Transcript Open poster - CTN Dissemination Library

Use of methamphetamine and alcohol in Native American communities
Houck, J.M. 1, Daw, R. 2, Davis, M.P. 1, Forcehimes, A.A. 1, Bogenschutz, M.P. 1
1Center
on Alcoholism, Substance Abuse, and Addictions (CASAA)
2Totah Behavioral Health Authority
http://casaa.unm.edu
INTRODUCTION
Methamphetamine (meth) use has been endemic in the Western
United States for over two decades. Higher rates of meth use have
been reported in the Western US than in other parts of the nation
(Office of Applied Studies, 2007a). The National Survey on Drug
Use and Health suggests that about 5% of the population 12 years
of age and older report some lifetime use of meth (Office of
Applied Studies, 2006). New Mexico represents a severe case,
ranking in the top 10 states for meth use in recent years (Office of
Applied Studies, 2006). While the actual scope of meth use
remains unknown for most tribal communities, surveys suggest
elevated rates of substance use among American Indians and
Alaska Natives (AIAN) compared with other racial/ethnic groups
(Office of Applied Studies, 2007b). The present study evolved
from successful past collaborations with AIAN treatment sites
(e.g., Daw, 2006) and was designed to examine the treatment
needs and impacts of meth and other drugs on AIAN individuals,
families, and communities, using a community-based participatory
research approach (Wallerstein & Duran, 2006).
METHOD
Demographic and Addiction Severity Index (ASI) data were
collected from three AIAN sites in New Mexico. The ASI was
customized by each site to meet the unique needs of their
particular communities, thus not all items were assessed. ASI
results were collated from existing datasets (N=300).
Amphetamine use as reported in the ASI was used as a proxy for
meth use. Standard composite scores including Medical,
Employment, Alcohol, Drug, Legal, Family, and Psychiatric were
computed. Multivariate analysis of variance was used to test for
differences in ASI composite scores across gender and sites,
using rates of use of meth and alcohol over the previous 30 days
as covariates.
RESULTS
A majority of participants were male (58.2% male, 41.8% female).
The mean age was 34.2, SD 10.95 years. The mean years of
education was 11.6 (SD 1.4). Most participants (93.1%) reported
at least 10 years of education, while 2/3 (66.7%) reported 12 or
more years of education.
Descriptive statistics revealed that 21.4% of participants reported
some lifetime amphetamine use, with 3.7% reporting amphetamine
use in the previous 30 days (see Table 1). Three participants
(1.6%) reported amphetamine as their primary problem substance,
while alcohol was reported as the major problem substance by
67.0% of respondents (see Table 2).
Substance
Previous 30
N
Lifetime
%
N
%
Composite
Site 1
Site 2
Site 3
Mean
Mean
Mean
Aggregate
Mean
SD
115
38.3
276
92.3
Medical
0.188
0.124
0.122
0.144
0.276
99
33.0
255
85
Employment
0.846
0.881
0.846
0.857
0.213
Heroin
3
1.0
9
3.0
Alcohol
0.262
0.168
0.217
0.216
0.213
Methadone
2
0.7
2
0.7
Drug
0.043
0.008
0.045
0.033
0.078
Opiates
5
1.7
4
1.3
Legal
0.200
0.050
0.259
0.176
0.159
Barbiturates
0
0.0
2
0.7
Psych
0.250
0.153
0.119
0.172
0.219
Sedatives
1
0.3
3
1.0
Family
0.190
0.084
0.153
0.144
0.167
Cocaine
9
3.0
41
13.7
Amphetamine
11
3.7
64
21.4
SUMMARY
Marijuana
38
12.7
159
53.2
Hallucinogen
2
0.7
14
4.7
Inhalant
0
0.0
7
2.3
22
7.3
92
30.8
Despite a high self-reported rate of lifetime amphetamine use nearly four times the national average - most participants in the
present study viewed alcohol, not amphetamine, as the primary
problem substance in their lives. While it is possible that the
potential for social stigmatization discouraged participants from
reporting amphetamine use, the high self-reported rates of alcohol
use to intoxication provides some argument against this. It should be
noted, however, that the present study relied upon a measure of
amphetamine use as a proxy for meth use.
Alcohol
Alcohol to intox.
More than one drug
Table 1. Number and percentage of participants reporting any use of a
substance in the previous 30 days and over lifetime
Average ASI composite scores for each site and in the aggregate
are reported in Table 3; higher scores indicate greater severity.
MANOVA results revealed no significant Gender×Site interaction
(p=.461), but did indicate significant main effects for both Gender
(F(7,285)=2.849, p=.007) and Site (F(14,572)=10.260, p< .001),
indicating significant group differences on the linear composite of
ASI scores. Amphetamine and alcohol use rates were both
significant covariates.
Univariate follow-up procedures indicated that the main effect of
Gender was driven primarily by the Drug, Psychiatric, and Family
composites. The main effect of Site was found in Alcohol, Drug,
Legal, Psychiatric, and Family composites. While the employment
composite score was quite high, follow-up tests did not indicate
differences on this measure for either Site or Gender, or an effect
for either covariate.
Substance
Alcohol
Alcohol to intoxication
f
%
38
20.2
126
67.0
Amphetamine
3
1.6
Cannabis
4
2.1
Alcohol +Drugs
11
5.9
Drugs -Alcohol
5
2.7
188
100
Total
Table 2. Self-reported major problem substance reported by number and
percentage of participants
Table 3. ASI composite scores by site
Analyses revealed significant effects of gender and site on ASI
composite scores, highlighting the unique challenges faced at AIAN
treatment sites within the same region. It is also apparent that rates
of alcohol use have not retreated during the widespread growth of
meth use.
Participants at all sites reported substantial employment problems,
an ongoing challenge that has been previously reported by our
research group (Foley et al., in review). In general, our results
suggest that meth treatment at AIAN sites must be customized to
meet the unique needs of these communities, and that concomitant
treatment for alcohol use should be considered whenever possible.
REFERENCES
Daw, R. (2006). Successful behavioral health research partnerships: The NCI experience. Paper
presented at the 18th Annual Indian Health Service Research Conference, Albuquerque, NM.
Foley, K., Pallas, D., Forcehimes, A., Houck, J.M., Bogenschutz, M.P., & Svikis, D. (in review).
Effect of job skills training on employment and job seeking behaviors in an American Indian
substance abuse treatment sample.
Office of Applied Studies. (2006). State estimates of past year methamphetamine use. The NSDUH
report .
Office of Applied Studies. (2007a). Methamphetamine use. The NSDUH report.
Office of Applied Studies. (2007b). Substance use and substance use disorders among American
Indians and Alaska Natives. The NSDUH report.
Wallerstein, N. B., & Duran, B. (2006). Using community-based participatory research to address
health disparities. Health Promotion Practice, 7(3), 312-323.
ACKNOWLEDGEMENTS
This research was supported by NIDA’s Clinical Trials Network (U10 015833).
We are grateful for the support and guidance of the Navajo Nation Human
Research Review Board.