American Indian Alcohol Research Articles

American Indian Alcohol Use from a Sex-Specific Wellness Approach: Exploring Its Associated Physical, Behavioral, and Mental Risk and Protective Factors

ABSTRACT Purpose The top causes of death for American Indians (AIs), including heart and liver disease, are associated with alcohol use. Using the culturally based Framework of Historical Oppression, Resilience, and Transcendence (FHORT), the purpose of this article was to examine AI alcohol use from a sex-specific wellness approach, exploring its associated physical, behavioral, and mental risk and protective factors. Method Data were drawn from a cross-sectional survey with 479 AI adults in South Dakota. We employed a series of multiple hierarchical regression analyses to assess the associations of demographic (sex, age, marital status, income, and educational attainment), physical (Body Mass Index and cardiovascular risk), behavioral (smoking and health self-efficacy) and mental (depressive symptoms) factors with alcohol use. Results Results indicated that surveyed males tended to drink three times that of females, and depressive symptoms were associated with higher levels of alcohol use. Discussion This study highlights the need to examine AI alcohol use with sex in mind.

Reflections on a proposed theory of reservation-dwelling American Indian alcohol use: Comment on Spillane and Smith (2007).

In their recent article, N. Spillane and G. Smith suggested that reservation-dwelling American Indians have higher rates of problem drinking than do either non-American Indians or those American Indians living in nonreservation settings. These authors further argued that problematic alcohol use patterns in reservation communities are due to the lack of contingencies between drinking and "standard life reinforcers" (SLRs), such as employment, housing, education, and health care. This comment presents evidence that these arguments were based on a partial review of the literature. Weaknesses in the application of SLR constructs to American Indian reservation communities are identified as is the need for culturally contextualized empirical evidence supporting this theory and its application. Cautionary notes are offered about the development of literature reviews, theoretical frameworks, and policy recommendations for American Indian communities.

Survey of American Indian Alcohol Statutes, 1975-2006: Evolving Needs and Future Opportunities for Tribal Health

American Indians and Alaska Natives have the nation's highest morbidity and mortality owing to alcohol but also have opportunities to employ policies that could reduce the harmful effects of drinking. As sovereign nations, federally recognized tribes can adopt policies that are highly likely to have a beneficial impact on alcohol problems. The most recently published nationwide research on American Indian alcohol policies (conducted some 30 years ago) suggested that tribal policies may help minimize adverse consequences related to drinking. However, much has changed in Indian country during the last few decades, including redefinitions of relationships among tribes, states, and the federal government; recognition of tribes not previously acknowledged by federal authorities; and the advent of gaming and casinos. These developments raise numerous questions regarding the adoption and implementation of policies pertaining to alcohol. This project used the Federal Register to catalog alcohol statutes adopted by the 334 federally recognized tribes in the lower 48 states between 1975 and 2006. Tribes that do not have an alcohol policy have, by default, retained federal prohibition. During the 30-year study period, the percentage of tribes with statutes that permit alcohol increased from 29.2% to 63.5%. Later policies showed increases in complexity, such as tribal licensing requirements and facility restrictions to accompany increases in gaming and tourism. These data are highly relevant to Native decision makers as they attempt to develop and implement policies that will minimize the harmful effects of alcohol among indigenous peoples.

A theory of reservation-dwelling American Indian alcohol use risk.

The authors present a theory for understanding risk for problem drinking among reservation-dwelling American Indians. The theory offers an overall framework for understanding the risk process for this group. It considers the distinction between factors that influence mean levels of American Indian problem drinking and factors that influence individual differences in American Indian drinking. It proposes important contextual differences between reservation-dwelling American Indians and Caucasians that may help explain the higher mean levels of American Indian problem drinking. The theory further holds that, within the high mean level of problem drinking characteristic of many American Indian reservations, individual differences in problem drinking can be explained by very similar personality and learning factors as those that influence problem-drinking levels for other ethnic groups.

A Program of Research on Spirituality and American Indian Alcohol Use

In this brief report we summarize a pattern of findings that has emerged from our research on American Indian (AI) alcohol use and spirituality. With funds from the National Institute of Alcohol Abuse and Alcoholism and the Fetzer Institute (AA 13 053; P. Spicer, PI) we have used both epidemiologic and ethnographic methods to develop a more complete understanding of the role that spirituality and religion play in changes in drinking behavior among AIs. We begin by first situating the importance of research on spirituality in the more general literature on the AI experience with alcohol before highlighting our published findings in this area. We then close with some speculation about possible next steps in this research program to address what remains one of the most compelling sources of health disparities in the first nations of the United States.

Traditional practices, traditional spirituality, and alcohol cessation among American Indians.

The detrimental effects of alcohol misuse and dependence are well documented as an important public-health issue among American Indian adults. This preponderance of problem-centered research, however, has eclipsed some important resilience factors associated with life course patterns of American Indian alcohol use. In this study, we investigate the influence of enculturation, and each of the three component dimensions (traditional practices, traditional spirituality, and cultural identity) to provide a stringent evaluation of the specific mechanisms through which traditional culture affects alcohol cessation among American Indians. These data were collected as part of a 3-year lagged sequential study currently underway on four American Indian reservations in the upper Midwest and five Canadian First Nation reserves. The sample consisted of 980 Native American adults, with 71% women and 29% men who are parents or guardians of youth ages 10-12 years old. Logistic regression was used to assess the unique contribution of the indicators of alcohol cessation. Excluding adults who had no lifetime alcohol use, the total sample size for present analysis is 732 adult respondents. The findings show that older adults, women, and married adults were more likely to have quit using alcohol. When we examined the individual components of enculturation, two of the three components (participation in traditional activities and traditional spirituality) had significantly positive effects on alcohol cessation. Although our findings provide empirical evidence that traditional practices and traditional spirituality play an important role in alcohol cessation, the data are cross-sectional and therefore do not indicate direction of effects. Longitudinal studies are warranted, in light of the work that concludes that cultural/spiritual issues may be more important in maintaining sobriety once it is established rather than initiating it.

Thr105Ile, a Functional Polymorphism of Histamine N‐Methyltransferase, Is Associated with Alcoholism in Two Independent Populations

Histamine is expressed in cortical and limbic areas that are involved in emotion and cognition and modulates these behaviors. H1 receptor antagonists are sedative. Histamine N-methyltransferase (HNMT) catalyzes the Ntau methylation of histamine, the sole pathway for termination of the neurotransmitter action of histamine in mammalian brain. A common and functionally significant polymorphism, a C314T transition in exon 4 of the HNMT gene results in a Thr105Ile substitution of the protein encoded. The Thr105 allele is associated with approximately 2-fold higher enzyme activity, leading to the prediction that it might be associated with diminished histamine levels, resulting in differences in anxiety, cognition, and sedation that play important roles in alcoholism. In two ethnically distinct populations, we tested whether the Thr105Ile polymorphism was associated with alcoholism and with harm avoidance, a dimensional measure of anxious personality. A 5' exonuclease assay (TaqMan) was used to genotype Thr105Ile in psychiatrically interviewed Finnish Caucasian (n = 218) and Plains American Indian (n = 186) alcoholics, along with ethnically matched, psychiatrically interviewed, controls (Finns: n = 313, Plains Indian: n = 140). Ile105 allele frequencies were significantly lower in alcoholics compared with nonalcoholics in both populations (Finns: 0.12 vs. 0.17, chi(2) = 6, p = 0.015; Plains Indians: 0.03 vs. 0.08, chi(2) = 5, p = 0.023). Genotype distributions also differed significantly. In Finns, Ile105 showed borderline significance for an association with lower harm avoidance (p = 0.070) after correcting for alcoholism diagnosis. Decreased levels of brain histamine consequent to the Thr105 allele may result in higher levels of anxiety and, as a consequence, vulnerability to alcoholism.

Discrimination, historical loss and enculturation: culturally specific risk and resiliency factors for alcohol abuse among American Indians.

This report investigates the effects of discrimination, historical loss and enculturation on meeting diagnostic criteria for 12-month alcohol abuse among American Indians who share a common culture in the upper Midwest. We introduce an empirical measure of historical loss and hypothesize that historical loss will mediate the effects of discrimination on meeting 12-month diagnostic criteria for alcohol abuse. We also hypothesize that enculturation will be negatively associated with 12-month alcohol abuse and mediate or moderate the effects of discrimination. A sample of 452 (351 women) American-Indian parents/caretakers (mean age: women = 39 years, men = 42 years) 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. Structural equation modeling was used to evaluate direct and potential mediating effects of latent constructs of enculturation (a resiliency factor) and historical loss (a risk factor) on the relationship between discrimination and meeting criteria for 12-month alcohol abuse. Historical loss mediated the effects of discrimination on 12-month alcohol abuse among women. Enculturation neither mediated nor moderated the effects of discrimination but had 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 important new evidence that historical loss affects American-Indian alcohol abuse. It also provides evidence for the resiliency effects of enculturation on alcohol abuse.

Racial disparities in alcohol use: comparison of 2 American Indian reservation populations with national data.

American Indian alcohol use has received scrutiny in recent decades,1 but data derived from samples that permit direct comparisons to other US epidemiological studies have been less commonly reported.2–4 This brief places rates of the quantity and frequency of alcohol use in 2 tribally defined reservation samples in such a comparative epidemiological context.

American Indian Adolescent Alcohol Involvement and Ethnic Identification

Structural equation modeling (SEM) techniques were used to explore the relationship between American Indian ethnic identification and alcohol involvement. The subject pool was comprised of 202 American Indian adolescents (114 females, 88 males). Measures of ethnic identity, frequency and style of alcohol use, peer alcohol associations, and family sanctions against alcohol were obtained through survey research. Results of the model analysis revealed that while peer alcohol associations significantly predicted alcohol involvement for both males and females, and family sanctions against alcohol were predictive for the females in the sample, ethnic identity did not predict alcohol involvement, directly or indirectly, for either males nor females. Results are discussed in terms of past theoretical explanations of American Indian youth involvement with alcohol.

Alcoholism Among New World Peoples

This review of the literature focuses on alcoholism among American Indian peoples. It is a critical review, aimed at elucidating methodological problems, establishing areas of relatively firm knowledge, and identifying gaps in our knowledge. The first two sections cover nonclinical areas: that is, 1) historical and anthropological studies of American Indian (AI) alcohol use, and 2) the nature and extent of alcoholism among various AI peoples. The remaining sections emphasize clinically related areas: that is, 1) clinical epidemiology, 2) intervention methods, and 3) outcomes.

Alcoholism Among New World Peoples:A Critique of History, Methods, and Findings

This review of the literature focuses on alcoholism among American Indian peoples. It is a critical review, aimed at elucidating methodological problems, establishing areas of relatively firm knowledge, and identifying gaps in our knowledge. The first two sections cover nonclinical areas: that is, 1) historical and anthropological studies of American Indian (AI) alcohol use, and 2) the nature and extent of alcoholism among various AI peoples. The remaining sections emphasize clinically related areas: that is, 1) clinical epidemiology, 2) intervention methods, and 3) outcomes.

Locus of Control and Drinking Behavior in American Indian Alcoholics and Non-Alchoholics

Many investigators have attempted to determine whether alcoholics differ from non-alcoholics in their perceived locus of control. The present study examined the responses of alcoholic and non-alcoholic American Indian males and females on Levenson's Multidimensional Locus of Control Scale. Subjects were 80 American Indian males and 40 American Indian females. All subjects were members of either an eastern (Cherokee) or western (Cheyenne) Oklahoma tribe. Results indicate no significant differences between the Cherokee male alcoholic and non-alcoholic group. Cheyenne male alcoholics reported significantly lower internal control scores than did Cheyenne male non-alcoholics. Within the female sample, alcohol use and tribal membership showed a significant interaction with locus of control. These findings suggest that locus of control may be a potentially useful clinical construct in the development of treatment plans and therapeutic issues for American Indian patients who are alcoholics.

Do we care enough to attempt change in American Indian alcohol policy?

Do we care enough to attempt change in American Indian alcohol policy?

Cultural affiliation among American Indian alcoholics: correlations and change over a ten-year period.

Cultural affiliation among American Indian alcoholics: correlations and change over a ten-year period.

Detoxification recidivism among urban American Indian alcoholics.

Fifty urban American Indians were interviewed during admission to a free-standing medical detoxification unit. From the year before the interview through 2 years of follow-up, this sample averaged 44.6 detoxification admissions and 64.1 days in other inpatient treatment and had no significant change in the number of annual detoxification admissions. At follow-up all but three subjects reported recent alcohol dependence symptoms or episodic alcohol abuse. these patients continued to experience serious alcohol-related problems despite repeated treatment in both medical detoxification and inpatient rehabilitation settings. These findings emphasize the need for more innovative and effective alternatives to the existing revolving door process.

Personality Characteristics of Female, American Indian Alcoholics: Implications for Counseling

Personality Characteristics of Female, American Indian Alcoholics: Implications for Counseling

Personality differences between alcoholics anonymous members and nonmembers.

The purpose of this study was to determine whether there are personality differences between members of Alcoholics Anonymous and nonmembers . A total of 91 alcoholics who were active members of A.A. and who had completed at least six months of abstinence were matched by race and sex with 91 alcoholics who had recently completed alcoholism treatment and who were not A.A. members. Four scales of the Eysenck Personality Questionnaire ( EPQ ), measuring toughmindedness , emotionality, extroversion and " fakability ," were administered to both groups. A 2 X 2 X 2 multivariate analysis of variance was performed using sex (men, women), race (American Indian, Caucasian) and group (A.A., non-A.A.) as the independent variables and the four EPQ scales as the dependent variables. The main effects of race and group were significant, but none of the interaction effects was significant. American Indian alcoholics were significantly more toughminded than the Caucasians. A.A. members were significantly more extroverted and less toughminded and emotional than nonmembers .

Predicting treatment outcome after ten years among American Indian alcoholics.

Forty-five American Indian alcoholics were intensively studied in 1970-1971. In addition to the usual demographic characteristics, research scales included Alcoholism History Scale, Alcohol Withdrawal Scale, Indian Culture Affiliation Scale, Social Competence Scale, Legal Problems Scale, Psychiatric Problems Scale, Liver Dysfunction Scale, Malnutrition Scale, and Abnormal Laboratory Screening Scale. These findings in 1970-1971 were then correlated with a four-item outcome rating obtained in 1980-1981. Better outcome was associated with less parental loss, ever having been married, compliance with treatment recommendations, and having predominantly Indian rather than non-Indian friends. Women alcoholics were unlikely to deteriorate and still survive, although this was the most frequent pattern among the men. Higher Indian Culture Affiliation and more severe Liver Dysfunction in 1970-1971 were correlated with better outcome in 1980-1981. Possible explanations for these findings are considered.

A cross-cultural MMPI comparison of alcoholics.

MMPI Profiles of 11 Caucasian, 11 Hispanic American, and 11 American Indian alcoholics were compared. The subjects were chosen randomly from among veterans in treatment for alcoholism at a small VA Medical Center. Subjects represented similar secondary diagnoses and did not differ significantly in age or education. One-way nonrepeated-measures analyses of variance on validity, clinical and the MacAndrews Alcoholism Scales showed significance only for Scale 2 scores, elevated for the Hispanic American group but within the normal range. Examination of dominant highpoint code types in each group indicated primarily 4 or 49 for the Caucasians and 24 for the Hispanic Americans. American Indian subjects were more heterogeneous with 1, 6, or 9 highpoints. Generally, the resultant profiles conform to previously published alcoholic MMPI prototypes, supporting use of the MMPI for the population studied. The results do not support development of separate MMPI norms for psychiatric subjects from these minority groups, but cross-validation on a larger sample is required.