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Cited by 60Indigenous Health, Education, and RightsSubstance Abuse Treatment and OutcomesOpioid Use Disorder Treatment

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

Open access
Rieckmann, Traci, McCarty, Dennis, Kovas, Anne, Spicer, Paul, Bray, Joe, Gilbert, Steve, Mercer, Jacqueline·2012·The American Journal of Drug and Alcohol Abuse
DOI 10.3109/00952990.2012.694530PMC PMC3622709
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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.

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Crossref · 10.3109/00952990.2012.694530

Cites

21 of 21 references verified0 citation errors · 0 not checkable

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  • Suicidal thoughts and attempts are risk factors for SUD as well as potential results of substance use.

    “Often indicative of great levels of despair and hopelessness, is the occurrence of suicidal thoughts and attempts, which are risk factors for SUD as well as potential results of substance use [44,56].”

    From Substance and Behavioral Addictions among American Indian and Alaska Native Populations (2022) · cites this paper as [56]

    The Introduction describes a bidirectional relationship between substance use and mental health problems generally. The Results (Subsample Analysis; page not provided) find that regular opioid users reported more suicidal thoughts and attempts, but do not establish that suicidality is a risk factor for SUD or a result of substance use. The Methods also specify that the psychiatric history assessed did not directly result from drug or alcohol use. (LLM, conf=0.84)

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  • Physical health conditions play a substantial role in the onset and maintenance of SUD, particularly the presence of chronic medical conditions.

    “Physical health conditions play a substantial role in the onset and maintenance of SUD, particularly the presence of chronic medical conditions [56].”

    From Substance and Behavioral Addictions among American Indian and Alaska Native Populations (2022) · cites this paper as [56]

    The Results (Medical Status; page unavailable) report chronic medical conditions among American Indian clients receiving SUD treatment, and the Discussion calls for coordinated care for these comorbid conditions. These passages support the relevance of physical health to treatment, but do not establish that chronic conditions contribute to the onset or maintenance of SUD. (LLM, conf=0.86)

    Experimental — accuracy not yet measured

  • Medical problems, particularly among AIANs living in reservations, are risk factors for SUD.

    “Medical problems, particularly among AIANs living in reservations, are risk factors for SUD [56].”

    From Substance and Behavioral Addictions among American Indian and Alaska Native Populations (2022) · cites this paper as [56]

    The Abstract (Results; page unavailable) reports more severe medical problems among reservation-based clients, and the Results (Medical Status; page unavailable) report more hospitalizations and days with medical problems than among urban clients. But all clients were already in substance-use treatment; these comparisons do not establish medical problems as risk factors for developing SUD. Chronic medical conditions were also more common among urban clients. (LLM, conf=0.87)

    Experimental — accuracy not yet measured

  • Limited experimental and longitudinal research makes it difficult to assert whether polysubstance use is an outcome of substance use addictions or a risk factor for such addictions, although there is some support for the latter.

    “Limited experimental and longitudinal research makes it difficult to assert whether polysubstance use is an outcome of substance use addictions or if polysubstance use is a risk factor for such addictions (or both), although there is some support for the latter [50,56,57].”

    From Substance and Behavioral Addictions among American Indian and Alaska Native Populations (2022) · cites this paper as [56]

    The Methods and Results describe polysubstance use and its association with regular opioid use, but do not address whether polysubstance use precedes or follows addiction. Searches for longitudinal or experimental evidence and for polysubstance use as a risk factor found no passage supporting that causal-direction claim. Page numbers were not available in our copy. (LLM, conf=0.73)

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Cites

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Research works printed but not linked: 2

  1. [14]Smedley BD Stith AY Nelson AR Institute of Medicine Committee on Understanding and Eliminating Racial and Ethnic Disparities in Health Care 2003 Washington, DC Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care 25032386
  2. [20]Carise D Wicks K McLellan AT Olton P Addiction Severity Index 5th Edition: North Dakota State Adaptation for Use with Native Americans Designed With Consideration for Native American Cultural and Ceremonial Practices 1998 Accessed June 5, 2013 Philadelphia, PA Treatment Research Institute at University of Pennsylvania from: http://www.tresearch.org/resources/instruments/ASI_NAV.pdf

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Authors
Rieckmann, T., McCarty, D., Kovas, A., Spicer, P., Bray, J., Gilbert, S., & Mercer, J.
Affiliations
  • Oregon Health & Science University (US)
  • University of Oklahoma (US)
  • South Central Tribal Program
  • Urban Northwest Treatment Center
Corresponding author
Rieckmann, Traci
ORCID
McCarty, Dennis
Venue
The American Journal of Drug and Alcohol Abuse
Publisher
Informa UK Limited
Published
2012-08-29
Volume
38
Issue
5
Pages
498-504
ISSN
  • 0095-2990 (ISSN-L)
  • 1097-9891
DOI
10.3109/00952990.2012.694530
PMC
PMC3622709
OpenAlex
W1972797452
Cited by
60
References
21
Citations by year
2026: 6 · 2025: 6 · 2024: 3 · 2023: 7 · 2022: 5 · 2021: 5 · 2020: 8 · 2019: 6 · 2017: 4 · 2016: 4 · 2015: 3 · 2014: 1 · 2013: 1 · 2012: 1
FWCI
2.20
Type
journal article
Language
en
Open access
Locations
  • The American Journal of Drug and Alcohol Abuse (publishedVersion)
  • PubMed (publishedVersion)
  • Europe PMC (PubMed Central) (acceptedVersion)
  • PubMed Central (acceptedVersion)
Funders
  • National Institute on Drug Abuse (U10DA015815, U10DA013036, U10-DA13036, K23DA021225, UG1DA015815)
  • National Drug Abuse Treatment Clinical Trials Network
Topics
  • Social Sciences › Health › Indigenous Health, Education, and Rights
  • Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Opioid Use Disorder Treatment
Keywords
American Indians and Alaska Natives, substance use disorders, treatment needs, comorbidities, opioid use, polydrug use, mood disorders, depression, suicide attempts, trauma, chronic disease, urban health centers, health disparities, integrative care, culturally sensitive interventions
MeSH terms
Adolescent, Adult, Alaska, Mental Disorders, Female, Health Services Accessibility, Health Services Needs and Demand, Humans, Indians, North American, Male, Middle Aged, United States, Substance Abuse Treatment Centers, Diagnosis, Dual (Psychiatry), Delivery of Health Care, Integrated, Urban Health Services, Substance-Related Disorders, National Institute on Drug Abuse (U.S.), Health Status Disparities, Healthcare Disparities, Young Adult

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