Contemporary American Indians and Alaska Natives (AIs/ANs) who live in urban areas today face the daunting task of navigating an urban landscape while maintaining the facets of their respective Native cultures. While AIs/ANs continue to grapple with the intergenerational trauma associated with forced assimilation, relocation movements, and boarding schools, these traumas have manifested themselves in elevated rates of psychopathology. AIs/ANs have elevated rates of domestic abuse, poverty, suicide, and substance misuse. Furthermore, AIs/ANs, like many other minority cultures often face discrimination in their everyday lives. In light of the aversive experiences they face, AI/AN people have followed the tenets of ritual and traditional healing to address imbalances in the body, mind, and spirit. For providers working with AI/AN clients, it is important to understand who is using traditional healing and why they are using alternative services. Secondary data analyses of survey data from 389 urban AIs/ANs were utilized in order to determine the relationship between experiences of discrimination and traditional healing use. Analyses indicated that experiences of discrimination in healthcare settings were significantly associated with participation in traditional healing. Analyses also indicated that nearly a quarter of the sample reported discrimination in a healthcare setting, roughly half of the sample had used traditional healing, and that the majority of those who had used traditional healing were women, and ages 35-44 (27%). This study calls attention to the socio-demographic factors implicated in traditional healing use by urban AI/AN people, in addition to the clinical and demographic characteristics of this sample.
American Indians and Alaska Natives (AI/ANs) have high rates of tobacco use compared to the general population. AI/ANs also have elevated rates of psychiatric and substance use disorders associated with nicotine dependence. However, very few studies have examined the comorbidity between nicotine dependence and psychiatric and substance use disorders within this population.
This study analyzes the comorbidity of lifetime nicotine dependence with both current and lifetime psychiatric disorders and substance use disorders in a nationally representative sample of 701 AI/AN women and men.
Using 95% confidence interval testing, lifetime nicotine dependence (29.5%) was associated with all main diagnostic categories (any mood disorder, any anxiety disorder, any personality disorder, any alcohol use disorder, and any drug use disorder) both at the lifetime level and current (12-month) level. Of the lifetime disorders, the strongest associations were with psychosis and drug dependence. For (current) 12-month disorders, the strongest associations were with alcohol dependence and drug dependence. Differences were noted between genders regarding personality disorders.
Culturally appropriate tobacco screening, prevention, and treatment curricula for adult AI/ANs with dual diagnoses are recommended. Understanding historically based factors that may contribute to psychiatric illness and substance use disorders may assist in more effective nicotine treatments for AI/ANs.