What is Alcohol and Substance Abuse Evaluation and Treatment in American Indians and Alaska Natives?
Alaskan Natives and American Indians make up a diverse and varied community. According to the 2010 census, this group includes over 560 federally recognized tribes and totals over 2.9 million people. Considering those who identify as both Alaskan Natives or American Indians and another race, this number increases to more than 5.2 million individuals. Historically, there’s been a belief that Native Americans consume alcohol at higher rates than white people. We see this assumption in a U.S. government report where ethnologist H.R. Schoolcraft wrote, “It’s amazing to see that almost every tribe and nearly each individual, regardless of gender, are fascinated with intoxicating drinks. It seems that nothing can stop their desire.”
The issue with many such assumptions is that they treat the entire Alaskan Natives and American Indians community as a single entity. However, in reality, there is a lot of variety within this community. Many tribes have their own unique languages, cultures, and customs. This diversity extends to different levels of alcohol and substance abuse, which can vary significantly between different tribes and geographic locations. Therefore, research on specific subgroups of Alaskan Natives and Native Americans cannot be accurately applied to the entire population. Such broad generalizations often lead to misunderstandings and oversimplifications.
What Causes Alcohol and Substance Abuse Evaluation and Treatment in American Indians and Alaska Natives?
Environmental and genetic factors play a role in substance and alcohol use disorders among Alaskan Natives and American Indians. For instance, some individuals within these populations lack the specific genes that help the body break down alcohol. These genes are linked with certain enzymes, including alcohol dehydrogenase and acetaldehyde dehydrogenase.
These crucial genes are found in specific locations within our DNA (called alleles). When these genes are less active or missing, the levels of a substance called acetaldehyde rise in the blood when alcohol is consumed. This increase can cause reactions like feeling dizzy, sweating, feeling sick, and having a flushed face. These responses are often uncomfortable and can discourage excessive drinking.
Like everyone else, Alaskan Natives and American Indians can be influenced by typical risk factors tied to alcohol and drug misuse, including a family history of addiction, certain personality traits, mental health disorders, gender, and exposure to trauma. But they also face unique challenges, including the lingering psychological impact of historic cultural traumas.
The community’s stance on recreational substances also comes into play. Many tribal reservations sell cigarettes and alcohol at lower prices due to reduced taxes, making these substances more accessible. However, this ease of access can hinder attempts to quit smoking or drinking. To combat this, some tribes have instituted strict laws against the sale or possession of alcohol on the reservations.
Despite these challenges, strong protective factors exist within these communities. The strong sense of family, tribal affiliation, and spirituality present in Alaskan Native and American Indian populations can substantially boost the effectiveness of attempts to prevent and treat substance abuse.
Risk Factors and Frequency for Alcohol and Substance Abuse Evaluation and Treatment in American Indians and Alaska Natives
Research on alcohol and substance abuse among Alaskan Native and American Indian populations reveals varied patterns. Nowadays, most of these populations live in cities and suburbs. In the mid-twentieth century, the federal government initiated programs to assimilate these groups, which resulted in their dispersion and has made research challenging.
Most studies on these populations, therefore, occur on tribal reservations and may not represent the whole group. They indicate that Alaskan Native and American Indian teenagers tend to use tobacco, alcohol, and drugs more often and start younger than peers from other backgrounds. The highest rates were found among school dropouts living on reservations. Another study found that substance use varied based on location.
Similarly, amongst Alaskan native and American Indian adults, substance and alcohol use rates vary depending on their location and specific tribal community. Some studies suggest those who lived in cities or suburbs drank more alcohol than those on reservations. Other research indicated lower overall alcohol use compared with other Americans but heavier use amongst those who did drink. Finally, it was noted that tobacco use rates were higher among these populations, with drug use rates being equal to other American adults.
- Most Alaskan Native and American Indians now live in urban or suburban areas.
- The dispersion of these groups due to past government programs complicates research.
- Teenagers from these backgrounds tend to start using tobacco, alcohol, and drugs earlier than peers from other groups.
- Substance use among Alaskan native and American Indian teenagers varies by location.
- Alaskan Native and American Indian adults in urban or suburban areas tend to drink alcohol more frequently.
- Alcohol use is generally lower in these groups, but those who do drink consume more heavily.
- Tobacco use is higher among these populations, while drug use rates are similar to those of other American adults.
Signs and Symptoms of Alcohol and Substance Abuse Evaluation and Treatment in American Indians and Alaska Natives
Medical check-ups among the Alaskan Native and American Indian populations reveal similar health patterns to other ethnic groups. Doctors often use screening tools to identify people who might have alcohol or substance abuse disorders or are at high risk. Two common screening tools are the Alcohol Use Disorders Identification Test (AUDIT) and the CAGE-AID questionnaire.
Screening everyone is important to avoid missing the chance to help someone cope with their substance use. Sometimes, the physical signs of alcohol and substance misuse are hard to spot or even non-existent. That’s why these screening tests are so essential. However, they do rely on the person being honest about their alcohol and substance use, how much and how often they consume, any negative effects on their health or personal life, and how this use impacts their relationships with family, friends, and colleagues.
- Physical indicators might include gaining or losing weight rapidly
- Frequent accidents or stumbling
- Signs of mental health issues
- Problems with sleeping
Excessive drinking can lead to withdrawal symptoms including shaking and tremors, hallucinations, and seizures. Other health problems caused by alcohol abuse might include pancreatitis (an inflamed pancreas), fatty liver, and in severe cases, jaundice (yellowing of the skin), ascites (fluid build-up in the abdomen), enlarged liver, spider angiomas (red skin spots), gynecomastia (enlarged breasts in men), and cirrhosis (liver scarring).
In young people, some warning signs that should prompt further investigation into alcohol and substance misuse include a sudden change in their looks, a distinct shift in their personality, a drop in school or work performance, engaging in illegal activities, or severe emotional instability.
Testing for Alcohol and Substance Abuse Evaluation and Treatment in American Indians and Alaska Natives
Doctors can use a variety of tests to detect if a person has been abusing alcohol or drugs. These tests can check samples from different parts of the body, like urine, blood, saliva, hair, or even breath.
For example, physicians can check the level of alcohol in the blood, look for signs of alcohol breakdown products in the urine, and check for certain substances in the blood that indicate heavy drinking. There’s a wide range of tests that can give an indication of someone’s history with drugs or alcohol.
Heavy drinking over time can lead to certain health changes. It can cause a rise in specific liver-related enzymes, usually in a particular pattern. It also can result in a specific form of anemia in which the red blood cells become larger than normal, increased levels of another liver enzyme called gamma-glutamyl transferase, and longer time taken for blood clotting to start. All these common signs are closely associated with the abuse of alcohol.
As part of the diagnosis process, healthcare professionals can use a widely-accepted set of criteria, called the DSM-5, to decide if a person has an alcohol or substance use disorder. These criteria look at many aspects of a person’s behavior and health to determine if they have a problem with alcohol or drugs.
Treatment Options for Alcohol and Substance Abuse Evaluation and Treatment in American Indians and Alaska Natives
Alcohol and drug abuse can negatively impact the health, relationships, and jobs of American Indian and Native Americans. It has been found that American Indian and Alaskan Natives are 41% more likely to seek help for alcohol addiction than non-Hispanic white individuals.
Motivational Interviewing is a method that’s proven effective for treating drug and alcohol addictions. It involves a conversation between the patient and therapist that focuses on the patient’s willingness to change and strengthens their commitment to do so. The therapist develops a positive relationship with the patient by showing empathy, respecting their autonomy and encouraging them. It’s been found to work well with American Indian and Alaskan Native cultures and values.
Beyond Motivational Interviewing, there are other treatment methods like cognitive behavioral therapy, group counseling, and medication specifically adapted for the particular substance being abused.
What else can Alcohol and Substance Abuse Evaluation and Treatment in American Indians and Alaska Natives be?
When we refer to mental health conditions, these are some examples of the disorders often mentioned:
- Bipolar disorder – A condition marked by periods of extreme mood swings.
- Panic disorder – A type of anxiety disorder characterized by unexpected and repeated panic attacks.
- Generalized anxiety disorder – A chronic disorder characterized by excessive, long-lasting anxiety and worry about multiple events or activities.
- Psychosis – A mental disorder where the person loses touch with reality and may experience delusions or hallucinations.
- Mania – An extremely elevated or irritable mood typically seen in bipolar disorder, marked by impulsive behavior and other symptoms.
What to expect with Alcohol and Substance Abuse Evaluation and Treatment in American Indians and Alaska Natives
In a study involving Alaskan Natives and American Indians attending an alcohol detox center, 75% successfully completed their treatment. It was observed that those who started drinking at a later age and stayed longer in the treatment facility were more likely to be successful in their detox journey.
However, those dealing with both alcohol and other substance abuse disorders were 50% less likely to finish their detox treatment. After completing detox, only 36% of Alaskan Natives and American Indians agreed to continue with further treatment in another inpatient or outpatient program. Women were 38% less likely to accept this further assistance. Interestingly, those facing legal troubles were two times more likely to accept the additional treatment. Out of those who accepted the referral, only 58% actually attended the recommended substance abuse treatment programs.
Possible Complications When Diagnosed with Alcohol and Substance Abuse Evaluation and Treatment in American Indians and Alaska Natives
Alcohol and substance abuse have been linked to various negative health events. It has been observed that Alaskan Natives and American Indians face higher death rates due to alcohol, chronic liver disease, and drug-related issues compared to all other races. Early death rates are about 90% higher for these groups in the U.S., primarily due to alcohol consumption.
For Alaskan Natives, alcohol abuse also leads to increased rates of cirrhosis (a liver disease) as well as dementia. Tragically, it’s also linked to suicide, homicide, and unintentional injuries. In fact, alcohol abuse is the leading cause of death for Alaskan Native men and the sixth highest cause of death for Alaskan Native women. A study by the Alaska Native Tribal Health Consortium found the death rate due to alcohol was over 16 times greater amongst Alaskan Natives compared to Whites in the U.S.
There is significant variation in alcohol and substance abuse rates across different tribes and areas, and this is also reflected in the death rates. For example, the Indian Health Service noted alcohol-related death rates as low as 18.3 per 100,000 people in the Eastern U.S. while areas like North and South Dakota have rates as high as 86.4 per 100,000.
Preventing Alcohol and Substance Abuse Evaluation and Treatment in American Indians and Alaska Natives
Alaskan Natives and American Indians can tap into the strength of their support networks, which includes their family, friends, peers, and tribe, to stick to their treatment programs. By nurturing a supportive environment and staying committed to their treatment, they can fend off the harmful effects of drug and alcohol use and lower the likelihood of falling back into old habits.
