Substance Abuse Among American Indians and Alaska Natives: An Integrative Cultural Framework for Advancing Research

Research consistently highlights the high prevalence of substance-related psychopathology in the American Indian/Alaska Native (AIAN) population. Recent epidemiological literature suggests that these trends are not diminishing, despite decades of etiological work and prevention programs. The aim of this article was to examine the literature on risk and protective factors for substance-related psychopathology in the AIAN population from the perspective of Betancourt’s integrative model of culture, psychological processes, and behavior (Betancourt et al. 1993, 2010, 2011). This model specifies the structure of relations among sociostructural (e.g., income and education), cultural (e.g., values and norms), and psychological (e.g., cognition and emotion) factors influencing behavior. Articles were reviewed that identified one or more determinants of substance-related psychopathology in the AIAN population. An analysis of the reviewed articles revealed that the factors investigated in relation to substance-related psychopathology have typically been studied independently of each other. Also, most studies have examined factors that are rather distal from behavior (e.g., sociostructural). Results suggest that research on the interrelations among cultural and psychological, in addition to sociostructural, determinants may enhance our understanding of substance-related psychopathology in this population. To this end, suggestions for future research are derived from results of the studies reviewed. Such theoretically driven research may contribute to more effective interventions and the reduction of substance-related disparities among the AIAN population.