Monitoring and peer influences as predictors of increases in alcohol use among american Indian youth.

This study investigated the combined influence of parental monitoring, community monitoring, and exposure to substance-using peers on early-onset alcohol use in a sample of American Indian adolescents in three Pacific Northwest tribal communities. We used structural equation modeling, including tests of indirect effects, in the investigation of 281 American Indian youth between ages 8 and 16 years at the time of consent. The effects of parental monitoring and community monitoring, mediated by friends' substance use, were examined in terms of youth alcohol use outcomes. Parental monitoring practices and contagion in peer substance use were proximal predictors of early-onset alcohol use and the mediating effect of friends' substance use was not significant. Community monitoring accounted for unique variance in affiliation with substance-using friends.

Predicting American Indian adolescent substance use trajectories following inpatient treatment.

This study examined the effects of psychopathological, peer, family, and cultural predictors of American Indian adolescents' drug use following inpatient treatment. Data regarding lifetime, 90 days prior to treatment, and 1-year posttreatment substance use were collected using interviews, questionnaires, and observations of 57 American Indian adolescents and their families. Trajectories of days-used measures were subjected to semiparametric trajectory analysis. Trajectories were then compared on baseline measures by using both univariate and multivariate logit regression techniques. The study sought to identify prerelease predictors of membership in post-inpatient treatment substance use trajectory groups. Findings provide insight into the unique and shared risk and protective factors relevant to American Indian adolescents' substance use outcomes. In particular, this study suggests that a combination of family management and American Indian traditional cultural practices in families serves as a potential target for interventions to reduce substance use in adolescence.

Traumatic events and alcohol use disorders among American Indian adolescents and young adults.

This study examined the relationship between severe traumatic events and alcohol use disorders in American Indian adolescents and young adults. Interviews of 432 adolescents and young adults who were enrolled tribal members living on or near two closely related American Indian reservations were used. Results indicated that severe trauma increased the odds of alcohol use disorders (p <.001), with the number of traumas having a dose-dependent effect. The authors conclude that trauma is associated with alcohol use disorders in this population. This study's findings yield important insights into the risks in American Indian adolescents and young adults that may result from early trauma, as well as implications for the timing and possible settings for intervention.

A culturally responsive, family-enhanced intervention model.

The Multicultural Interventions for Adolescent Substance Use, referred to as The Shadow Project, was a 3-year, NIAAA-funded pilot study involving 60 American Indian families who had a youth entering alcohol and drug inpatient treatment. Participation was voluntary and involved comparison of two different treatment modalities: treatment as usual and a brief family-enhanced intervention. In adapting this family-based intervention specifically for American Indian families, a cultural approach to assessment and intervention was integrated into the process, with the intervention focusing on building support around the youth to attain abstinence and assuring the youth that their family, community, and substance abuse counselor were motivating influences. Five areas were assessed in the family observation tasks: relationship building, positive reinforcement, limit setting, monitoring, problem solving, and communication. Cultural adaptation was made for two of the five tasks. Two legends were used to assess the families' skill level in relationship building, problem solving, and communication as a family unit. By incorporating Indian stories, families were encouraged to respond in a culturally appropriate manner. Preliminary findings show that these stories were linked to child prosocial behavior and the percentage of days abstinent from individual drug use. This pilot project also adapted culturally responsive instruments, tasks, and validity to this population. The first year required adaptation of recruitment methods, tribal and treatment center agreements, referral contacts, and implementation of intervention and follow-up with adolescents and their families. The second year was composed of intervention implementation and follow-up assessments. To determine the intervention program's long-term effect on reducing adolescent alcohol and other drug use, all families were followed up and assessed 11 months after they left treatment. The third and final year of the study included follow-up, data entry, and data analysis.