Drug use among two American Indian populations: prevalence of lifetime use and DSM-IV substance use disorders
Introduction
In studies to date, American Indians (AIs) have been found to have higher rates of drug use than have other racial/ethnic groups (Bachman et al., 1991, Beauvais, 1992, Beauvais et al., 1989, Cockerham, 1977, Moncher et al., 1990, Young, 1988). Overwhelmingly, though, the published research about drug use among AIs has focused on school-based samples of adolescents. The data reported in this paper are among the first derived from well-defined community samples of AI people ranging from adolescents through older adults.
In the adolescent literature, AI rates of drug use have been quite consistently reported higher than a variety of other groups: e.g. White Canadian youth (Gfellner, 1994, Gfellner and Hundleby, 1995); a combination of White youth, rural youth (race not specified), Mexican-Americans, and Western Hispanic-Americans (Oetting and Beauvais, 1990); a nationally representative sample of high school seniors (Bachman et al., 1991). However, the national picture is likely to be more complex than most researchers have conceptualized it. For instance, Plunkett and Mitchell (2000) compared drug use data from a sample of approximately 75% of all seniors in seven high schools in predominantly AI communities (the Voices of Indian Teens project) to high school seniors from the national sample of Monitoring the Future during the same year. They found that lifetime drug use among AI youth was significantly higher than among non-AI youth for only two of six drugs (marijuana and cocaine); non-AI youth were significantly higher on 1 of 6 (inhalants). Split into matching geographic regions, AI youth were higher on 30-day use for only three of the six drugs, with no significant differences for the other three drugs.
All of the studies cited above focused on levels of lifetime or past-month drug use, with little or no attention to pathological use such as abuse or dependence as defined by the Diagnostic and Statistical Manual of Mental Disorders (DSM; American Psychiatric Association, 1994). A small number of studies have examined DSM-based diagnostic rates among AIs—again, though, for adolescents only; and again, higher levels of disorder have been reported among AI youth than among comparison groups of predominantly White youth (Beals et al., 1997, Costello et al., 1997, Kilpatrick et al., 2000).
Despite such consistent reports of high rates of drug use and disorders among AI youth, very little systematic work has examined drug use among AI adults. Although extremely diverse, with more than 300 Federally recognized tribes (Bureau of Indian Affairs, 2000), the AI population makes up only about 1.5% of the US population (US Department of Commerce, 2001). To date, none of the national epidemiological studies has had AI subsamples of sufficient size to allow valid comparisons of AI populations to others in terms of DSM-defined pathological use (Anthony et al., 1994, Kandel et al., 1997, Warner et al., 1995). Moreover, in such national samples, urban AIs are likely to be better represented than are rural, reservation AIs; yet almost half of the AIs in the US live on or near their reservations (Passel, 1996, Snipp, 1996). Since the social context of life in an urban setting is quite different from that of a rural reservation community, knowledge about disorders among AIs living in cities may not translate directly into knowledge useful in reservation settings. Finally, in national efforts, only a small number of members from a wide variety of tribes are likely to have been included, obviating the opportunity to examine in any meaningful way cultural differences in prevalence rates that may be important to the understanding of substance use, either quantitatively or qualitatively.
Despite the lack of systematic research in the area—especially focusing on AI adults—a perception exists that drug use is one of the most significant and urgent health problems facing AIs (Beauvais, 2000, Young, 1988). To begin to address some of the gaps in research to date, we examined the prevalence of drug use and abuse/dependence among two AI populations, using data from an epidemiological study patterned after the National Comorbidity Survey (NCS)—the American Indian Service Utilization, Psychiatric Epidemiology, Risk and Protective Factors Project (AI-SUPERPFP). This article focuses on drug use and drug use disorders. However, to provide a broader context, we have included alcohol use and disorder rates where appropriate. When discussing combined drug and alcohol rates, we use the term substance; when alcohol is excluded, we use drug.
Section snippets
Sample
The AI-SUPERPFP methods are described in greater detail elsewhere (http://www.uchsc.edu/ai/ncaianmhr/presentresearch/superprj.htm). In brief, the two populations of inference for the AI-SUPERPFP were enrolled members of either one of two Northern Plains (NP) tribes that historically belonged to the same culture group (and thus were sampled as one NP population) or one Southwest (SW) tribe (the SW culture group) who were 15–54 years old at the time of development of the sample frame (i.e., in
Lifetime substance use
Table 2 shows estimates and standard errors of lifetime use for each substance. Lifetime use of any drugs for nonmedical purposes ranged from 41.3 (SW women) to 60.1% (NP men). Marijuana was the drug most commonly used in the NP, followed by cocaine; in the SW, hallucinogenics were second most common, followed by cocaine for SW men and analgesics for SW women. Inhalants were the next most commonly used substance, with the exception of NP women, for whom stimulants were third and inhalants were
Discussion
This paper is the first to report AI community-based rates of drug use and disorder. The importance of considering cultural variation was demonstrated by different patterns of use and disorder prevalence rates by gender and culture group. In addition, demographic correlates highlighted special target groups for possible intervention. We discuss each in turn. We also point out this study's limitations, and place these findings in a broader context of national data.
Acknowledgements
AI-SUPERPFP would not have been possible without the significant contributions of many people. The following interviewers, computer/data management and administrative staff supplied energy and enthusiasm for an often difficult job: Anna E. Barón, Antonita Begay, Amelia I. Begay, Cathy A.E. Bell, Phyllis Brewer, Nelson Chee, Mary Cook, Helen J. Curley, Mary C. Davenport, Rhonda Wiegman Dick, Marvine D. Douville, Pearl Dull Knife, Geneva Emhoolah, Roslyn Green, Billie K. Greene, Jack Herman,
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In addition to those listed above, the American Indian Service Utilization, Psychiatric Epidemiology, Risk and Protective Factors Project (AI-SUPERPFP) team included Cecelia Big Crow, Dedra Buchwald, Buck Chambers, Michelle Christensen, Denise Dillard, Karen DuBray, Paula Espinoza, Candace Fleming, Ann Wilson Frederick, Joe Gone, Diana Gurley, Lori Jervis, Shirlene Jim, Carol Kaufman, Ellen Keane, Suzell Klein, Denise Lee, Spero Manson, Monica McNulty, Denise Middlebrook, Laurie Moore, Tilda Nez, Ilena Norton, Theresa O'Nell, Heather Orton, Carlette Randall, Angela Sam, James Shore, Sylvia Simpson, and Lorette Yazzie.