Department of Psychology, Montana State University.
Department of Psychology, Washington State University.
Am Psychol. 2019 Jan;74(1):88-100. doi: 10.1037/amp0000331.
Historians and scholars from various disciplines have documented the pervasive influence of racism on American society and culture, including effects on the health and well-being of American Indian (AI) people. Among the many health problems affected by racial discrimination and oppression, both historical and current, are substance use disorders. Epidemiological studies have documented greater drug and alcohol-related morbidity and mortality among AI/AN Alaska Natives compared to other ethnic groups, and culturally appropriate, effective interventions are sorely needed. We collected, as part of a larger community-based participatory research project to address substance use disparities in rural AI communities, qualitative interview data from 25 AI key informants from a frontier reservation in Montana. Using a semistructured interview guide, we asked participants to discuss their perceptions of the causes of substance use problems and barriers to recovery on the reservation. Although no questions specifically asked about discrimination, key informants identified stress from racism as an important precipitant of substance use and barrier to recovery. As one participant stated: "Oppression is the overarching umbrella for all sickness with drugs and alcohol." Participants also identified historical trauma resulting from colonization as a manifestation of race-based stress that drives behavioral health problems. Findings suggest that interventions for AIs with substance use disorders, and possibly other chronic health problems, may be more effective if they address social determinants of health such as racial discrimination and historical trauma. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
历史学家和来自不同学科的学者记录了种族主义对美国社会和文化的普遍影响，包括对美洲印第安人（AI）健康和福祉的影响。在历史上和当前受到种族歧视和压迫影响的许多健康问题中，包括药物使用障碍。流行病学研究记录了与其他族裔群体相比，阿拉斯加原住民中的 AI/AN 药物和酒精相关发病率和死亡率更高，并且迫切需要文化上适当和有效的干预措施。我们收集了来自蒙大拿州一个边疆保留地的 25 名 AI 主要信息提供者的定性访谈数据，作为解决农村 AI 社区药物使用差异的更大的基于社区的参与式研究项目的一部分。使用半结构化访谈指南，我们要求参与者讨论他们对保留地药物使用问题的原因和康复障碍的看法。尽管没有专门询问歧视问题，但主要知情人指出，种族主义造成的压力是导致药物使用和康复障碍的重要原因。正如一位参与者所说：“压迫是所有与毒品和酒精有关的疾病的总括保护伞。”参与者还确定了殖民化造成的历史创伤是导致行为健康问题的基于种族的压力的表现。研究结果表明，如果干预措施针对与药物使用障碍相关的 AIs（可能还有其他慢性健康问题），解决健康的社会决定因素，如种族歧视和历史创伤，可能会更有效。
