Issues in the Treatment of Native Americans with Alcohol Problems
Thomason, Timothy C., Journal of Multicultural Counseling and Development
The author reviews the literature on the treatment of Native Americans who have alcohol abuse or dependence disorders and provides an interpretation of the research on this topic. The most common alcohol treatment modalities used with Native Americans are described and critiqued, including adapted versions of standard treatments. Several practical recommendations are made regarding revising standard treatments to make them more culturally appropriate for Native Americans.
This article focuses on the most significant reports regarding treatment modalities and their efficacy for Native Americans with alcohol problems. The literature on alcoholism in Native Americans is comprehensive and includes information on the social and psychological aspects of alcoholism among this population (Beauvais, 1992; May, 1994) and information on incorporating traditional healing methods into standard treatment methods (Edwards & Edwards, 1988; Hall, 1986; Parker, 1990). See May for an excellent summary of general information about alcohol abuse among Native Americans.
NATIVE AMERICANS AND ALCOHOL
According to leading researchers, "there is no universal and all encompassing explanation for drug and alcohol abuse among American Indians" (Trimble, Padilla, & Bell, 1987, p. 5). Factors that seem to be related to alcohol abuse in this population include cultural dislocation (the feeling of not fitting into either traditional Native American culture or the general U.S. culture), the lack of clear sanctions or punishments for alcohol abuse, and strong peer pressure and support for alcohol abuse (Bell, 1988; Edwards & Edwards, 1984). Many researchers in this area speculate that alcohol abuse is related to poverty, school failure, unemployment, poor health, feelings of hopelessness, and the breakdown of the Native American family (Duran & Duran, 1995; Edwards & Edwards, 1984; Trimble, 1984). Griffith (1996) pointed out that compared with the majority population, Native Americans experience four times as much alcohol-related mortality, three times as much alcohol-related illness, and increased rates of alcohol-related accidental deaths, suicides, and homicides. Royce and Scratchley (1996) emphasized that there is no single reason for the prevalence of alcoholism among Native Americans and state that 42 different theories have been proposed. It is important to know the causes of alcohol problems in Native Americans because prevention and treatment efforts could be more focused if specific causes were known. It is clear that there is not consensus on this issue.
RESEARCH ON ALCOHOL TREATMENT FOR NATIVE AMERICANS
Many different alcohol treatment programs and modalities have been used with Native Americans. Weibel-Orlando (1989) described five common treatment models: the Medical Model, the Psychosocial Model, the Assimilative Model, the Culture-Sensitive Model, and the Syncretic Model. The Medical Model is based on the Disease Model of alcoholism, which is also a basic assumption of Alcoholics Anonymous (AA) and of U.S. society. At the other extreme is the Syncretic Model, which has primarily a Native American orientation, including the use of techniques such as the medicine wheel, talking circles, the sweat lodge, and tribal healers. The Red Road is one example of a specifically Native American treatment approach (Arbogast, 1995; Books & Berryhill, 1991). Nativized treatments are standard treatment modalities that have been adapted to be more culturally appropriate for Native Americans, usually by including discussion of traditional Native American concepts and the use of Native American healing techniques.
The Medical Model of alcoholism is often criticized as being culturally inappropriate when applied to Native Americans. Many Native Americans do not accept the Disease Model, although most would readily admit that alcohol abuse results in dysfunction and various problems in living. …