Journeys of the Circle

A Culturally A Culturally Relevant Life Skills Relevant Life Skills Intervention for Intervention for Adolescent Indian Adolescent Indian DrinkingDrinking

Research Society on AlcoholismResearch Society on AlcoholismVancouver, B.C., June 28, 2004Vancouver, B.C., June 28, 2004

A Collaborative Effort

University of Washington, University of Washington,

Department of Psychology, Department of Psychology,

Addictive Behaviors Research Center Addictive Behaviors Research Center

ANDAND

The Seattle Indian Health BoardThe Seattle Indian Health Board

PROJECT FUNDING

National Institute on Alcohol National Institute on Alcohol Abuse and Alcoholism Abuse and Alcoholism (AA12321) (AA12321)

Robert Wood Johnson Robert Wood Johnson FoundationFoundation

Seattle Indian Health Board (SIHB)

Seattle non-profit serving the Seattle non-profit serving the Native Community for over 30 Native Community for over 30 yearsyears

Offering a wide spectrum of health Offering a wide spectrum of health services for adults, youth, and services for adults, youth, and childrenchildren

Seattle Indian Health Board Team

Executive DirectorExecutive Director

Assistant Executive Assistant Executive DirectorDirector

Operations Operations CoordinatorCoordinator

Community Services Community Services ManagerManager

Ralph Forquera, Ralph Forquera, MPHMPH

Rebecca Rebecca GonzalesGonzales CorpuzCorpuz

Crystal Tetrick, Crystal Tetrick, MPHMPH

Steve GallionSteve Gallion

University of WashingtonTeam

Principal InvestigatorPrincipal Investigator Co-Principal Co-Principal

InvestigatorsInvestigators Project Post-DocsProject Post-Docs

Research CoordinatorResearch Coordinator

Research AssistantsResearch Assistants

G. Alan Marlatt, PhDG. Alan Marlatt, PhD

Mary Larimer, PhDMary Larimer, PhD Patricia Mail, PhD, MPHPatricia Mail, PhD, MPH

Lillian Huang Cummins, Lillian Huang Cummins, PhDPhD

Heather Lonczak, EdDHeather Lonczak, EdD

Jessica CronceJessica Cronce

June La MarrJune La Marr Sandra RadinSandra Radin Karen ChanKaren Chan Kelly BurnsKelly Burns

UW and SIHB Partnership

In 1997, SIHB youth activities program In 1997, SIHB youth activities program staff approached members of the staff approached members of the Addictive Behaviors Research Center Addictive Behaviors Research Center (ABRC), University of Washington about (ABRC), University of Washington about the possibility of collaborating on a grant the possibility of collaborating on a grant to develop a brief clinical intervention for to develop a brief clinical intervention for adolescent clients of SIHBadolescent clients of SIHB

The ABRC had several Native students The ABRC had several Native students enrolled in the Clinical Psychology enrolled in the Clinical Psychology program who were enthusiastic about the program who were enthusiastic about the proposalproposal

Native American Youth

Alcohol use appears to begin at an Alcohol use appears to begin at an earlier age among Native adolescents earlier age among Native adolescents (Beauvais, 1992)(Beauvais, 1992)

Perhaps as many as one-third of Perhaps as many as one-third of American Indian youth having American Indian youth having consumed alcohol by age 11consumed alcohol by age 11(May, 1986)(May, 1986)

Over ½ report having been intoxicated Over ½ report having been intoxicated at least once by age 15 at least once by age 15 (Beauvais, 1996)(Beauvais, 1996)

Culturally Specific Risk Factors

Ethnic Dislocation Ethnic Dislocation (May, 1982; Oetting, Beauvais (May, 1982; Oetting, Beauvais

&Velarde, 1982; Trimble Padilla, & Bell, 1987)&Velarde, 1982; Trimble Padilla, & Bell, 1987)

Acculturation Stress Acculturation Stress (LaFromboise, 1988)(LaFromboise, 1988)

Alienation from the Larger Culture Alienation from the Larger Culture (Moncher et al., 1990)(Moncher et al., 1990)

Unstructured time on reservations, Unstructured time on reservations, during which drinking is also a during which drinking is also a response to boredom response to boredom (Edwards & Edwards, 1988)(Edwards & Edwards, 1988)

Project Beginnings

Native youth were recruited for Native youth were recruited for Focus Groups to provide input Focus Groups to provide input about the programabout the program

Community Elders were consultedCommunity Elders were consulted Meetings between UW and SIHB Meetings between UW and SIHB

continuedcontinued Specific Aims developedSpecific Aims developed

Initial Project Challenges

Hiring appropriate intervention Hiring appropriate intervention staffstaff

Gaining community trustGaining community trust Gathering community and Gathering community and

youth input on assessments youth input on assessments and intervention materialsand intervention materials

Recruiting youthRecruiting youth

Project Development

Canoe Journey,Canoe Journey,

Life’s JourneyLife’s Journey

The Canoe Journey

Pacific Northwest Coast people Pacific Northwest Coast people preferred water travel to any other preferred water travel to any other means of transportationmeans of transportation Drucker (1955)Drucker (1955)

Early explorers, missionaries and Early explorers, missionaries and traders all commented on the Indian traders all commented on the Indian canoes, their size, utility, and canoes, their size, utility, and manufacturemanufacture (Gunther, 1972; Sproat, 1966)(Gunther, 1972; Sproat, 1966)

Canoes were usually made from the Canoes were usually made from the straight-grained cedar trees straight-grained cedar trees (Drucker, 1955; Sproat, (Drucker, 1955; Sproat,

19661966

The Canoe Journey

Canoe clubs were formed for Canoe clubs were formed for interested adolescents and interested adolescents and young adults, but designed to young adults, but designed to accommodate and include accommodate and include families and, eventually, the families and, eventually, the whole communitywhole community

Reestablishing the Canoe Tradition

Strengthen Strengthen Native IdentityNative Identity

Involve Involve members of the members of the communitycommunity

Canoe ClubsCanoe Clubs

Canoe FamiliesCanoe Families Powerful Powerful

Primary Primary InterventionIntervention

All canoes are All canoes are DRUG and DRUG and ALCOHOL FreeALCOHOL Free

Quinault Indian NationOcean Canoe Paddle

Canoe Journey, Life’s Journey

Development of Culturally Relevant Life Development of Culturally Relevant Life Skills ManualSkills Manual

Canoe Journey as a metaphor for life’s Canoe Journey as a metaphor for life’s journeyjourney

Use of other traditionally Native Use of other traditionally Native symbols, particularly the Medicine symbols, particularly the Medicine Wheel Wheel

Medicine Wheel generally understood to Medicine Wheel generally understood to have similar meaning across tribal have similar meaning across tribal boundariesboundaries

Canoe Journey, Life’s Journey

The Wheel is often used to The Wheel is often used to represent the four directions: represent the four directions: North, South, East, WestNorth, South, East, West

Four Seasons: Summer, Fall, Four Seasons: Summer, Fall, Winter, SpringWinter, Spring

Four parts of self: Physical, Mental, Four parts of self: Physical, Mental, Emotional, SpiritualEmotional, Spiritual

Canoe Journey, Life’s JourneyThe Manual Sessions

1. The Medicine 1. The Medicine Wheel/Canoe Journey as Wheel/Canoe Journey as a metaphor for Healtha metaphor for Health

2. Who Am I? Beginning at 2. Who Am I? Beginning at the Centerthe Center

3. Community Help and 3. Community Help and Support: Help on the Support: Help on the JourneyJourney

4. The Quest: Goal Setting4. The Quest: Goal Setting5. Overcoming Obstacles: 5. Overcoming Obstacles:

Solving ProblemsSolving Problems

6. Effective 6. Effective Communications: Communications: Listening to Others Listening to Others & Expressing Self& Expressing Self

7. Moods and Coping 7. Moods and Coping with Negative with Negative EmotionsEmotions

8. Strengthening our 8. Strengthening our Body and SpiritBody and Spirit

Canoe Journey, Life’s JourneyThe Manual Sessions

The manual sessions are taught by a The manual sessions are taught by a lead facilitator, and a co-facilitatorlead facilitator, and a co-facilitator

The facilitators involve participants The facilitators involve participants through role-plays, practice of skills, through role-plays, practice of skills, and reflective journal writing and reflective journal writing

The courses can be taught individually The courses can be taught individually or in a group settingor in a group setting

The courses can be taught in one hour The courses can be taught in one hour blocks or divided into two 3-4 hour blocks or divided into two 3-4 hour sessionssessions

Sample Population

Participants, age 13-19, were Participants, age 13-19, were initially recruited from Seattle initially recruited from Seattle Public Schools and eventually Public Schools and eventually through Outpatient Services at through Outpatient Services at the Seattle Indian Health the Seattle Indian Health BoardBoard

Sample Population

Demographics

Geographic Region Geographic Region n=88n=88

Urban n (%)Urban n (%) SuburbanSuburban RuralRural

Education Status n=93Education Status n=93 In SchoolIn School Graduated High SchoolGraduated High School Not Attending or Dropped Not Attending or Dropped

OutOut

61 (65.6)61 (65.6)

25 (26.9)25 (26.9)

2 (2.2)2 (2.2)

82 (88.2)82 (88.2)

5 (5.4)5 (5.4)

6 (6.5)6 (6.5)

Sample Population

Alcohol and Drug UseEver Used n=92

Tobacco n (%)Tobacco n (%) AlcoholAlcohol CannabisCannabis CocaineCocaine AmphetaminesAmphetamines Barbiturate/SedativesBarbiturate/Sedatives InhalantsInhalants HallucinogensHallucinogens OpiatesOpiates

50 (53.8)50 (53.8)

55 (59.1)55 (59.1)

49 (52.7)49 (52.7)

10 (10.8)10 (10.8)

7 (7.5)7 (7.5)

1 (1.1)1 (1.1)

5 (5.4)5 (5.4)

9 (9.7)9 (9.7)

5 (5.4)5 (5.4)

Sample Population

Alcohol and Drug UseAge of First Regular Use

Tobacco n=34Tobacco n=34 Alcohol n=13Alcohol n=13 Cannabis n=29Cannabis n=29

12.62 (SD=2.42)12.62 (SD=2.42) 13.08 (SD=1.61)13.08 (SD=1.61) 13.07 (SD=1.81) 13.07 (SD=1.81)

Sample PopulationAlcohol and Drug Use

Problems Associated with Use4

Used while in a Used while in a dangerous situation dangerous situation n=93; n (%)n=93; n (%)

Had accidents or was Had accidents or was injured n=93injured n=93

Had repeated legal Had repeated legal problems n=92problems n=92

Consistently used Consistently used instead of going to instead of going to school n=92school n=92

44 Includes non-users, coded as zero Includes non-users, coded as zero

13 (14)13 (14)

7 (7.5)7 (7.5)

4 (4.3)4 (4.3)

12 (12.9)12 (12.9)

Sample PopulationAlcohol and Drug Use

Problems Associated with Use4 Blacked out due to Blacked out due to

alcohol n=92alcohol n=92 Experienced withdrawal Experienced withdrawal

symptoms n=92symptoms n=92 Perceives him/herself as Perceives him/herself as

maybe or definitely maybe or definitely having a substance use having a substance use problem n=92problem n=92

44 Includes non-users, coded as zero Includes non-users, coded as zero

14 (15.1)14 (15.1)

10 (10.8)10 (10.8)

12 (12.9)12 (12.9)

Participants: Demographics (N = 50)

AgeAge 15.24 years (SD = 15.24 years (SD = 1.61)1.61)

FemaleFemale 27 (54%)27 (54%)

Native AmericanNative American 32 (64%)32 (64%)

Native and OtherNative and Other 16 (32%)16 (32%)

Identifies with a Identifies with a tribetribe

40 (80%)40 (80%)

Recruited from Recruited from SIHBSIHB

28 (56%)28 (56%)

Assessment Measures

Comprehensive Adolescent Severity Index Comprehensive Adolescent Severity Index (CASI)(CASI) Past month substance use: tobacco, Past month substance use: tobacco,

alcohol, marijuana, any drugs excluding alcohol, marijuana, any drugs excluding tobaccotobacco

Rutgers Alcohol Problem Index (RAPI)Rutgers Alcohol Problem Index (RAPI) Alcohol-related consequencesAlcohol-related consequences

Situational Confidence Questionnaire (SCQ)Situational Confidence Questionnaire (SCQ) Confidence to resist the urge to drink Confidence to resist the urge to drink

heavilyheavily

Past Month Substance Use

0

2

4

6

8

10

12

14

16

Tobacco Alcohol Marijuana All But Tobacco

Baseline

Follow-up

Alcohol-Related Consequences

0

2

4

6

8

10

12

14

16

18

20

Alcohol-Related Consequences

Baseline

Follow-up

p < .05

Confidence to Resist Urge to Drink

0

20

40

60

80

100

120

140

160

IntrapersonalDeterminants

InterpersonalConflict

PositiveEmotional

States

InterpersonalDeterminants

Baseline

Follow-up

Summary of Results Trends towards reduced alcohol, Trends towards reduced alcohol,

marijuana, and other drug use and marijuana, and other drug use and increased confidence to resist the increased confidence to resist the urge to drink in multiple contextsurge to drink in multiple contexts increased tobacco use?increased tobacco use?

Participants reported a significant Participants reported a significant decrease in alcohol-related decrease in alcohol-related consequences at follow-upconsequences at follow-up

Implications/Issues Environment: Urban versus Environment: Urban versus

ReservationReservation After School Intervention v. Camp After School Intervention v. Camp

settingsetting Transportation and FoodTransportation and Food Can there be one program that Can there be one program that

works successfully across different works successfully across different Native communities?Native communities?