Some thoughts about the epidemiology of alcohol and drug use among American Indian/Alaska Native populations

Disparities In The Quality Of Clinical Care Delivered To American Indian/Alaska Native Medicare Advantage Enrollees

This study used data from the 2019 Healthcare Effectiveness Data and Information Set (HEDIS) to examine differences in the quality of care received by American Indian/Alaska Native beneficiaries versus care received by non-Hispanic White beneficiaries enrolled in Medicare Advantage (managed care) plans. American Indian/Alaska Native beneficiaries were more likely than White beneficiaries to receive care that meets clinical standards for eight of twenty-six HEDIS measures and were less likely than White beneficiaries to receive care that meets clinical standards for five of twenty-six measures. Measures for which American Indian/Alaska Native beneficiaries were less likely to receive care meeting clinical standards were mainly ones pertaining to appropriate treatment of diagnosed conditions. In all cases, differences in care for American Indian/Alaska Native and White beneficiaries were largely within-plan differences. These findings indicate the need for improved clinical care for all beneficiaries. For American Indian/Alaska Native beneficiaries, there is a particular need for improvement in the treatment of diagnosed conditions, including diabetes, chronic obstructive pulmonary disease, and alcohol and other forms of substance abuse.

Racial/ethnic differences in prevalence of hallucinogen use by age cohort: Findings from the 2018 National Survey on Drug Use and Health

Background

Few studies have assessed the epidemiology of hallucinogenic substance use among racial and ethnic groups of varying age cohorts. Use of psychedelic substances may differ among people of color (POC), due to factors such as stigma and discriminatory drug enforcement practices against POC. The lack of inclusion of POC in psychedelic research further underscores the importance of identifying differences in use among racial/ethnic groups and age cohorts.

Methods

Data from the 2018 National Survey on Drug Use and Health (NSDUH) was used for this analysis (N = 56,313, unweighted), representative of the non-institutionalized U.S. population. Proportions of lifetime hallucinogen use by race/ethnicity were compared. Proportions of past year rates of use were compared to examine differences by race/ethnicity and age cohort.

Results

Approximately 15.9% of the U.S. population over 12 had used a hallucinogen at some point in their lifetime and 2.0% had used in the past year. Lifetime hallucinogen use was most prevalent among non-Hispanic White and multi-racial individuals, while Black/African Americans reported the lowest rates of use. White and multi-racial groups also reported the highest proportions of past year use among 12–34 year olds, and White individuals reported the highest proportions among 35–49 year olds. Hispanic individuals reported higher proportions of use among the 12–17 cohort, but lower proportions among the 26–49 year old cohorts. Black/African Americans reported the lowest rates of past year use among the 12–25 year old cohorts. 50+ and older cohorts reported the lowest rates of hallucinogen use in the past year.

Limitations

Data is cross-sectional and self-reported. “Race” is a social construction is subject to change over time, and NSDUH ethnoracial categories are limited. Institutionalized populations are not included in the study.

Conclusions

Significant differences in hallucinogen use among ethnoracial groups by substance and age cohorts were observed. Findings from this work may inform education, interventions, and therapeutic psychedelic research.

The Validity of the Short Inventory of Problems and Drinking Intensity among Urban American Indian Adults

BACKGROUND

American Indian (AI) adults have both high prevalence rates of alcohol abstinence and alcohol use disorders compared to non-Hispanic White adults. We investigated the applicability and validity of the Short Inventory of Problems (SIP) among AI urban adults and the moderating effect of biological sex.

METHODS

AI adults from three Alcoholics Anonymous samples (n = 124) provided baseline, 3-, 6- and 9-month data. Measures included Form 90 and the SIP, which includes 5 domains of alcohol-related negative consequences including interpersonal, intrapersonal, physical, impulse control and social. Drinking frequency and intensity were assessed by percent days abstinent (PDA) and drinks per drinking day (DPDD).

RESULTS

Cronbach alphas of the SIP were similar between urban AI adults and the mainstream treatment-seeking population reported in the SIP manual. DPDD was a significant and positive predictor of all five SIP scales collected 9-months later. Higher PDA was significantly and negatively associated with later consequences, and all 5 SIP scales. Moderation tests indicated that the association between consequences and drinking intensity was stronger for AI females with fewer drinking days resulting in significantly fewer consequences for AI males relative to AI females.

CONCLUSIONS

Findings highlight the acceptability of SIP as a measure to assess drinking related consequences among AI urban adults, with clinical implications related to alcohol use and sex. Further research is warranted to examine differential drinking related outcomes among AI men and women in addition to adaptations of the SIP that more fully capture the range of negative drinking consequences.

Perceptions of alcohol misuse among Alaska native health care system stakeholders: A qualitative exploration

Although alcohol misuse is a priority for health care systems serving Alaska Native and American Indian (ANAI) people, stakeholders' perceptions of misuse are understudied. Patients (n = 34), providers (n = 20), and leaders (n = 16) at a Tribally owned and operated health care system reported that alcohol misuse results from the interaction of factors, including colonization, structural factors, social alienation, social norms about overdrinking introduced at the time of colonizing contact, coping with emotions, and beliefs about ANAI people and alcohol. Childhood exposure to alcohol misuse leads some ANAI people to avoid alcohol altogether, shedding light on the high levels of abstinence observed in ANAI communities.

Native American adolescent narrative written stories of stress

OBJECTIVE(S)

The purpose of this paper is to report study findings related to themes of stress and coping strategies experienced by non-reservation-based Native American adolescents as expressed by their written stories.

DESIGN

A qualitative descriptive narrative approach was used to capture written stories of stress.

ANALYSIS

Key concepts and themes were identified by using the consensual qualitative research (CQR) approach from the participant's stories of stress.

RESULTS

Written stories of stress were collected and analyzed from a convenience sample of 179 Native American adolescent's ages 13-18-years old. Five major themes related to experiences of stress emerged from the stories including (a) relationships, (b) responsibilities, (c) socioeconomic status, (d) negative coping strategies, and (e) positive coping through Native-Reliance.

CONCLUSION

The findings reveal the importance of understanding the types and response to stress experienced by Native American adolescents.

DSM-5 cannabis use disorder in the National Epidemiologic Survey on Alcohol and Related Conditions-III: Gender-specific profiles

OBJECTIVE

The objective of this study was to present current information on the prevalence, correlates, comorbidity and quality of life among men and women with cannabis use disorder (CUD).

METHODS

In 2012-2013, 36,309 respondents ≥18years old participated in face-to-face interviews in the National Epidemiologic Survey on Alcohol and Related Conditions-III.

RESULTS

Prevalence of 12-month CUD was greater among men (3.5%) than women (1.7%). Women experienced shorter duration from onset of cannabis use to onset of CUD than men (mean=5.8years, men; mean=4.7years, women). In both men and women, prevalences of CUD were greater among young adults, Blacks, and those with lower income and greater among Native American women relative to White women. CUD was highly comorbid with other substance use disorders, PTSD, ASPD and borderline and schizotypal PDs for men and women. Quality of life for individuals with CUD was low regardless of gender.

CONCLUSIONS

DSM-5 CUD among men and women is highly prevalent, comorbid and characterized by low quality of life. Results highlighted the need for integrated treatment of CUD and comorbid disorders and the urgency of identifying and implementing effective prevention and intervention approaches, especially for those sociodemographic subgroups for which both men and women are at greater risk for the disorder.

School Context and American Indian Substance Use

The present study extends prior research exploring the role of school contextual factors in predicting individual adolescent substance use by examining how a school's racial composition is associated with American Indian adolescent tobacco and marijuana use. Using a subsample of 523 American Indian students from the restricted use Add Health data, we consider both individual and school contextual factors across 99 schools. Our results suggest that a school's racial composition is associated with individual tobacco and marijuana use among American Indian youth, but in different ways depending upon the substance. Our findings illustrate the importance of extending research on the correlates of substance use for racial and ethnic minorities beyond studies examining African-Americans and/or Hispanics.

Unintended consequences of local alcohol restrictions in rural Alaska

Since 1981, Alaskans have had the ability to enact by referendum local restrictions in alcohol sales, importation, and possession, known as "local options." Intended to empower rural communities to reduce alcohol abuse and associated violence and trauma, the "local option" laws have led to unintended consequences as individuals in alcohol-restricted communities seek intoxication from both legal and illegal sources of alcohol. Based on 68 interviews with 72 community members in eight rural sites in Alaska, this article examines these unintended consequences of local options restrictions and provides context to the challenges rural communities face in implementing alcohol policies.

Religious and Spiritual Practices Among Home-less Urban American Indians and Alaska Natives with Severe Alcohol Problems

Engagement in religious and spiritual practices may be protective for homeless individuals with alcohol-related problems. However, little is known in this regard for urban-dwelling American Indians and Alaska Natives (AI/ANs) who have disproportionately high rates of homelessness and co-occurring alcohol use problems. Using secondary data from a nonrandomized controlled study testing a Housing First intervention, AI/AN participants (n = 52) and non-AI/AN participants (n = 82) were compared on demographic variables, alcohol use problems, religious affiliations, and religious/spiritual practices (importance, frequency, and type). AI/ANs who engaged in Native-specific independent spiritual practices had significantly lower alcohol use frequency in comparison to AI/ANs who did not.

Substance Use Profiles of Urban American Indian Adolescents: A Latent Class Analysis

A growing majority of American Indian adolescents now live in cities and are at high risk of early and problematic substance use and its negative health effects.

OBJECTIVE

This study used latent class analysis to empirically derive heterogeneous patterns of substance use among urban American Indian adolescents, examined demographic correlates of the resulting latent classes, and tested for differences among the latent classes in other risk behavior and prosocial outcomes.

METHOD

The study employed a representative sample of 8th, 10th, and 12th grade American Indian adolescents (n = 2,407) in public or charter schools in metropolitan areas of Arizona in 2012. Latent class analysis examined eight types of last 30 day substance use.

RESULTS

Four latent classes emerged: a large group of "nonusers" (69%); a substantial minority using alcohol, tobacco, and/or marijuana [ATM] (17%); a smaller group of polysubstance users consuming, alcohol, tobacco, marijuana, other illicit drugs, and prescription or OTC drugs in combination (6%); and a "not alcohol" group reporting combinations of tobacco, marijuana, and prescription drug use, but rarely alcohol use (4%). The latent classes varied by age and grade level, but not by other demographic characteristics, and aligned in highly consistent patterns on other non-substance use outcomes. Polysubstance users reported the most problematic and nonusers the least problematic outcomes, with ATM and "not alcohol" users in the middle.

CONCLUSIONS

Urban AI adolescent substance use occurs in three somewhat distinctive patterns of combinations of recent alcohol and drug consumption, covarying in systematic ways with other problematic risk behaviors and attitudes.

Alcohol use among Native Americans compared to whites: Examining the veracity of the 'Native American elevated alcohol consumption' belief

BACKGROUND

This study uses national survey data to examine the veracity of the longstanding belief that, compared to whites, Native Americans (NA) have elevated alcohol consumption.

METHODS

The primary data source was the National Survey on Drug Use and Health (NSDUH) from 2009 to 2013: whites (n=171,858) and NA (n=4,201). Analyses using logistic regression with demographic covariate adjustment were conducted to assess differences in the odds of NA and whites being alcohol abstinent, light/moderate drinkers (no binge/heavy consumption), binge drinkers (5+ drinks on an occasion 1-4 days), or heavy drinkers (5+ drinks on an occasion 5+ days) in the past month. Complementary alcohol abstinence, light/moderate drinking and excessive drinking analyses were conducted using Behavioral Risk Factor Surveillance System (BRFSS) data from 2011 to 2013: whites (n=1,130,658) and NA (n=21,589).

RESULTS

In the NSDUH analyses, the majority of NA, 59.9% (95% CI: 56.7-63.1), abstained, whereas a minority of whites, 43.1% (CI: 42.6-43.6), abstained-adjusted odds ratio (AOR): 0.64 (CI: 0.56-0.73). Approximately 14.5% (CI: 12.0-17.4) of NA were light/moderate-only drinkers, versus 32.7% (CI: 32.2-33.2) of whites (AOR: 1.90; CI: 1.51-2.39). NA and white binge drinking estimates were similar-17.3% (CI: 15.0-19.8) and 16.7% (CI: 16.4-17.0), respectively (AOR: 1.00; CI: 0.83-1.20). The two populations' heavy drinking estimates were also similar-8.3% (CI: 6.7-10.2) and 7.5% (CI: 7.3-7.7), respectively (AOR: 1.06; CI: 0.85-1.32). Results from the BRFSS analyses generally corroborated those from NSDUH.

CONCLUSIONS

In contrast to the 'Native American elevated alcohol consumption' belief, Native Americans compared to whites had lower or comparable rates across the range of alcohol measures examined.

EXPLAINING THE ASSOCIATION BETWEEN GENDER AND SUBSTANCE USE AMONG AMERICAN INDIAN ADOLESCENTS: AN APPLICATION OF POWER-CONTROL THEORY

This study evaluates the utility of Hagan's power-control theory for explaining substance use behaviors for a sample of American Indian adolescent males and females. Consistent with the theory, we found that patriarchal family form and the affective bond between father and daughter were significant predictors of female substance use behaviors. Compared to results from an analysis of non-Hispanic whites, these results reveal the importance of testing generalist explanations of deviant behavior across racial and ethnic groups. Our findings encourage a more in depth consideration of the gendered nature of work, it's association with socialization and control in American Indian families, and it's impact on gender differences in substance use and delinquent behaviors.

American Indians, substance use, and sexual behavior: do predictors of sexually transmitted infections explain the race gap among young adults?

BACKGROUND

In this study, we examined whether substance use and risky sexual behaviors predicted sexually transmitted infections (STIs) among American Indian (AI) and white young adults. Furthermore, we explored whether these factors explained the race disparity in STIs.

METHODS

We conducted a cross-sectional analysis of wave 3 of the National Longitudinal Study of Adolescent Health collected in 2001 to 2002. Young adult participants (aged 18-26 years) provided urine specimens that were tested for chlamydia, gonorrhea, and trichomoniasis infection. Estimates of the association between AI with any STI were adjusted for sexual and other risk behavior correlates using multivariate regression techniques.

RESULTS

Nine percent of AIs (n = 367) and 3.6% of whites (n = 7813) tested positive for an STI. Race differences were found for substance use (injection drug use, 3.1% AI vs. 1.3% white; alcohol use frequency, 2.01% AI vs. 2.5% white; binge drinking frequency, 1.25% AI vs. 1.53% white). Among sexually active respondents, AIs were more likely to have paid for sex (9%) than whites (3%). After adjustment, early sexual initiation (adjusted odds ratio, 1.69; 95% confidence interval, 1.19-2.41), no condom use at last sex (adjusted odds ratio, 1.47; 95% confidence interval, 1.08-2.01), and AI race (adjusted odds ratio, 2.45; 95% confidence interval 1.46-4.11) were significantly associated with having an STI.

CONCLUSIONS

Individual-level sexual and other risk behaviors do not fully explain disparities in STIs among AIs compared with white young adults. Further examination of network and community factors is needed to explain these disparities.

Factors Associated With American Indian and White Adolescent Drug Selling in Rural Communities

Relatively few studies have examined the correlates of adolescent drug selling in America, with most of these studies focusing on urban settings. The present study examines the risk and protective factors associated with drug selling among American Indian and white adolescents residing in a rural Northwestern state in the United States. Using survey data collected in 2010-2012, we conduct logistic regression analyses exploring the correlates of drug selling (n=568). Generally, we found support for prior explanations of drug selling, but identified some important race-specific differences. Specifically, we found that stress exposure was a risk factor for American Indians, but not whites. Conversely, academic achievement served as a protective factor for white adolescents but not American Indians. Our findings suggest that the race gap in rural drug selling can be explained by considering differences in social bonds, stress exposure, and exposure to substance using family and friends.

Alcohol use among reserve-dwelling adult First Nation members: use, problems, and intention to change drinking behavior

INTRODUCTION

Although alcohol use was not part of traditional First Nation (FN) life, alcohol misuse currently poses a significant public health problem. There is a dearth of research efforts to understand both alcohol misuse and efforts to resolve these problems. The primary aims of this study were to 1) present descriptive data on alcohol use in FN adults living on one reserve in Eastern Canada; and 2) explore correlates of help seeking intentions and past behaviors.

METHODS

We administered questionnaires to 211 FN people (96 men; 113 women; 2 unknown).

RESULTS

Nearly two-thirds of our sample were current drinkers (N=150). Of those, 29% endorsed they needed help with their drinking, and half reported that they would probably try to cut down or stop drinking in the next year. Multiple regression analyses suggested that drinking was positively associated with a greater perceived need for help with drinking (β=.40, p=<.001). Lower scores on a measure of cultural identity (i.e., stronger FN identity) was associated with a greater perceived need for help with drinking (β=-.18, p=.04). Greater endorsement of past year attempts to stop drinking (β=.33, p<.001) and higher alcohol reduction expectancies (β=.43, p<.00) were positively associated and lower scores on cultural identity (i.e., stronger FN identity) (β=-.19, p=.03) was associated with trying to cut down or stop drinking in the next year.

CONCLUSIONS

Future research should explore the nature of cultural identity as a protective factor.

Off-premise alcohol outlets on and around tribal land: risks for rural California Indian youth

Investigating the alcohol environment for rural American Indian youth, we conducted 70 interviews with leading members and youth representatives of nine Southern California tribes. We also conducted brief observations in all 13 stores licensed to sell alcohol on and close to the reservation lands of the nine tribes. Underage youth may obtain alcoholic beverages at stores either directly through illegal sales to minors or indirectly through social sources. Stores are also environments within which alcoholic beverages and heavy drinking may become normalized for youth. Limitations and implications for convenience store-based prevention research on alcohol retail environment for youth in rural populations areas are discussed.

Intergenerational patterns of substance abuse among urban American Indian families

Substance abuse continues to be a family problem in American Indian (AI) families. This article highlights findings from a two generation study on substance abuse among nine AI families. Five common themes shared by the parent and adult child groups included early onset of substance abuse, minimization of substance abuse (and a subtheme of efforts to control use), taking accountability for substance abuse (and a subtheme about perpetuated stereotypes), turning point moments in use (and a subtheme of negotiating and exploring sobriety), and perceptions of the abstinence only approach. Clinical implications are discussed in light of the findings.

Adult social roles and alcohol use among American Indians

American Indians are disproportionately burdened by alcohol-related problems. Yet, research exploring predictors of alcohol use among American Indians has been limited by cross-sectional designs and reservation-based samples. Guided by a life course developmental perspective, the current study used a subsample of American Indians (n=927) from the National Longitudinal Study of Adolescent Health (Add Health) to explore alcohol use (current drinking, usual number of drinks, and binge drinking) among this population. We examined whether adult social roles (i.e., cohabitation, marriage, parenthood, college enrollment, and full-time work) were linked to the rise and fall of alcohol use. Multi-level models demonstrated that adult social roles were linked to alcohol use at the within- and between-person levels. Becoming a parent was linked to a lower likelihood of being a current drinker, fewer alcoholic drinks, and less frequent binge drinking. Transitioning to full-time work was associated with a higher likelihood of being a current drinker and more frequent binge drinking. Results point to the importance of exploring within-group trajectories of alcohol use and highlight the protective and risky nature of adult social roles among American Indians.

Race, coping strategies, and substance use behaviors: a preliminary analysis examining white and American Indian adolescents

The association between stress exposure and substance use has been the subject of numerous studies. However, no prior study has explored the role of coping strategies in moderating the stress-substance use association for American Indian adolescents. Our preliminary study of coping strategies and substance use among a sample (n = 568) of rural American Indian and white adolescents revealed a number of similarities across both groups, but also some important differences. Results of logistic regression analyses revealed that the relationship between an avoidant coping strategy and marijuana use differed for whites and American Indians. Study limitations and future research directions are discussed.

Gender, Race, and Delinquent Behavior: An Extension of Power-Control Theory to American Indian Adolescents

Research testing Hagan's power-control theory has largely been tested with samples of non-Hispanic whites. We extend prior research by testing the theory's merits with a sample of American Indian (AI) adolescents. Overall, we find mixed support for the theory's merits. However, we find that our measure of patriarchy is a robust predictor of AI female delinquent activity. We also find that a grandparent in the household serves to greatly reduce involvement in violent behavior among AI females. Compared to a sample of non-Hispanic whites, these results reveal the importance of testing explanations of deviant behavior across racial and ethnic groups.

Characteristics of Northern Plains American Indians seeking substance abuse treatment in an urban, non-tribal clinic: a descriptive study

Because few data exist on substance abuse rates in American Indian (AI) communities, the Methamphetamine and Other Drug project was developed and implemented by five nodes within the National Institute on Drug Abuse Clinical Trials Network (NIDA CTN). This article presents findings from AI clients in a Northern Plains urban non-Native substance abuse treatment setting. Alcohol and marijuana were used earlier, longer, and by more clients, followed by stimulants and prescription opioids. Most regularly smoked tobacco. Differences in substance use patterns were associated with age of onset and victimization. Age of onset was correlated with victimization, gender, cognitive impairment, and suicidal behavior. Despite considerable health and economic disparities, most clients found support for recovery in relationships and elements of Native culture.

Methamphetamine use among rural White and Native American adolescents: an application of the stress process model

Methamphetamine use has been identified as having significant adverse health consequences, yet we know little about the correlates of its use. Additionally, research has found that Native Americans are at the highest risk for methamphetamine use. Our exploratory study, informed by the stress process model, examines stress and stress buffering factors associated with methamphetamine use among a cross-sectional sample of rural White and Native American adolescents (n = 573). Results of logistic regression analyses revealed mixed support for the stress process model; while stress exposure and family methamphetamine use predicted past year methamphetamine use, the inclusion of these variables failed to attenuate the association between race and past year use.

Association of contextual factors with drug use and binge drinking among White, Native American, and Mixed-Race adolescents in the general population

Large-scale surveys have shown elevated risk for many indicators of substance abuse among Native American and Mixed-Race adolescents compared to other minority groups in the United States. This study examined underlying contextual factors associated with substance abuse among a nationally representative sample of White, Native American, and Mixed-Race adolescents 12-17 years of age, using combined datasets from the National Survey on Drug Use and Health (NSDUH 2006-2009, N = 46,675, 48.77 % female). Native American adolescents displayed the highest rate of past-month binge drinking and past-year illicit drug use (14.06 and 30.91 %, respectively). Results of a logistic regression that included seven predictors of social bonding, individual views of substance use, and delinquent peer affiliations showed that friendships with delinquent peers and negative views of substance use were associated significantly with both substance abuse outcomes among White and Mixed-Race adolescents and, to a lesser extent, Native American adolescents. The association of parental disapproval with binge drinking was stronger for White than for Native American adolescents. Greater attention to specific measures reflecting racial groups' contextual and historical differences may be needed to delineate mechanisms that discourage substance abuse among at-risk minority adolescent populations.