Substance use among American Indians and Alaska natives: incorporating culture in an "indigenist" stress-coping paradigm.
OBJECTIVE
This article proposes a new stress-coping model for American Indians and Alaska Natives (AIs) that reflects a paradigmatic shift in the conceptualization of Native health. It reviews sociodemographic information on AIs, rates of substance abuse and related health outcomes, and the research supporting the model's pathways.


METHODS
Although health outcomes among AIs are improving, large disparities with other racial and ethnic groups in the United States remain. Many health-related problems are directly linked to high rates of substance use and abuse.


CONCLUSIONS
Eurocentric paradigms focus on individual pathology. An "indigenist" perspective of health incorporates the devastating impact of historical trauma and ongoing oppression of AIs. The model emphasizes cultural strengths, such as the family and community, spirituality and traditional healing practices, and group identity attitudes.
Walters
Karina L
KL
School of Social Work, University of Washington, 4101 15th Avenue, NE, Seattle, WA 98105-6299, USA. kw5@u.washington.edu
Simoni
Jane M
JM
Evans-Campbell
Teresa
T
D000223:Adaptation, Psychological; D000413:Alaska / Q000453:epidemiology; D001294:Attitude to Health / Q000208:ethnology*; D003466:Cultural Characteristics; D005006:Ethnicity / Q000523:psychology* / Q000706:statistics & numerical data; D005260:Female; D015658:HIV Infections / Q000208:ethnology; D006304:Health Status; D006801:Humans; D007198:Indians, North American / Q000523:psychology* / Q000706:statistics & numerical data; D008297:Male; D008519:Medicine, Traditional; D008960:Models, Psychological; D011287:Prejudice; D011634:Public Health; D012307:Risk Factors; D029181:Spirituality; D040921:Stress Disorders, Traumatic / Q000150:complications / Q000208:ethnology*; D019966:Substance-Related Disorders / Q000150:complications / Q000208:ethnology* / Q000523:psychology; D014754:Violence / Q000208:ethnology / Q000523:psychology