Studies of Substance Abuse with Interventions for the Youth of Native American Indian Communities #7

Definitions #2

According to the Diagnostic and Statistical Manual of Mental Disorders (American Psychiatric Association, 2000), substance abuse is characterized by a maladaptive pattern of use leading to recurrent and significant impairment or distress. For example, criteria for alcohol abuse include problems at work or school due to drinking, or repeatedly driving while intoxicated. Chemical dependence is a more severe disorder and is additionally marked by the development of tolerance or withdrawal symptomatology (American Psychiatric Association, 2000). Terms such as addiction or alcoholism generally refer to substance dependence disorders. Whereas diagnostic criteria for adults are clearly defined, there is less standardization for the diagnosis of substance use disorders in youth. To a large extent, this is the result of significant developmental, physiological, and social differences between adult and adolescent substance use and misuse. For example, research indicates that young people drink less frequently than adults but that they tend to consume larger amounts when they do drink (Oetting & Beauvais, 1989; White & LaBouvie, 1989). Among youth, drinking and drug use is more likely to be associated with “partying.” This pattern decreases the likelihood that substance abusing youth will experience tolerance or withdrawal symptoms, which are necessary criteria for a diagnosis of substance dependence.

It can be a challenge to ascertain which theoretical model is a good fit with alcoholism and Native American Indians. The first required element is to determine a suitable definition for alcoholism. Alcoholism has been theoretically defined by a 1992, 23-member multidisciplinary committee of the National Council on Alcoholism and Drug Dependence and the American Society of Addiction Medicine. The committee conducted a 2-year study of the definition of alcoholism in the light of current concepts (Morse & Flavin, 1992). Their goal was to create by consensus a revised definition of alcoholism that was (1) scientifically valid, (2) clinically useful, and (3) understandable by the general public. The definition is as follows:

“Alcoholism is a primary, chronic disease with genetic, psychosocial, and environmental factors influencing its development and manifestations. The disease is often progressive and fatal. It is characterized by continuous or periodic: impaired control over drinking, preoccupation with the drug alcohol, use of alcohol despite adverse consequences, and distortions in thinking, most notably denial. (Morse & Flavin, 1992)” The revised definition recognizes alcoholism as a heterogeneous disease (that is, biopsychosocial factors are implicated in the causes, signs and symptoms, complications, and treatment of alcoholism). It also acknowledges a genetic vulnerability in the evolution of alcoholism in many alcoholics; and, for the first time, formally incorporates denial as a major concept (Morse & Flavin, 1992).

May (1996) reported that both American Indian youth and adults frequently consume large amounts of alcohol in a short period of time, a style often referred to as binge drinking (commonly defined as five or more drinks in a row for males and four or more drinks in a row for females; Wechsler, Lee, Kuo, & Lee, 2000). Beauvais (1992c) has observed two distinct types of drinkers among American Indian youth. He reported that approximately 20% of American Indian youth in the 7th through 12th grades begin heavily using alcohol and other drugs at an early age and continue this use into adulthood. These youth are at high risk for lifelong problems with alcohol abuse and dependence. The second type of drinker, which is also estimated to account for 20% of American Indian youth, uses alcohol socially and recreationally. Drinking for this group is often experimental in nature and highly dependent on the environment. This pattern is less likely to lead to long-term problems. It has been noted that in addition to using alcohol and other drugs at high rates, American Indian and Alaskan Native youth often tend to use in ways different from other adolescent groups. Numerous studies have examined gender and regional or cultural differences. However, research findings often contradict one another, highlighting the complexities of making general statements about this very heterogeneous group.

Within the general adolescent population, boys usually have higher rates of drug use, particularly higher rates of frequent use, than do girls. In particular, they tend to have higher rates of heavy drinking, smokeless tobacco use, and steroid use (Johnston, O’Malley, & Bachman, 2002). From his research using school based surveys, Beauvais (1992c) reported that there does not appear to be a significant difference in alcohol use rates between American Indian adolescent boys and girls. Furthermore, it has been reported that American Indian male and female youth experience drinking problems at equally high rates (Beauvais, 1992c; Cockerham, 1975; Oetting & Beauvais, 1989), and in a sample of urban Native youth, gender may not have influenced which youth abused alcohol (Walker, 1992).