ABSTRACT
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 AIs. We begin by first situating the importance of research on spirituality in the more general literature on the AI 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.
Subject(s)
Alcohol Drinking , Biomedical Research/organization & administration , Indians, North American , Program Evaluation , Spiritual Therapies/methods , Spirituality , Alcohol Drinking/ethnology , Alcohol Drinking/prevention & control , Alcohol Drinking/psychology , Humans , Prevalence , United States/epidemiologyABSTRACT
OBJECTIVE: This study examined the reliability of the Structured Clinical Interview for DSM-III-R (SCID) in the administration of psychiatric assessments by real-time videoconferencing compared to face-to-face assessment within a rural American Indian community. METHOD: The SCID was administered to 53 male American Indian veterans who were randomly assigned over two separate occasions by different interviewers to face-to-face and real-time interactive videoconferencing within 2 weeks. Comparisons were made with prevalences, the McNemar test, and the kappa statistic. RESULTS: With the exception of past-year substance dependence and abuse/dependence combined, there were no significant differences between face-to-face and videoconference administration. The majority of kappas calculated (76%) indicated a good or fair level of agreement. Externalizing disorders tended to elicit greater concordance than internalizing disorders. CONCLUSIONS: Overall, SCID assessment by live interactive videoconferencing did not differ significantly from face-to-face assessment in this population. Videoconferencing is a viable vehicle for clinical and research purposes.
Subject(s)
Indians, North American/psychology , Mental Disorders/diagnosis , Psychiatric Status Rating Scales/statistics & numerical data , Remote Consultation/methods , Veterans/psychology , Aged , Diagnostic and Statistical Manual of Mental Disorders , Humans , Male , Middle Aged , Physician-Patient Relations , Psychiatric Status Rating Scales/standards , Remote Consultation/standards , Reproducibility of Results , Videoconferencing/standardsABSTRACT
In this study the authors examined the prevalence and correlates of posttraumatic stress disorder (PTSD) and trauma symptomatology among a sample of 89 American Indian adolescents in a residential substance abuse treatment program. These youths reported an average of 4.1 lifetime traumas, with threat of injury and witnessing injury being most common; molestation, rape, and sexual attack were least common. Approximately 10% of participants met the Diagnostic and Statistical Manual IV Text Revision (DSM-IV-TR) criteria for full PTSD, and about 14% met the criteria for subthreshold PTSD. Molestation (including rape and sexual attack), experiencing 6 or more traumas, and a diagnosis of abuse of or dependence on stimulants were significantly associated with PTSD. Findings indicated that trauma was a pervasive phenomenon among this population, with sexual traumas being particularly stigmatizing, resulting in high rates of posttraumatic symptomatology, specifically PTSD.
Subject(s)
Illicit Drugs , Indians, North American/statistics & numerical data , Life Change Events , Residential Treatment , Stress Disorders, Post-Traumatic/epidemiology , Stress Disorders, Post-Traumatic/rehabilitation , Substance-Related Disorders/epidemiology , Adolescent , Central Nervous System Stimulants , Child Abuse, Sexual/psychology , Child Abuse, Sexual/statistics & numerical data , Comorbidity , Cross-Sectional Studies , Female , Humans , Indians, North American/psychology , Male , Rape/psychology , Rape/statistics & numerical data , Statistics as Topic , Stress Disorders, Post-Traumatic/diagnosis , Substance-Related Disorders/diagnosis , Substance-Related Disorders/rehabilitation , United States , Wounds and Injuries/psychologyABSTRACT
OBJECTIVE: This study addresses the prevalence of DSM-IV substance abuse and dependence and the endorsement of specific symptoms of these disorders among American Indian adolescents admitted to a residential substance abuse treatment program. METHOD: We interviewed 89 American Indian adolescents using the Composite International Diagnostic Interview-Substance Abuse Module (CIDI-SAM). RESULTS: The most frequent diagnoses included marijuana dependence (51.7%), followed by alcohol abuse and dependence (33.7% each) and marijuana abuse (32.6%). Among the three substances with the highest prevalence of any use disorder (alcohol, marijuana and stimulants), the most frequently endorsed abuse criterion was Impaired Role Obligations. The two most frequently endorsed dependence criteria were Use Despite Substance-Related Psychological/Physical Problems and Unsuccessful Attempts to Quit/Cut down on substance use. CONCLUSIONS: These American Indian adolescents presented to a residential substance abuse treatment program with serious, highly complex substance use disorders that represent substantial challenges to effective treatment.
