The negative effects of racial discrimination and microaggressions on health have been consistently documented, but only a handful of studies have examined this topic among Native Americans. The goal ...of this study was to test the Indigenist Stress-Coping Model (Walters, Simoni, & Evans-Campbell, 2002) among Native American college students attending two post-secondary institutions in the Southwestern United States. It was hypothesized that microaggressions would be positively related to substance use, and that cultural factors would attenuate the strength of this relationship. A total of 347 participants (65% female) completed a one-time online survey that included the Microaggressions Scale, the Actualization subscale of the Urban American Indian Identity Attitudes Scale (a measure of cultural identity), and measures of past-month and lifetime substance use. In the past month, only 43% of participants drank alcohol and only 27% binge drank – figures much lower than national averages for college students. Thirteen percent were current smokers and 20% had used illicit drugs in the past month. Almost all (94%) had experienced a microaggression in the past year. In regression models, microaggressions were positively related to using an illicit drug more than 100 times and to lifetime CAGE-AID score when controlling for gender, age, income, and cultural identity. However, microaggressions were unrelated to past-month substance use variables. While stronger Native American cultural identity was related to less past-month substance use, cultural identity did not moderate the relationship between discrimination and substance use. A subgroup of participants (n = 61) from the larger study completed a 21-day daily diary measuring substance use, discrimination, and cultural involvement. The goal was to examine the prospective influence of daytime experiences of racial discrimination on evening substance use, as well as the moderating effects of cultural identity, positive and negative interpersonal interactions, and alcohol expectancies. Using multi-level modeling, daytime discrimination did not predict evening substance use, and moderators could not be tested because of statistical convergence issues. These findings highlight cultural strengths and comparatively low rates of tobacco and alcohol use among Native American college students despite substantial experiences of lifetime discrimination; implications for future research and intervention are discussed.
Alcohol Use Disorders Hallgren, Kevin A.; Greenfield, Brenna L.; Ladd, Benjamin ...
Handbook of Evidence‐Based Practice in Clinical Psychology,
06/2012
Reference
Alcohol use disorders have a 30% lifetime prevalence rate and are associated with numerous problems, including disease, injury, social impairment, occupational dysfunction, domestic violence, and ...economic burden. Despite the availability and demonstrated efficacy of several treatments, many providers fail to use evidence‐based practices. Moreover, most treatments deemed efficacious yield only modest improvements in outcomes, and no single modality is considered universally superior. A review of randomized clinical trials, meta‐analyses, literature reviews, and consensus panel recommendations identified nine treatments with evidence for efficacy in the treatment of alcohol use disorders: cognitive behavior therapy, contingency management, cue exposure therapy, community reinforcement approach, behavioral couples and family treatment, brief interventions, motivational interviewing and motivational enhancement therapy, 12‐step‐based therapies, and case management. Therapist factors shown to influence treatment outcomes were also reviewed. Treatments were found to vary considerably in the quantity and rigor of studies testing their efficacy. Although large‐scale treatment studies have identified few client‐treatment matching effects, some client characteristics may determine which treatments are a better fit. For example, behavioral couples and family treatment or the community reinforcement approach may be optimal when a significant other is available to participate in treatment, motivational interviewing and specific therapist techniques may be helpful with resistant or angry clients, and brief interventions may be optimal when time and resources are limited. More research is needed to examine treatment efficacy for clients with co‐occurring psychiatric disorders or drug use, and to determine the effectiveness of these treatments in real‐world settings.
As global mental health research and programming proliferate, research that prioritizes women’s voices and examines marginalized women’s mental health outcomes in relation to exposure to violence at ...community and relational levels of the socioecological model is needed. In a mixed methods, transnational study, we examined armed conflict exposure, intimate partner violence (IPV), and depressive symptoms among 605 women in Northeastern Uganda. We used analysis of variance to test between groups of women who had experienced no IPV or armed conflict, IPV only, armed conflict only, and both; and linear regression to predict depressive symptoms. We used rapid ethnographic methods with a subsample (n = 21) to identify problem prioritization; and, to characterize women’s mental health experiences, we conducted follow up in-depth interviews (n = 15), which we analyzed with grounded theory methods. Thirty percent of the sample met the cut-off for probable major depressive disorder; women exposed to both IPV and armed conflict had significantly higher rates of depression than all other groups. While women attributed psychological symptoms primarily to IPV exposure, both past-year IPV and exposure to armed conflict were significantly associated with depressive symptoms. Women identified socioeconomic neglect as having the most impact and described three interrelated mental health experiences that contribute to thoughts of escape, including escape through suicide. Policy efforts should be interprofessional, and specialists should collaborate to advance multi-pronged interventions and gender-informed implementation strategies for women’s wellbeing. Additional online materials for this article are available on PWQ’s website at http://journals.sagepub.com/doi/suppl/10.1177/0361684319864366
Objectives: There is a growing awareness of the prevalence of abstinence and rates of remission from alcohol problems among Native Americans (NAs). Past NA remission research has included ...epidemiological studies, treatment outcomes, and qualitative inquiry. In this study, we sought to qualitatively examine how NAs resolved moderate to severe alcohol use disorder (AUD) and maintained long-term sobriety. Method: Recruitment via newspaper advertisements, flyers, and word-of-mouth yielded 55 NA participants (56% male). Face-to-face semistructured interviews lasted about 1 hr. We transcribed the audio recordings and analyzed data with NVivo software using an iterative process of thematic analysis and consensus building. Results: Two major coding categories were used: motivating factors and actions used to resolve AUD. Each of these categories consisted of subcodes (8 and 13, respectively). Conclusions: NAs resolved AUD via multiple methods and efforts. What worked for one individual did not necessarily work the first time or for another individual. Although some motivators or actions were unique to NAs, others were similar to findings in the general population. Because multiple and varied motivations and actions may be required to resolve AUD, individuals with AUD and their loved ones should persevere in their efforts to make positive changes. Future research should examine other NA tribal regions and NA remission from drug use disorder.
This study examined community perceptions and prevalence of alcohol use and cigarette smoking among American Indian adults with type 2 diabetes. Results revealed normative rates and perceptions of ...smoking and negative views and low rates of alcohol use. Participants reported high levels of household indoor smoking and comorbid high-risk drinking and smoking. The high smoking rate among the adult American Indians in this study is especially problematic given the increased risk of cardiovascular problems related to both smoking and type 2 diabetes. The results underscore the importance of considering substance use behaviors and beliefs as a component of overall health and well-being for people with diabetes.
PDF
