September 1, 2012

Studies of Substance Abuse with Interventions for the Youth of Native American Indian Communities #9

Definitions #4

Substance misuse is directly implicated in the disproportionately high morbidity and mortality rates found among American Indian teens. American Indian youth (ages 15 to 24 years) have an all-cause mortality rate 2.1 times higher than that of the general population (196.5 vs. 95.3 per 100,000 population) and 2.3 times higher than that of Whites, the group with the lowest rate (196.5 vs. 84.3 per 100,000 population; Indian Health Service, Office of Public Health, Program Statistics Team, 1999). Of the 10 leading causes of death for American Indian youth, at least 3 are related to heavy use of alcohol: accidents, suicide, and homicide (Indian Health Service, Office of Public Health, Program Statistics Team, 1999). In addition, the alcoholism death rate for Native youth served by Indian Health Services was 11.3 times higher than the combined all-races rate (Indian Health Service, Office of Public Health, Program Statistics Team, 1999). This statistic does not include alcohol-related deaths due to accidents, suicide, or homicide. It is apparent that suicide is related to structural circumstances within communities, such as unemployment and poverty. When communities provide little opportunity for economic self-sufficiency, frustrations appear to be manifested in acts of violence. These acts appear to be nondiscriminatory and are directed both toward the self in acts of suicide and toward others in acts of assault that are often lethal.

The theoretical model for American Indian violence combines the causal forces of social disorganization, economic deprivation, a culture of violence, and the psychological mechanisms of culture conflict and perceived powerlessness with the intervening variable of alcohol/drug abuse. No model explaining any phenomenon with regard to American Indians would be complete without acknowledgment of the colonization process to which our government has subjected this population.

The colonization process has produced other forms of dislocation among the American Indian people besides economic dislocation. This process has also created many unique pressures on the relationships among American Indian family members. The indicators of social disorganization, such as divorce and other forms of family disruption, can foster such maladies as aggression directed toward others. When a community is living under conditions of extreme deprivation, it is not surprising that the stresses of everyday existence are played out in the family context. The results of research, suggest that families may be stress collection points not only for stressful events created within the family, but also for stresses originating outside of the family. People often express their anger and frustration toward family members in ways that would be unacceptable if used outside the family. This ventilation of frustrations within the family sometimes escalates from verbal confrontations to physical aggression, and a certain proportion of these situations become lethal. Native American Indian families must have resources available in order to become the backbone of American Indian communities that they once were. Programs that teach family members effective ways to communicate and also techniques to manage and reduce stress are seriously needed in most American Indian communities.

Further, research indicates that supportive human relationships can protect stressed individuals against a variety of ills. Therefore, programs that teach American Indian families how to build these supportive networks can have positive consequences on several levels. These social supports for individuals can provide increased reassurance of worth, increase self-concept and self-esteem, assist in problem solving, and help prevent demoralization in times of stress. Because most of the violence examined in this study has been male perpetrated (including a higher rate of suicide for males), these programs should aggressively seek male participants. Other literature further substantiates this need. For example, studies of coping mechanisms find that females show a greater propensity to mobilize social supports in times of stress. In addition, females are more likely than males to seek out social support, to receive social support, and to be pleased with the support they receive. There may be an additional stigma for American Indian males to perform emotively. These men must learn that seeking social supports does not threaten their competence or independence and that displaying emotions other than anger does not threaten their masculinity. Of course, the goal of this recommendation is to restabilize American Indian families that may be in crisis. Against this ideal backdrop of restabilization, however, is the reality for many American Indians of a family life characterized by chaos and destructive modes of communication. When domestic situations become violent, family members who become the victims of this violence must have havens in which to seek shelter. Most Indian communities are in desperate need of such safe havens. Of immediate importance here is the funding of battered women's shelters to meet the needs of abused American Indian women and their children. When there is no alternative within a family but divorce or disruption, steps must also be taken to assure the best interests of any children who may be involved. American Indian child-welfare services need to become more aware of the deleterious effects that removing a child from both his culture and his family may have. When questions of custody arise, both Indian children and their parents should have the right to counsel and access to the services of expert witnesses. If removal of an Indian child is the only solution, foster and adoptive parents must be provided who have adequate means and knowledge to meet both the cultural and structural needs of that child.