Running head: NATIVE AMERICAN SUBSTANCE ABUSE 1
Native American Substance Abuse
Name
University
NATIVE AMERICAN SUBSTANCE ABUSE 2
Abstract
Substance abuse disproportionately impacts Native Americans’ communities throughout the
United States. Native Americans have a unique cultural history that has caused much trauma in
the lives of many people within this cultural group. Past trauma still affects the current
generation within the Native American cultural group. Counselors must understand why past
trauma affects today's generation. When people struggle to overcome traumatic events, they
often desire of a “mental escape” and turn toward alcohol or drug substances that they believe
will relieve the pain temporarily. Counselors have an essential job of integrating Spiritual belief
and using multicultural counseling methods to prevent such substance abuse within the Native
American cultural group. Education and multicultural approaches can be beneficial when trying
to assist with clients in breaking or preventing the addiction to drugs and alcohol. By analyzing
the cultural history of Native Americans on what causes the trauma to lead to substance abuse,
human service professionals can apply preventive methods to help clients and future generations.
Keywords: American Indian, evidence-based method, implementation, substance use,
integrating, and multicultural counseling
NATIVE AMERICAN SUBSTANCE ABUSE 3
Native American Substance Abuse
Native Americans endure significant struggles with substance abuse compared to other
cultural groups. With limited information available to provide insight on the prevalence of the
issue among a population that still suffers from its cultural policy, research into substance abuse
among Native Americans is a necessity. Notably, stereotypes concerning problems such as
alcohol abuse, the nature of self-discipline in recovery, and awareness of the evolution of an
alcohol use disorder continue to increase within the Native American cultural group (Lowe,
Liang, Henson, & Riggs, 2016). For the Native American cultural group to have success with
counseling, the counselor must apply multicultural counseling skills to help the clients to
overcome their problems. Along with counseling approaches to help support the Native
American people, the religious and spiritual application can be used to heal a Native client as a
whole better. By exampling Native American Culture, counseling, and spiritual application,
counselors can use their skills to help and prevent future pain within many communities.
Cultural Awareness
Native Americans have a robust tribal culture despite the 10% decrease in population
compared to the eighteenth century (Sue, 2019). Many Native Americans identify strongly with
their tribal cultural roots, which makes it important for counselors to assess the role in forming a
client-professional relationship that incorporates the client's culture. Otherwise, the Native
American client may experience a stiff resistance in developing a professional connection
because they will be resident in discussing issues outside the setting of their tribe. Additionally,
consideration of Native American's extended families helps improve understanding of the
patient’s views in the treatment process (Sue, 2019). By including the extended family, the client
can discuss issues that are bothering them about their position within the family. Most
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importantly, cultures influence the nature of family relationships, a factor whose consideration
would be of significant impact in treatment sessions involving a client with extensive ties to his
or her native culture. In particular, Native American parents have a higher likelihood of being
perceived as indulgent compared to parents from Euro-American cultures. This explains the
common practice within the Native American culture, where children often stay with other
family members. Counselors should recognize the traditions and customs as behavior and not
interpret such activities as negligence by the parents. Therefore, counselors must complete a
thorough screening to uncover issues that can be directly altered with the counseling process.
The guidelines provided by the American Psychiatric Association’s Diagnostic and
Statistical Manual allow professionals to examine the degree of trauma. An investigation among
Native American communities to identify domestic abuse victims, adolescents' risk factors, and
contributors to cases of trauma has been integral to understanding the implications of the
experiences on behavior (Good & Hinton, 2018). Past trauma and withdrawal have caused PTSD
to cumulate emotional and psychological hurt over a lifetime, and that pain has transferred across
generations affecting Native American culture. Many Native Americans, (36%) lost their
traditional language, which caused the feelings of losing one's culture (Good & Hinton, 2018).
Native American people have suffered from the mistakes of the past by White people. Many
Native Americans still hold a distrust of the intentions of the dominant Caucasian people because
of the historical suffering and loss they experienced (Sue, 2019). Generations of Native
American people have suffered from stress, grief, cultural displacement, discrimination, and loss.
By exploring significant aspects of local experience of trauma-linked disorders, counselors can
reshape the understanding of PTSD and other trauma-related disorders. Throughout the world,
trauma and stress have caused much suffering leading to PTSD. By educating the importance of
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history and ethnography to counseling sessions, PTSD healing techniques can reshape social
settings, cultural traditions, and psychological methods.
In today's society, there are many causes of trauma for the Native American people. One
article, Taking back the fire: Schooling experiences of Central California Indian people across
generations, discussed the differences with the Native American educational policies and
programs (Williams & Tracz, 2016). The study used data from several generations of Central
California Native Americans to document their schooling experiences through interviews, which
helped explain how the perceived role of education was for the Central Valley Native American
tribes. Analysis of the collected information indicated that the initial immersion in traditional
language, cultural knowledge seems to have improved resilience with ancestors, and Native
American boarding school occurrences for interviewees ranged depending on the traditional
context. The potential benefits of culturally understanding schooling were designed to improve
present and future generations of the Central California Native youth. Many can learn through
the mainstream culture of the fragments that remain from the Native American people. The
historical mistreatment the Native American people suffered from the dominant society has
remained susceptible, but by distributing their educational beliefs in the interest of improving the
well-being of future generations for the Native American people. The Central California Native
American people desire to collaborate with other cultures to help enhance the lives of all
children. Many interviewees were not pleased with the schooling experience from government
boarding, public, and missionary school from the past; however, numerous people agreed that
schooling is essential in improving lives. The barriers that the interviewees expressed were that
while discrimination and racism have lessened, the potential of teachers or curriculum is still
feared.
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Substance abuse
Native American communities have experienced more significant rates of alcohol, drug
misuse, and alcohol-related mortalities compared to other communities in addition to less access
to proper treatments for overcoming substance abuse compared to other persons within the U.S
population (Moore, Aarons, Davis, & Novins, 2015). Research provides useful insight on the
growth of EBT in substance abuse programs for treatment has increased to focus on
pharmacologic EBTs. In particular, a study by Moore, Aarons, Davis, & Novins (2015) helped
develop critical information in relation to intervention involving the use of EBT in treatment for
Native American patients suffering from alcohol and substance use disorders using
psychological approaches. However, the psychosocial treatments were proven to create more
positive attitudes related to the treatment option for pharmacologic — the traditional methods of
incorporating Native American programs observed only rare usages of EBTs. There are several
modified interventions shown effective within the Native American population. However, in as
much as these approaches may be improved with time following the use of evidence from
research on potential improvements, barriers such as low funding and work labor that lacked
proper training to deliver the EBTs cause limitation on the ability of the programs to implement,
identify, and maintain the use of treatment (Moore, Aarons, Davis, & Novins, 2015). The
barriers cause difficulties in guidance on how to evaluate cultural appropriateness with EBT of a
community and problems with the adaption process of interventions concerning the compromise
of one's therapeutic benefits.
Additionally, the Native American cultural group has experienced significant inequalities
to access to proper mental health care in regards to substance misuse (Rieckmann, Moore, Croy,
Novins, & Aarons, 2016). The long-term concerns of the disparity of health care regarded the
NATIVE AMERICAN SUBSTANCE ABUSE 7
Native American people in rural areas because of the lack of staff, organization training, and
beliefs toward evidence-based treatment for substance dependency. The researcher explored the
correspondence between a Native American client's openness toward using evidence-based
treatments (EBTs) to implementing programs located in rural areas. The results revealed that
there was significantly less probability of a Native American Client to have proper staff for
assistance such as traditional healing experts, nurses, or conventional providers to consult
strategic planning cultural activities with the services. There was more considerable openness
toward EBTs related to a more extensive clinical staff, having addiction providers, being led by
supervisors who observed the rift in access to EBTs, and working with essential providers to
increase access to assistance (Rieckmann, Moore, Croy, Novins, & Aarons, 2016). Many
programs of early intervention assistance reported less openness for clientele. Researchers
believed their study provided personal and program level information to use to understand better
changed in quality and access for Native Americans over some time.
Research conducted surveillance health movements of substantial differences in the
impact of substance abuse within the Native American people. The evidence-based treated found
significant improvement treatment options regarding substance use issues of Native Americans,
either by limiting intake or breaking the addiction altogether (Novins, Croy, Moore, &
Rieckmann, 2016). By analyzing the awareness of EBTs substance misuse programs designed
for treatment, Native American communities can receive assistance to help improve their way of
life. The methods used had data showing the first national examination of tribal substance misuse
treatment plans. There were one hundred ninety-two programs completed surveys from clinicians
and clinical administrators. Many participants had interrogated their awareness of attitudes,
medications, and psychosocial to evidence-based treatments. The most common executed
NATIVE AMERICAN SUBSTANCE ABUSE 8
psychosocial EBTs were medications with 43.3%, Relapse Prevention Therapy with 66.8%,
Cognitive Behavioral Therapy 82.2%, and Motivational interviewing 68.6% (Novins, Croy,
Moore, & Rieckmann, 2016). The largest EBT used a combination of different programs.
However, one of the two EBTs from Motivational Interviewing and Relapse Prevention Therapy
are concerned to be culturally appropriate. EBT information and use are essential in substance
misuse treatment plans helping Native American communities that have previously estimated.
Nevertheless, various users of the EBTs proceed to have concerns regarding the cultural
appropriateness, which restricts one's dissemination more.
There are several adverse effects caused by substance abuse. One article discusses the
adverse childhood experiences (ACEs) among youth to identify the several risky behaviors and
the association with mental illness. The researchers conducted a study to examine the
relationship between risky behaviors, types of exposures to adverse childhood experiences, and
results of reservation Native Americans with mental health issues (Brockie, Dana-Sacco, Wallen,
Wilcox, & Campbell, 2015). In 2011, the collected data from web-based questionnaires that were
conducted anonymously from Native American people ages 15-24 years analyzed the correlation
between six ACEs. The six ACEs examined were: neglect both emotionally and physically,
emotional abuse, physical abuse, sexual abuse, witness to violence, and for those some teenagers,
ages 18-19 years, the combined of historical loss connected symptoms to the four risk
behavior/mental health outcomes: post‐traumatic stress disorder (PTSD) indicators, poly‐drug
use, depression signs, and attempted suicide. The researchers found that 78% of the tested
sample had one or more ACE incidences reported, with 40% having two or more reported
occurrences (Brockie, Dana-Sacco, Wallen, Wilcox, & Campbell, 2015). The combined result of
the ACEs was significant for the four results with each extra ACE boosting the probabilities of
NATIVE AMERICAN SUBSTANCE ABUSE 9
suicide attempts (37 %), multiple drug use (51 %), PTSD traits (55 %), and symptoms of
depression (57 %) (Brockie, Dana-Sacco, Wallen, Wilcox, & Campbell, 2015). To approach the
culturally relevant results with children and adolescent intervention methods for interventions for
reservation‐based groups, it is essential that counselors create, examine, and review
longitudinally evaluate.
Counseling Approach
Multicultural counseling is necessary because it allows the counselor to conduct two
assessments; one assesses the extent manner of acculturations on the client's cultural identity,
and the other allows the counselor to gain the understanding on the influences of substance abuse
to the Native Americans culture. To improve the process of forming a positive counselor-client
relationship, the counselor must learn which tribe the client associates with and possible
affiliation of the client's tribe such as state, federal, or community acceptance. Counselors gain
insight into a client's perspective when they learn about the client's experiences and placement
within their society. When counselors assist Native American clients with prevention or
treatment of substance abuse, it is essential to improve the historical trauma responses and to
encourage a reattachment to the client's traditional Native traditions. Applying historical trauma
responses into the client's sessions can serve as a protective agent to limit future substance abuse
(Hays & Erford, 2018). The center focus on helping clients heal from historical trauma and
improving the next generations is one method of intervention. By emphasizing traditional
culture, counselors can help decrease substance abuse within the cultural group.
There is an overwhelming number of Native Americans that suffer from substance abuse.
With a wide range of intervention methods to prevent future drug problems or alcohol
dependency with the youth, counselors can potentially save many lives by studying the effects of
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developmental causes. With the overview of the article, readers learn methods to prevent
substance use among Native American adolescents by providing program development that
focuses on cultural group adolescents, background epidemiological, and recommendations of
prevention strategies into counseling practice (Lowe, Liang, Henson, & Riggs, 2016). Substance
abuse, such as misuse of alcohol, is one of the most critical health concerns facing Native
American communities. The United States Department of Health and the human services field
has identified the harmful consequences that affect societal and individual levels of Native
American cities are caused by historical trauma, either directly or indirectly. The past trauma
surrounding alcohol consumption of Native American people have devastated a cultural society
group by directly attributing alcohol use. While alcohol has damaged many Native communities,
there is a sizable population of Native Americans that refuse to drink. Unfortunately, alcohol use
is widespread with the Native American youth and continues to progress into other primary drug
use choices. The United States estimates that there is 2.5 million single race within the Native
American population and 4.1 million people with a combination of one race with the Native
American ethnic group (Lowe, Liang, Henson, & Riggs, 2016). Epidemiological analysis
indicates a significant level of normative underage substance use with a small minority of
teenagers considered as heavy substance users. The youth of Native American communities tend
to start alcohol and drug use at a very young age and have higher rates of polysubstance use.
Substance initiation in Native American populations typically happens between 10 and 13 years
of age, and some people reported starting using different substances as early as five or six years
of age (Lowe, Liang, Henson, & Riggs, 2016).
The adverse effects that the Native American people suffered held the long-lasting impact
on Native culture lifestyle. There are five periods that formed much of the trauma for the Native
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American: 1600-1840s the removal period ("The only good Indian is a dead Indian"), 1860-1920
the reservation period ("Kill the Indian, but save the man"), 1930-1950s the reorganization
period that allowed schools on the reservations, 1950-1960 the termination period that created
relocation programs designed to produce sociocultural integration to stop dependency of the
federal government (results were massive sale of parcels of native property and increased
poverty), and 1975-present the self-determination period that increased tribal sovereignty then
later Native activism known as "Red Power" (Hays & Erford, 2018). Counselors need to do two
early assessments when working with Native American clients. The first assessment is to
examine the extent of acculturation within the client's cultural identity, and the second
assessment is to understand the influences of oppression within one's current experiences.
Counselors can work with their clients to discuss the implications of spirituality, values about
contrasts and balance, tradition, and communication style.
Religious and Spiritual Application
Spiritual integration is crucial because it allows counselors to care and assist clients by
serving the whole person, such as physical, social, emotional, and spiritual needs of a person.
Spiritual engagement tends to enhance recovery from past traumas. By integrating spiritual
beliefs into counseling, clients shift their focus away from the stressors in their life to living in
the present moment. Results showed specific improvement in clients health when spiritual
practices were integrated (Puchalski, 2004). To the degree that any trauma has caused can
worsen with stress, to that amount evoked by the relaxation acknowledgment gained from
spiritual integration can create a favorable effective treatment.
Integrating religion into professional practice takes recognition of training literature that
can indicate spirituality problems within a client during a counselling session. By identifying
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potential barriers to incorporating spirituality into strategies for overcoming challenges for
clients, counselors can alter integration methods to serve their clients better (Adams, Puig,
Baggs, & Wolf, 2015). Often the obstacles of not being able to integrate faith during a
counseling setting successfully are due to lack of information, personal interest, relevance, and
strategies on educating the awareness of how God can assist His people in overcoming the
greatest of challenges. Delphi mythology focuses on increasing use in counseling and
psychotherapy. Researchers can increase the counseling and psychotherapy by an open-ended
questionnaire that was designed to gain the client's opinions on a particular inquiry topic. The
researchers used the results of the questionnaires compiled and assessed by a group of expert
researchers to explore and develop the different views points to create follow-up survey, and all
data collected to be analyzed and provide feedback. By using the Delphi method, the counselor
was able to develop several advantages to apply with their clients such as, gaining a deeper
understanding of different struggling issues to reflect upon, creating a geographical diversity
within clientele, and eliminating common problems that are associated with lack of anonymity
and conformity (Adams, Puig, Baggs, & Wolf, 2015). Counselors can increase awareness of the
client's sense of self and curriculum recommendations for the client to implement within their
lives to build a better future.
Conclusion
Native American people have struggled with their historical culture’s past that lead to
current day struggles with substance abuse. By knowledge the need for cultural awareness of the
Native American people, a positive movement can occur to achieve better treatment that would
serve the cultural group that still suffers from its cultural history. To have more success in
counseling with Native American clients, counselors should apply multicultural counseling
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skills, and integrate the spiritual application to better support a client as a whole, including
mental, emotional, socially, physically, and spiritual wellness. By applying the needed skills
from counselors, they can create a future of less pain for many Native American communities.
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