Alcohol and other drug (AOD) use is a serious and growing problem among American Indian and Alaska Native (Al/AN) women. In addition, there is wide variation across communities in AOD use patterns, access to treatment for substance use, and access to other needed health services. An evaluation study was conducted to document the needs of AI/AN women in AOD treatment and the treatment services and community factors that both facilitate and impede recovery at nine IHS-funded treatment centers. The data illuminate the challenges posed to the treatment centers, and how communities influence the substance use patterns of AI/AN women, as well as prevention efforts and health promotion. The information derived from this study can be used to improve services for AI/AN women and the potential role of communities in reducing substance use among AI/AN women.
KEY WORDS: American Indians, Alaska Natives, women, drug/alcohol treatment, health, treatment.
American Indians and Alaska Natives (AI/AN) living in the United States comprise one of the most diverse ethnic groups living in North America. Although Native Americans constitute less than 1% of the U.S. population, they represent more than 280 recognized tribes (Institute of Medicine [IOM], 1990). Once reduced to as few as 200,000 people in the 1960s, the Native American population has now grown to approximately 1.5 million (National Institute on Alcohol Abuse and Alcoholism, 1994; Christian, Dufour and Bertolucci, 1989; IOM, 1990). Historical and social variations in language, settlement patterns, and tribal values, as well as individual-mediated influences such as reserve residence and level of acculturation, have all contributed to this diversity. In addition, there is wide variation across communities in alcohol and other drug (AOD) use patterns, access to treatment for substance use, and access to other needed health services. This article illuminates the needs of AI/AN women in AOD treatment and the treatment services and community factors that both facilitate and impede recovery.
Alcohol and substance use among Native Americans
AOD use is a serious problem among American Indian and Alaska Native (AI/AN) people. Alcohol is three and a half more times likely than other causes to be implicated in deaths among AI/AN people (Christian et al., 1989) and is responsible for 25% of all deaths for AI/AN women (Leland, 1984). Research has demonstrated much higher levels of morbidity and mortality from alcohol and substance use-related conditions among AI/AN populations as compared with the national population (Lamarine, 1988).
Moreover, alcohol consumption is increasing among women (IOM, 1990; Fleming and Manson, 1990; Leung, Kinzie, Boehnlein and Shore, 1993). Women are more likely than men to use alcohol and/or other drugs alone, while men are more likely to drink socially (Scott, 1993). Although in general AI/AN males drink more than females, females die from alcohol-induced morbidity more often than AI/AN men and the general population (Hisnanick and Erickson, 1993).
The roots of substance abuse in this population can be traced back to the influence of Europeans and the displacement of Natives from their culture and land during the 1800s. In this century the continued attempts to "assimilate" the Native population have led to forced resettlement to urban areas or less productive land, to sending children to boarding schools, and subsequently to isolation, high unemployment and poverty.
The impact of substance use extends beyond its influence on morbidity and mortality rates. Alcohol abuse can affect the AI/AN family in many ways, both directly and indirectly. One of the most direct routes is through alcohol exposure during pregnancy; this can cause fetal alcohol syndrome (FAS), which is caused by maternal alcohol use during pregnancy and can result in severe birth defects and shortened life expectancy (Duimstra, Johnson, Kutsch, Wang, Zentner, Kellerman and Welty, 1993; Masis and May, 1991; State of Alaska Indian Health Service and National Centers for Disease Control and Prevention, 1993). …