title: Substance use, treatment admissions, and recovery trends in diverse Washington State tribal communities.
abstract: BACKGROUND
  Qualitative and quantitative data and participatory research approaches might be most valid and effective for assessing substance use/abuse and related trends in American Indian and Alaska Native (AIAN) communities.
  
  
  METHODS
  Twenty-nine federally recognized AIAN tribes in Washington (WA) State were invited to participate in Health Directors (HD) interviews and State treatment admissions data analyses. Ten Tribal HD (or designees) from across WA participated in 30-60-minute qualitative interviews. State treatment admissions data from 2002 to 2008 were analyzed for those who identified with one of 11 participating AIAN communities to explore admission rates by primary drug compared to non-AIANs. Those who entered treatment and belonged to one of the 11 participating tribes (n = 4851) represented 16% of admissions for those who reported a tribal affiliation.
  
  
  RESULTS
  Interviewees reported that prescription drugs, alcohol, and marijuana are primary community concerns, each presenting similar and distinct challenges. Additionally, community health is tied to access to resources, services, and culturally appropriate and effective interventions. Treatment data results were consistent with interviewee-reported substance use/abuse trends, with alcohol as the primary drug for 56% of AIAN adults compared to 46% of non-AIAN, and other opiates as second most common for AIAN adults in 2008 with 15% of admissions.
  
  
  CONCLUSIONS
  Findings are limited to those tribal communities/community members who agreed to participate.
  
  
  CONCLUSIONS
  Analyses suggest that some diverse AIAN communities in WA State share similar substance use/abuse, treatment, and recovery trends and continuing needs.
  
  
  CONCLUSIONS
  Appropriate and effective research with AIAN communities requires respectful and flexible approaches.
authors.affiliation: Alcohol and Drug Abuse Institute, University of Washington, Seattle, WA 98105, USA. sradin@adai.washington.edu
authors.forename: Sandra M
authors.initials: SM
authors.lastname: Radin
authors.forename: Caleb J
authors.initials: CJ
authors.lastname: Banta-Green
authors.forename: Lisa R
authors.initials: LR
authors.lastname: Thomas
authors.forename: Stephen H
authors.initials: SH
authors.lastname: Kutz
authors.forename: Dennis M
authors.initials: DM
authors.lastname: Donovan
mesh_terms: D000328:Adult; D019973:Alcohol-Related Disorders / Q000453:epidemiology* / Q000208:ethnology / Q000534:rehabilitation; D006301:Health Services Needs and Demand; D006801:Humans; D007198:Indians, North American / Q000706:statistics & numerical data*; D007406:Interview, Psychological; D002189:Marijuana Abuse / Q000453:epidemiology / Q000208:ethnology / Q000534:rehabilitation; D009293:Opioid-Related Disorders / Q000453:epidemiology / Q000208:ethnology / Q000534:rehabilitation; D063487:Prescription Drug Misuse; D019966:Substance-Related Disorders / Q000453:epidemiology* / Q000208:ethnology / Q000534:rehabilitation; D014861:Washington / Q000453:epidemiology