Psychology

Drug and alcohol-related problems are the major issues that the government is dealing with and many people are suffering from. Alcohol is the most abused substance, and it is often paired with a number of alcohol-related problems in the society. Drugs, on the other hand, is often associated with a number of violent behaviors exhibited by an involved individual.

The problem of drugs and substance abuse is so prevalent in all parts of the world. It is a concern that is addressed to the community by the government due to its harmful effects on the overall health of an individual.

However, despite many advices and warnings, many people still indulge themselves in such destructive behaviors.

The following discussions will focus on how the abuse of alcohol and drugs among the Native Americans impact their lives as well as their health.

Purpose of the paper
The main purpose of this paper is to look at the issue of drug and alcohol abuse among the Native Americans. It is going to focus on the problems that occur as a result of alcohol and drug misuse. It will discuss the prevalence, the harmful effects, as well as the treatment and interventions of substance abuse. It will also focus on what kind of treatment is necessary for the Native Americans since they have different culture and beliefs.

The paper will also give focus on Nancy as an example of a female Native American substance abuser. Based from the effective substance abuse interventions for Native Americans, this paper will incorporate such interventions into Nancys case to determine its effectiveness.

Discussion
Prevalence of alcoholdrug use among Native Americans
Drug and alcohol abuse is so prevalent among people in all walks of life. This part will focus on Native Americans as the particular population, and see how alcohol and drug problems impact their lives.

Alcohol and drug use is one of the major causes of disability and death among Native Americans. According to the Arizona Department of Health Services (2005), alcohol is still the most abused substance by the natives, and is characterized by progressive and severe drinking patterns. Most Native Americans will involve themselves in drugsalcohol to overcome the stresses of life, inferiority complex and cultural conflict (Arizona Department of Health Services, 2005).

In a study carried out on the effects of alcohol on Native Americans, the results indicated that drinking was on the rise with people aged between 12 to 20 years accounting for more than ten million drinkers in America (National Household Survey on Drug Abuse, 1999). The report continues to indicate that out of this, about twenty percent engage in binge drinking and about six percent are heavy drinkers. According to Wallace et al. (2003), Native Americans have higher rates of alcohol use, as well as other substance use, compared to other minority groups.

Alcoholdrug use among Native American youths. On a research conducted among Native American youths, the average age for them to consume alcohol starts at 13. The percentage of those who engage in substance abuse had risen, with findings indicating a 31 percent increase in the 1990s from seven percent in the 60s (Substance Abuse Among Native Americans, 1996). It is also claimed that since many teenager are engaged in binge drinking and sometimes heavy drinking, about 16 percent of them experienced  black out . Most of them could not recall events prior to drinking as they had lost their conscience (Substance Abuse Among Native Americans, 1996). The act of drinking has been linked to the easy accessibility of alcohol among young people. It has been noted that young people will purchase alcohol without anyone considering they are underage (Alexander, 2000).

Alcohol consumption has also been identified as one of the four causes of deaths among the youth aged between 10 to around 24 (Kann et al., 2000). Other identified death causes were accidents, but in many instances caused by drivers who are under the influence of alcohol (Kann et al., 2000).

It has been indicated that those who begin taking alcohol at the age of 15 is at a higher risk of developing drug dependency than their counterparts who begin at a later age of about 21 (Center on Addiction and Substance Abuse, 1999). There are greater chances for people who begin drinking at the age of 15 years to use other forms of illicit drugs. Most of them are seven times likely to use illicit drugs, with over 22 percent using marijuana and more than 50 percent using cocaine   a percentage that is way higher than the number of those who do not engage in early use of alcohol (Center on Addiction and Substance Abuse, 1999).

The possibility of Native American youth under the influence of alcohol to engage in illicit sexual activities has also been found to be very high. The research indicates that about 39 percent of the teens who are sexually active have had sexual intercourse with four or more multiple partners (Costs of Underage Drinking, 1999). The problems that many young people are also contending with include the sexual assaults and acquaintance or date rape cases which are on the rise among the youth.

Alcoholdrug use among Native American adults. Tribal diversity greatly affects the prevalence of substance use in Native American adults. Studies regarding substance abuse in adults are limited as compared to the Native American youth (Szlemko et al., 2006). According to Szlemko et al. (2006), Northern reservations report higher rate of substance-related problems than the Southern reservations. It has also been found that Native American men are more likely to engage in substance use than females (Szlemko et al., 2006). In a survey conducted by the Arizona Department of Health Service (2005), the percentage of substance-related mortality among Native American adults was 58.2 deaths per 100,000 deaths. These deaths were linked with other factors such as substance-related accidents and substance-related diseases. It can also be said that the conducted survey has dramatically increased compared from the 50.6 deaths per 100,000 deaths in 1996 (Szlemko et al., 2006). In addition, the number of age-adjusted substance abuse and alcohol-related mortality among Native American adults are relatively higher than the general population (Szlemko et al., 2006).

Effects of drugs and alcohol among the Native American population
The effects of alcohol and other related drugs on the life of the Native Americans greatly impact their emotional and social life as well as cognitive abilities. Therefore the effects of these substances is very dangerous. In many ways, the effects of drugsalcohol among the Native Americans is primarily due to remote and rural characteristics of their location, lack of infrastructures to deliver prevention and treatment services, language and distance barriers and significant social and cultural history (Arizona Department of Health Services, 2005).

As discussed, alcohol abuse among Native Americans can be a cause of death, accidents and other related disorders, while underage drinkers often suffer from blackout due to heavy alcohol consumption (Substance Abuse Among Native Americans, 1996).

Accidents are also considered to be the effects of substance abuse. In a survey conducted, about 21 percent of reported accidents involved Native American drivers who were intoxicated Many of the lives of these population are lost annually due to the act of driving under the influence of alcohol (Center on Addiction and Substance Abuse, 1999).

Native Americans have also been influenced by their diverse culture in using marijuana and other forms of illicit substances such as cocaine and metamphetamine. The possibility for them to indulge in drug abuse is relatively high during adolescence and early adulthood (Center on Addiction and Substance Abuse, 1999).

Female natives who are under the influence of alcohol and drugs can also participate in illicit sexual activities. Effects these activities are dangerous since it may expose them to high risks of acquiring sexually transmitted infections, date rape and sexual violence (Center on Addiction and Substance Abuse, 1999). Individuals may also have unprotected sex with multiple partners, which poses a great threat to their health. Many organizations and governments are trying to come up with various measures focused on mitigating the spread of sexually transmitted infections, and this can be fully achieved if the problems of drugs and alcohol prevalence among the Native population will be resolved (Center on Addiction and Substance Abuse, 1999).

These  effects on the lives of Native Americans can be incorporated in the case of Nancy. As told, Nancys alcohol dependence for 2 years involved him in a car accident, in which two people died. Her substance abuse is probably the result of the domestic violence she suffered from her husband. In addition, Nancy also engaged in using marijuana since the age of 15, which can be associated from the cultural diversity of the Native American population in general.

Impact of drugs and alcohol on targeted persons life
In this part, we will focus on how Nancys drugs and alcohol abuse impact her life. As discussed in the literature, the influence of alcohol can make a person become irresponsible and indulge in some life threatening behaviors. Nancy got involved in car accident while intoxicated, harming two people and herself. Her average alcohol consumption is one case per day. Prior to Nancys admission to the facility, her last alcohol consumption was 10 days ago.

Since Nancy began using marijuana at an early age, she is reported smoking an average of one gram per day, and her last usage was one month ago. This is mainly because as one continues to use a certain drug for a long period of time, chances are they become used to it until it has no satisfying effects. They would then increase the dosage to achieve its satisfying effects.

Another impact is that it may lead to violent behaviors that are life threatening. Nancy suffered domestic violence from her husband. She received a severe blow on her head causing a traumatic brain injury, which then resulted to her Post-Traumatic Stress Disorder (PTSD). The traumatic brain injury has left a soft spot on the left side of Nancys brain, and put her in a coma state for three months. Nancy was also reported to act violently while she was put on rehab. This is mainly because of the traumatic events that happened to her life as a result of domestic violence. It is also due to her dependence on alcohol and drugs. Prior to her admission to the facility, Nancy has already been kicked out on three previous rehab centers due to her aggressive and violent behavior.

Treatment options for targeted population
Alcoholism and other substance abuse is a major problem for Native Americans. It is important that prior to the treatment procedure, one must consider the cultural diversity and historical context of the population (Duran et al., 1998). Interventions and treatments for the said population can be categorized into non-native-centered and native-centered (Duran et al., 1998).

Non-native centered treatment
Some interventions focus on non-native-centered, which are found to be effective for European Americans. However, these interventions are found to be less effective for the natives since they have different world view as well as mistrust for some government-sponsored agencies. Such mistrust is reasonable because of the cultural diversity of different Native Americans tribes (Duran et al., 1998). As a result, natives may not participate in certain treatment procedures due to lack of cooperation with the agencies and health workers.

Native-centered treatment
The other category, which is native-centered is considered to be more effective for the Native Americans. Cliff (2005) stated that social workers must familiarize himherself first into the culture, beliefs and history of the natives prior to the treatment procedure. There are also substance abused  Nativized  programs that had been culturally modified for the Native Americans. These treatment programs basically include coping and social skills training, culturally-modified AAs, relapse educationprevention and cognitive behavioral modification.

Prior to the treatment, the use of  traditional ceremonies  greatly improves the outcome of the treatment. Since Native Americans have a variety of traditional beliefs, it is important to incorporate it to the treatment programs to enhance their social, physical, mental as well as spiritual health (Cliff, 2005).

Talking in circles is a nativized form of group therapy for the Native Americans, which begins with smudging and ends with a prayer. This form of group therapy is found to be effective in enhancing their social communication skills as well as participation (Szlemko et al., 2006).
Another form of effective substance abuse treatment is with the use of  sweat lodges.  Sweat lodges are similar to saunas, but the only difference is that it incorporates the  spiritual elements  of the Native American tradition. Aside from its popularity as a substance treatment program, sweat lodges has been found to be effective in curing many forms of illnesses (Szlemko et al., 2006).

Treatment options for targeted person
Going back to the case of Nancy, it will be difficult for the social health-worker to implement treatment options if heshe will not familiarize himherself to the background of Nancys culture. Treatment for Nancys substance dependency can be native-centered to ensure that the highest quality of care will be delivered.

According to the story, Nancy was also already enrolled in different treatment centers, but she was kicked out due to her violent and aggressive behavior. It is also said that Nancy was a notable drinker and drug user. It is important to explore Nancys feelings towards such behavior because it is the result of substance dependence as well as PTSD.

Initially, it is important to thoroughly assess Nancys overall well-being. Since she is a victim of domestic violence, Nancy suffered from PTSD. Therefore, health-workers must educate Nancy on the prevalence and origin of PTSD to decrease her anxiety and increase her participation in other program interventions. Health workers should also encourage Nancy to verbalize her feelings to establish rapport and increase her over-all mental health.

Focusing on Nancys drug and alcohol dependency, social health-workers must use both native- and non-native-centered treatment interventions. Non-intervention treatment must be utilized initially so that Nancy improve her coping, social and cognitive skills. Since Nancy was reported to assault co-patients and staff members, interventions should initially focus on a one-on-one basis. As soon as Nancy exhibits improvement on the said treatment, she can now engage in group activities to further enhance her coping skills.

Other native-centered interventions can then be utilized to ensure that Nancy is receiving a  standardized and quality care. These include sweat lodges, culturally-modified AAs, group therapy sessions and other traditional ceremonies by the Native Americans.

Barriers to successful treatment for targeted person
It is however at times difficult to treat people who are suffering from drug and alcohol related problems as we have seen above. This is due to the fact that alcohol and drugs have already altered the mind functions. In Nancys case, it is obvious that lack of participation in treatment programs is the main problem.

With regards to Nancys PTSD, she has a noted reaction to loud noises. She is also reported to be crying and flinching without valid reason. These symptoms can also be associated with her substance dependence. Nancy also insists to be on her bedroom instead of joining other patients in the rehab, demonstrating lack of social participation.

Since Nancys husband assaulted her with the use of a hammer, Nancy developed traumatic brain injury. This is another barrier for Nancys successful treatment since she is noted to have slow speech, deficits in reading and lack of retention of information.

On her third treatment, Nancy chose to leave the center on her own saying that  It was just too much.  Obviously, this phrase means that Nancy is trying to struggle from her problem, but she feels like there is no way she can recover from her substance dependence. This barriers can be considered as a great barrier for the health-workers to develop a well-planned intervention and treatment program for Nancy.

Considerations for RehabilitationCommunity Counselors
Considered to be a major problem not only for the Native Americans but also for the general population, substance dependence greatly impacts the lives of the affected individuals. Most substance users do not admit that they are already addicted even though the symptoms are obvious. This is the main concern why families of affected individuals often seek the help of counselors and rehabilitation centers.

If a person starts to exhibit acts of violence and other abusive behaviors due to substance dependency, it is a must for himher top be referred to treatment programs or institutions. It is very helpful for these individuals to get help from experts to help them overcome their dependency.

In Nancys case, her substance dependency is already severe since she started engaging in such activities at an early age. Cultural differences and beliefs greatly affect her over-all well being. Therefore, considerations for rehabilitations is a must for her.

Counseling sessions could be carried on from rehabilitation centers, depending on the damage caused by the effects of the drugs and alcohol. The main importance of the rehab is to keep involved individuals away from the reach of addictive substances, as well as help them recover from the state of addiction.

Conclusion
The prevalence of alcohol and substance abuse among the Native American population is wide and growing concern that cannot be ignored. The effects of these problems  can be dangerous to ones health. Therefore, counselors should work hand-in-hand to help individuals suffering from such problem. It is important to consider the Native Americans historical context as well as cultural beliefs to ensure that the best quality of intervention and treatment will be delivered by the social health-workers.