Department of Public Health and Preventive Medicine, Oregon Health & Science University , Portland, OR 97239, USA.
Am J Drug Alcohol Abuse. 2012 Sep;38(5):498-504. doi: 10.3109/00952990.2012.694530.
American Indians and Alaska Natives (AI/ANs) experience significant disparities in health status and access to care. Furthermore, only limited data are available on substance use, mental health disorders, and treatment needs for this population. Addressing such disparities and developing culturally relevant, effective interventions for AI/AN communities require participatory research.
The Western States Node of the National Institute on Drug Abuse Clinical Trials Network partnered with two American Indian substance abuse treatment programs: an urban health center and a reservation-based program to assess client characteristics, drug use patterns, and treatment needs. Data collected by staff members at the respective programs from urban (n = 74) and reservation (n = 121) clients were compared. Additional sub-analysis examined patients reporting regular opioid use and mood disorders.
Findings indicate that urban clients were more likely to report employment problems, polysubstance use, and a history of abuse. Reservation-based clients reported having more severe medical problems and a greater prevalence of psychiatric problems. Clients who were regular opioid users were more likely to report having a chronic medical condition, suicidal thoughts, suicide attempts, polysubstance abuse, and IV drug use. Clients who reported a history of depression had twice as many lifetime hospitalizations and more than five times as many days with medical problems.
Findings from this project provide information about the patterns of substance abuse and the importance of comprehensive assessments of trauma and comorbid conditions. Results point to the need for integrative coordinated care and auxiliary services for AI/AN clients seeking treatment for substance use disorders.
美国印第安人和阿拉斯加原住民（AI/ANs）在健康状况和获得医疗保健方面存在显著差异。此外，关于该人群的药物使用、心理健康障碍和治疗需求的数据非常有限。为了解决这些差异并为 AI/AN 社区制定文化相关、有效的干预措施，需要开展参与式研究。
国家药物滥用研究所临床试验网络的西部各州节点与两个美国印第安人药物滥用治疗项目合作：一个城市健康中心和一个保留地项目，以评估客户特征、药物使用模式和治疗需求。分别由各项目工作人员从城市（n = 74）和保留地（n = 121）客户收集的数据进行了比较。进一步的亚分析检查了报告经常使用阿片类药物和情绪障碍的患者。
研究结果表明，城市客户更有可能报告就业问题、多种物质使用和滥用史。基于保留地的客户报告有更严重的医疗问题和更高的精神问题患病率。经常使用阿片类药物的客户更有可能报告有慢性疾病、自杀念头、自杀企图、多种物质滥用和静脉注射药物使用。报告有抑郁病史的客户住院次数是其两倍，有医疗问题的天数是其五倍以上。
本项目的研究结果提供了关于药物滥用模式以及全面评估创伤和合并症的重要性的信息。研究结果表明，需要为寻求治疗药物使用障碍的 AI/AN 客户提供综合协调护理和辅助服务。
