American Indian and Alaska Native substance abuse: co-morbidity and cultural issues.

The devastating impact of substance abuse on American Indians and Alaska Natives (AI/ANs) is reviewed with an emphasis on psychological and physical effects. Co-morbidity of substance abuse, trans-generational trauma, Post Traumatic Stress Disorder, and depression among AI/ANs is also discussed since each condition may cause, impact, and/or exacerbate the others. The Medicine Wheel, one respected and accepted treatment approach developed by AI/AN communities, is described in detail since it helps address all of the co-morbid issues discussed.