American Indian/Alaska Native

Substance Use and Treatment

Alec W. Burrola, Cindy Hoang, and Carlyn Morones

CSP 626
 12% of the total AI/AN population lives in
Prevalence & ●
California

Statistics ● 28.4% of the AI/AN population live below the

poverty line

Higher rates of:

● Alcohol dependence
● Abuse of tobacco (43%) and illicit drugs (13.4%)
● Alcohol-related mortality
● Fetal alcohol spectrum disorders
● Cirrhosis
● AIDS

“Alcohol dependence/addiction among

Native Americans is more than twice
the level experienced by Whites.”

(California Courts, 2019; Dickerson et al., 2011; Grant et al., 2015; Mignon
& Holmes, 2013; Nebelkopf & Penagos, 2005; Venner et al., 2018)
Signs and Symptoms of Addiction for AI/NAs

Co-Occurring Most Commonly Warning Signs/Symptoms

Mental Health Concerns Abused Substances
● General: unexplained need
● Anxiety disorders ● Alcohol for money, interactions with
● Mood disorders ● Tobacco law enforcement
● Personality disorder ● Marijuana ● Cocaine: hyperactivity,
● Trauma (childhood ● Cocaine excessive talking followed by
abuse and family ● Hallucinogens depression or excessive and
violence) unusual sleep patterns
● Hallucinogens: bizarre and
irrational behavior, paranoia,
aggression, and mood
swings

(Dickerson et al., 2011; IHS, n.d.a; IHS, n.d.a; Mignon & Holmes, 2013;
Moghaddam, Dickerson, Yoon, & Westermeyer, 2014; Nebelkopf & Penagos, 2005)
Contextual Factors Biological
● Allele variations of alcohol metabolizing
genes

Social
● Familial Influence
Biological ● Trauma Exposure
● Delinquent Peers

Factors
Environmental
● Historical Trauma
● SES
Social Environmental

(Mulligan et al., 2003; Walls, Whitbeck, Hoyt, & Johnson, 2007; Beals, Novins,
Mitchell, Shore, & Manson, 2002; Chen et al., 2012; Braveheart, 2005)
Barriers to Treatment

Geographic Location

Indian Health Services (IHS)

Tradition-Based Practices

Low SES

Unemployment

Reliance on Welfare Systems

(Gerard, 2005; Whitesell, Beals, Crow, Mitchell, & Novins, 2012;

Dickerson et al., 2014)
Evidence-Based
Treatments
Motivational Interviewing

Drum-Assisted Recovery Therapy for

Native Americans (DARTNA)

Medicine Wheel
Motivational Interviewing

● One of the best studied evidence-based

treatments for substance use disorders
● Nonjudgmental, non-confrontational, and
nonauthoritative therapy that encourages respect
● 64% of AI/AN tribal leaders accepted MI
intervention to reservation-based youth whom
were drinking and had a family history of
substance abuse
● Pregnant women of the tribe had their own case
managers (CMs) enhanced with MI as part of a
fetal alcohol syndrome prevention program in
the AI/AN community
(Dickerson, 2017)
 Drum-Assisted Recovery Therapy for Native
Americans (DARTNA)
● A culturally relevant and tribally adaptable drum
behavior therapy developed by Francis Robichaud
for AI/ANs with substance use disorders
● The treatment incorporates drumming, talking
circles and the 12 steps of Alcoholics
Anonymous (AA)
● Participants in the DARTNA pretest demonstrated
a 50% completion rate, with 80% completing at
least half of the 12-week DARTNA treatment
protocol.
● 60% of the participants reported no recent
alcohol or drug use at while 20% reduced alcohol
(Dickerson, 2014) or drug use.
Medicine Wheel/“Sacred Hoop”

● Divided into four different categories (mental,

emotional, physical, and spiritual) to help
determine the focus of each intervention group
meeting
● Before using the Medicine Wheel, the group took
the first 3 weeks to explain each category and
educate the members about how each area is
affected by substance use and abuse.
● Stages of life: birth, youth, adult (or elder), death

Seasons of the year: spring, summer, winter, fall

Aspects of life: spiritual, emotional, intellectual,

physical
(Dickerson, 2014)
 Screening
● Varied healthcare settings such as psychiatric and
medical facilities, emergency departments, and
dental offices
● Screening, Brief Intervention, and Referral to
Treatment (SBIRT)

Engagement Traditional-based Healing

Four principal components self-transformation through an
acknowledgement of past personal struggles using:
and Retention of
1. Disclosure and catharsis
2. Introspection
3. Working towards self-understanding

AI/AN Clients 4. Finding purpose as an AI/AN

Cultural Competency
● Mignon (2013) found that the majority of Native
American tribes and bands are matriarchal
● the Native person may prefer to be “transformed”
and “healthy” rather than being “treated” and
“changed”
(Dickerson, 2014; Dickerson, 2011; Hodge, 2009; Gone, 2009; Mignon, 2013)
Limitations/ Areas of Study Gaps in Research

● Substance abuse treatment outcomes among AN/AIs are limited as

most studies have been conducted in small, community samples
and have focused primarily on Alcoholism rather than an expansive
and comprehensive focus on other addictive substances

● Over 300 different tribal or language groups with different variability

in histories, levels of enculturation, and different traditional
practices both among individual tribes and within the smaller
communities

● Limited in research such as research on the extent to which AN/AIs

use and benefit from evidence-based treatment; results may have
been generalized to those where either did not have access or
choose not to engage in Western treatment practices

(Dickerson, 2011; Walls, 2007; Venner, 2018)

Community
Resource
Thank you!

Any questions? 😃
References
Beals, J., Novins, D. K., Mitchell, C., Shore, J. H., & Manson, S. M. (2002). Comorbidity between alcohol abuse/dependence and psychiatric disorders: Prevalence, treatment implications, and new directions for
research among American Indian populations. NIAAA Research Monograph Series, 37, 371–410.
Braveheart, M. Y. H. (2003). The historical trauma response among natives and its relationship with substance abuse: A Lakota illustration. Journal of Psychoactive Drugs, 35(1), 7–13.
California Courts, The Judicial Branch of California. (2019). California tribal communities. Retrieved from https://www.courts.ca.gov/3066.htm.
Chen, H. J., Balan, S., & Price, R. K. (2012). Association of contextual factors with drug use and binge drinking among White, Native American, and Mixed-Race adolescents in the general population. Journal of
Youth and Adolescence, 41(11), 1426-1441.
Dickerson, D. L., Spear, S., Marinelli-Casey, P., Rawson, R., & Li, L. (2011). American Indians/Alaska Natives and substance abuse treatment outcomes: Positive signs and continuing challenges. Journal of Addictive
Diseases, 30(1), 63-74.
Dickerson, D. L., Venner, K. L., Duran, B., Annon, J. J., Hale, B., & Funmaker, G. (2014). Drum-assisted recovery therapy for Native Americans (DARTNA): Results from a pretest and focus groups. American Indian and Alaska native
mental health research (Online), 21(1), 35.
Dickerson, D., Moore, L. A., Rieckmann, T., Croy, C. D., Venner, K., Moghaddam, J., Novins, D. K. (2017). Correlates of motivational interviewing use among substance use treatment programs serving American Indians/Alaska
Natives. Journal of Behavioral Health Services & Research, 45(1), 31–45.
Gerard, S. (2005, June 16). Prevention and treatment of substance abuse in Native American communities. Phoenix, AZ: Arizona Department of Health Services; Bureau for Substance Abuse Treatment and
Prevention.
Gone, J. P. (2013). A community-based treatment for Native American historical trauma: Prospects for evidence-based practice. Spirituality in Clinical Practice, 1(S), 78–94.
Grant, B. F., Goldstein, R. B, Saha, T. D., Chou, S. P., Jung, J. Zhang, H.,...Hasin, D. S. (2015). Epidemiology of DSM-5 alcohol use disorder: Results from the national epidemiologic survey on alcohol and related
conditions III. JAMA Psychiatry, 72(8), 757-766.
Hodge, D. R., Limb, G. E., Cross, T. L. (2009). Moving from colonization toward balance and harmony: A Native American perspective on wellness. Social Work, 54(3).
Mignon, S. I., & Holmes, W. M. (2013). Substance abuse and mental health issues within Native American grandparenting families. Journal of Ethnicity in Substance Abuse, 12, 210-227.
Moghaddam, J. F., Dickerson, D. L., Yoon, G., & Westermeyer, J. (2014). Nicotine dependence and psychiatric and substance use disorder comorbidities among American Indians/Alaska Natives: Findings from the
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Mulligan, C. J., Robin, R. W., Osier, M. V., Sambuughin, N., Goldfarb, L. G., Kittles, R. A., & Long, J. C. (2003). Allelic variation at alcohol metabolism genes (ADH1B, ADH1C, ALDH2) and alcohol dependence in an
American Indian population. Human Genetics, 113(4), 325-336.
References (continued)
Nebelkopf, E., & Penagos, M. (2005). Holistic Native network: Integrated HIV/AIDS, substance abuse, and mental health services for Native Americans in San Francisco. Journal of Psychoactive Drugs, 37(3),
257-264.
Venner, K. L., Hagler, K., Cloud, V., & Greenfield, B. (2018). Native Americans resolve alcohol use disorder: “Whatever it takes or all that it takes.” Cultural Diversity and Ethnic Minority Psychology, 1-9.
Walls, M. L., Whitbeck, L. B., Hoyt, D. R., & Johnson, K. D. (2007). Early‐onset alcohol use among Native American youth: Examining female caretaker influence. Journal of Marriage and Family, 69(2), 451-464.
Whitesell, N. R., Beals, J., Crow, C. B., Mitchell, C. M., & Novins, D. K. (2012). Epidemiology and etiology of substance use among American Indians and Alaska Natives: Risk, protection, and implications for
prevention. The American Journal of Drug and Alcohol Abuse, 38(5), 376-382.