Alcohol Abuse Treatment for Native Americans
Numerous stereotypes remain about alcohol abuse and alcohol use disorders (AUDs). Stereotypes regarding the cause of alcohol abuse, about the nature of willpower in recovery, and even regarding ethnic differences in susceptibility to the development of an alcohol use disorder continue to proliferate. Native Americans may be the group that suffers from the most extreme stereotypes regarding their problems with alcohol use disorders and susceptibility to alcohol abuse.
Treatment for Native Americans Struggling with Alcohol Abuse
According to numerous sources, including American Psychological Association (APA) and the National Institute on Drug Abuse (NIDA), the effective treatment for any AUD should consider an overall treatment plan that consists of:
- A formal assessment of the individual to determine the severity of their alcohol abuse, the presence of other co-occurring mental health factors, their social situation, any medical conditions, and their situation, including understanding cultural factors that may be important considerations during their diagnosis and treatment.
- Withdrawal management when necessary.
- Medically assisted treatment, such as medications and other medical procedures, when necessary.
- Counseling or substance use disorder therapy, which is the mainstay of any recovery program.
- Social support groups and peer and family support.
- Any other interventions that may be useful in the particular case, such as complementary and alternative therapies, case management, tutoring or training, etc.
- Maintenance in a treatment program for a sufficient length of time.
- Individualized care to suit the special needs of the person in treatment, including consideration for cultural factors.
According to the book Ethnocultural Factors in Substance Abuse Treatment and other research sources, Native Americans will benefit most from a culturally sensitive approach to substance use disorder (SUD) treatment. Some alterations to the overall treatment plan are outlined below.
- Native Americans may be more responsive to tribal and spiritual interventions for all of their issues. This can include the use of therapy groups that are composed of Native Americans with Native American therapists and 12-Step groups primarily composed of Native American individuals where the focus is on spiritual and tribal principles.
- Native Americans are often responsive to complementary and alternative treatments that are delivered in a manner that allows them to be compatible with traditional forms of therapy. This includes music therapy, art therapy, wilderness therapy, etc. The use of these treatments should be integrated with the individual’s spiritual and cultural belief system.
- It can be beneficial to get family members and tribal members involved in the process of alcohol use disorder treatment, as well as in education and prevention programs aimed at reducing the risk and prevalence of substance abuse within the tribe and family system.
- A long-term aftercare program that focuses on the spiritual and cultural aspects of the individual’s cultural tradition and tribal beliefs can help them maintain long-term abstinence.
Stereotypes Regarding Native Americans and Alcohol Abuse
One of the most common stereotypes regarding the prevalence of alcohol abuse is the stereotype that Native Americans have higher rates of alcohol abuse and AUDs than other groups of individuals. Empirical research has determined repeatedly that the stereotype is not supported by the data.
For instance, a large epidemiological study reported in the Journal of Drug and Alcohol Dependence in 2016 investigated the prevalence of alcohol use disorders according to respondent’s scores on an empirically based measure of alcohol use (a standardized questionnaire) and their responses on a national survey conducted by the Substance Abuse and Mental Health Services Administration (SAMHSA). The study compared the results across Native Americans, Caucasians, Hispanics, African Americans, Asian Americans, and Native Hawaiian and Pacific Islanders. The results indicated the following:
- Native Americans reported that they were heavy drinkers in the survey data at a rate of 8.3% compared to an average prevalence of 6.5% over all groups.
- Native Americans reported that they engaged in binge drinking at a prevalence of 17.3% compared to the overall average of 15% over all groups.
- Native Americans reported that they were typically light to moderate drinkers at a rate of 24.7% to an overall average of 37.2% across all groups.
- Native Americans reported that they were abstainers from alcohol at a rate of 59.9% compared to an overall average of 52.3% over all groups.
- Native Americans were classified as heavy drinkers on the empirical measure at a rate of 17.1% compared to overall average of 19.8%.
- Native Americans were classified as light to moderate drinkers at a rate of 30% on the empirical measure compared to an overall average of 41.7%.
- Native Americans were classified as abstainers from alcohol on the empirical measure at a rate of 57.5% compared to an overall average of 46.8%.
- The highest rates of binge drinking and heavy alcohol use occurred in Hispanics and Native Hawaiian and Pacific Islanders, whereas the highest rate of abstainers from alcohol occurred in Asians and Native Americans.
The results from this large empirically based data set that combined and compared from different sources indicates that the findings are relatively consistent across different sources and that Native Americans have comparable rates of alcohol abuse to other ethnic groups. An additional interesting finding in this research indicated that Native Americans had the second highest rate of individuals claiming an annual income of less than $20,000 (at the poverty level) and had second highest rate of individuals who had not completed high school.
Some of the highest risk groups to develop SUDs are individuals from extremely low economic status backgrounds and individuals with poor educational backgrounds. These factors certainly contribute to alcohol and substance use among Native Americans.
A study looking at rates of individuals diagnosed with alcohol use disorders according to DSM-5 diagnostic criteria published by the Journal of the American Medical Association (JAMA) indicated that the highest prevalence rates for alcohol use disorders were found in:
- Caucasians and Native Americans
- Low-income individuals
- Those with significant disability, including medical disability and mental health disorders
Numerous research studies have determined that Native Americans have significantly higher rates of disability than other ethnic groups. For instance, Native Americans are shown to have extremely high rates of:
- Tuberculosis, diabetes, pneumonia, physical injuries, liver and kidney problems, problems with vision, and other debilitating medical conditions
- Injuries due to accidents, such as motor vehicle crashes
- Elevated rates of mental health disorders, including depression and trauma- and stressor-related disorders.
- High rates of suicide, with the highest rate of suicide among all ethnic groups in the US falling to young Native Americans between the ages of 15 and 24
Again, these factors are far better predictors of substance abuse than ethnicity.
Is There a Genetic Susceptibility to Alcohol Abuse in Native Americans?
There is a longstanding belief in the US that Native Americans have an inherent susceptibility to alcohol abuse that results in higher levels of alcoholism in this particular group. Explanation’s range from Native Americans having a genetic abnormality that does not allow them to process alcohol in the same way as Caucasians, to Native Americans having a genetic makeup that simply makes them more susceptible to enjoying the effects of alcohol compared to Caucasians. These are all myths, most likely developed early in the history of the country and propagated by the same types of factors that propagate other racist beliefs.
Based on the empirical evidence, including genetic research, there is no current evidence to suggest that Native Americans have an increased susceptibility to the development of any type of substance use disorder compared to other ethnic groups. Instead, Native Americans like all ethnic groups, share the same risk factors for the development of substance use disorders. Native Americans are more likely to have several significant risk factors than most other ethnic groups. The American Psychiatric Association (APA) lists these risk factors as being:
- Family history of substance abuse, encompassing both genetic and learning factors
- Some other mental health disorder
- Being male (In most cases, males are more susceptible to developing substance use disorders than females.)
- History of trauma or stress, particularly as a child
- Being in a lower social economic status group
- Poor health or chronic medical conditions
- Being poorly educated
- Exposure to substance use at an early age and developing an attitude that substance usage is a proper coping mechanism
- Peers who regularly engage in substance use
As can be seen from this list, Native Americans as a group do have significant risk factors that lead to an increased susceptibility to the development of substance use disorders that may make them more vulnerable. Despite multiple research studies that have found associations between numerous genes and increased vulnerability to alcohol abuse, no individual can be diagnosed with an alcohol use disorder or even with a greater potential to develop any substance use disorder based on their genetic makeup alone. There are no specified genetic associations that guarantee the development of any substance use disorder. There are no medical tests that can currently be used to reliably diagnose any form of a substance use disorder in anyone at this time.
Recognizing an Alcohol Use Disorder
The formal diagnosis of an alcohol use disorder (alcoholism or alcohol abuse) can only be made by a trained mental health clinician. APA lists the diagnostic criteria for alcohol use disorders that are designed to be applicable across all ethnic backgrounds and cultural beliefs in the United States. The consideration of an individual’s cultural beliefs and practices is always important when diagnosing any form of mental health disorder, and trained clinicians are required to consider these factors. According to APA, the diagnosis of an alcohol use disorder would be made on the basis of:
- An individual meeting at least two of 11 formal diagnostic criteria within the same 12-month period
- The person suffering significant distress or functional impairment as a result of their alcohol use
- The person displaying significant difficulties controlling their alcohol use that can occur in a number of different contexts
- The person displaying signs associated with physical dependence on alcohol
Clinicians would consider the individual’s cultural background, beliefs, and other relevant factors when diagnosing an alcohol use disorder in a Native American individual. A trained clinician would not assume that Native Americans are more vulnerable to developing alcohol use disorders based on their genetic makeup, but instead would include an understanding of the relevant risk factors discussed above in the determination of their diagnosis.
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