title: Treatment implications of comorbid psychopathology in American Indians and Alaska Natives.
abstract: This paper discusses treatment implications of comorbid psychopathology in the context of American Indian and Alaska Native culture and in the context of the Indian Health Service's Mental Health and Alcohol and Substance Abuse Program Branches. Treatment of comorbidity in this population is a particularly difficult problem due to numerous barriers to treatment and a poorly defined treatment system. As in other clinical populations, these patients are high utilizers of the limited treatment services available, but may not receive the type of treatment they need. After describing the extent of comorbidity in this population, we present an historical perspective of mental illness that provides an Indian's view of why we are where we are today in treating these problems. Next, we discuss Western and traditional treatment implications for comorbidity among adults and adolescents. Finally, we suggest directions for future research in this area.
authors.affiliation: Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle.
authors.forename: R D
authors.initials: RD
authors.lastname: Walker
authors.forename: M D
authors.initials: MD
authors.lastname: Lambert
authors.forename: P S
authors.initials: PS
authors.lastname: Walker
authors.forename: D R
authors.initials: DR
authors.lastname: Kivlahan
mesh_terms: D000413:Alaska / Q000453:epidemiology; D000437:Alcoholism / Q000453:epidemiology / Q000523:psychology / Q000534:rehabilitation*; D015897:Comorbidity; D003431:Cross-Cultural Comparison; D003430:Cross-Sectional Studies; D006801:Humans; D015994:Incidence; D007198:Indians, North American / Q000523:psychology* / Q000706:statistics & numerical data; D004930:Inuit / Q000523:psychology* / Q000706:statistics & numerical data; D001523:Mental Disorders / Q000453:epidemiology / Q000523:psychology / Q000534:rehabilitation*; D012047:Rehabilitation Centers; D012307:Risk Factors; D012931:Social Environment; D019966:Substance-Related Disorders / Q000453:epidemiology / Q000523:psychology / Q000534:rehabilitation*; D014861:Washington / Q000453:epidemiology