Development and Feasibility Pilot Study of Indigenous Recovery Planning: A Community-Engaged Approach to Addressing Substance Use in a Native Community.

Although Native (American Indian and Alaska Native [AI/AN]) populations have high rates of abstinence from alcohol, health problems associated with substance use remain a pressing concern in many AI/AN communities. As part of a longstanding community-based participatory research (CBPR) project involving five years of relationship building and three preliminary studies, our team of academic and community co-researchers developed a culturally grounded intervention to facilitate recovery from substance use disorders among tribal members from a rural AI reservation. Our Indigenous Recovery Planning (IRP) intervention consists of six weekly sessions and aims to provide inroads to existing resources in the community, affirm and enhance Native identity, address culturally relevant risk factors, and build upon strengths. Results from a feasibility pilot study (N = 15) suggest that IRP is feasible to implement and acceptable to the community. Although there was insufficient statistical power to conduct hypothesis testing, there were changes between pretest and posttest scores in the expected directions. Future directions and limitations of this research are discussed.

Association of racism and substance use treatment with belief in the myth of an American Indian/Alaska Native biological vulnerability to alcohol problems.

OBJECTIVES: Belief in an American Indian/Alaska Native (AIAN) specific biological vulnerability (BV) to alcohol problems is associated with worse alcohol outcomes among AIANs. Despite a notable lack of evidence that biogenetic factors play a greater role in the development of alcohol problems among AIANs than other groups, many people still believe this myth. Consistent with theory and evidence that greater experiences with discrimination leads to the internalization of stereotypes and oppression, we hypothesized that greater perceived racial discrimination (racism) would be associated with greater BV belief, but that having a stronger ethnic identity would weaken this association. We also examined whether previous substance use treatment as well as participation in Alcoholics Anonymous (AA) or Narcotics Anonymous (NA) was associated with BV belief. METHOD: Participants were 198 reservation-dwelling AI adults with a substance use problem who completed a survey as part of a larger community-based participatory study. RESULTS: A multiple regression analysis revealed that greater systemic racism was associated with greater belief in a BV; this association was not moderated by ethnic identity. Greater interpersonal racism was also associated with greater BV belief-but only among those low in ethnic identity. A regression analysis revealed that previous treatment, AA, and NA participation were not associated with BV belief. CONCLUSIONS: Greater systemic and interpersonal racism were associated with belief in a BV, and greater ethnic identity buffered the association between interpersonal racism and BV belief. This suggests that both combatting racism and fostering positive ethnic identity may help to lessen BV belief. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Beliefs about causal factors for suicide in rural Alaska Native communities and recommendations for prevention.

Rural Indigenous communities in Alaska suffer staggeringly high rates of suicide. In close-knit Alaska Native villages, each suicide leaves a trail of affected family and community members in its wake. This research aimed to understand community perceptions of what causes suicide in rural Alaska Native villages and generate recommendations for prevention strategies. In-depth interviews were conducted with 25 Alaska Native university students who moved from rural villages to an urban area to attend college. All had been profoundly affected by others' suicides and shared their beliefs about causal factors and recommendations for prevention efforts. Perceived causes included resistance to seeking help or discussing personal problems, loss of culture, traumatic experiences, geographical and social isolation, lack of opportunity, substance abuse, and exposure to others' suicides. Participants believed that suicide is preventable and recommended multi-level approaches to address suicide disparities. They provided recommendations for potentially effective and culturally appropriate prevention strategies, including increasing cultural and social connections, educating community members about mental health, and increasing accessibility of counseling services/reducing barriers to mental health services utilization.

Belief in the myth of an American Indian/Alaska Native biological vulnerability to alcohol problems among reservation-dwelling participants with a substance use problem.

BACKGROUND: Belief in the myth of an American Indian/Alaska Native (AIAN)-specific biological vulnerability (BV) to alcohol problems is associated with worse alcohol outcomes among AIAN college students who drink, despite also being associated with greater attempts to reduce drinking. This study examined the association of belief in a BV with alcohol use among reservation-dwelling AI adults with a substance use problem. METHODS: Participants (n = 141) who drank alcohol in the past 90 days were selected from a larger AI sample who self-identified as having a substance use problem. Moderated-mediation analyses examined whether belief in a BV was positively associated with alcohol- and substance use-related consequences and whether self-efficacy and craving mediated the association of belief in a BV with alcohol use. RESULTS: Among participants who reported using alcohol but not hard drugs (e.g., methamphetamine, opioids), greater belief in a BV was associated with more drinking days, which in turn was associated with greater alcohol-related consequences. Among participants who used alcohol only, belief in a BV was also significantly associated with greater craving, and in turn with more drinking days. Among individuals who used both alcohol and hard drugs, greater belief in a BV was associated with fewer drinking days, but was not significantly associated with substance use-related consequences. No association was found between belief in a BV and self-efficacy to avoid alcohol or drug use. CONCLUSIONS: Among individuals who use only alcohol, belief in a BV may contribute to more drinking days and greater alcohol-related consequences through its association with greater craving. This study provides further evidence of the potential harm of internalizing the belief that being AIAN contributes to the risk for alcohol problems, a notion that lacks scientific evidence despite decades of research. The findings highlight the importance of combating societal myths regarding AIAN peoples and the internalization of these stereotypes.

Determinants of Relapse and Opportunities for Growth: Perspectives on Substance Use among American Indian Community Members.

Resulting from generations of historical oppression and systemic racism, American Indian and Alaska Native (AI/AN) communities experience serious health disparities associated with substance use disorders (SUDs). As part of a longstanding community-based participatory research intervention development project, our partnership of academic and community co-researchers conducted seven focus groups (N = 35) to understand community stakeholders' perspectives on substance use, relapse, and recovery on a rural AI reservation. Participants included cultural leaders (n = 10), SUD treatment providers (n = 5), people with SUD (n = 10), and affected family members (n = 10). Cultural leaders viewed relapse as symptomatic of historical oppression, whereas other stakeholder groups attributed relapse to individual and interpersonal risk factors such as peer influence, lack of family support, and traumatic stress. All participant groups recognized relapse as a normative aspect of recovering from SUD that presents new opportunities for learning and growth. Specifically, regaining humility, learning to ask for help, recognizing one's triggers, and strengthening commitment to change were identified as learning outcomes for people with SUD. For family members, relapse provided the opportunity to practice forgiveness and compassion, two important cultural values. All groups emphasized the importance of grounding interventions in cultural values and traditions.

Historical trauma and substance use among American Indian people with current substance use problems.

OBJECTIVE: In the United States, American Indian and Alaska Native (AI/AN) people suffer health inequities associated with alcohol and other drug use and also experience historical trauma symptoms resulting from colonization. Research suggests that historical trauma may be associated with substance use among AI/ANs. METHOD: As part of a Community-Based Participatory Research project with tribal partners from a rural AI reservation, our team collected cross-sectional survey data from 198 tribal members who self-identified as having substance use problems. We examined associations between historical trauma thoughts, historical trauma symptoms, and substance use outcomes. We also examined historical trauma symptoms, current trauma symptoms, awareness of systemic discrimination, and ethnic identity as moderators of the associations between historical trauma thoughts and substance use variables. RESULTS: Historical trauma thoughts, controlling for symptoms, were associated with greater abstinent days, fewer heavy alcohol use days, fewer drinks per drinking day, and fewer drug use days; historical trauma symptoms, controlling for thoughts, were associated only with fewer abstinent days. Moderation analyses showed that historical trauma thoughts were associated with better substance use outcomes when historical trauma symptoms were low, current trauma symptoms were low, awareness of systemic discrimination was high, and ethnic identity was high. CONCLUSION: When distressing trauma symptoms are low, historical trauma thoughts may act as a protective factor or as a marker for other factors associated with better substance use outcomes. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Belief in the American Indian/Alaska Native biological vulnerability myth and drinking to cope: Does stereotype threat play a role?

Objectives: The effects of stereotype threat and internalized alcohol stereotypes on negative affect and negative affect-related drinking have not been examined in American Indians/Alaska Natives (AI/ANs), despite their frequently being subjected to alcohol stereotypes. The current study examined the association of belief in the myth of an AI/AN specific biological vulnerability (BV) with alcohol consequences through its effect on depression and drinking to cope with negative affect. Method: In this cross-sectional study, a moderated mediation model examined the association of belief in a BV with alcohol consequences via sequential mediators of depression and drinking to cope. It was hypothesized that the positive association of belief in a BV with depression would be stronger among individuals who engaged in more frequent heavy episodic drinking. Participants were 109 female (69.9%) and 47 male (30.1%) AI/AN college students (Mage = 27.1 years, range 18 to 61) who reported having at least 1 drink in the past month. Results: Belief in a BV was positively associated with depression symptoms among participants reporting average or high frequency of heavy episodic drinking. Greater depression symptoms predicted greater drinking to cope, which in turn predicted greater alcohol consequences. Conclusion: Belief in the BV myth may act as a type of stereotype threat, contributing to alcohol consequences by increasing negative affect and drinking to cope. These results suggest that for AI/ANs who drink, there are psychological and behavioral health ramifications of believing in the notion of a BV, and a need to debunk this myth. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Alcohol Consumption, History of Sexual Assault in Adolescence, and Revictimization in a Sample of University Students in the Western United States.

This study evaluated alcohol consumption as a moderator of the association between adolescent sexual assault and risk of sexual assault in college. It was hypothesized that sexual assault in adolescence would be associated with higher risk of college victimization and that this association would be moderated by alcohol consumption. Predominantly female and European-American university students (N = 201) completed self-report measures of alcohol consumption and sexual assault victimization in adolescence and since enrolling in college at a medium-sized university in the Western United States. Controlling for effects of age and gender, there was a significant interaction between alcohol consumption variables (i.e., typical weekly alcohol consumption and binge drinking) and adolescent sexual assault, such that the greatest risk for sexual assault in college was incurred by the heaviest drinkers with the greatest frequencies of adolescent sexual assault. This study highlights the importance of considering past victimization history in concert with alcohol consumption in efforts to prevent sexual victimization in college.

Health Disparities Research with American Indian Communities: The Importance of Trust and Transparency.

American Indian and Alaska Native (AI/AN) communities experience notable health disparities associated with substance use, including disproportionate rates of accidents/injuries, diabetes, liver disease, suicide, and substance use disorders. Effective treatments for substance use are needed to improve health equity for AI/AN communities. However, an unfortunate history of unethical and stigmatizing research has engendered distrust and reluctance to participate in research among many Native communities. In recent years, researchers have made progress toward engaging in ethical health disparities research by using a community-based participatory research (CBPR) framework to work in close partnership with community members throughout the research process. In this methodological process paper, we discuss the collaborative development of a quantitative survey aimed at understanding risk and protective factors for substance use among a sample of tribal members residing on a rural AI reservation with numerous systems-level barriers to recovery and limited access to treatment. By using a CBPR approach and prioritizing trust and transparency with community partners and participants, we were able to successfully recruit our target sample and collect quality data from nearly 200 tribal members who self-identified as having a substance use problem. Strategies for enhancing buy-in and recruiting a community sample are discussed.

Negative life events and incident alcohol use disorders among ethnic minorities.

The association of negative life events (NLEs) with incident alcohol use disorders (AUDs) was examined among Blacks, Hispanics, and Whites in the second wave of the National Comorbidity Survey (NCS) among 3,679 participants without AUDs at the first wave. The number of past-year NLEs at NCS-2 was higher for Black than White participants, but the rates of incident AUDs did not differ by racial/ethnic group (14.2% among all participants). Past-year NLEs were associated with increased odds of incident AUDs for Whites and Hispanics but not Blacks. The implications of racial/ethnic differences in life events and AUDs are discussed.

A Systematic Review of Trauma Interventions in Native Communities.

American Indian/Alaska Native and First Nations communities suffer from health disparities associated with multiple forms of trauma exposure. Culturally appropriate interventions are needed to heal current and historical trauma wounds. Although there are evidence-based trauma interventions for other populations, few have been implemented or evaluated with Native communities. Understanding the extant research on trauma interventions in Native communities is crucial for advancing science and filling gaps in the evidence base, and for meeting the needs of underserved people. In this systematic review of the literature on trauma interventions in Native communities in the United States, Canada, Australia, and New Zealand, we identified 15 studies representing 10 interventions for historical and/or current trauma. These studies involved the community to some extent in developing or culturally adapting the interventions and suggested positive outcomes with regard to historical and interpersonal trauma symptoms. However, notable limitations in study design and research methods limit both internal validity and external validity of these conclusions. Only one study attempted (but did not achieve) a quasi-experimental design, and small sample sizes were persistent limitations across studies. Recommendations for researchers include working in partnership with Native communities to overcome barriers to trauma intervention research and to increase the rigor of the studies so that ongoing efforts to treat trauma can yield publishable data and communities can secure funding for intervention research.

Partnering with Native Communities to Develop a Culturally Grounded Intervention for Substance Use Disorder.

Studies have documented serious disparities in drug and alcohol-related morbidity and mortality among American Indians and Alaska Natives (AI/ANs) compared to other ethnic groups in the U.S. despite high rates of abstinence in these groups. Further complicating these health disparities are barriers to accessing evidence-based treatments that are culturally appropriate and acceptable. As part of a research program to promote health equity in rural communities, we developed an academic-community partnership to create a culturally grounded intervention for adults with substance use disorder (SUD) residing on a rural AI reservation. We describe the early phases of our long-term Community Based Participatory Research project and report findings from the first study we conducted. This key informant interview study consisted of in-depth qualitative interviews with 25 tribal members knowledgeable about substance use and recovery on the reservation. The goal was to understand social norms and cultural conceptualizations of substance use to inform the development of a sustainable, community-driven intervention. Participants reported that a holistic approach to recovery that emphasizes spiritual, cultural, and interpersonal harmony and connectedness was important to the community and would be necessary for the intervention to succeed. They also emphasized the need for a multi-level intervention targeting individuals, families, and the community as a whole. Through this initial study, we not only gained valuable information that will be used to guide future research and treatment efforts, but we also strengthened our partnership and built trust with the community. In this manuscript we tell the story of the development of our project and describe our shared vision for future directions.

Understanding the link between racial trauma and substance use among American Indians.

Historians and scholars from various disciplines have documented the pervasive influence of racism on American society and culture, including effects on the health and well-being of American Indian (AI) people. Among the many health problems affected by racial discrimination and oppression, both historical and current, are substance use disorders. Epidemiological studies have documented greater drug and alcohol-related morbidity and mortality among AI/AN Alaska Natives compared to other ethnic groups, and culturally appropriate, effective interventions are sorely needed. We collected, as part of a larger community-based participatory research project to address substance use disparities in rural AI communities, qualitative interview data from 25 AI key informants from a frontier reservation in Montana. Using a semistructured interview guide, we asked participants to discuss their perceptions of the causes of substance use problems and barriers to recovery on the reservation. Although no questions specifically asked about discrimination, key informants identified stress from racism as an important precipitant of substance use and barrier to recovery. As one participant stated: "Oppression is the overarching umbrella for all sickness with drugs and alcohol." Participants also identified historical trauma resulting from colonization as a manifestation of race-based stress that drives behavioral health problems. Findings suggest that interventions for AIs with substance use disorders, and possibly other chronic health problems, may be more effective if they address social determinants of health such as racial discrimination and historical trauma. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Association of belief in the "firewater myth" with strategies to avoid alcohol consequences among American Indian and Alaska Native college students who drink.

Belief in an American Indian/Alaska Native (AI/AN) specific biological vulnerability (BV) to alcohol problems (aka the "firewater myth") is associated with worse alcohol outcomes among AI/AN college students who drink, despite also being associated with greater attempts to reduce drinking. The current study examined how belief in a BV may have affected how 157 AI/AN college students who drink (a) attempted to moderate their alcohol use and avoid alcohol-related problems using abstinence-based and harm reduction strategies, and (b) attitudes toward these strategies as a means of addressing alcohol problems. Contrary to our hypotheses, belief in a BV was not found to be associated with use of harm reduction strategies or with how effective students believed these strategies to be. However, greater belief in a BV was associated with lower self-efficacy for the use of harm reduction strategies among more frequent heavy episodic drinkers. This is concerning, as the use of harm reduction strategies was associated with less frequent heavy episodic drinking in this sample. In contrast, belief in a BV was positively associated with the use of abstinence-based strategies and with how effective these strategies were perceived to be. However, for individuals with average or greater belief in a BV, abstinence-based strategies were associated with greater alcohol consequences. The results suggest that for AI/AN students who drink, belief in a BV may be influencing the strategies used to moderate alcohol use and avoid alcohol-related harm, as well as attitudes toward these strategies, in ways that do not appear helpful. (PsycINFO Database Record

A preliminary needs assessment of American Indians who inject drugs in northeastern Montana.

BACKGROUND: Injection drug use has not been well documented in American Indians living in the USA. American Indian and Alaskan Natives (AI/ANs) show higher rates of substance use compared to the general population, and have historically been subject to a number of risk factors that are known to increase the likelihood of substance use. AI/ANs also experience increased risk for infectious diseases that are transmitted via injection drug use and/or sexual activity. Harm reduction approaches have been shown to be effective for decreasing risk of disease transmission in at-risk populations, and may be well suited for AI/AN injection drug users residing in rural reservation communities. In this study, we aimed to examine the characteristics of American Indians (AI) who use injection drugs (PWUID) in northeastern Montana to identify needs that could be addressed with harm reduction programming. METHODS: For the present study, we used a respondent-driven sampling approach to generate a sample of 51 self-identified male and female injection drug users ≥18 years of age who were American Indians living on the Fort Peck Indian Reservation. Sampling weights were applied to all analyses using Respondent-Driven Sampling Analysis Tool (RDSAT). RESULTS: There were no strong recruitment patterns by age, sex, or ethnic identity status of the recruiter or participant, but there were strong within-group recruitment patterns by location within the reservation. The majority of the sample reported initiating substance use before the age of 18. Participants reported significant risk for HIV, hepatitis, and other infectious diseases through their drug use and/or risky sexual behavior. Sixty-five percent reported having reused syringes, and 53% reported drawing from the same filter. Seventy-five percent reported inconsistent condom use during the 3 months preceding the survey, and 53% reported injecting drugs during sex during the 3 months preceding the survey. Only 66% of participants reported having been tested for HIV in the 12 months preceding the survey. The vast majority (98%) of respondents expressed interest in a harm reduction program. Seventy-six percent reported that it was easy or very easy to obtain new syringes. CONCLUSIONS: We documented several risks for blood-borne pathogens, including elevated levels of syringe reuse. Further, we documented significant interest in harm reduction interventions in the present sample of AI/AN injection drug users. Findings suggest a need for increased access to harm reduction programming for AI/AN injection drug users to reduce the transmission of infectious disease and increase access to compassionate care.

Association of the firewater myth with drinking behavior among American Indian and Alaska Native college students.

The firewater myth (FM) is the notion that American Indians and Alaska Natives (AI/ANs) are more susceptible to the effects of alcohol and vulnerable to alcohol problems due to biological or genetic differences. Believing that one is vulnerable to problems with alcohol may have negative effects on expectancies and drinking behavior among AI/ANs who drink; however, the association of belief in the FM with alcohol outcomes has not previously been examined. In this study we examined the factor structure of a revised version of the Firewater Myth Scale (FMS; LaMarr, 2003) and the association of belief in the FM with alcohol use, consequences, attitudes, and expectancies with 159 AI/AN college students who drink. On average, participants "slightly agreed" with the FM and scores were normally distributed. There were significant small to moderate positive associations between believing that AI/ANs have a biological vulnerability to problems with alcohol (i.e., the FM) and drinks consumed per week, frequency of heavy episodic drinking, and alcohol consequences, as well as belief in a disease model of "alcoholism," attempts to control drinking, guilt over drinking small amounts of alcohol, both positive and negative alcohol expectancies, temptation to drink heavily, and lack of self-efficacy to drink moderately. Although this is only an initial examination of potential consequences of belief in the FM for AI/AN students who drink, the results suggest that this belief may be harmful and have negative effects on attempts to moderate drinking. (PsycINFO Database Record

Symptoms of Alcohol Dependence Predict Suicide Ideation Among Alaskan Undergraduates.

BACKGROUND: Previous research has demonstrated an association between alcohol-related problems and suicidal ideation (SI). AIMS: The present study evaluated, simultaneously, alcohol consequences and symptoms of alcohol dependence as predictors of SI after adjusting for depressive symptoms and alcohol consumption. METHOD: A sample of 298 Alaskan undergraduates completed survey measures, including the Young Adult Alcohol Consequences Questionnaire, the Short Alcohol Dependence Data Questionnaire, and the Beck Depression Inventory - II. The association between alcohol problems and SI status was evaluated using sequential logistic regression. RESULTS: Symptoms of alcohol dependence (OR = 1.88, p < .05), but not alcohol-related consequences (OR = 1.01, p = .95), emerged as an independent predictor of SI status above and beyond depressive symptoms (OR = 2.39, p < .001) and alcohol consumption (OR = 1.08, p = .39). CONCLUSION: Alcohol dependence symptoms represented a unique risk for SI relative to alcohol-related consequences and alcohol consumption. Future research should examine the causal mechanism behind the relationship between alcohol dependence and suicidality among university students. Assessing the presence of dependence symptoms may improve the accuracy of identifying students at risk of SI.

Sobriety and alcohol use among rural Alaska Native elders.

BACKGROUND: Although notable health disparities related to alcohol use persist among Alaska Native people living in rural communities, there is a paucity of research examining drinking behaviour in particular segments of this population, including elders. One explanation for this is the distrust of behavioural health research in general and alcohol research in particular following the legacy of the Barrow Alcohol Study, still regarded as a notable example of ethics violations in cross-cultural research. OBJECTIVE: The present study reports findings from one of the first research studies asking directly about alcohol abuse among rural Alaska Natives (AN) since the study in Barrow took place in 1979. DESIGN: We report findings regarding self-reported alcohol use included in an elder needs assessment conducted with 134 Alaska Native elders from 5 rural villages off the road system in Alaska. Data were collected in partnership between academic researchers and community members in accordance with the principles of Community-Based Participatory Research. RESULTS: Findings showed very high rates of sobriety and low rates of alcohol use, contradicting stereotypes of widespread alcohol abuse among AN. Possible explanations and future research directions are discussed. CONCLUSIONS: This research represents one step forward in mending academic-community relationships in rural Alaska to further research on alcohol use and related health disparities.

Ethnic identity, drinking motives, and alcohol consequences among Alaska Native and non-Native college students.

This research involves the examination of drinking motives, alcohol consequences, and ethnic identity in a sample of Native and non-Native college student drinkers in Alaska. Although more Alaska Native students are abstinent from alcohol compared to any other ethnic group, Native students who do drink experience greater alcohol consequences and dependence symptoms. Therefore, we attempted to examine the influence of ethnic identity on alcohol consequences in a diverse sample of Native and non-Native students in Alaska. Findings showed that drinking motives, as measured by the Drinking Motives Questionnaire (social, coping, enhancement, and conformity), significantly predicted alcohol consequences after controlling for frequency of monthly binge drinking. In addition, after controlling for depression, binge drinking, and drinking motives, one aspect of ethnic identity (Affirmation, Belonging, and Commitment) was significantly negatively related to alcohol consequences, whereas another aspect of ethnic identity (Ethnic Identity Search) was not. Taken together, these findings suggest that interventions for college student alcohol misuse that target Native students should be culturally grounded and focused on enhancing the Affirmation, Belonging, and Commitment to one's ethnic heritage and should address drinking motives, especially drinking to cope, as a way to reduce alcohol related harm.