American Indians with Substance Use Disorders: Treatment Needs and Comorbid Conditions

Abstract

Background American Indians and Alaska Natives (AI/ANs) experience significant disparities in health status and access to care. Furthermore, only limited data are available on substance use, mental health disorders, and treatment needs for this population. Addressing such disparities and developing culturally relevant, effective interventions for AI/AN communities require participatory research. Objectives and Methods The Western States Node of the National Institute on Drug Abuse Clinical Trials Network partnered with two American Indian substance abuse treatment programs: an urban health center and a reservation-based program to assess client characteristics, drug use patterns, and treatment needs. Data collected by staff members at the respective programs from urban (n = 74) and reservation (n = 121) clients were compared. Additional sub-analysis examined patients reporting regular opioid use and mood disorders. Results Findings indicate that urban clients were more likely to report employment problems, polysubstance use, and a history of abuse. Reservation-based clients reported having more severe medical problems and a greater prevalence of psychiatric problems. Clients who were regular opioid users were more likely to report having a chronic medical condition, suicidal thoughts, suicide attempts, polysubstance abuse, and IV drug use. Clients who reported a history of depression had twice as many lifetime hospitalizations and more than five times as many days with medical problems. Conclusions Findings from this project provide information about the patterns of substance abuse and the importance of comprehensive assessments of trauma and comorbid conditions. Results point to the need for integrative coordinated care and auxiliary services for AI/AN clients seeking treatment for substance use disorders.

Flourishing

“…Mental health research with AI people, however, has overwhelmingly focused on disparities in negative mental health outcomes such as suicide, substance abuse, and psychological distress (Bridges and Kunselman 2005; Rieckmann et al 2012). This preoccupation on negative outcomes precludes the examination of how various social conditions and arrangements impact the full range of mental health outcomes (Aneshensel 2005).…”

The Affordable Care Act and Implications for Health Care Services for American Indian and Alaska Native Individuals

“…9,10,11 According the 2001–2002 National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) of adults 18 years and older, the prevalence of drinking for AI/ANs was 70.7%, compared with 77.1% for Whites, 60.1% for Blacks, and 60.4% for Hispanics. In addition, AI/AN individuals had the highest prevalence of exceeding the recommended daily and weekly drinking limits (53% and 27.4% of the population exceeding the two limits, respectively) compared with Whites (52.5% and 17.3%, respectively), Blacks (29% and 8.9%), and Hispanics (37.3% and 8.5%).…”

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

“…Taken as a whole, the papers demonstrate the variation across AI/AN populations in substance abuse patterns. Further, these articles explore some of the outcomes related to substance abuse, as well as the relationship of substance abuse patterns with other behaviors and comorbidities, in an attempt to provide information particularly relevant to preventing and treating substance abuse and related disorders (10)(11)(12). For example, in addition to disproportionately high substance abuse rates, AI/AN populations also have disproportionately high suicide rates; understanding the overlapping trajectories of these intersecting conditions will be important for designing health solutions (5,11,13).…”