Residential Substance Abuse Treatment for Urban American Indians and Alaska Natives, Part I: Services and Staff.

Although residential substance abuse treatment is utilized extensively by urban American Indians and Alaska Natives (AI/ANs), there are few detailed descriptions of this care. This study delineated services provided by and interviewed staff working at residential programs designed for chemically dependent urban AI/ANs. Study agencies were compared to national data from residential programs serving general population clients. Study agencies delivered arrays of services substantially broader than those provided by general population programs. As well as culturally specific programs tailored for AI/ANs plus so-called "mainstream" substance abuse treatments, study facilities provided numerous ancillary services, such as care for clients' children.

Residential Substance Abuse Treatment for Urban American Indians and Alaska Natives, Part II: Costs.

The present study examined costs of two residential substance abuse treatment programs designed for urban American Indians and Alaska Natives (AI/ANs). Costs for one agency were well within national norms, while costs at the other program were less than expected from nationwide data. Economies of scale accounted for much of the difference between observed and expected costs. Culturally specific residential substance abuse treatment services can be provided to urban AI/ANs within budgets typically found at mainstream programs.

The effects of parental diagnosis and changing family norms on alcohol use and related problems among urban American Indian adolescents.

This study investigated the role of parental diagnosis of alcohol abuse/dependence and perceived family norms for adolescent drinking on alcohol use and alcohol-related problems among urban American Indian youth. A total of 251 urban, American Indian youth and their parents/caregivers were followed from ages 13 to 18. Perceived family norms against alcohol decreased and alcohol use increased from ages 13 to 18. Relative to no parental diagnosis, youth with one or two parents diagnosed with alcohol abuse/dependence were less likely to perceive family norms against alcohol use. Youth with two parents diagnosed were more likely to report alcohol-related problems at age 18 compared to no parental diagnosis. Faster rates of decrease in perceived family norms against alcohol use were associated with faster increases in alcohol use over time. Higher rates of perceived family norms against alcohol use protected youth from high rates of use at age 13, but higher rates of alcohol use at age 13 predicted more alcohol-related problems at age 18. These results suggest that both family history and family behaviors in the form of communication of norms for adolescent alcohol use are likely to impact both rates of use and eventual alcohol-related problems.