title: American Indians with substance use disorders: treatment needs and comorbid conditions.
abstract: BACKGROUND
  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.
  
  
  OBJECTIVE
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Public Health and Preventive Medicine, Oregon Health & Science University , Portland, OR 97239, USA. rieckman@ohsu.edu
authors.forename: Traci
authors.initials: T
authors.lastname: Rieckmann
authors.forename: Dennis
authors.initials: D
authors.lastname: McCarty
authors.forename: Anne
authors.initials: A
authors.lastname: Kovas
authors.forename: Paul
authors.initials: P
authors.lastname: Spicer
authors.forename: Joe
authors.initials: J
authors.lastname: Bray
authors.forename: Steve
authors.initials: S
authors.lastname: Gilbert
authors.forename: Jacqueline
authors.initials: J
authors.lastname: Mercer
mesh_terms: D000293:Adolescent; D000328:Adult; D000413:Alaska / Q000453:epidemiology; D019033:Delivery of Health Care, Integrated / Q000458:organization & administration; D017831:Diagnosis, Dual (Psychiatry); D005260:Female; D006297:Health Services Accessibility / Q000706:statistics & numerical data; D006301:Health Services Needs and Demand / Q000706:statistics & numerical data*; D054624:Health Status Disparities; D054625:Healthcare Disparities / Q000208:ethnology; D006801:Humans; D007198:Indians, North American; D008297:Male; D001523:Mental Disorders / Q000453:epidemiology* / Q000208:ethnology; D008875:Middle Aged; D054577:National Institute on Drug Abuse (U.S.); D016320:Substance Abuse Treatment Centers / Q000458:organization & administration; D019966:Substance-Related Disorders / Q000453:epidemiology / Q000208:ethnology / Q000534:rehabilitation*; D014481:United States / Q000453:epidemiology; D019037:Urban Health Services / Q000458:organization & administration; D055815:Young Adult