependence on foraging and subsistence agriculture may have led to selective enrichment of traits that improve genetic fitness, so called 'thrifty' or 'fat sparing' genes. We have speculated that this same selective pressure may have enriched for genetic variants that increase the risk for consumption of alcohol and drugs of abuse. Here, we report the results of a genome scan that compared findings for two consumption phenotypes: 'any drug dependence and/or regular tobacco use' and body mass index (BMI) in southwest California (SWC) Indian families. Variance component analyses from SOLAR were used to generate log of the odds ratio (LOD) scores. Evidence for linkage was found on chromosome 6 for both the 'any drug' (LOD score = 3.3) and BMI (LOD score = 2.3) phenotypes. Bivariate analyses of the two phenotypes revealed a combined LOD score of 4.1 at that location. Additional loci on chromosomes 6, 15, 16 and 21 were found for the 'any drug' phenotype, and on chromosomes 8, 16 and 18 for BMI (LOD scores ranged between 1.2 and 2.3). These results provide suggestive evidence for linkage for substance abuse and BMI in this Mission Indian population and, furthermore, provide preliminary data suggesting that 'consumption phenotypes' may share some genetic determinants.

Fagan P; Moolchan ET; Lawrence D; Fernander A; Ponder PK. Identifying health disparities across the tobacco continuum. (review). Addiction 102(Supplement 2): 5-29, 2007. (179 refs.)

Aims: Few frameworks have addressed work-force diversity, inequities and inequalities as part of a comprehensive approach to eliminating tobacco-related health disparities. This paper summarizes the literature and describes the known disparities that exist along the tobacco disease continuum for minority racial and ethnic groups, those living in poverty, those with low education and blue-collar and service workers. The paper also discusses how work-force diversity, inequities in research practice and knowledge allocation and inequalities in access to and quality of health care are fundamental to addressing disparities in health. Methods: We examined the available scientific literature and existing public health reports to identify disparities across the tobacco disease continuum by minority racial/ethnic group, poverty status, education level and occupation. Findings: Results indicate that differences in risk indicators along the tobacco disease continuum do not explain fully tobacco-related cancer consequences among some minority racial/ethnic groups, particularly among the aggregate groups, blacks/African Americans and American Indians/Alaska Natives. The lack of within-race/ethnic group data and its interactions with socio-economic factors across the life-span contribute to the inconsistency we observe in the disease causal paradigm. Conclusions: More comprehensive models are needed to understand the relationships among disparities, social context, diversity, inequalities and inequities. A systematic approach will also help researchers, practitioners, advocates and policy makers determine critical points for interventions, the types of studies and programs needed and integrative approaches needed to eliminate tobacco-related disparities.

Falk D; Yi HY; Hiller-Sturmhofel S. An epidemiologic analysis of co-occurring alcohol and drug, use and disorders. Alcohol Research & Health 31(2): 100-110, 2008. (22 refs.)

The 2001-2002 National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) sought to determine the prevalence of alcohol use and alcohol use disorders (AUDs), other drug use and drug use disorders (DUDs), and co-use and co-morbidity in the general adult U.S. population. Findings indicate that 5.6 percent of U.S. adults used both alcohol and drugs in the past year and that 1.1 percent had a co-morbid AUD and DUD. Alcohol use prevalence peaked between the ages of 25 and 44 and declined thereafter. The prevalence of other drug use, co-use, AUDs, DUDs, and co-morbid disorders was highest between the ages of 18 and 24 and declined steadily thereafter. Women and men showed similar trends for alcohol use, drug use, and co-use. Among ethnic/racial groups evaluated, Whites displayed the highest rates of alcohol use and American Indians/Alaskan Natives the highest rates of drug use. For AUDs, DUDs, and co-morbid disorders, rates were highest among American Indians/Alaskan Natives. The prevalence of drug use, weekly drug use, and DUDs increased with increasing levels of alcohol consumption and the presence of AUDs. The proportion of people with AUDs who had a co-morbid DUD varied considerably by drug type. These findings have important implications for the development of prevention and intervention approaches.

Public Domain

Forster JL; Brokenleg I; Rhodes KL; Lamont GR; Poupart J. Cigarette smoking among American Indian youth in Minneapolis-St. Paul. American Journal of Preventive Medicine 35(6, Supplement): S449-S456, 2008. (33 refs.)

Background: Reported prevalence of cigarette smoking among American Indian youth is higher than other racial/ethnic minorities, and limited data indicate that this disparity is especially pronounced in the Upper Midwest of the U.S. The purposes of this study are to measure traditional and recreational tobacco use among American Indian youth in an urban Upper Midwest area, and to identify social and environmental factors associated with recreational tobacco use (cigarette smoking). Methods: A cross-sectional convenience sample of 336 American Indian youth aged 11-18 years was given a self-administered survey. Data were analyzed using bivariate chi-square tests and multivariate logistical stepwise regression. Results: Almost 37% reported some recreational smoking in the previous 30 days, with about three times as many in the group aged 16-18 years reporting smoking as in the group aged 11-13 years (p<0.0001). Social exposure to cigarette smoking was very strong; more than three fourths reported living with an adult who smokes, and 44% have a brother/a sister who smokes. Yet more than 65% report a household rule against their smoking, and 43% report a household rule against anyone smoking inside. Youth who smoke report buying cigarettes often and smoking on school property. Household rules against smoking and hearing of someone getting caught smoking at school have an independent negative association with likelihood of being a smoker. Conclusions: These results indicate that American Indian youth in this area report high use of recreational tobacco, and the statewide focus on youth smoking prevention has not eliminated the disparity in smoking levels between American Indian youth and Minnesota youth overall. These findings suggest several pathways to reduce cigarette smoking among urban American Indian youth.

Galliher RV; Evans CM; Weiser D. Social and individual predictors of substance use for Native American youth. Journal of Child & Adolescent Substance Abuse 16(3): 1-16, 2007. (29 refs.)

Substance abuse is a primary concern for youth worldwide and increasingly so for Native American Youth. Guided by theoretical models of the socialization of substance use in children and adolescents, we conducted a preliminary examination of socialization factors specific to Native American Youth. Strong, pro-social bonds with three primary socialization sources (family, school, and peer networks) were hypothesized to facilitate child self-efficacy and refusal skills and predict drug use. Participants were 84 Native American children between the ages of 9 and 11, living on or near a northern reservation. Structural path analysis results Indicated that self-efficacy was predicted from school bonding and peer social skills, while refusal skills were predicted from parent support/involvement and school bonding. Both self-efficacy and refusal skills predicted child drug use/experimentation. This preliminary study expands the limited research available for substance abuse prevention projects specific to rural, reservation-based Native American communities.

Gilder DA; Lau P; Corey L; Ehlers CL. Factors associated with remission from cannabis dependence in Southwest California Indians. Journal of Addictive Diseases 26(4): 23-30, 2007. (41 refs.)

Cannabis is the most widely used illicit substance in the United States, and rates of cannabis use disorders in some Native American samples have been reported to be higher than in the general U.S. Population. However, little is known about factors which are associated with remission from cannabis dependence in any ethnicity. Using the SSAGA, this study examined variables associated with complete remission (defined as no symptoms of dependence for 6 months or more) from DSM-III-R cannabis dependence in 159 Southwest California Indians living on contiguous reservations. Female gender, employment, having, more cannabis-induced symptoms, and a shorter duration of dependence were all associated with an increased likelihood of remission. Attention to factors associated with remission from cannabis dependence may be important in designing more effective treatment and intervention programs in this high-risk population.

Gilder DA; Lau P; Corey L; Ehlers CL. Factors associated with remission from alcohol dependence in an American Indian community group. American Journal of Psychiatry 165(9): 1172-1178, 2008. (40 refs.)

Objective: This study identified factors associated with remission from DSM-III-R alcohol dependence in an American Indian community group. Method: Participants were assessed by using the Semi-Structured Assessment for the Genetics of Alcoholism. Results: Five hundred eighty participants were assessed for alcohol use and alcohol use symptoms; 254 participants were found to have alcohol dependence. The rate of remission in this group was 59%. Thirty-four percent of remitters and 39% of nonremitters had received treatment for alcohol problems. Remission from alcohol dependence was associated with being female, older, and married; an earlier age of onset of alcohol dependence; and self-reported depression symptoms from drinking. Absence of remission was associated with continuing to drink despite knowing one had medical problems from drinking and self-reported anxiety symptoms from drinking. Conclusions: Attention to factors associated with remission from alcohol dependence may be important in designing more effective treatment and prevention programs in this high-risk population.

Gilligan C; Sanson-Fisher R; Eades S; D'Este C. Antenatal smoking in vulnerable population groups: An area of need. Journal of Obstetrics and Gynaecology 27(7): 664-671, 2007. (49 refs.)

Antenatal smoking is a potentially preventable risk factor associated with pre-term birth and low birth weight. Rates of antenatal smoking, low birth weight, and infant mortality are all higher among the Indigenous populations than the non-Indigenous populations of Australia, Canada, New Zealand and the USA. Given this, it might be expected that publications examining smoking cessation efforts in Indigenous antenatal groups would be substantive. We examined the differences in the number and type of antenatal smoking publications for Indigenous and non-Indigenous populations across three time periods (1984-86, 1994-96 and 2004-06). Articles were classified as research studies (focusing on measurement, descriptive, or intervention studies), literature reviews, descriptions of programmes or research (with no data), or discussions. There was a significant increase in the number of publications relating to antenatal smoking among Indigenous populations in the time periods examined, but the total number of publications remained small. The number relating to general antenatal populations increased, but remained substantially lower than that relating to low birth weight. There was no increase in the proportional allocation of research articles to the intervention category in the later time period. The pattern of research output relating to antenatal smoking by mainstream or Indigenous populations is not optimal for advancement of knowledge in the field. There is a clear need for intervention-based research to allow the development of evidence-based practice for reducing the prevalence of antenatal smoking and associated health issues.

Gonzales AA; Lyson TA; Mauer KW. What does a casino mean to a tribe? Assessing the impact of casino development on Indian reservations in Arizona and New Mexico. Social Science Journal 44(3): 405-419, 2007. (14 refs.)

Using data from the 1990 and 2000 U.S. Census of Population and Housing, we examine five social and economic characteristics of individuals and households living on reservations in Arizona and New Mexico that have a casino to those that do not. This research differs in two ways from previous studies that have attempted to assess the social and economic impacts of Indian gaming. First, the unit of observation and analysis is the reservation, not a tribe. A focus on reservations allows us to assess the role casinos play in "place-based" economic development. Second, since reservations and tribes are not coterminous, we seek to differentiate the effects of casinos on the Indian population living on reservations from the effects for all reservation residents (Indians and others). The results show that casino gambling is associated with improvements in social and economic welfare for both the Indian and non-Indian populations alike. However, Indian gaming did not contribute to positive outcomes in all cases. Indeed, the effects of gaming are filtered through a myriad of structural and cultural contexts that shape who wins and who loses when a casino opens on a reservation. The implications of Indian gaming for economic development are discussed.

Horn K; McCracken L; Dino G; Brayboy M. Applying community-based participatory research principles to the development of a smoking-cessation program for American Indian teens: "Telling our story". Health Education & Behavior 35(1): 44-69, 2008. (50 refs.)

Community-based participatory research provides communities and researchers with opportunities to develop interventions that are effective as well as acceptable and culturally competent. The present project responds to the voices of the North Carolina American Indian (AI) community and the desire for their youth to recognize tobacco addiction and commercial cigarette smoking as debilitating to their health and future. Seven community-based participatory principles led to the AI adaptation of the Not On Tobacco teen-smoking-cessation program and fostered sound research and meaningful result s among an historically exploited population. Success was attributed to values-driven, community-based principles that (a) assured recognition of a community-driven need, (b) built on strengths of the tribes, (c) nurtured partnerships in all project phases, (d) integrated the community's cultural knowledge, (e) produced mutually beneficial tools/products, (f) built capacity through co-learning and empowerment, (g) used an iterative process of development, and (h) shared findings /knowledge with all partners.

Horn K; Noerachmanto N; Dino G; Manzo K; Brayboy M. Who wants to quit? Characteristics of American Indian youth who seek smoking cessation intervention. Journal of Community Health 34(2): 153-163, 2009. (41 refs.)

No group is more at-risk for tobacco-related health disparities than are American Indian youth. Little is known about their readiness to quit smoking and the extent to which cessation programs may require cultural tailoring related to recruitment, implementation, or content. This study identifies unique characteristics of American Indian teen smokers who enrolled in a school-based smoking cessation program, Not On Tobacco (called N-O-T). Using data from N-O-T intervention trials conducted in North Carolina between 2001 and 2004, the present study (a) describes the characteristics of American Indian participants (n = 91); (b) determines if basic demographics and smoking history affect intervention readiness; and (c) compares findings with non-Native participants (n = 138) enrolled in N-O-T within the same state. Upon enrollment, 80% of the sample reported that they planned to quit smoking in the next 1-6 months. We found significant differences between American Indian and non-Native youth on smoking history, with non-Natives smoking with greater intensity and frequency. Contrary to previous reports, American Indian youth in this study smoked with less intensity and were more ready to quit smoking than non-Native youth. Results reveal previously unreported characteristics of American Indian teen smokers. Study findings may advance the development of effective marketing, recruitment, and programming among American Indian teen smokers into cessation programs, particularly N-O-T, which is the only teen smoking cessation program which includes an adaptation specifically for American Indians.

Johnson JL; Gryczynski J; Wiechelt SA. HIV/AIDS, substance abuse, and hepatitis prevention needs of Native Americans living in Baltimore: In their own words. AIDS Education and Prevention 19(6): 531-544, 2007. (22 refs.)

A needs assessment funded by the Center of Substance Abuse Prevention was conducted in 2005-2006 to determine the HIV/AIDS, substance abuse, and hepatitis prevention needs of Native Americans living in Baltimore, Maryland. We used a community-based participatory approach to gain an in-depth understanding of local Native American health service needs. Community stakeholders and key informants embedded in the local Native American population were consulted at each stage of the research planning process. Two complementary methodologies (focus groups and surveys) produced a holistic assessment of the population's needs, risks, and strengths and uncovered the social and cultural contexts in which health risk behaviors unfold. The use of these methods within a participatory framework produced a more complete portrait of the service needs of the Native American population in Baltimore. Findings from this study support the necessity for future HIV/AIDS, substance abuse, and hepatitis prevention programming for urban Native Americans.

Kunitz SJ. Risk factors for polydrug use in a Native American population. Substance Use & Misuse 43(3/4): 331-339, 2008. (13 refs.)

The Diagnostic Interview Schedule was used in 1993-1995 to collect information on the use of alcohol and other substances from 1,086 Navajo Indians living on or near their reservation in the southwestern United States. Bivariate and multivariate analyses are used to show that age of first alcohol use has declined over the past 50 years and is a significant risk factor for both alcohol dependence and polysubstance use. Limitations are noted.

Kvigne VL; Leonardson GR; Borzelleca J; Brock E; Neff-Smith M; Welty TK. Alcohol use, injuries, and prenatal visits during three successive pregnancies among American Indian women on the northern Plains who have children with fetal alcohol syndrome or incomplete fetal alcohol syndrome. Maternal and Child Health Journal 12(Supplement 1): S37-S45, 2008. (42 refs.)

Introduction: The purpose of the study was to compare three sequential pregnancies of American Indian women who have children with FAS or children with incomplete FAS with women who did not have children with FAS. Methods: Two retrospective case-control studies were conducted of Northern Plains American Indian children with fetal alcohol syndrome (FAS) (Study 1) or incomplete FAS (Study 2) in 1981 1993. Three successive pregnancies ending in live births of 43 case mothers who had children with FAS, and 35 case mothers who had children with incomplete FAS were compared to the pregnancies of 86 and 70 control mothers who did not have children with FAS, respectively, in the two studies. Prenatal records were abstracted for the index child (child with FAS or incomplete FAS) and siblings born just before and just after the index child, and comparable prenatal records for the controls. Results: Compared to the controls, significantly more case mothers used alcohol before and after all three pregnancies and during pregnancy with the before sibling and the index child. Mothers who had children with FAS reduced their alcohol use during the pregnancy following the birth of the index child. All Study 1 case mothers (100%) and 60% of Study 2 case mothers used alcohol during the pregnancy with the index child compared to 20 and 9% of respective control mothers. More study 1 case mothers experienced unintentional injuries (OR 9.50) and intentional injuries during the index pregnancy (OR 9.33) than the control mothers. Most case mothers began prenatal care in the second trimester. Conclusions: Alcohol use was documented before, during and after each of the three pregnancies. Women of child-bearing age should be screened for alcohol use whenever they present for medical services. Mothers who had a child with FAS decreased their alcohol consumption with the next pregnancy, a finding that supports the importance of prenatal screening throughout pregnancy. Women who receive medical care for injuries should be screened for alcohol use and referred for appropriate treatment. Protective custody, case management and treatment services need to be readily available for women who use alcohol.

Libby AM; Orton HD; Beals J; Buchwald D; Manson SM. Childhood abuse and later parenting outcomes in two American Indian tribes. Child Abuse & Neglect 32(2): 195-211, 2008. (53 refs.)

Objectives: To examine the relationship of childhood physical and sexual abuse with reported parenting satisfaction and parenting role impairment later in life among American Indians (AIs). Methods: AIs from Southwest and Northern Plains tribes who participated in a large-scale community-based study (n = 3,084) were asked about traumatic events and family history; those with children were asked questions about their parenting experiences. Regression models estimated the relationships between childhood abuse and parenting satisfaction or parenting role impairment, and tested for mediation by depression or substance use disorders. Results: Lifetime substance use disorder fully mediated the relationship between childhood physical abuse and both parenting satisfaction and parenting role impairment in the Northern Plains tribe. There was only partial mediation between childhood sexual abuse and parenting role impairment in the Southwest. In both tribes, lifetime depression did not meet the criteria for mediation of the relationship between childhood abuse and the two parenting outcomes. Instrumental and perceived social support significantly enhanced parenting satisfaction; negative social support reduced satisfaction and increased the likelihood of parenting role impairment. Exposure to parental violence while growing up had deleterious effects on parenting outcomes. Mothers and fathers did not differ significantly in the relation of childhood abuse experience and later parenting outcomes. Conclusions: Strong effects of social support and mediation of substance abuse disorders in the Northern Plains offer direct ways in which childhood victims of abuse could be helped to avoid negative attributes of parenting that could put their own children at risk. Practice implications: Mothers were not significantly different from fathers in the relation of abusive childhood experiences and later parenting outcomes, indicating both are candidates for interventions. Strong effects of social support offer avenues for interventions to parents. The prevalence of substance use disorders and their role as a mediator of two parenting outcomes in the Northern Plains should focus special attention on substance use treatment, especially among those who experienced childhood victimization. These factors offer direct ways in which childhood victims of abuse can be helped to avoid negative attributes of parenting that could put their own children at risk of violence.

Medicine B. Drinking and Sobriety among the Lakota Sioux. Walnut Creek, CA: Altamira Press, a division of Rowman & Littlefield Publishers, 2007

Where previous studies have focused primarily upon drinking styles among Indian populations, the author employing ethnographic research methods to analyze the nature of drinking and control of alcohol abuse. This study focuses upon the Lakota (Standing Rock in North and South Dakota). It examines patterns of alcohol consumption and strategies by individuals to attain a new life-style and achieve sobriety. The author also speaks to the importance of understanding specific cultural tradition. Numerous examples are provided of how Lakota men and women experience and culturally manage alcohol consumption, helping readers understand how certain undercurrents of Lakota life and culture support both alcoholism and sobriety. For example, in a culture packed with rewards for behaviors that are indicative of strong individualism, data is provided to describes how alcoholics use this value to maintain heavy drinking (on the one hand) and (on the other) to invoke it as part of their strategic determination to attain new and individual sobriety. The pattern is nearly full opposite to 12-step programs and others that call upon 'group' or 'community' sanction against alcoholism in order to 'cure' individual alcoholics. The work is organized into 8 chapters. The first chapter deals with the pervasive myth that "All Indians are drunks." Chapter two sets forth the origins of alcohol use among American Indians, followed by a chapter dealing with the more recent path and Minnewakan "magic water." Attention then turns to the Sioux social system, drinking behavior among contemporary Lakota (Sioux) Indians. The concluding chapters consider American Indian sobriety, religious renaissance and the control of alcohol, and the Lakota sun dance; and finally the patterns of sobriety among the Sioux.

Mitchell CM; Beals J; Whitesell NR; Voices Indian Teens & Pathways. Alcohol use among American Indian high school youths from adolescence and young adulthood: A latent Markov model. Journal of Studies on Alcohol and Drugs 69(5): 666-675, 2008. (53 refs.)

Objective: We explored patterns of alcohol use among American Indian youths as well as concurrent predictors and developmental outcomes 6 years later. Method: This study used six semi-annual waves of data collected across 3 years from 861 American Indian youths, ages 14-20 initially, from two western tribes. Using a latent Markov model, we examined patterns of change in latent states of adolescent alcohol use in the past 6 months, combining these states of alcohol use into three latent statuses that described patterns of change across the 3 years: abstainers, inconsistent drinkers, and consistent drinkers. We then explored how the latent statuses differed, both initially and in young adulthood (ages 20-26). Results: Both alcohol use and nonuse were quite stable across time, although we also found evidence of change. Despite some rather troubling drinking patterns as teens, especially among consistent drinkers, most of the youths had achieved important tasks of young adulthood. But patterns of use during adolescence were related to greater levels of substance use in young adulthood. Conclusions: Latent Markov modeling provided a useful categorization of alcohol use that more finely differentiated those youths who would otherwise have been considered inconsistent drinkers. Findings also suggest that broad-based interventions during adolescence may not be the most important ones; instead, programs targeting later alcohol and other drug use may be a more strategic use of often limited resources.

Morton DJ; Garrett M; Reid J; Wingard DL. Current smoking and type 2 diabetes among patients in selected Indian health service clinics, 1998-2003. American Journal of Public Health 983(3): 560-565, 2008. (37 refs.)

Objectives. In non-American Indian/Alaska Native groups, current smoking prevalence is similar for those with or without diabetes (26%) We analyzed current smoking prevalence in American Indian/Alaska Natives by diabetes status. Methods. Data were extracted from Indian Health Service clinic visit information from 1998 to 2003. After consolidation into unique patient records, the sample comprised 71221 patients aged 14 years or older with both diabetes and current smoking information. Results. Cross-sectional results indicated that diabetic American Indian/Alaska Natives were significantly more likely than those without diabetes to be current smokers (29.8% vs 18.8%; P<.01). Smoking rates were 2 to 3 times higher among diabetic American Indians and Alaska Natives for each age category (P<.001), and current smokers with diabetes were more likely than nonsmokers to have glycosylated hemoglobin A(1c) levels at 8.0% or higher (P<.05). Conclusions. American Indian/Alaska Natives with diabetes at all sites and age categories were found to smoke at significantly higher rates than those without diabetes. Smoking cessation programs should target diabetic patients to more effectively prevent complications and promote successful management of diabetes in American Indians/Alaska Natives.

O'Connell JM; Novins DK; Beals J; Whitesell N; Libby AM; Orton HD; AI-SUPERPFP Team. Childhood characteristics associated with stage of substance use of American Indians: Family background, traumatic experiences, and childhood behaviors. Addictive Behaviors 32(12): 3142-3152, 2007. (13 refs.)

The purpose of this analysis is to examine childhood characteristics associated with stage of substance use in adulthood in two American Indian (AI) populations. Data were drawn from an epidemiologic study of two AI reservation populations for persons age 18-44 years (n = 2070). We used descriptive and multivariate analysis to examine correlates of four mutually exclusive stages of substance use: lifetime abstinence (Stage 0), use of alcohol only (Stage 1A), use of marijuana/inhalants with or without alcohol (Stage 1B), and use of other illicit drugs with or without the previously listed substances (Stage 2). Problematic substance use by parents, younger age of first substance use, initiating substance use with a drug (with or without alcohol), and adolescent conduct problems were associated with higher stage substance use. Persons who experienced sexual abuse, witnessed family violence, or experienced other traumatic events before the age of 18 were more likely to be at Stage 1B than Stage 1A

Oetzel J; Duran B; Jiang YZ; Lucero J. Social support and social undermining as correlates for alcohol, drug, and mental disorders in American Indian women presenting for primary care at an Indian health service hospital. Journal of Health Communication 12(2): 187-206, 2007. (72 refs.)

The purpose of this study was to determine the relationship of two types of social support (emotional and instrumental) and two types of social undermining (critical appraisal and isolation) with five categories of alcohol, drug, or mental disorders (ADM; any mood, any anxiety, any substance abuse, any disorder, and two or more disorders) in 169 American Indian women presenting for primary care at an Indian Health Service facility. Social support and social undermining are often treated as opposite poles, but in fact they are distinct factors with independent effects. The findings illustrate that social support and undermining variables have a significant relationship with ADM outcomes even when controlling for confounding demographic variables. Any substance abuse was associated with all four social variables, while two or more disorders were associated with instrumental support and isolation. Any anxiety (isolation), any mood (critical appraisal), and any disorder (isolation) were each associated with one social variable. Overall, social undermining appears to have a stronger relationship with mental health than with social support.

Office of Applied Studies, Substance Abuse and Mental Health Services Administration. The NSDUH Report. Substance Use and Substance Use Disorders among American Indians and Alaska Natives. (January 19, 2007). Rockville MD: Substance Abuse and Mental Health Services Administration, 2007. (4 refs.)

Data from SAMHSA's 2002, 2003, 2004, and 2005 National Surveys on Drug Use and Health were combined to calculate annual averages in order to make reliable estimates comparing substance use and substance use disorders by American Indians and Alaska Natives with substance use and substance disorders by the overall group of persons from other racial backgrounds. Rates of past year use disorders were higher among American Indians and Alaska Natives than members of other racial groups for alcohol, illicit drug use, marijuana, cocaine, and hallucinogen use disorders. Although in the past year American Indians and Alaska Natives were less likely than persons of other racial backgrounds to have used alcohol (60.8% vs. 65.8%), they were more likely to have an alcohol use disorder (10.7% vs. 7.6%). For illicit drug use, however, in the past year, American Indians and Alaska Natives were more likely than persons of other racial backgrounds both to have used an illicit drug (18.4% vs. 14.6%) and to have an illicit drug use disorder (5.0% vs. 2.9%).

Public Domain

Office of Applied Studies, Substance Abuse and Mental Health Services Administration. The NSDUH Report. Illicit Drug Use by Race/Ethnicity in Metropolitan and Non-Metropolitan Counties: 2004 and 2005. (June 21, 2007). Rockville MD: Substance Abuse and Mental Health Services Administration, 2007. (6 refs.)

SAMHSA's National Survey of Drug Use and Health provides data on past month use of the following: any illicit drug, marijuana, and nonmedical use of prescription type drugs by race/ethnicity. This report also presents these by metropolitan status. Among whites and Hispanics: past month use of any illicit drug, marijuana, or nonmedical prescription drugs was lowest in non metropolitan areas than in any other area. Among blacks: past month use of any illicit drug or marijuana was lowest in non metropolitan areas than in any other area but nonmedical prescription drug use was highest in non metropolitan areas. Among American Indians/Alaska Natives: past month use of any illicit drug or nonmedical prescription drug use was lowest in large metropolitan areas than in any other area but marijuana use was lowest in non metropolitan areas.

Public Domain

O'Malley SS; Robin RW; Levenson AL; Wolf IG; Chance LE; Hodgkinson CA et al. Naltrexone alone and with sertraline for the treatment of alcohol dependence in Alaska Natives and non-natives residing in rural settings: A randomized controlled trial. Alcoholism: Clinical and Experimental Research 32(7): 1271-1283, 2008. (90 refs.)

Background: Access to specialty alcoholism treatment in rural environments is limited and new treatment approaches are needed. The objective was to evaluate the efficacy of naltrexone alone and in combination with sertraline among Alaska Natives and other Alaskans living in rural settings. An exploratory aim examined whether the Asn40Asp polymorphism of the mu-opioid receptor gene (OPRM1) predicted response to naltrexone, as had been reported in Caucasians. Methods: Randomized, controlled trial enrolling 101 Alaskans with alcohol dependence, including 68 American Indians/Alaska Natives. Participants received 16 weeks of either (1) placebo (placebo naltrexone + placebo sertraline), (2) naltrexone monotherapy (50 mg naltrexone + sertraline placebo) and (3) naltrexone + sertraline (100 mg) plus nine sessions of medical management and supportive advice. Primary outcomes included Time to First Heavy Drinking Day and Total Abstinence. Results: Naltrexone monotherapy demonstrated significantly higher total abstinence (35%) compared with placebo (12%, p = 0027) and longer, but not statistically different, Time to First Heavy Drinking Day (p = 0.093). On secondary measures, naltrexone compared with placebo demonstrated significant improvements in percent days abstinent (p = 0.024) and drinking-related consequences (p = 0.02). Combined sertraline and naltrexone did not differ from naltrexone alone. The pattern of findings was generally similar for the American Indian/Alaska Native subsample. Naltrexone treatment response was significant within the group of 75 individuals who were homozygous for OPRM1 Asn40 allele. There was a small number of Asp40 carriers, precluding statistical testing of the effect of this allele on response. Conclusions: Naltrexone can be used effectively to treat alcoholism in remote and rural communities, with evidence of benefit for American Indians and Alaska Natives. New models of care incorporating pharmacotherapy could reduce important health disparities related to alcoholism.

Osilla KC; Lonczak HS; Mail PD; Larimer ME; Marlatt GA. Regular tobacco use among American Indian and Alaska Native adolescents: An examination of protective mechanisms. Journal of Ethnicity in Substance Abuse 6(3/4): 143-153, 2007

American Indian and Alaska Native (AIAN) adolescents use tobacco at earlier ages and in larger quantities compared to nonAIAN peers. Regular tobacco use was examined against five protective factors (peer networks supportive of not using drugs, college aspirations, team sports, playing music, and volunteerism). Participants consisted of 112 adolescents between the ages of 13 and 19 who participated in a study testing the efficacy of a life-skills program aimed at reducing substance-related consequences. Findings indicated that, with the exception of prosocial peer networks and volunteerism, each of the above factors was significantly associated with a reduced probability of being a regular tobacco user. Gender differences were notable. These results hold important treatment implications regarding the reduction and prevention of tobacco use among AIAN youth.

Prussing E. Reconfiguring the empty center: Drinking, sobriety, and identity in Native American women's narratives. Culture, Medicine and Psychiatry 31(4): 499-526, 2007. (65 refs.)

Although anthropologists have paid little attention to popular American psychological discourse about addiction and recovery, the cultural politics of its engagement by Native North American communities warrant closer examination. By ethnographically contextualizing personal narratives, this paper describes how addiction/recovery discourse has been selectively engaged by younger generations of women in a northern Plains reservation community. Sobriety is not only a therapeutic transformation but also a socially negotiated identity change in this community and, therefore, engages ongoing local identity politics. Many community members evaluate the legitimacy of claims to Native identity by essentializing boundaries between Native and non-Native, as well as between past and present-a discursive convention that O'Nell has called "the rhetoric of the empty center" (Disciplined Hearts: History, Identity and Depression in an American Indian Community. Berkeley: University of California Press, 1996, p. 55). Yet by selectively appropriating elements of addiction/recovery discourse, younger women in the 1990s increasingly positioned emotional experience and expression as central arbiters of the legitimacy of Native identity. In so doing, they reconfigured the rhetoric of the empty center, eliciting both controversy and support from the larger community. This analysis highlights new dimensions of the social life of addiction/recovery discourse in contemporary Native North America, and calls for increased ethnographic attention to how localized cultural politics can orient the ways in which communities engage therapeutic discourses.

Prussing E. Sobriety and its cultural politics: An ethnographer's perspective on "Culturally Appropriate" addiction services in Native North America. Ethos 36(3): 354-375, 2008. (52 refs.)

The growing international trend toward greater community control of mental health programs in indigenous communities illuminates ongoing discursive and material pressures that shape the development of locally responsive and culturally relevant health services. In this article, I apply insights derived from practice theory and critical psychological anthropology to the ethnographic example of a substance abuse program on a Northern Plains reservation. This analysis suggests that by attending to how addiction and its psychotherapeutic transformation are represented in various community and institutional discourses impacting local services, ethnographers can accomplish two vital tasks: (1) documenting social, cultural, and psychological diversity within contemporary Native American communities, and (2) illuminating forces that undermine recognition of this diversity by federally funded mental health services. These forces include the often subtle but persistent power inequalities in relationships between local communities and federal health agencies.

Scott JD; Garland N. Chronic liver disease in Aboriginal North Americans. (review). World Journal of Gastroenterology 14(29): 4607-4615, 2008. (71 refs.)

A structured literature review was performed to detail the frequency and etiology of chronic liver disease (CLD) in Aboriginal North Americans. CLD affects Aboriginal North Americans disproportionately and is now one of the most common causes of death. Alcoholic liver disease is the leading etiology of CLD, but viral hepatitis, particularly hepatitis C, is an important and growing cause of CLD. High rates of autoimmune hepatitis and primary biliary cirrhosis (PBC) are reported in regions of coastal British Columbia and southeastern Alaska. Non-alcoholic liver disease is a common, but understudied, cause of CLD. Future research should monitor the incidence and etiology of CLD and should be geographically inclusive. In addition, more research is needed on the treatment of hepatitis C virus (HCV) infection and non-alcoholic fatty liver disease (NAFLD) in this population.

Silmere H; Stiffman AR. Factors associated with successful functioning in American Indian youths. American Indian and Alaska Native Mental Health Research 13(3): 23-47, 2007. (56 refs.)

This study examines environmental and cultural factors related to successful functioning in a stratified random sample of 401 American Indian youths. The success index included seven indicators: good mental health, being alcohol-and drug-free, absence of serious misbehavior, clean police record, good grades, positive psychosocial functioning, and positive behavior and emotions. Family satisfaction was positively related to overall successful functioning, whereas misbehaving peers, living in a dysfunctional neighborhood, and experiencing child abuse had an inverse relationship with success.

Spear S; Crevecoeur DA; Rawson RA; Clark R. The rise in methamphetamine use among American Indians in Los Angeles County. American Indian and Alaska Native Mental Health Research 14(2): 1-15, 2007. (24 refs.)

A preliminary review of substance abuse treatment admission data from 2001-2005 was conducted to explore the use of methamphetamine among American Indians in treatment programs funded by Los Angeles County. Comparisons were made between primary methamphetamine users and users whose primary drug was a substance other than methamphetamine. In that period, the number of American Indians reporting methamphetamine as their primary drug in Los Angeles County significantly increased, particularly among females.

Spicer P; Bezdek M; Manson SM; Beals J. A program of research on spirituality and American Indian alcohol use. Southern Medical Journal 100(4): 430-432, 2007. (12 refs.)

In this brief report we summarize a pattern of findings that has emerged from our research on American Indian (AI) alcohol use and spirituality. With funds from the National Institute of Alcohol Abuse and Alcoholism and the Fetzer Institute (AA 13 053; P. Spicer, PI) we have used both epidemiologic and ethnographic methods to develop a more complete understanding of the role that spirituality and religion play in changes in drinking behavior among American Indians. We begin by first situating the importance of research on spirituality in the more general literature on the American Indian experience with alcohol before highlighting our published findings in this area. We then close with some speculation about possible next steps in this research program to address what remains one of the most compelling sources of health disparities in the first nations of the United States.

Spillane NS; Smith GT. A theory of reservation-dwelling American Indian alcohol use risk. (review). Psychological Bulletin 133(3): 395-418, 2007. (193 refs.)

The authors present a theory for understanding risk for problem drinking among reservation-dwelling American Indians. The theory offers an overall framework for understanding the risk process for this group. It considers the distinction between factors that influence mean levels of American Indian problem drinking and factors that influence individual differences in American Indian drinking. It proposes important contextual differences between reservation-dwelling American Indians and Caucasians that may help explain the higher mean levels of American Indian problem drinking. The theory further holds that, within the high mean level of problem drinking characteristic of many American Indian reservations, individual differences in problem drinking can be explained by very similar personality and learning factors as those that influence problem-drinking levels for other ethnic groups.

Steinman KJ; Hu Y. Substance use among American Indian youth in an eastern city. Journal of Ethnicity in Substance Abuse 6(1): 15-29, 2007

This study represents one of the first efforts to examine substance use among American Indian (AI) youth in an Eastern city. As part of a school-based study in metropolitan Columbus, Ohio, 596 self-identified AI youth (grades 6-12) completed surveys describing their use of alcohol, cigarettes, smokeless tobacco, marijuana and inhalants. Net of gender, grade and family structure, AI youth were more likely than their white peers to regularly use most substances while overall prevalence resembled estimates from studies of urban AI youth in the Western United States. These findings highlight the complex interactions of geography, identity and risk behavior among ethnic minority adolescents.

Tann SS; Yabiku ST; Okamoto SK; Yanow J. TriADD: The risk for alcohol abuse, depression, and diabetes multimorbidity in the American Indian and Alaska native population. American Indian and Alaska Native Mental Health Research 14(1): 1-23, 2007. (52 refs.)

This study examined the risk for alcoholism, diabetes, and depression (triADD) in American Indian/Alaska Native (AI/AN) populations in the U. S. Using the Behavioral Risk Factor Surveillance System, a series of descriptive statistics and regression models were used to examine the interrelationships among these disorders in AI/AN populations. Despite a small sample size, results indicate that AI/ANs are at elevated risk for the individual and combined presence of triADD (OR = 12.5) when compared to the White population. These findings indicate the need for further investigation and prevention focused on effective, culturally appropriate interventions with these populations.

Venner KL; Feldstein SW; Tafoya N. Helping clients feel welcome: Principles of adapting treatment cross-culturally. Alcoholism Treatment Quarterly 25(4): 11-30, 2007

Empirically supported interventions (ESIs) for treating substance problems have seldom been made available to or tested with minority populations. Dissemination of ESIs may help reduce the disproportionate health disparities that exist. However, ESIs may require some adaptation to be effective with minority populations. One ESI, motivational interviewing (MI), appears to be particularly culturally congruent for Native American communities. We worked with Native American community members and treatment providers to adapt MI for Native communities. Reflecting their feedback and suggested amendments, we created and disseminated an intervention manual to improve the accessibility of MI within Native communities. To help guide practitioners working with Native American clients, we used focus-group methodology to explore communication patterns for negotiating change. Native American treatment providers expressed comfort with and enthusiasm for integrating MI into their current practices. Recommendations for adaptations ranged from simple to complex changes. The unique value and challenges of collaboration between academic and community members are presented from each author's perspective. This culturally adapted MI manual will likely improve the accessibility and adoption of MI practices as well as encourage controlled, clinical trials with Native communities.

Villanueva M; Tonigan JS; Miller WR. Response of Native American clients to three treatment methods for alcohol dependence. Journal of Ethnicity in Substance Abuse 6(2): 41-48, 2007

Objective: It is well-documented that American Indians suffer disproportionately high rates of alcohol use disorders as well as correspondingly high rates of alcohol based mortality, health, and social problems. Despite these health disparities, anecdotal evidence continues to guide alcohol treatment approaches in Indian Country, in part due to a dearth of clinical trials with Native Americans. Project MATCH, a multisite clinical trial, included 25 Native Americans (1.4% of the total sample) whowere randomized to three psychosocial treatments. Based on cultural compatibility, our a priori hypothesis was that Native Americans in Motivational Enhancement Therapy (MET) would fare better than those assigned either to Cognitive Behavioral Therapy (CBT) or to Twelve-step Facilitation (TSF). Method: Of 25 Native Americans in Project MATCH, 23 (92%) were interviewed at all six assessment points. Four ANOCOVA's were computed to investigate possible differential treatment response. Results: Despite a small sample, Native Americans assigned to MET reported significantly less drinking intensity relative to those assigned to CBT or TSF, with the highest proportion of abstinent days and lowest drinking intensity at both proximal and distal follow-ups. Conclusions: These findings suggest a differentially better response to MET than to TSF or to CBT among Native Americans with alcohol dependence. Although this is, to date, the largest randomized trial of treatments for alcohol dependence in Native Americans, the findings require replication.

Walls ML. Marijuana and alcohol use during early adolescence: Gender differences among American Indian/First Nations youth. Journal of Drug Issues 38(4): 1139-1160, 2008. (62 refs.)

This study examines the growth of alcohol and marijuana use during early adolescence among a sample of 746 Indigenous youth (aged 10 - 12 years at wave 1; 50.3% female) of the upper Midwest and Canada, With a special focus on potential gender differences in these patterns. Research documenting the disproportionately high rates of Indigenous substance use, coupled by our lack of understanding of gender patterns among this group-especially in very early adolescence-highlight the need for this culturally specific work. Results of latent growth curve analyses from three waves of annual data collection indicate that the females in our sample engage in alcohol and marijuana use at rates similar to or greater than their male peers. This finding counters conventional ideas of gender and substance use that place young males at elevated rates of use compared to females, and also adds to our understanding of gendered substance use patterns among Indigenous youth.

Walls ML; Whitbeck LB; Hoyt DR; Johnson KD. Early-onset alcohol use among Native American youth: Examining female caretaker influence. Journal of Marriage and the Family 69(2): 451-464, 2007. (58 refs.)

This article investigates the influence of female caretaker substance use on early-onset youth drinking among Native American families in the Northern Midwest. Data include 603 Native American families, with reports from female caretakers and youths aged 10 - 13 years. Two potential caretaker influences are taken into account: adolescent modeling of caretaker behaviors and the effects of caretaker substance abuse on parenting. Results of bivariate and path analysis provide support for the influence of caretaker substance use on adolescent drinking from both perspectives; these effects vary, however, depending on the type or degree of adult substance use, or both.

Watt JP; O'Brien KL; Benin AL; Mccoy SI; Donaldson CM; Reid R et al. Risk factors for invasive pneumococcal disease among Navajo adults. American Journal of Epidemiology 166(9): 1080-1087, 2007. (24 refs.)

Invasive pneumococcal disease (IPD) is 3-5 times more common among Navajo adults than in the general US population. The authors conducted a case-control study to identify risk factors for IPD among Navajo adults. Navajos aged >= 18 years with IPD were identified through prospective, population-based active laboratory surveillance (December 1999-February 2002). Controls matched to cases on age, gender, and neighborhood were selected. Risk factors were identified through structured interviews and medical record reviews. The authors conducted a matched analysis based on 118 cases and 353 controls. Risk factors included in the final multivariable analysis were chronic renal failure (odds ratio (OR) = 2.6, 95% confidence interval (Cl): 0.9, 7.7), congestive heart failure (OR = 5.6, 95% Cl: 2.2, 14.5), self-reported alcohol use or alcoholism (OR = 2.9, 95% Cl: 1.5, 5.4), body mass index (weight (kg)/height (m)(2)) <5th (OR = 3.2, 95% Cl: 1.0, 10.6) or >95th (OR = 2.8, 95% Cl: 1.0, 8.0) percentile, and unemployment (OR = 2.6, 95% Cl: 1.2, 5.5). The population attributable fractions were 10% for chronic renal failure, 18% for congestive heart failure, 30% for self-reported alcohol use or alcoholism, 6% for body mass index, and 20% for unemployment. Several modifiable risk factors for IPD in Navajos were identified. The high prevalence of renal failure, alcoholism, and unemployment among Navajo adults compared with the general US population may explain some of their increased risk of IPD.

Westermeyer J; Canive J; Thuras P; Thompson J; Crosby R; Garrard J. A comparison of substance use disorder severity and course in American Indian male and female veterans. American Journal on Addictions 18(1): 87-92, 2009. (24 refs.)

The purpose of this analysis was to compare substance use disorder (SUD) diagnoses, severity, comorbidity, and course in 362 American Indian veterans. The sample was drawn from communities in the north central and southwestern areas of the United States, structured to over-sample women and to include half-rural/half-urban residents. Instruments used in the study included current demography, military history, the Diagnostic Interview Schedule/Quick Version, Michigan Alcoholism Screening Test modified to include alcohol and drugs (MAST/AD), Brief Symptom Inventory, Posttraumatic Checklist, and a treatment algorithm. Univariate analyses showed that women had lower scores on the MAST/AD, reported lower symptom levels on the Posttraumatic Checklist, and were less apt to use VA mental health services, but were more willing to seek mental health treatment if needed (with probabilities of .01 to .001). At borderline probabilities (.02 to .05), women were younger and had more education, whereas men had more drug-related diagnoses and more combat exposure. On binary logistic regression, women were less apt to have a drug diagnosis and had lower MAST/AD scores; the other differences were not significant. Female American Indian veterans with SUD manifested many of the same gender-related differences as women in the population at large, but with some exceptions (eg, comorbidity). Trauma, PTSD, and continuing posttraumatic symptoms occurred frequently in both male and female veterans of American Indian heritage. VA facilities should out-reach to American Indian women, who report a willingness to seek mental health services but may avoid VA care.

Whitbeck LB; Yu M; Johnson KD; Hoyt DR; Walls ML. Diagnostic prevalence rates from early to mid-adolescence among indigenous adolescents: First results from a longitudinal study. Journal of the American Academy of Child and Adolescent Psychiatry 47(8): 890-900, 2008. (37 refs.)

Objective: Investigate change in prevalence rates for mental and substance abuse disorders between early and mid-adolescence among a cohort of indigenous adolescents. Method: The data are from a lagged, sequential study of 651 indigenous adolescents from a single culture in the northern Midwest U0nited States and Canada. At waves 1 (ages 10-12 years) and 4 (ages 13-15 years), one adult caretaker and one tribally enrolled adolescent completed a computer-assisted personal interview that included Diagnostic Interview Schedule for Children-Revised assessment for 11 diagnoses. Multivariate analyses investigate effects of wave 1 adolescent diagnosis and wave 1 biological mother diagnosis (University of Michigan Composite International Diagnostic Interview) on wave 4 diagnostic outcomes. Results: The findings show a increase in prevalence rates for substance abuse disorders and conduct disorders between ages 10 and 12 years and 13 and 15 years among indigenous adolescents, with these disorders affecting more than one fourth of the children. The rate of lifetime conduct disorder is about twice that expected in general population studies (23.4% versus 5%-10%), and the rate of lifetime substance abuse disorder (27.2%) is three times that reported in the 2004 National Survey on Drug Use and Health (9.4%) for individuals 12 years or older. Prevalence rates for any single mental or substance use disorder (44.8 lifetime) for the 13- to 15-year-olds are similar to the lifetime prevalence rates reported in the National Comorbidity Survey-Replication (46.4%) for individuals 18 years and older. Conclusions: A mental health crisis exists on the indigenous reservations and reserves that participated in this study. Current service systems are overwhelmed and unable to meet the demands placed upon them.

Whitbeck LB; Yu M; McChargue DE; Crawford DM. Depressive symptoms, gender, and growth in cigarette smoking among indigenous adolescents. Addictive Behaviors 34(5): 421-426, 2009. (51 refs.)

This study reports findings from two-level growth curve modeling of cigarette smoking and depressive symptoms based on the first three waves of data from a longitudinal study of Indigenous adolescents and their parents/caretakers in the northern Midwest and Canada. The 743 adolescents were aged 10-13 years at Wave 1 and 12-15 years at Wave 3. Over the three years of the study the overall retention rate was 93%. By Wave 3, 39% of the adolescent girls and 25% of the boys had smoked cigarettes in the past 12 months. The growth curve results indicated that smoking increased for both adolescent boys and girls across time. Depressive symptoms were associated with an increase in cigarette smoking for girls but not boys.

Whitesell NR; Beals J; Mitchell CM; Keane EM; Spicer P; Turner RJ. The relationship of cumulative and proximal adversity to onset of substance dependence symptoms in two American Indian communities. Drug and Alcohol Dependence 91(2/3): 279-288, 2007. (44 refs.)

The proximal and distal effects of adversity on the onset of symptoms of substance dependence during adolescence were explored in two culturally distinct American Indian (AI) reservation communities (Northern Plains and Southwest). Data (N=3084) were from the American Indian Service Utilization, Psychiatric Epidemiology, Risk and Protective Factors Project (AI-SUPERPFP). The age-related risk of symptom onset increased gradually from age 11 through age 16, remained relatively high through age 18, then declined rapidly. Both tribe and gender were related to onset of dependence symptoms; men and Northern Plains tribal members were at greatest risk and Southwest women were at particularly low risk of symptom onset across adolescence. For all tribe and gender groups, both proximal and cumulative distal experiences of adversity were associated with substantially increased risk of symptom onset. The relationship of adversity to onset of substance dependence symptoms remained strong when previous symptoms of psychiatric disorder and childhood conduct problems were considered. These findings suggest that efforts to help children and adolescents in AI communities develop constructive mechanisms for coping with adversity may be especially valuable in substance dependence prevention.

Whitton M; Weatherly JN. The effect of near-miss rate and card control when American Indians and non-indians gamble in a laboratory situation: The influence of alcohol. American Indian And Alaska Native Mental Health Research 16(2): 28-42, 2009. (25 refs.)

Twelve American Indian (AI) and 12 non-AI participants gambled on a slot-machine simulation and on video poker. Prior to the gambling sessions, half of the participants consumed alcohol while the other half consumed a placebo beverage. They then played the slot-machine simulation three times, with the percentage of programmed "near misses" varying across sessions. They also played video poker three times, with the control the players had over holding and discarding cards varying across sessions. Results showed that AI participants played significantly fewer poker hands than did non-AIs and that participants played most when they had the least control over what cards were played. No significant effect of alcohol consumption was observed. Likewise, results failed to show a significant effect of the percentage of near misses when participants played the slot-machine simulation. The present results lend support for the idea that the differences in gambling problems between AI and non-AI reported in the literature are not a function of ethnicity per se. They may also suggest that providing video poker players with accurate information may have the unintended effect of increasing the rate at which they gamble.

Woodall WG; Delaney HD; Kunitz SJ; Westerberg VS; Zhao HW. A randomized trial of a DWI intervention program for first offenders: Intervention outcomes and interactions with antisocial personality disorder among a primarily American-Indian sample. Alcoholism: Clinical and Experimental Research 31(6): 974-987, 2007. (51 refs.)

Background: Randomized trial evidence on the effectiveness of incarceration and treatment of first-time driving while intoxicated (DWI) offenders who are primarily American Indian has yet to be reported in the literature on DWI prevention. Further, research has confirmed the association of antisocial personality disorder (ASPD) with problems with alcohol including DWI. Methods: A randomized clinical trial was conducted, in conjunction with 28 days of incarceration, of a treatment program incorporating motivational interviewing principles for first-time DWI offenders. The sample of 305 offenders including 52 diagnosed as ASPD by the Diagnostic Interview Schedule were assessed before assignment to conditions and at 6, 12, and 24 months after discharge. Self-reported frequency of drinking and driving as well as various measures of drinking over the preceding 90 days were available at all assessments for 244 participants. Further, DWI rearrest data for 274 participants were available for analysis. Results: Participants randomized to receive the first offender incarceration and treatment program reported greater reductions in alcohol consumption from baseline levels when compared with participants who were only incarcerated. Antisocial personality disorder participants reported heavier and more frequent drinking but showed significantly greater declines in drinking from intake to posttreatment assessments. Further, the treatment resulted in larger effects relative to the control on ASPD than non-ASPD participants. Conclusions: Nonconfrontational treatment may significantly enhance outcomes for DWI offenders with ASPD when delivered in an incarcerated setting, and in the present study, such effects were found in a primarily American-Indian sample.

Yabiku ST; Rayle AD; Okamoto SK; Marsiglia FF; Kulis S. The effect of neighborhood context on the drug use of American Indian youth of the southwest. Journal of Ethnicity in Substance Abuse 6(2): 181-204, 2007

This study examined neighborhood effects on the drug use of American Indian youth of the Southwest. We compared these effects with American Indian and non-American Indian youth in order to examine the universality of neighborhood disorganization as a risk factor for drug use. Neighborhood level variables included unemployment, poverty, education, and violent crime rate. Results indicated that American Indian youth were not as adversely affected by these neighborhood factors. American Indian youth may possess cultural characteristics that protect them from the adverse effects of neighborhood disorganization, including close familial relationships and ethnic pride. Culturally competent practice with American Indian youth may best be implemented through the enhancement of relational and cultural strengths as described in the literature.

Yu M; Stiffman AR. Culture and environment as predictors of alcohol abuse/dependence symptoms in American Indian youths. Addictive Behaviors 32(10): 2253-2259, 2007. (16 refs.)

This study utilizes Bronfenbrenner's ecological model (1979) to examine multiple and interactive environmental (familial, social, and cultural) predictors of adolescent alcohol abuse/dependence symptoms. A stratified random sample of 401 American Indian youths was interviewed in 2001. The findings showed that family members' substance problems, peer misbehaviors, and participation in generic cultural activities positively predicted adolescent alcohol symptoms. Conversely, cultural pride/spirituality predicted fewer alcohol symptoms, and, importantly, religious affiliation moderated the effects of problematic peers and family members on adolescent alcohol symptoms. The findings suggest further study of intervention and prevention efforts regarding the benefits from consideration of the complex relationships among multiple environmental variables.