Substance and Behavioral Addictions among American Indian and Alaska Native Populations

Cultural norms can play a significant role in substance use among AIANs.

“Cultural norms can play a significant role in substance use among AIANs [30].”

• cites [30] McKinley, 2021, American Indian Alcohol Use from a Sex-Specific Wellness Approach: Exploring Its Associated Physical, Behavioral, and Mental Risk and Protective Factors, J. Evid.-Based Soc. Work sourceSupported

A cross-sectional survey found that AIAN adult males drink nearly three times as much alcohol as adult females.

“A cross-sectional survey found that AIAN adult males drink nearly three times as much alcohol as adult females [30].”

• cites [30] McKinley, 2021, American Indian Alcohol Use from a Sex-Specific Wellness Approach: Exploring Its Associated Physical, Behavioral, and Mental Risk and Protective Factors, J. Evid.-Based Soc. Work sourceSupported

The cultural and emotional losses tied to forced relocation have been associated with increased SUD.

“The cultural and emotional losses tied to forced relocation have been associated with increased SUD [40,42].”

• cites [40] Castor, 2006, A Nationwide Population-Based Study Identifying Health Disparities between American Indians/Alaska Natives and the General Populations Living in Select Urban Counties, Am. J. Public Health sourcePartly supported

  The introductory passage (labeled Abstract in our copy; page unavailable) links urban relocation to federal policies, and the Results report higher alcohol-related mortality among American Indians/Alaska Natives than among the corresponding general populations. The paper does not associate cultural or emotional losses from relocation with increased substance use disorder (SUD), nor does it report SUD rates. (LLM, conf=0.78)

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• cites [42] Peterson, 2002, Native American Women in Alcohol and Substance Abuse Treatment, J. Health Care Poor Underserved sourceNot checked — no full text of the source

Limited education about substance use and its adverse health effects in AIAN communities is a sociocultural factor in the onset and development of SUD.

“Another sociocultural factor that plays a role in the onset and development of SUD is limited education about substance use and its adverse health effects in AIAN communities [33].”

• cites [33] Whitesell, 2012, Epidemiology and Etiology of Substance Use among American Indians and Alaska Natives: Risk, Protection, and Implications for Prevention, Am. J. Drug Alcohol Abuse sourceCould not verify

  The Etiology section discusses community attitudes, substance-related expectancies, and limited treatment services, but does not identify limited education about substance use or its health effects as a risk factor. A search for education, awareness, and knowledge of harmful effects found no passage making that connection. Page numbers are not available in our copy. (LLM, conf=0.72)

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AIANs experience acculturation-related challenges due to transition from reservation to urban environments and social demands to fit in with both Native culture and American mainstream practices.

“AIANs also experience acculturation related challenges, not only because of the transition from reservation to urban environments, but also because of the social demands to fit in with both the Native culture and American mainstream practices [31].”

• cites [31] Kulis, 2006, Social Contexts of Drug Offers among American Indian Youth and Their Relationship to Substance Use: An Exploratory Study, Cult. Divers. Ethn. Minor. Psychol. sourcePartly supported

  The passage labeled Abstract reports that minority youth may face pressure to fit within both dominant and minority cultures, supporting the claim's bicultural-pressure component. The Method and Discussion describe youth living on and off reservations in a metropolitan area, but do not say that a transition from reservation to urban life causes acculturation challenges. No page numbers are available in our copy. (LLM, conf=0.86)

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Substance use can provide respite from pressures associated with acculturation and balancing roles in minority and majority cultures.

“Substance use can provide respite from the pressures associated with acculturation and balancing roles in minority and majority cultures [31].”

• cites [31] Kulis, 2006, Social Contexts of Drug Offers among American Indian Youth and Their Relationship to Substance Use: An Exploratory Study, Cult. Divers. Ethn. Minor. Psychol. sourceSupported

One potential risk factor for the alcohol disparity between AIAN adult males and females is that historical and cultural norms have been more permissive of men drinking larger quantities of alcohol.

“One potential risk factor for this disparity is that historical and cultural norms have been more permissive of men drinking larger quantities of alcohol [30].”

• cites [30] McKinley, 2021, American Indian Alcohol Use from a Sex-Specific Wellness Approach: Exploring Its Associated Physical, Behavioral, and Mental Risk and Protective Factors, J. Evid.-Based Soc. Work sourceSupported

Substance use is a common correlate of unemployment and poverty.

“Substance use is a common correlate of unemployment and poverty, further complicating individuals’ situational and relational dynamics [40,41].”

• cites [40] Castor, 2006, A Nationwide Population-Based Study Identifying Health Disparities between American Indians/Alaska Natives and the General Populations Living in Select Urban Counties, Am. J. Public Health sourcePartly supported

  The Results (Table 2) report higher poverty and unemployment rates among American Indians/Alaska Natives than among the corresponding general populations; other Results passages report higher maternal alcohol use and alcohol-related mortality. These are separate population-level comparisons, not evidence that substance use commonly correlates with unemployment or poverty among individuals. (LLM, conf=0.82)

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• cites [41] Szlemko, 2006, Native Americans and Alcohol: Past, Present, and Future, J. Gen. Psychol. sourceNot checked — no full text of the source

Sexual abuse nearly doubled the odds of alcohol and other drug use among AIANs.

“Another study on the association between ACEs and substance use among AIANs found that sexual abuse nearly doubled the odds of alcohol and other drug use [58].”

• cites [58] Novins, 2007, Childhood Characteristics Associated with Stage of Substance Use of American Indians: Family Background, Traumatic Experiences, and Childhood Behaviors, Addict. Behav. sourcePartly supported

  The Results (section 3) say that sexual-abuse-related trauma nearly doubled the odds of Stage 1B substance use versus Stage 1A. The Methods (section 2) define that comparison as marijuana and/or inhalant use, with or without alcohol, versus alcohol use only—not the odds of alcohol and other drug use generally. (LLM, conf=0.88)

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Early onset of substance use predicted subsequent and potentially higher rates of use.

“Additionally, early onset of substance use predicted subsequent and potentially higher rates of use [58,59]”

• cites [58] Novins, 2007, Childhood Characteristics Associated with Stage of Substance Use of American Indians: Family Background, Traumatic Experiences, and Childhood Behaviors, Addict. Behav. sourcePartly supported

  The Results (section 3; page unavailable) associate initiation by age 13 with higher odds of Stage 1B rather than Stage 1A substance use, and the Discussion (section 4; page unavailable) describes a strong relationship between younger initiation and higher stage. The stages classify lifetime types of substances used, not rates or frequency of use; the paper also reports an association rather than demonstrating that early onset predicted subsequent use. (LLM, conf=0.86)

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• cites [59] Whitbeck, 2008, Diagnostic Prevalence Rates from Early to Mid-Adolescence among Indigenous Adolescents: First Results from a Longitudinal Study, J. Am. Acad. Child Adolesc. Psychiatry sourcePartly supported

  The Results (Substance use disorders) report that adolescents with a substance use disorder at Wave 1 were 8.65 times more likely to meet disorder criteria at Wave 4, supporting the claim about subsequent problems. The paper measures substance use disorders rather than rates or amounts of substance use, so it does not establish that early onset predicted higher rates of use. (LLM, conf=0.85)

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Dose-response relationships between adverse childhood experiences (ACEs) and multiple risk factors have been documented among AIANs and non-AIANs.

“Dose-response relationships between adverse childhood experiences (ACEs) and multiple risk factors have been documented among AIANs and non-AIANs [51,70].”

• cites [51] Warne, 2017, Adverse Childhood Experiences (ACE) among American Indians in South Dakota and Associations with Mental Health Conditions, Alcohol Use, and Smoking, J. Health Care Poor Underserved sourceNot checked — no full text of the source
• cites [70] Felitti, 1998, Relationship of Childhood Abuse and Household Dysfunction to Many of the Leading Causes of Death in Adults: The Adverse Childhood Experiences (ACE) Study, Am. J. Prev. Med. sourcePartly supported

  The Significance of Dose-Response Relationships section reports strong associations between childhood exposures and each of 10 risk factors in the study sample. Table 3 lists racial categories but does not identify an AIAN group, and the reported dose-response models adjust for race rather than establish the relationship separately among AIANs and non-AIANs. This source therefore supports the general finding, but not the sentence’s population-specific claim in full. (LLM, conf=0.88)

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The increased availability of substances in the home combined with fewer parental consequences for substance use can create opportunities for youth to explore different substances.

“The increased availability of substances in the home combined with fewer parental consequences for substance use can create opportunities for youth to explore different substances [32].”

• cites [32] Kulis, 2002, Ethnic Pride, Biculturalism, and Drug Use Norms of Urban American Indian Adolescents, Soc. Work Res. sourcePartly supported

  The Method section measures adolescents’ expectations of parental anger about drug use, and the Results report that some students perceived a lower likelihood of parental anger. The paper does not address substance availability in the home or show that availability combined with fewer parental consequences creates opportunities to try different substances. (LLM, conf=0.72)

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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].”

• cites [56] Rieckmann, 2012, American Indians with Substance Use Disorders: Treatment Needs and Comorbid Conditions, Am. J. Drug Alcohol Abuse sourcePartly supported

  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)

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Maternal mental illness and SUD is correlated with offspring's substance use.

“Maternal mental illness and SUD is correlated with offspring’s substance use [59].”

• cites [59] Whitbeck, 2008, Diagnostic Prevalence Rates from Early to Mid-Adolescence among Indigenous Adolescents: First Results from a Longitudinal Study, J. Am. Acad. Child Adolesc. Psychiatry sourcePartly supported

  The Results (Substance use disorders; page not provided) report that maternal internalizing disorder was associated with nearly doubled odds of adolescent SUD. They do not report an association between maternal SUD and adolescent SUD; the Results (Externalizing disorders; page not provided) instead associate maternal SUD with adolescent externalizing disorders. The claim therefore supports the maternal mental-illness component but not the maternal-SUD component. (LLM, conf=0.86)

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Parental divorce, family separation, and parental loss was also associated with alcohol use and other substances.

“Parental divorce, family separation, and parental loss was also associated with alcohol use and other substances [58].”

• cites [58] Novins, 2007, Childhood Characteristics Associated with Stage of Substance Use of American Indians: Family Background, Traumatic Experiences, and Childhood Behaviors, Addict. Behav. sourcePartly supported

  The family-background table (2. Methods; page unavailable) shows some differences by substance-use stage for parental divorce and family separation, but not for death of a parent. The Discussion (4. Discussion; page unavailable) says these three circumstances showed minimal associations with stage of use, so the claim overstates the evidence and is unsupported for parental loss. (LLM, conf=0.86)

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Given the substantial emphasis that AIANs place on family relationships and the extended amount of time that AIAN youth spend with their family members, youth may be more hesitant to refuse engaging in substance use with their cousins or other adult relatives, increasing substance use frequency.

“Given the substantial emphasis that AIANs place on family relationships and the extended amount of time that AIAN youth spend with their family members, youth may be more hesitant to refuse engaging in substance use with their cousins or other adult relatives (e.g., Tribal elders), increasing substance use frequency [32].”

• cites [32] Kulis, 2002, Ethnic Pride, Biculturalism, and Drug Use Norms of Urban American Indian Adolescents, Soc. Work Res. sourcePartly supported

  Split into 2 atoms — 0 confirmed, 1 partially supported, 0 disputed, 0 misattributed, 1 unverifiable. Expand the claim to see per-atom verdicts.

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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].”

• cites [56] Rieckmann, 2012, American Indians with Substance Use Disorders: Treatment Needs and Comorbid Conditions, Am. J. Drug Alcohol Abuse sourcePartly supported

  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)

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In a study with AIAN veterans, lifetime nicotine dependence was associated with lifetime alcohol use, drug use disorders, mood and anxiety disorders, and antisocial personality disorder.

“Similar findings were obtained in a study with AIAN veterans, where lifetime nicotine dependence was associated with lifetime alcohol use, drug use disorders, mood and anxiety disorders, and antisocial personality disorder [60].”

• cites [60] Dickerson, 2009, Nicotine Dependence and Psychiatric and Substance Use Comorbidities in a Sample of American Indian Male Veterans, Drug Alcohol Depend. sourceSupported

For some AIAN youth it is difficult to refuse drug or other substance offers when they come from parents and other family members or when tobacco products are offered during a ceremony.

“Specifically, for some AIAN youth it is difficult to refuse drug or other substance offers when they come from parents and other family members or when tobacco products are offered during a ceremony [32,66].”

• cites [32] Kulis, 2002, Ethnic Pride, Biculturalism, and Drug Use Norms of Urban American Indian Adolescents, Soc. Work Res. sourcePartly supported

  The Method section measures confidence in refusing offers from family members, and the Results report that some students were less than confident about resisting drug offers. The paper does not establish that offers from parents or family members are particularly difficult to refuse, and the passages found do not address tobacco offered during ceremonies (no page numbers available in our copy). (LLM, conf=0.82)

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• cites [66] Unger, 2020, Spirituality, Ethnic Identity, and Substance Use among American Indian/Alaska Native Adolescents in California, Subst. Use Misuse sourceCould not verify

  The Introduction (page unavailable) discusses ceremonial tobacco use and the possibility that substituting commercial tobacco makes it more available to adolescents. Neither it nor the Discussion (page unavailable) addresses whether AIAN youth have difficulty refusing substance offers from family members or tobacco offered during a ceremony; searches for refusal and offers found no such passage. (LLM, conf=0.73)

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Positive substance-related expectancies pose a risk for SUD.

“Cognitive-behavioral processes—specifically, positive substance-related expectancies pose a risk for SUD [33].”

• cites [33] Whitesell, 2012, Epidemiology and Etiology of Substance Use among American Indians and Alaska Natives: Risk, Protection, and Implications for Prevention, Am. J. Drug Alcohol Abuse sourcePartly supported

  The “Cognitive Behavioral Processes” subsection links alcohol-use expectancies with the quantity and frequency of drinking among American Indian and Alaska Native adolescents. It does not specify positive expectancies or establish a risk for substance use disorder, so the claim extends beyond the finding reported here (page unavailable). (LLM, conf=0.85)

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The effect of genetic variants such as ALDH2*2 and ADH1B*3 on SUD among AIAN has not been studied thoroughly.

“Reviewed studies indicate AIAN appear to lack metabolizing enzyme genes, similar to other population groups (East Asian and some Africans) (e.g., ALDH2*2 and ADH1B*3), but the effect of these genetic variants on SUD among AIAN has not been studied thoroughly [46].”

• cites [46] Ehlers, 2013, Evidence for a Genetic Component for Substance Dependence in Native Americans, Am. J. Psychiatry sourcePartly supported

  The Discussion and Conclusions (page unavailable) says larger studies across more tribal groups are needed, supporting the claim that the evidence remains limited. But the Results (page unavailable) report that ADH1B*3 has already been associated with reduced alcohol-dependence risk in a California Indian sample; the paper does not establish effects on substance use disorders broadly. (LLM, conf=0.83)

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Parental and other family members' substance use was associated with increased likelihood of substance use among AIAN youth.

“Parental and other family members’ substance use was associated with increased likelihood of substance use among AIAN youth [48,64,65].”

• cites [48] Montag, 2019, Community-Specific Risk and Protective Factors for Risky Alcohol Consumption in American Indian Women of Reproductive Potential: Informing Interventions, Int. J. Indig. Health sourcePartly supported

  The Discussion (page not specified) says that female friends and family members influenced drinking among the women studied, and the Subset Sample reports that some women binge drank with a parent, sibling, or cousin. But the Sample Source identifies participants as AIAN women aged 18–45; the paper does not establish an association between family members’ substance use and substance use among AIAN youth. (LLM, conf=0.83)

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• cites [64] Burnette, 2016, Risk and Protective Factors Related to the Wellness of American Indian and Alaska Native Youth: A Systematic Review, Int. Public Health J.Not checked — no full text of the source
• cites [65] Burnette, 2017, Historical Oppression, Resilience, and Transcendence: Can a Holistic Framework Help Explain Violence Experienced by Indigenous People?, Soc. Work sourceCould not verify

  The Family-Level Factors section mentions parental substance abuse as a possible risk factor for intimate partner violence experienced by Indigenous women. It does not address whether parental or other family members’ substance use is associated with substance use among AIAN youth; searches for that association found no passage in our copy. No page number was available. (LLM, conf=0.77)

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Reviewed studies indicate AIAN appear to lack metabolizing enzyme genes, similar to other population groups (East Asian and some Africans) (e.g., ALDH2*2 and ADH1B*3).

“Reviewed studies indicate AIAN appear to lack metabolizing enzyme genes, similar to other population groups (East Asian and some Africans) (e.g., ALDH2*2 and ADH1B*3), but the effect of these genetic variants on SUD among AIAN has not been studied thoroughly [46].”

• cites [46] Ehlers, 2013, Evidence for a Genetic Component for Substance Dependence in Native Americans, Am. J. Psychiatry sourcePartly supported

  The Discussion and Conclusions says that some Native American tribes appear to lack protective variants in alcohol-metabolizing enzyme genes, including ALDH2*2 and ADH1B*3, and calls for larger studies across more tribal groups. The claim overgeneralizes this to AIAN as a whole and says they lack the genes rather than particular variants. The Results also report ADH1B*3 in a California Indian sample. (LLM, conf=0.88)

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The prevalence for any substance use, mood, and personality disorders was higher for AIAN males and females compared to males and females in the general population.

“The study also concluded that the prevalence for any substance use, mood, and personality disorders was higher for AIAN males and females compared to males and females in the general population [52].”

• cites [52] Beals, 2016, Psychiatric Disorders and Mental Health Treatment in American Indians and Alaska Natives: Results of the National Epidemiologic Survey on Alcohol and Related Conditions, Soc. Psychiatry Psychiatr. Epidemiol. sourcePartly supported

  The Results, Lifetime Psychiatric Disorders (Table 2), state that AIAN men and women had higher prevalence of any substance use, mood, and personality disorders. But the comparison was with non-Hispanic White men and women, not men and women in the general population as a whole. (LLM, conf=0.85)

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Accessibility to preventive healthcare and SUD treatment services is often limited.

“Accessibility to preventive healthcare and SUD treatment services is often limited [33,62]”

• cites [33] Whitesell, 2012, Epidemiology and Etiology of Substance Use among American Indians and Alaska Natives: Risk, Protection, and Implications for Prevention, Am. J. Drug Alcohol Abuse sourcePartly supported

  The Service Systems section says health services for substance use problems have limited availability in American Indian and Alaska Native communities, and that urban and suburban residents have little access to Indian Health Service facilities. It does not specifically establish limited access to preventive healthcare; the Implications for Prevention section discusses how to develop interventions, not access to preventive services. No page numbers are available in our copy. (LLM, conf=0.85)

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• cites [62] Hertz, T., Kelly, S., Osterhus, D., Greenberg, H., Romine, K., Cooper, S., Davis, N., Strickland, C., Beauvais, D., and Godfrey, F. (2006). Barriers to American Indian, Alaska Native, and Native American Access to HHS Programs, ASPE.Not checked yet

  Not checked in the free run.

Depressive symptoms and clinical depression are significantly associated with substance use among AIAN.

“Depressive symptoms and clinical depression are significantly associated with substance use among AIAN [30,48].”

• cites [30] McKinley, 2021, American Indian Alcohol Use from a Sex-Specific Wellness Approach: Exploring Its Associated Physical, Behavioral, and Mental Risk and Protective Factors, J. Evid.-Based Soc. Work sourcePartly supported

  The Results (Mental risk factors; Regression results, pages unavailable) report that depressive symptoms were significantly associated with alcohol use in the American Indian sample. The paper defines a PHQ-9 threshold for clinical depression in Methods, but does not report a separate significant association for clinical depression. Its finding concerns alcohol use, not substance use generally, and the study sample is American Indian rather than AIAN broadly. (LLM, conf=0.88)

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• cites [48] Montag, 2019, Community-Specific Risk and Protective Factors for Risky Alcohol Consumption in American Indian Women of Reproductive Potential: Informing Interventions, Int. J. Indig. Health sourcePartly supported

  The Discussion reports that depression was an independent risk factor for risky drinking in the study’s AIAN women, but says the difference between nondrinkers and current drinkers was not significant. The Measures section defines depression by a PHQ-9 screening score, not a clinical diagnosis. The source therefore supports a narrower association with risky alcohol use, not the claim about clinical depression and substance use across AIAN populations. (LLM, conf=0.87)

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Witnessing family violence significantly contributed to alcohol use among AIANs.

“The same study also found that witnessing family violence significantly contributed to alcohol use [58].”

• cites [58] Novins, 2007, Childhood Characteristics Associated with Stage of Substance Use of American Indians: Family Background, Traumatic Experiences, and Childhood Behaviors, Addict. Behav. sourcePartly supported

  The Results (section 3) report that witnessing family violence was significantly associated with higher odds of alcohol-only use versus abstinence among Northern Plains participants (OR 1.85, p<0.01). The Methods (section 2) identify the sample as members of specific American Indian tribes, not AIANs generally. The study reports an association with a defined substance-use stage, not that family violence causally contributed to alcohol use across the broader population. (LLM, conf=0.86)

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Use of prescribed opioids for pain can lead to opioid addiction.

“Use of prescribed opioids for pain can lead to opioid addiction [61].”

• cites [61] Klimas, 2019, Strategies to Identify Patient Risks of Prescription Opioid Addiction When Initiating Opioids for Pain, JAMA Netw. Open sourceSupported

A study based on the National Epidemiologic Survey on Alcohol and Related Conditions found that 70% of AIAN men and 63% of AIAN females met the criteria for at least one mental health lifetime disorder as defined in the Diagnostic and Statistical Manual-IV.

“A study based on the National Epidemiologic Survey on Alcohol and Related Conditions found that 70% of AIAN men and 63% of AIAN females met the criteria for at least one mental health lifetime disorder as defined in the Diagnostic and Statistical Manual-IV [52].”

• cites [52] Beals, 2016, Psychiatric Disorders and Mental Health Treatment in American Indians and Alaska Natives: Results of the National Epidemiologic Survey on Alcohol and Related Conditions, Soc. Psychiatry Psychiatr. Epidemiol. sourceSupported

Traumatic events in the family were independently associated with various forms of substance use.

“While causal relationships cannot be asserted in these domains, research indicates that traumatic events in the family were independently associated with various forms of substance use [58].”

• cites [58] Novins, 2007, Childhood Characteristics Associated with Stage of Substance Use of American Indians: Family Background, Traumatic Experiences, and Childhood Behaviors, Addict. Behav. sourceSupported

Strong associations have been observed between experiencing abuse in the family structure and substance use severity.

“Strong associations have been observed between experiencing abuse in the family structure and substance use severity [51,58].”

• cites [51] Warne, 2017, Adverse Childhood Experiences (ACE) among American Indians in South Dakota and Associations with Mental Health Conditions, Alcohol Use, and Smoking, J. Health Care Poor Underserved sourceNot checked — no full text of the source
• cites [58] Novins, 2007, Childhood Characteristics Associated with Stage of Substance Use of American Indians: Family Background, Traumatic Experiences, and Childhood Behaviors, Addict. Behav. sourcePartly supported

  The Results (section 3; page unavailable) report strong associations between childhood trauma and stage of substance use, including sexual abuse and witnessing family violence. The paper does not establish that the sexual abuse occurred within the family, and witnessing family violence is not necessarily experiencing abuse directly; it measures stage of use rather than severity as such. (LLM, conf=0.82)

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Among survivors of child sexual abuse in residential schooling, unresolved grief was linked to pathological gambling.

“A study with survivors of child sexual abuse in residential schooling found that survivors had unresolved grief, and that was linked to pathological gambling [93].”

• cites [93] Dion, 2015, Sexual Abuse, Residential Schooling and Probable Pathological Gambling among Indigenous Peoples, Child Abus. Negl. sourcePartly supported

  The Abstract proposes that sexual abuse in residential schooling may lead to unresolved grief contributing to pathological gambling. But it reports measuring sexual abuse, residential schooling and gambling—not grief—and the Conclusion links the two traumas to probable pathological gambling, not unresolved grief specifically. The citing sentence presents the proposed grief link as a finding about survivors. (LLM, conf=0.90)

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Among AIAN compared to non-AIANs, problem gambling is strongly associated with past-year psychiatric disorders.

“Another study found a strong association between problem gambling and past-year psychiatric disorders among AIAN compared to non-AIANs [94].”

• cites [94] Kong, 2016, Problem-Gambling Severity and Psychiatric Disorders among American-Indian/Alaska Native Adults, J. Psychiatr. Res. sourceSupported

A second study of AI in New Mexico found the prevalence of pathological gambling was significantly higher for AI (2.2%) than among non-AIANs (0.9%).

“A second study of AI in New Mexico found the prevalence of pathological gambling was significantly higher for AI (2.2%) than among non-AIANs (0.9%) [85].”

• cites [85] Volberg, R.A., and Bernhard, B. (2006). The 2006 Study of Gambling and Problem Gambling in New Mexico, Responsible Gaming Association of New Mexico. sourceSupported

Lower socioeconomic status was significantly associated with problem gambling.

“Researchers also found that lower socioeconomic status was significantly associated with problem gambling [92].”

• cites [92] Barnes, 2017, Gambling Involvement among Native Americans, Blacks and Whites in the United States, Am. J. Addict. sourceSupported

Increased risk for gambling addiction among AIAN might be due to other inequities faced by AIAN that are also risk factors for problematic gambling.

“The increased risk for gambling addiction among AIAN might be due to other inequities faced by AIAN that are also risk factors for problematic gambling.”

• cites [88] Dowling, 2017, Early Risk and Protective Factors for Problem Gambling: A Systematic Review and Meta-Analysis of Longitudinal Studies, Clin. Psychol. Rev. sourcePartly supported

  The Conclusions identify socioeconomic status, depression symptoms, and alcohol and drug use as factors relevant to problem gambling in young people. The review does not establish that AIAN people face these particular inequities or that they explain increased gambling risk among AIAN; that population-specific explanation is an extrapolation. (LLM, conf=0.85)

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• cites [89] Potenza, 2019, Gambling Disorder, Nat. Rev. Dis. Prim. sourceNot checked — no full text of the source
• cites [90] Volberg, 1997, Gambling and Problem Gambling among Indigenous Peoples, Subst. Use Misuse sourceNot checked — no full text of the source
• cites [91] Welte, 2017, Predictors of Problem Gambling in the U.S, J. Gambl. Stud. sourceNot checked — no full text of the source

• AssumptionRests on an assumption: AIAN have an increased risk for gambling addiction.

AIANs resorted to substance use and other behavioral addictions to cope with multiple, chronic, and acute stressors related to discrimination, cultural and material losses, genocide, and knowledge of deliberate efforts to erase the culture.

“Potentially as a direct result, or through indirect associations, AIANs resorted to substance use and other behavioral addictions to cope with the multiple, chronic, and acute stressors related to discrimination, cultural and material losses, genocide, and knowledge of the deliberate efforts to erase the culture [26,27,28,29,99].”

• cites [26] Ehlers, 2013, Measuring Historical Trauma in an American Indian Community Sample: Contributions of Substance Dependence, Affective Disorder, Conduct Disorder and PTSD, Drug Alcohol Depend. sourcePartly supported

  The Results and Discussion (page not available in our copy) link substance dependence with symptoms associated with historical loss in one American Indian community. The Discussion explicitly says the cross-sectional data cannot establish the direction of that relationship. The paper therefore does not establish that AIANs used substances to cope with those stressors, and it does not address behavioral addictions. (LLM, conf=0.88)

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• cites [27] Soto, 2015, Stressful Life Events, Ethnic Identity, Historical Trauma, and Participation in Cultural Activities: Associations with Smoking Behaviors among American Indian Adolescents in California, Addict. Behav. sourcePartly supported

  The Introduction (§§1.2, 1.5; page not provided) links historical trauma and stressful life events, including discrimination and cultural loss, to smoking and substance use among American Indian youth. The Results (§3.2; page not provided) find associations between stressful life events, historical trauma, and smoking in California adolescents. The paper does not establish that AIANs broadly use substances to cope with these stressors, and it does not address other behavioral addictions. (LLM, conf=0.88)

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• cites [28] Whitbeck, 2004, Conceptualizing and Measuring Historical Trauma among American Indian People, Am. J. Community Psychol. sourceNot checked — no full text of the source
• cites [29] Wiechelt, 2012, Historical Trauma among Urban American Indians: Impact on Substance Abuse and Family Cohesion, J. Loss Trauma sourceNot checked — no full text of the source
• cites [99] Pokhrel, 2014, Historical Trauma and Substance Use among Native Hawaiian College Students, Am. J. Health Behav. sourcePartly supported

  The Historical Trauma section says research among American Indians links historical trauma with substance use and describes substance use as a possible means of coping. The paper does not establish that AIANs resorted to substance use as a direct or indirect result of the full list of stressors, and it does not address other behavioral addictions; its own study concerns Native Hawaiian college students. (LLM, conf=0.88)

  Experimental — accuracy not yet measured

Developmentally appropriate family rules and restrictions protect youth from SUD by potentially providing structure and monitoring.

“Developmentally appropriate family rules and restrictions also protect youth from SUD by potentially providing structure and monitoring as indicated in the general parenting literature [78].”

• cites [78] Wang, 2011, Trajectories of Family Management Practices and Early Adolescent Behavioral Outcomes, Dev. Psychol. sourcePartly supported

  In Results (Moderation Effect of Parental Support; page unavailable), the paper reports that parental rule making had a more positive association with substance-use outcomes when adolescents experienced greater parental warmth. It also associates parental knowledge with less substance use, supporting the proposed monitoring component. But the study measured alcohol and tobacco use, not SUD, and its Discussion distinguishes beneficial rules from restrictions on freedom, which it links to increased norm-breaking behavior. (LLM, conf=0.84)

  Experimental — accuracy not yet measured

Poverty, acculturation, and personality disorders appear to be risk factors for addiction in AIAN individuals as well.

“Consistent with prior research in non-AIAN samples, poverty, acculturation, and personality disorders [95,96,97,98] appear to be risk factors for addiction in AIAN individuals as well [33,43,50].”

• cites [95] 2020, Risk Factors Associated with Substance Use in Female Victims of Abuse Living in a Context of Poverty, An. Psicol.Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

• cites [96] McQueen, 2003, Acculturation, Substance Use, and Deviant Behavior: Examining Separation and Family Conflict as Mediators, Child Dev. sourceNot checked — no full text of the source
• cites [97] Parmar, 2018, Comorbidity of Personality Disorder among Substance Use Disorder Patients: A Narrative Review, Indian J. Psychol. Med. sourceSupported
• cites [98] Trull, 2018, Borderline Personality Disorder and Substance Use Disorders: An Updated Review, Bord. Personal. Disord. Emot. Dysregul. sourcePartly supported

  The review’s ‘Across settings’ section reports substantial co-occurrence of borderline personality disorder and substance use disorders, supporting the personality-disorder association in the sentence’s non-AIAN background claim. Its ‘Co-occurrence with substance use disorders’ section cautions that cross-sectional studies cannot establish which disorder develops first, so it does not establish personality disorder as a risk factor for addiction. The AIAN-specific claim is attached to different citations. (LLM, conf=0.86)

  Experimental — accuracy not yet measured
• cites [33] Whitesell, 2012, Epidemiology and Etiology of Substance Use among American Indians and Alaska Natives: Risk, Protection, and Implications for Prevention, Am. J. Drug Alcohol Abuse sourcePartly supported

  The Psychiatric Risk section (page unavailable) associates personality characteristics and psychiatric comorbidities with substance use and disorder among AI/ANs, but does not specifically identify personality disorders. The Demographic Factors section says poverty is prevalent but cautions that attributing risk to it is difficult. The Cultural Identity section reports mixed findings about culture-related risk; it does not establish acculturation as a risk factor. (LLM, conf=0.87)

  Experimental — accuracy not yet measured
• cites [43] Gibbs, J.T., and Huang, L.N. (2003). American Indian Children and Adolescents. Children of Color: Psychological Interventions with Culturally Diverse Youth, Jossey-Bass.Not checked yet

  Not checked in the free run.

• cites [50] Moghaddam, 2014, Nicotine Dependence and Psychiatric and Substance Use Disorder Comorbidities among American Indians/Alaska Natives: Findings from the National Epidemiologic Survey on Alcohol and Related Conditions, Drug Alcohol Depend. sourceNot checked — no full text of the source

Drinking with family members or peers who drink lower amounts of alcohol compared to socializing with people who drink a lot can be protective against developing a more severe SUD.

“Drinking with family members or peers who drink lower amounts of alcohol compared to socializing with people who drink a lot can also be protective against developing a more severe SUD [48].”

• cites [48] Montag, 2019, Community-Specific Risk and Protective Factors for Risky Alcohol Consumption in American Indian Women of Reproductive Potential: Informing Interventions, Int. J. Indig. Health sourcePartly supported

  The Discussion (page not specified) says female friends and family members influence participants’ drinking, and Implications for Prevention (page not specified) recommends supportive friend networks. Neither passage compares drinking with lighter versus heavier drinkers or examines whether doing so prevents a more severe substance use disorder. (LLM, conf=0.78)

  Experimental — accuracy not yet measured

Decision making and problem-solving skills appear to be protective for SUD.

“Decision making and problem-solving skills also appear to be protective for substance use disorder (SUD) [48]”

• cites [48] Montag, 2019, Community-Specific Risk and Protective Factors for Risky Alcohol Consumption in American Indian Women of Reproductive Potential: Informing Interventions, Int. J. Indig. Health sourcePartly supported

  The Discussion (page not supplied) says nondrinkers’ reasons for abstaining tended to reflect more considered, longer-term decisions than drinkers’ reasons, which lends some support to the decision-making part. It does not assess problem-solving skills or establish either skill as protective against substance use disorder; the study concerns risky alcohol consumption in a specific group of women. (LLM, conf=0.83)

  Experimental — accuracy not yet measured

Numerous risk factors (life stressors, severe trauma, family history of alcohol use) and protective factors (ethnic identity, family support) influence multiple substance (commercial tobacco, alcohol, opioid, stimulants) and behavioral (e.g., gambling) addictions among AIANs.

“Numerous risk factors (i.e., life stressors, severe trauma, family history of alcohol use) and protective factors (i.e., ethnic identity, family support) influence multiple substance (i.e., commercial tobacco, alcohol, opioid, stimulants) and behavioral (e.g., gambling) addictions.”

There is a dearth of research on behavioral addictions among AIANs.

“There is a dearth of research on behavioral addictions among AIANs.”

Little is known about behavioral addictions among AIAN populations.

“Little is known about behavioral addictions among AIAN populations.”

The available research on behavioral addictions indicates that AIANs are at increased risk for problem and pathological gambling, relative to other racial and ethnic groups in the United States.

“The available research on behavioral addictions indicates that AIANs are at increased risk for problem and pathological gambling, relative to other racial and ethnic groups in the United States [84].”

• cites [84] Cozzetto, 1996, Compulsive Gambling in the Indian Community: A North Dakota Case Study, Am. Indian Cult. Res. J. sourceNot checked — no full text of the source

The sparse literature on AIAN addictions only includes substance use and gambling addiction.

“This article provides a review of addictions among AIANs, but the sparse literature on this population only includes substance use and gambling addiction.”

The limited studies on gambling among AIANs have primarily been conducted in only a few geographic areas.

“The limited studies on gambling that do exist have primarily been conducted in only a few geographic areas.”

Urban environments away from reservations potentially increased the risk of engaging in substance use among AIANs.

“Urban environments away from reservations limited AIANs’ accessibility to social and family networks [39,43], increased alienation [44], exposure to discrimination, and potentially increased the risk of engaging in substance use [39].”

• cites [39] Lafromboise, 2006, Family, Community, and School Influences on Resilience among Family, Community, and School Influences on Resilience among American Indian Adolescents in the Upper Midwest American Indian Adolescents in the Upper Midwest, J. Community Psychol. sourceNot checked — no full text of the source

Sparse job and economic opportunities, largely due to geographic remoteness and poor industrial diversity, perpetuated already high rates of poverty in various AIAN reservations, rancherias, villages and communities.

“The sparse job and economic opportunities, largely due to geographic remoteness and poor industrial diversity, perpetuated already high rates of poverty in various AIAN reservations, rancherias, villages and communities [36].”

• cites [36] Davis, 2016, American Indian Poverty in the Contemporary United States, Sociol. Forum sourceNot checked — no full text of the source

Poverty poses limitations on availability and accessibility of mental health or counseling services, potentially aggravating maladaptive coping strategies, including substance use.

“Poverty also poses limitations on availability and accessibility of mental health or counseling services, potentially aggravating maladaptive coping strategies, including substance use [38].”

• cites [38] Jones, 2008, The Distinctive Characteristics and Needs of Domestic Violence Victims in a Native American Community, J. Fam. Violence sourceNot checked — no full text of the source

AIANs were forcibly removed from their lands to remote locations with stagnant rural economies that offered few opportunities to improve socio-economic status and living conditions.

“AIANs were forcibly removed from their lands to remote locations with stagnant rural economies that offered few opportunities to improve socio-economic status and living conditions [36].”

• cites [36] Davis, 2016, American Indian Poverty in the Contemporary United States, Sociol. Forum sourceNot checked — no full text of the source

The use of alcoholic beverages is relatively new to AIAN cultures.

“The use of alcoholic beverages is relatively new to AIAN cultures.”

• cites [45] Beauvais, 1998, American Indians and Alcohol, Alcohol Heal. Res. WorldNot checked — no full text of the source

Urban environments away from reservations limited AIANs' accessibility to social and family networks.

“Urban environments away from reservations limited AIANs’ accessibility to social and family networks [39,43], increased alienation [44], exposure to discrimination, and potentially increased the risk of engaging in substance use [39].”

• cites [39] Lafromboise, 2006, Family, Community, and School Influences on Resilience among Family, Community, and School Influences on Resilience among American Indian Adolescents in the Upper Midwest American Indian Adolescents in the Upper Midwest, J. Community Psychol. sourceNot checked — no full text of the source
• cites [43] Gibbs, J.T., and Huang, L.N. (2003). American Indian Children and Adolescents. Children of Color: Psychological Interventions with Culturally Diverse Youth, Jossey-Bass.Not checked yet

  Not checked in the free run.

AIANs who had six or more ACEs were significantly more likely to experience mood and anxiety disorders along with alcohol and nicotine use.

“Per the Warne and colleagues’ study, AIANs who had six or more ACEs (e.g., neglect,) were significantly more likely to experience mood and anxiety disorders along with alcohol and nicotine use [51].”

• cites [51] Warne, 2017, Adverse Childhood Experiences (ACE) among American Indians in South Dakota and Associations with Mental Health Conditions, Alcohol Use, and Smoking, J. Health Care Poor Underserved sourceNot checked — no full text of the source

The limited availability of paternal role models who lead healthier life paths may leave youth without proactive coping strategies and render them more vulnerable to substance use.

“However, the limited availability of paternal role models who lead healthier life paths may leave youth without proactive coping strategies and render them more vulnerable to substance use [67].”

• cites [67] Hurdle, 2003, Family Influences on Alcohol and Drug Use by American Indian Youth: Implications for Prevention, J. Fam. Soc. Work sourceNot checked — no full text of the source

The quality of parenting skills is adversely impacted among parents who consume substances and/or who are suffering from anxiety and depression.

“The quality of parenting skills is adversely impacted among parents who consume substances and/or who are suffering from anxiety and depression [68].”

• cites [68] Warne, 2015, American Indian Health Disparities: Psychosocial Influences, Soc. Personal. Psychol. Compass sourceNot checked — no full text of the source

Psychosis, personality, and other mood disorders (e.g., posttraumatic stress disorder) are intricately linked with substance use and dependence among AIANs.

“Psychosis, personality, and other mood disorders (e.g., posttraumatic stress disorder) are intricately linked with substance use and dependence as well [49,50,51].”

• cites [49] Beckstead, 2015, Dialectical Behavior Therapy with American Indian/Alaska Native Adolescents Diagnosed with Substance Use Disorders: Combining an Evidence Based Treatment with Cultural, Traditional, and Spiritual Beliefs, Addict. Behav. sourceNot checked — no full text of the source
• cites [50] Moghaddam, 2014, Nicotine Dependence and Psychiatric and Substance Use Disorder Comorbidities among American Indians/Alaska Natives: Findings from the National Epidemiologic Survey on Alcohol and Related Conditions, Drug Alcohol Depend. sourceNot checked — no full text of the source
• cites [51] Warne, 2017, Adverse Childhood Experiences (ACE) among American Indians in South Dakota and Associations with Mental Health Conditions, Alcohol Use, and Smoking, J. Health Care Poor Underserved sourceNot checked — no full text of the source

Physical health conditions that adversely impact quality of life are risk factors for alcohol dependence.

“Physical health conditions that adversely impact quality of life are risk factors for alcohol dependence [57].”

• cites [57] Novins, 2006, The Relationship between Patterns of Alcohol Use and Mental and Physical Health Disorders in Two American Indian Populations, Addiction sourceNot checked — no full text of the source

Fathers' alcohol consumption adversely impacts children as fathers can become neglectful.

“Fathers’ alcohol consumption adversely impacts children as fathers can become neglectful [67].”

• cites [67] Hurdle, 2003, Family Influences on Alcohol and Drug Use by American Indian Youth: Implications for Prevention, J. Fam. Soc. Work sourceNot checked — no full text of the source

Strong relationships were found between past-year use of alcohol and drug dependence.

“Strong relationships were found between past-year use of alcohol and drug dependence [50].”

• cites [50] Moghaddam, 2014, Nicotine Dependence and Psychiatric and Substance Use Disorder Comorbidities among American Indians/Alaska Natives: Findings from the National Epidemiologic Survey on Alcohol and Related Conditions, Drug Alcohol Depend. sourceNot checked — no full text of the source

Risk factors often have synergistic and cumulative effects on SUD.

“As can be inferred, risk factors often have synergistic and cumulative effects on SUD [50].”

• cites [50] Moghaddam, 2014, Nicotine Dependence and Psychiatric and Substance Use Disorder Comorbidities among American Indians/Alaska Natives: Findings from the National Epidemiologic Survey on Alcohol and Related Conditions, Drug Alcohol Depend. sourceNot checked — no full text of the source

Lifetime and past-year nicotine dependence were correlated with mood, anxiety, and personality disorders, alcohol use, and any drug use disorders in a nationally representative sample of AIAN adults.

“Lifetime and past-year nicotine dependence were correlated with mood, anxiety, and personality disorders, alcohol use, and any drug use disorders [50].”

• cites [50] Moghaddam, 2014, Nicotine Dependence and Psychiatric and Substance Use Disorder Comorbidities among American Indians/Alaska Natives: Findings from the National Epidemiologic Survey on Alcohol and Related Conditions, Drug Alcohol Depend. sourceNot checked — no full text of the source

IHS services are not always readily available outside of reservations, thwarting timely and comprehensive care.

“IHS services not always being readily available outside of reservations [63] thwart timely and comprehensive care.”

• cites [63] Zuckerman, 2004, Health Service Access, Use, and Insurance Coverage among American Indians/Alaska Natives and Whites: What Role Does the Indian Health Service Play?, Am. J. Public Health sourceNot checked — no full text of the source

Comorbid drug use, alcohol dependence, and psychiatric disorders exacerbate each other.

“For instance, comorbid drug use, alcohol dependence, and psychiatric disorders exacerbate each other [57].”

• cites [57] Novins, 2006, The Relationship between Patterns of Alcohol Use and Mental and Physical Health Disorders in Two American Indian Populations, Addiction sourceNot checked — no full text of the source

The use of alcohol typically precedes "harder drug" use (e.g., cocaine and methamphetamine).

“What is known is that the use of alcohol typically precedes “harder drug” use (e.g., cocaine and methamphetamine).”

Polysubstance use is often linked to unresolved grief and ongoing discrimination.

“Polysubstance use is also often linked to unresolved grief and ongoing discrimination [35].”

• cites [35] Walters, 2002, Substance Use among American Indians and Alaska Natives: Incorporating Culture in an “Indigenist” Stress-Coping Paradigm, Public Health Rep.Not checked — no full text of the source

Self-efficacy is protective against SUD.

“Self-efficacy is also protective against SUD possibly by trusting that they can work through an obstacle or improve their mood, for instance.”

A third study showed significantly higher rates among AIAN veterans (9.9%) compared to Hispanic veterans (4.3%) from southwest and north central regions of the USA.

“A third study showed significantly higher rates among AIAN veterans (9.9%) compared to Hispanic veterans (4.3%) from southwest and north central regions of the USA [86].”

• cites [86] Westermeyer, 2005, Lifetime Prevalence of Pathological Gambling among American Indian and Hispanic American Veterans, Am. J. Public Health sourceNot checked — no full text of the source

Connecting AIANs with their culture, language, traditions, and heritage through elders is protective because these interactions help to develop cultural knowledge, strength, and increase cultural identity.

“Connecting AIANs with their culture, language, traditions, and heritage through elders is protective because these interactions help to develop cultural knowledge, strength, and increase cultural identity [71]”

• cites [71] Cwik, 2019, “Let Our Apache Heritage and Culture Live on Forever and Teach the Young Ones”: Development of The Elders’ Resilience Curriculum, an Upstream Suicide Prevention Approach for American Indian Youth, Am. J. Community Psychol. sourceNot checked — no full text of the source

Characteristics such as the ability to find a greater meaning, purpose, and internal strengths build and contribute to resilience among AIAN.

“Characteristics such as the ability to find a greater meaning, purpose, and internal strengths build and contribute to resilience among AIAN [71].”

• cites [71] Cwik, 2019, “Let Our Apache Heritage and Culture Live on Forever and Teach the Young Ones”: Development of The Elders’ Resilience Curriculum, an Upstream Suicide Prevention Approach for American Indian Youth, Am. J. Community Psychol. sourceNot checked — no full text of the source

Continuous parental involvement and positive interactions help AIAN youth make healthier decisions around substance use.

“Additionally, continuous parental involvement and positive interactions help AIAN youth make healthier decisions around substance use [54].”

• cites [54] Baldwin, 2011, Culture and Context: Buffering the Relationship between Stressful Life Events and Risky Behaviors in American Indian Youth, Subst. Use Misuse sourceNot checked — no full text of the source

A study on two North Dakota Indian reservations found the pathological gambling rate was 14% and 10%, respectively, compared to 6% statewide.

“A study on two North Dakota Indian reservations found the pathological gambling rate was 14% and 10%, respectively, compared to 6% statewide [84].”

• cites [84] Cozzetto, 1996, Compulsive Gambling in the Indian Community: A North Dakota Case Study, Am. Indian Cult. Res. J. sourceNot checked — no full text of the source

Social support and supportive family and peer relationships with people who help strengthen cultural identity are protective for SUD.

“Social support and supportive family and peer relationships with people who help strengthen cultural identity are protective for SUD [54].”

• cites [54] Baldwin, 2011, Culture and Context: Buffering the Relationship between Stressful Life Events and Risky Behaviors in American Indian Youth, Subst. Use Misuse sourceNot checked — no full text of the source

Focusing on positive aspects of people's own lives, and their community and culture promote well-being among Native populations.

“Additionally, focusing on positive aspects of people’s own lives, and their community and culture promote well-being among Native populations [76].”

• cites [76] Kirmayer, 2011, Rethinking Resilience from Indigenous Perspectives, Can. J. Psychiatry sourceNot checked — no full text of the source

Social acceptance, depression, and the number of negative life events were significant predictors of substance and/or behavioral addictions among AIAN youth.

“Social acceptance, depression, and the number of negative life events were significant predictors of substance and/or behavioral addictions [83].”

• cites [83] Sussman, S. (2017). Substance and Behavioral Addictions: Concepts, Causes, and Cures, Cambridge University Press.Not checked yet

  Not checked in the free run.

One national study on AIAN in the U.S. indicated AIANs also had higher problem gambling rates compared to the general population (18% vs. 8%, respectively).

“One national study on AIAN in the U.S. indicated AIANs also had higher problem gambling rates compared to the general population (18% vs. 8%, respectively) [87].”

• cites [87] Welte, 2014, Sociocultural Influences on Gambling and Alcohol Use among Native Americans in the United States, J. Gambl. Stud.Not checked yet

  Not checked in the free run.

In a large sample of AIAN and Blacks across the U.S., neighborhood disadvantage and readily available opportunities for gambling were significantly associated with overall gambling, frequent gambling, and problem gambling.

“A study of risk factors for gambling among a large sample of AIAN and Blacks across the U.S. found that neighborhood disadvantage and readily available opportunities for gambling were significantly associated with overall gambling, frequent gambling, and problem gambling [87].”

• cites [87] Welte, 2014, Sociocultural Influences on Gambling and Alcohol Use among Native Americans in the United States, J. Gambl. Stud.Not checked yet

  Not checked in the free run.

The number of substance and/or behavioral addictions increased with age in a sample of AIAN youth.

“The number of substance and/or behavioral addictions increased with age in this sample of AIAN youth [83].”

• cites [83] Sussman, S. (2017). Substance and Behavioral Addictions: Concepts, Causes, and Cures, Cambridge University Press.Not checked yet

  Not checked in the free run.

There are promising culturally appropriate addiction treatment programs that incorporate AIAN healing practices and traditions in SUD services.

“There are promising culturally appropriate addiction treatment programs that incorporate AIAN healing practices and traditions in SUD services [106].”

• cites [106] Dickerson, 2021, Drum-Assisted Recovery Therapy for Native Americans (DARTNA): Results from a Feasibility Randomized Controlled Trial, J. Subst. Abuse Treat. sourceNot checked — no full text of the source

These programs have provided clients opportunities to reconnect with their culture and their community.

“These programs have also provided clients opportunities to reconnect with their culture and their community [110].”

• cites [110] Zeledon, 2020, Statewide Collaborative Partnerships among American Indian and Alaska Native (AI/AN) Communities in California to Target the Opioid Epidemic: Preliminary Results of the Tribal Medication Assisted Treatment (MAT) Key Informant Needs Assessment, J. Subst. Abuse Treat. sourceNot checked — no full text of the source

AIANs fostered and held on to cultural values and practices that help build resilience.

“Despite the numerous injustices and inequities that AIANs experienced, and continue to experience, AIANs fostered and held on to cultural values and practices that help build resilience.”