American Indians with Substance Use Disorders: Treatment Needs and Comorbid Conditions

Abstract

Background: American Indians and Alaska Natives (AI/ANs) experience significant disparities in health status and access to care. Furthermore, only limited data are available on substance use, mental health disorders, and treatment needs for this population. Addressing such disparities and developing culturally relevant, effective interventions for AI/AN communities require participatory research. Objectives and Methods: The Western States Node of the National Institute on Drug Abuse Clinical Trials Network partnered with two American Indian substance abuse treatment programs: an urban health center and a reservation-based program to assess client characteristics, drug use patterns, and treatment needs. Data collected by staff members at the respective programs from urban (n = 74) and reservation (n = 121) clients were compared. Additional sub-analysis examined patients reporting regular opioid use and mood disorders. Results: Findings indicate that urban clients were more likely to report employment problems, polysubstance use, and a history of abuse. Reservation-based clients reported having more severe medical problems and a greater prevalence of psychiatric problems. Clients who were regular opioid users were more likely to report having a chronic medical condition, suicidal thoughts, suicide attempts, polysubstance abuse, and IV drug use. Clients who reported a history of depression had twice as many lifetime hospitalizations and more than five times as many days with medical problems. Conclusions: Findings from this project provide information about the patterns of substance abuse and the importance of comprehensive assessments of trauma and comorbid conditions. Results point to the need for integrative coordinated care and auxiliary services for AI/AN clients seeking treatment for substance use disorders.

• Indians
• North American
• substance abuse treatment

ACKNOWLEDGMENTS

This work was supported by the National Institute on Drug Abuse, Award #5K23DA021225 (Rieckmann, principal investigator) and the National Institutes on Drug Abuse Treatment Clinical Trials Network Oregon/Hawaii Node (U10 DA13036) and Western States Node (U10 DA015815). The authors acknowledge their consultants and colleagues Dr. Daniel Dickerson (United American Indian Involvement/University of California-Los Angeles) and Dr. John Spence (NW Indian Training Associates).

Declaration of Interest

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of this article.