25-2 Winter 2013: “Tribal and Behavioral Health” Resource Guide

Oct 31st, 2013 | By | Category: 25-2: Tribal and Behavioral Health, Online resource guides, Resource Guides, Web Exclusive
By Teresa Abrahamson-Richards and Jessyca Murphy

Substance Abuse, Historical Trauma, and Tribal and Behavioral Health

The following resource guide compiles contemporary research on preventative methods for reducing substance abuse in American Indian communities, with a specific focus given to young adults. We selected these works to illustrate the connection between historical trauma and alcohol abuse, and to show how strengthening cultural connections can aid efforts to moderate unhealthy drinking. For added perspective on the impact of social environments on alcohol consumption, we have included more generalized studies on perceived norms and intervention methods for substance abuse on college campuses.

Cummins, L.H., Chan, K.K., Burns, K.M., Blume, A.W., Larimer, M., & Marlatt, G.A. (2003). Validity of the CRAFFT in American-Indian and Alaska-Native adolescents: Screening for drug and alcohol risk. Journal of Studies on Alcohol, 64(5), 727-732.

Description: Native American adolescents are reported to be at high risk for drug and alcohol use and related negative consequences. The CRAFFT (a mnemonic acronym for the 6 screening domains) has been shown to be a valid and reliable substance use screening tool for clinicians who work with a general adolescent outpatient population. This study collected data as part of the Journeys of the Circle project, a collaboration between the Seattle Indian Health Board and the University of Washington’s Addictive Behaviors Research Center. Properties of the CRAFFT were examined in 70 American Indian and Alaska Native youths ages 13-19. The CRAFFT demonstrated good internal consistency, making it a potentially useful tool for providers as a valid instrument for identifying Native youths at risk for alcohol and other drug related problems.

Suggested Use: Tribal colleges can use this research article to decide if the CRAFFT is an appropriate tool for substance abuse screening among their student population.

Geisner, I.M., Neighbors, C., Lee, C.M., & Larimer, M.E. (2007). Evaluating personal alcohol feedback as a selective prevention for college students with depressed mood. Addictive Behaviors, 32(12), 2776-2787.

Description: This study evaluated a brief mailed intervention for alcohol use as an addition to a treatment for college students with depression symptoms. The intervention aimed to correct misperceptions and reduce students’ drinking-related consequences. Researchers randomly assigned a sample of 177 college students (70% female) to the intervention or control group. Participants in the intervention received feedback and information via the mail detailing their reported alcohol use and moderation strategies, as well as accurate information regarding student drinking. Results showed no major effects on drinking or related problems, but the students who received feedback showed significant reductions in their perception of drinking norms compared to the control group. The formative group showed significant reductions in total drinks per week and total alcohol-related problems compared to those whose norms did not reduce. Results support the importance of correcting normative perceptions and provide direction for selective prevention of alcohol use and related problems among this population.

Suggested Use: This information is useful for understanding how drinking interventions work in the college student population and what aspects of the intervention make a difference.

Hawkins, E.H., Cummins, L.H., & Marlatt, G.A. (2004). Preventing substance abuse in American Indian and Alaska Native youth: Promising strategies for healthier communities. Psychological Bulletin, 130(2), 304-323.

Description: Substance abuse has had profoundly devastating effects on the health and well-being of American Indians and Alaska Natives. A wide variety of intervention methods has been used to prevent or stem the development of alcohol and drug problems among Native youth, but there is little empirical research evaluating these efforts. This article is an overview of the published literature on substance use prevention among Indian adolescents, providing background epidemiological information, a review of programs developed specifically for American Indian adolescents, and recommendations for the most promising prevention strategies currently in practice.

Suggested Use: This review can serve as a quick overview of a variety of interventions that tribal college administrators can use when selecting a substance abuse program.

LaBrie, J.A., Hummer, J.F., Neighbors, C., & Pedersen, E.R. (2008). Live interactive group-specific normative feedback reduces misperceptions and drinking in college students: A randomized cluster trial. Journal of the Society of Psychologists in Addictive Behaviors, 22(1), 141-148.

Description: This research assessed the efficacy of an intervention designed to correct misperceptions of alcohol-related group norms and to subsequently reduce drinking behavior. Twenty campus organizations with 1,162 college students were randomly assigned to either an intervention or control group. The intervention occurred during the organizations’ regular standing meeting. Data were gathered using computerized keypads which participants used to enter personal responses to a series of alcohol-related questions assessing perceptions of normal group behavior, as well as actual individual behavior. These data were then immediately presented in graphical form to illustrate discrepancies between perceived and actual group norms. Results indicated that compared with the control group, the intervention group reduced drinking behavior and misperceptions of group norms at one and two-month follow-ups. Changes in perceived norms influenced the reductions in drinking. Results demonstrate the effectiveness of this type of intervention that can be implemented with entire groups at relatively low cost.

Suggested Use: Tribal colleges looking for a relatively low-cost strategy to influence student drinking that easily reaches a large number of students may find this intervention useful.

LaBrie, J.A., Hummer, J.F., & Neighbors, C. (2008). Self-consciousness moderates the relationship between perceived norms and drinking in college students. Addictive Behaviors, 33(12), 1529-1539.

Description: This study examined whether measures of self-consciousness have predictive value in the relationship between perceived norms and drinking, and if that differs among college men and women. Results indicate that self-consciousness moderates gender differences in the relationship between perceived social norms and drinking. A strong positive relationship was found between perceived norms and drinking for men, relative to women. Further, this relationship was more pronounced among individuals who were lower in public self-consciousness. Similarly, the relationship between perceived norms and drinking was significantly stronger among men than women, and this was more pronounced among individuals who were higher in private self-consciousness or social anxiety. These results highlight the important influence of social factors in peer groups.

Suggested Use: This research can help tribal college personnel familiarize themselves with the ways in which social perceptions, gender, and self-consciousness influence student drinking behaviors.

Larimer, M.E., & Cronce, J.M. (2002). Identification, prevention and treatment: A review of individual-focused strategies to reduce problematic alcohol consumption by college students [Supplement]. Journal of Studies on Alcohol, 14, 148-163.

Description: This article reviews the literature on individually focused prevention and treatment approaches for college student drinking. Little evidence exists for the usefulness of educational or awareness programs. Cognitive-behavioral skills-based interventions and brief motivational feedback have consistently shown greater efficacy than informational interventions. There is mixed support for values clarification and normative reeducation approaches. Much of the research suffers from serious methodological limitations. The evidence from this review suggests that campuses would best serve the student population by implementing brief, motivational or skills-based interventions that target high-risk students identified either through brief screening in health care centers and other campus settings or through membership in an identified risk group. More research is needed on effective strategies for identifying and recruiting students in individualized prevention services. Integration between campus policies and individualized prevention approaches is recommended.

Suggested Use: This review not only evaluates a variety of alcohol interventions for college students, it also explains what strategies do and do not work in general.

Larimer, M.E., Cronce, J.M., Lee, C.M., & Kilmer, J.R. (2004-2005). Brief interventions in college settings. Alcohol Research and Health, 28(2), 94-104.

Description: This article discusses best practices for conducting brief interventions in college settings, which have been successful in reducing alcohol consumption and/or alleviating the related consequences. Several screening tools have been developed to detect problematic alcohol use and associated disorders, and some are designed specifically for use with college students. College campuses offer opportunities to implement screening and interventions, including universal or large-scale assessments, health services, counseling centers, and local emergency rooms. Colleges also have established judicial or grievance systems for students who violate campus alcohol policies. There are a variety of issues to consider when implementing screening and brief interventions in college populations. For example, who should deliver the interventions—peer or professional counselors? How should students be encouraged to participate in the interventions. Regardless of how the measures are implemented, the content and process of the brief interventions should be based on the available scientific evidence regarding established efficacious interventions.

Suggested Use: Brief interventions are popular in college settings and this article explains what to consider if your college is planning to implement one.

Lee, C.M., Geisner, I.M., Lewis, M.A., Neighbors, C., & Larimer, M.E. (2007). Social motives and the interaction between descriptive and injunctive norms in college student drinking. Journal of Studies on Alcohol and Drugs, 68(5), 714-721.

Description: Social norms are a key determinant of young adult drinking, yet little research has evaluated potential interaction among different types of norms. This study was designed to evaluate perceptions of friends’ approval of drinking (injunctive norms) as a moderator in the relationship between perceived prevalence of friends’ drinking (descriptive norms) and personal alcohol consumption. The authors also evaluated whether social drinking motives further influence this relationship. A sample of 1,400 first-year college students (61% women) completed web-based assessments of descriptive and injunctive norms, personal drinking, and social drinking motives. Results showed that both descriptive and injunctive norms regarding close friends were associated with drinking behavior. The relationship between perceived descriptive norms and personal drinking was stronger among those who also perceived their friends as being more approving of drinking, but only among students who reported stronger social motives for drinking. Results are considered in terms of their implications for brief interventions.

Suggested Use: Specific research like this can help develop understanding of the precise personal characteristics that influence students’ drinking behaviors and how they apply to interventions.

Leigh, J., Bowen, S., & Marlatt, G.A. (2005). Spirituality, mindfulness and substance abuse. Addictive Behaviors, 30(7), 1335-1341.

Description: Research suggests that mindfulness-based therapies may be effective in treating a variety of disorders, including stress, chronic pain, depression, and anxiety. However, there are few valid and reliable measures of mindfulness. Furthermore, mindfulness is often thought to be related to spirituality, but empirical studies on this relationship are difficult to find. This study tested the reliability and validity of the Freiburg Mindfulness Inventory (FMI), explored the relationship between mindfulness and spirituality, and investigated the relationship between mindfulness/spirituality and alcohol/tobacco use in an undergraduate college population. Results support the reliability of the FMI and suggest that spirituality and mindfulness may be separate constructs. In addition, as spirituality scores increased, the use of alcohol and tobacco decreased. Thus, spirituality may be related to decreased substance use. In contrast, a positive relationship between mindfulness and smoking/frequent binge-drinking behavior was uncovered, and warrants further investigation.

Suggested Use: This article is useful for organizations considering implementing less customary approaches to substance abuse treatment.

Lewis, M.A., & Neighbors, C. (2006). Social norms approached using descriptive drinking norms education: A review of the research on personalized normative feedback. Journal of American College Health, 54(4), 213-218.

Description: College students have been shown to consistently overestimate the drinking of their peers. As a result, social norms approaches are effective in correcting these misperceived norms to reduce alcohol consumption and alcohol-related problems. In this review of literature, the authors critically evaluated the effectiveness of personalized normative feedback. In addition, the authors reviewed personalized normative feedback interventions and provided suggestions for increasing the efficacy of these interventions by making better use of salient referent group data.

Suggested Use: Those who are interested in implementing a normative feedback intervention will find this review useful for maximizing the treatment’s effectiveness.

Mallett, K.A., Lee, C.M., Neighbors, C., & Larimer, M. L. (2005). Do we learn from our mistakes? An examination of the impact of negative alcohol-related consequences on college students’ drinking patterns and perceptions. Journal of Studies on Alcohol, 67(2), 269-276.

Description: Little research has examined antecedents of specific drinking consequences, such as vomiting, regretted sex, hangover, and blackouts, among college students. This research examined how students’ experiences of past consequences relate to their beliefs of experiencing similar consequences in the future and how these beliefs relate to current drinking patterns. Self-reported past drinking behavior and resulting consequences were assessed among 303 college students—66% of which were women. Students also estimated the number of drinks associated with risk of experiencing similar consequences in the future. Results indicated that students significantly overestimated the number of drinks it would take to vomit, have unwanted sexual experiences, experience hangovers, and blackout in comparison with the actual self-reported number of drinks consumed the last time identical consequences were experienced. In addition, greater mismatches between the perceived and actual number of drinks associated with each type of consequence were consistently associated with heavier drinking. Clinical implications of these findings are discussed.

Suggested Use: Colleges can develop a better understanding of heavy-drinking students’ perceptions of their own alcohol experiences and how those experiences can be incorporated into clinical treatment.

Marlatt, G.A., Larimer, M. L., Baer, J.S., Quigley, L.A. (1993). Harm reduction for alcohol problems: Moving beyond the controlled drinking controversy. Behavior Therapy, 24(4), 461-504.

Description: This randomized controlled trial evaluated the efficacy of a brief intervention designed to reduce the harmful consequences of heavy drinking among high-risk college students. Students screened for risk while in their senior year of high school were randomly assigned to receive an individualized, motivational brief intervention in their freshman year of college or to a no-treatment control condition. A normative group selected from the entire screening pool provided a natural history comparison. Follow-up assessments over a two-year period showed significant reductions in both drinking rates and harmful consequences, favoring students receiving the intervention. Although high-risk students continued to experience more alcohol problems than the natural history comparison group over the two-year period, most showed a decline in problems over time, suggesting a developmental maturational effect.

Suggested Use: The brief intervention described in this study was shown to be effective and could be implemented by colleges looking for evidence based programs to address drinking.

Mohatt, N.V., Fok, C.C., Burket, R., Henry, D., & Allen, J. (2011). Assessment of awareness of connectedness as a culturally-based protective factor for Alaska Native youth. Cultural Diversity & Ethnic Minority Psychology, 17(4), 444-455.

Description: Research with Native Americans has identified connectedness as a culturally based protective factor against substance abuse and suicide. Connectedness refers to the interrelated welfare of the individual, one’s family, the community, and the natural environment. The authors of this study developed an 18-item assessment of awareness of connectedness and tested it with Alaska Native youth. The measure has utility in the study of culture-specific protective factors and as an outcomes measure for behavioral health programs with Native youth.

Suggested Use: Colleges looking for an outcome measure for a substance use intervention that has been tested with Native youth may find this culturally based scale relevant.

Neighbors, C., Fossos, N., Woods, B.A., Fabiano, P., Sledge, M., & Frost, D. (2006). Social anxiety as a moderator of the relationship between perceived norms and drinking. Journal of Studies on Alcohol and Drugs, 68(1), 91-96.

Description: This study was designed to evaluate social anxiety as a moderator of the relationship between perceived norms and drinking among college men and women. A sample of first-year residence-hall students completed web-based assessments of social anxiety, perceived norms, and self-reported drinking. Results replicated previous research in that students overestimated the amount their peers drank. Students who had higher social anxiety drank somewhat more but did not differ from students who had lower social anxiety on perceived norms. However, the relationship between perceived norms and drinking was stronger among students who had higher social anxiety compared to students who were less socially anxious. Higher levels of social anxiety were associated with a stronger relationship between perceived norms and drinking for both men and women, but stronger for men.

Suggested Use: Social anxiety was shown to increase drinking in this study. Colleges therefore might consider addressing social anxiety as part of a broader strategy to reduce student drinking.

Peterson, S., Berkowitz, G., Cart, C.U., Brindis, C. (2002). Native American women in alcohol and substance abuse treatment. Journal of Health Care for the Poor and Underserved, 13(3), 360-378.

Alcohol and other drug use is a serious problem among American Indian and Alaska Native women. However, information about their needs for treatment is lacking. In response, this study documents the life experiences and perceived recovery needs of American Indian and Alaska Native women at nine treatment centers nationwide. The data show that most of these women have experienced various forms of abuse and neglect from childhood into adulthood and have been exposed to alcohol and other drugs from an early point in their lives. Most of these women have made multiple attempts to recover from their addictions, often for the sake of their children. The information derived from this study can be used as the foundation for further research about the treatment needs of American Indian and Alaska Native women.

Suggested Use: This study can inform administrators’ and students’ background knowledge of the life experiences of Native women who struggle with substance abuse.

Radin, S., Neighbors, C., Walker, P.S., Walker, R.D., Marlatt, G.A., & Larimer, M. (2006). The changing influences of self-worth and peer deviance on drinking problems in urban American Indian adolescents. Psychology of Addictive Behaviors, 20(2), 161-170.

Description: This study explored the changing relations among self-worth, peer deviance, and alcohol-related problems in a sample of 224 urban-dwelling, American Indian adolescents. Data were collected annually to test a proposed mediational model. As expected, peer deviance mediated the relation between low self-worth and alcohol-related problems in younger adolescents. However, this relationship did not hold as participants became older. In older adolescents, low self-worth and peer deviance directly and independently contributed to alcohol problems. Possible explanations for these include developmental changes during adolescence.

Suggested Use: Those interested in urban Indian adolescents and changes in adolescent drinking risk factors over time may find this article useful.

Stone, R.A., Whitbeck, L.B., Chen, X., Johnson, K. (2005). Traditional practices, traditional spirituality, and alcohol cessation among American Indians. Journal of Studies on Alcohol, 67(2), 236-244.

Description: Problem-centered research has eclipsed important resilience factors associated with American Indian alcohol use. This study investigated the influence of enculturation, and each of its three component dimensions—traditional practices, traditional spirituality, and cultural identity—in order to evaluate how traditional culture affects alcohol cessation among American Indians. These data were collected as part of a three-year study on four American Indian reservations in the upper Midwest and five First Nation reserves in Canada. The sample consisted of Native adults who were parents or guardians of youth ages 10-12 years-old. The findings show that older adults, women, and married adults were more likely to have quit using alcohol. Participation in traditional activities and traditional spirituality had significantly positive effects on alcohol cessation. Although these findings provide evidence that these components play an important role in alcohol cessation, the data are cross-sectional and cannot indicate direction of effects.

Suggested Use: Colleges that have an interest in protective factors that lessen substance abuse can use research like this to enhance their familiarity with evidence based resiliency components.

Ward, B.W., & Ridolfo, H. (2011). Alcohol, tobacco, and illicit drug use among Native American college students: An exploratory quantitative analysis. Substance Use & Misuse, 46(11), 1410-1419.

Description: This study examined alcohol, tobacco, and illicit drug use among Native American college students by using four years of College Alcohol Study data (1993, 1997, 1999, and 2001). This was among the first studies to quantitatively examine this population using advanced statistical analyses and a nationally representative sample of US college students. Descriptive and logistic regression analyses show that Native college students have unique rates and patterns of substance use that must be addressed accordingly. It is suggested that specialized future research and policy are needed to properly address alcohol and drug use among this population.

Suggested Use: The data in this study can be used for building background knowledge of American Indian college student drinking patterns, as well as for grant writing when seeking funds for alcohol screening and treatment services.

Whitbeck, L.B., Chen, X., Hoyt, D.R., & Adams, G.W. (2004). Discrimination, historical loss and enculturation: Culturally specific risk and resiliency factors for alcohol abuse among American Indians. Journal of Studies on Alcohol, 65(4), 409-418.

Description: This report investigates the effects of discrimination, historical loss, and enculturation on meeting diagnostic criteria for alcohol abuse among American Indians in the upper Midwest. The authors developed a measure of discrimination, historical loss, and enculturation. American Indian parents/caretakers of children ages 10 to 12 years participated in diagnostic interviews for lifetime and 12-month alcohol abuse. The subjects’ perceptions of discrimination, historical loss and enculturation were also measured. Historical loss mediated the effects of discrimination on 12-month alcohol abuse among women. Enculturation neither mediated nor moderated the effects of discrimination, but did have an independent negative effect on alcohol abuse. In a combined model comprising both enculturation and historical loss, the effects of discrimination on 12-month alcohol abuse were mediated. This study presents evidence that both historical loss and resiliency affect American Indian alcohol abuse.

Suggested Use: This study is relevant for those who want to include culturally relevant mediating factors in substance abuse treatment programs.

Teresa Abrahamson-Richards (Colville/Coeur d’Alene/Spokane) and Jessyca Murphy (Cherokee) work at the Indigenous Wellness Research Institute at the University of Washington.

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