Alcohol Use Trajectories and Problem Drinking, Capstone Project Example

Pico Question

Are American Indian adolescents between the ages of 11 and 18 dealing with substance abuse more likely to have decreased substance abuse cases with the implementation of community-specified outreach programs containing a public health professional?

P: American Indian adolescents between the ages of 11-18 who are dealing with substance abuse

I: Strategy for education, including after school programs, summer programs, follow up screenings, educational counseling, and the availability of a public health nurse to the community to perform outreach

C: A lack of outreach programs, no available public health nurses for the community, and no programs that are available to use

O: Improvements are observed with in the American Indian adolescent communities when education and public health nurses are utilized. In addition, there is a significant decrease of substance abuse that is observed within these communities, using intervention methods. There is improved quality of life, improved treatment results, a decreased rate of adverse events, decreases in substance abuse, and improved patient safety.

This discussion will examine a number of current and relevant research studies from nursing journals in regards to adolescent substance abuse within the American Indian population. Nurses working in community-based and public health settings must play an active and participatory role in establishing programs for American Indian adolescents in order to identify the scope of the target population through outreach and addressing possible educational opportunities that will facilitate successful outcomes in this population group. It is known that in many vulnerable populations, including American Indians, adolescent youth often experience significant disparities and poorer health outcomes, along with limited educational achievement in many cases (HealthyPeople.gov, 2014).  Existing policies and support systems for American Indian adolescents are severely limited; therefore, resources are lacking and public health nursing interventions are essentially nonexistent (Katz, Martinez, & Paul, 2014). In American Indian communities, substance abuse is a serious issue that also requires a stronger support system in order to escape these circumstances and to be receptive to changes that are likely to have a positive impact on their health and wellbeing, as well as their emotional needs (Katz et.al, 2014). Furthermore, mental health issues are often a key contributor to substance abuse in adolescent youth, but this problem remains elusive and very difficult to manage in communities where public health resources are limited or nonexistent (Katz et.al, 2014).

The recognition of substance abuse within the Native American youth population is often fulfilled when community-based resources are available to support this group so that they are able to share their experiences and seek treatment accordingly (Novins et.al, 2012). From this perspective, adolescents should receive specific types of interventions that are designed to support their transition into the treatment environment, using a pathways approach that relies on storytelling in order to express ideas and issues regarding substance abuse (Novins et.al, 2012). Adolescents, therefore, require a specialized focus within Native American communities as a means of addressing issues that have a direct impact on their reasons for substance abuse, including mental health issues, lack of resources, and limited opportunities, among others (Novins et.al, 2012). The use of Network-Episode Model represents a means of identifying specific episodes that impact this population and that also facilitate and support the appropriate response to the issue (Novins et.al, 2012).

Native American adolescent youth require community-based interventions regarding issues of substance abuse, as these opportunities are designed to engage this population group in areas where treatments might be affected by these interventions (Lowe, Liang, Riggs, Henson, & Elder, 2012). It is known that “Native American youth begin abusing substances at an earlier age, with greater degrees of frequency and amount and they experience more negative consequences. By twelfth grade, 80% of Native American youth are active drinkers and usually have close ties to substance abusing peers, do not perform well in school, do not strongly identify with Native American culture, and come from families where family members also abuse substances” (Lowe et.al, 2012). Based upon these circumstances, it is essential to establish community-based approaches to substance abuse that will be effective in engaging adolescents in discussing their issues and in considering treatment (Lowe et.al, 2012). In this context, a significant loss of cultural identity is an important contributor to substance abuse problems for many Native Americans; as a result, the risk of substance abuse continues to build until it becomes a reality and a difficult issue to contend with that requires significant attention and focus from community-based experts (Lowe et.al, 2012).

An effective substance abuse model for intervention within Native American communities requires a high level understanding of the cultural values and issues that impact this population group and the level of trust that they possess in regards to sharing information and declaring vulnerabilities such as substance abuse (Lowe, Riggs, & Henson, 2011). In this context, the community-based intervention must be identified in accordance with the principles that are observed within the community, including core values (Lowe et.al, 2011). A commitment from community health nurses is an essential component of an intervention to assist Native American adolescents facing substance abuse, as this demonstrates the following: “The commitment of nursing to human caring is considered to be in contrast with social trends that emphasize materialism and individualism instead of being in relationship and human community” (Lowe et.al, 2011). This strategy is encouraging because it demonstrates the importance of shaping the environment and in determining how to best approach a set of circumstances that are detrimental to the health and wellbeing of many adolescent Native American youth (Lowe et.al, 2011). If these youth are able to identify a specific support system of community health nurses who are willing to work with them on a long-term basis in order to improve their lives and overall wellbeing, this concept is worthy of further investigation (Lowe et.al, 2011).

Lowe & Nichols (2013) established a conceptual framework that is applicable to the Native American community, since many models do not reflect the core values and beliefs of this population as a whole. The model in question is comprised of a number of critical factors that include holistic concepts, reflection, wisdom, rituals, and ceremonies (Lowe & Nichols, 2013). Furthermore, it is necessary to incorporate relationship-based characteristics and community as a means of establishing trust and understanding of the core values and beliefs that exist within these areas (Lowe & Nichols, 2013). The proposed model must also respect the history of the culture and the core values that exist within that environment, along with the development of strong relationships and togetherness to address concerns that exist (Lowe & Nichols, 2013). Primary values must include traditional medicine, rituals, ceremonies, and other forms of homage to the Native American culture (Lowe & Nichols, 2013). These factors represent an opportunity to examine the different constructs of care and to be cognizant of the issues that lead to distrust and lack of support for the conceptual framework if it is not properly constructed and is not well-received by the community at large (Lowe & Nichols, 2013).

Population

The proposed population is Native American adolescents between the ages of 11 and 18 who are experiencing substance abuse on a regular basis. This population represents an important segment of the Native American population because it is likely that these individuals possess considerable challenges that impact their lives on a continuous basis. This population does not always possess the desired level of support and guidance from community-based nurses, largely because these individuals do not exist. Therefore, the population remains vulnerable to many different conditions, as well as a lack of support and guidance from their fellow community members to support their own improvement. The journal articles that have been examined evaluate specific issues involving Native American adolescents with substance abuse problems, including lack of nursing-based models that are appropriate for this population, a lack of interventions, and a lack of available resources, namely community health nurses. This population possesses a high degree of vulnerability that impacts their physical, mental, and psychological health and contributes to a higher risk of substance abuse.

Interventions

An article by Ramirez, Hinman, Sterling, Weisner, & Campbell (2012) addresses the importance of a substance abuse intervention and evaluation one year later for 419 adolescents between the ages of 13 and 18 who have undergone substance abuse treatment. It was determined that the family environment is not necessarily related to substance abuse outcomes, but that peer relationships have an impact, particularly if these individuals do not partake in substance abuse themselves (Ramirex et.al, 2012). The family dynamic is an important contributor in identifying the primary causes of substance abuse in adolescents; however, the family does not have a significant impact on treatment outcomes (Ramirez et.al, 2012).  Many adolescents who experience these issues have significant problems that are difficult to treat and from which to abstain (Ramirez et.al, 2012). Therefore, adolescent youth are heavily influenced by their surroundings, and this contributes to a lack of confidence and /or trust in the ability of individuals to be receptive to treatment and to abstain over a longer period of time (Ramirez et.al, 2012).

Comparison

In a study by Cheadle & Whitbeck (2011) recounting alcohol use in North American Indigenous Youth, it was observed using growth mixture models that 40 percent of the youth observed began drinking around age 11 or 12, or soon after. In examining the etiological analysis, it was observed that a number of stressors have an impact on outcomes and on attitudes and behaviors regarding substance abuse and related behaviors (Cheadle & Whitbeck, 2011). It should also be noted that “perceived discrimination and parent major depression are important stressors predicting early drinking that have both direct and indirect effects by decreasing positive school attitudes, generating feelings of anger, and increasing associations with deviant peers” (Cheadle & Whitbeck, 2011). These conclusions demonstrate that individuals require a higher level of support and guidance at the community-based level, i.e. community nursing, in order to address the propensity for alcohol abuse and whether or not it will continue once it is identified and addressed (Cheadle & Whitlock, 2011).

Outcomes

Recognizing the risks associated with substance abuse in Native American adolescent youth will provide a basis for examining interventions that will aid in an individual’s recovery and level of strength in moving forward beyond this significant obstacle. Core values and beliefs of the Native American culture must be reiterated throughout the treatment phase and must be instrumental to the community health nurse’s approach to the patient and in obtaining support for his or her level of addiction. Native American youth require specialized attention and treatment that is sensitive to their background needs and expectations in different ways and that is associated with their own perspectives regarding their culture and how it impacts their lives. However, it is also known that there are differences within Native American cultures, depending on their specific groups; therefore, not all studies and interventions are applicable to all populations in the same manner (Cheadle & Whitbeck, 2011). The use of alcohol as the sole dependent variable also limits the potential of this study to be duplicated in other areas, depending on the specific factors that are being explored (Cheadle & Whitbeck, 2011). The response and behaviors associated with alcohol, for example, in the Native American population is not the same as other variables, yet there is an opportunity to engage adolescent youth in treatment alternatives that will be effective in addressing this population and in identifying the options that might be available from the community nurse perspective (Cheadle & Whitbeck, 2011).

It is estimated that many Native American adolescents will exhibit drinking tendencies as early as the age of ten, typically with a marked increase throughout the adolescent years, and by ages 15-17, the risk of substance abuse is quite significant (Cheadle & Whitbeck, 2011). As a result, the risk factors for this population continue to increase, thereby creating an environment in which interventions and treatment are required in order to overcome significant deficits that impact quality of life for this group. It is necessary for community health nurses to be available to this population not only to educate Native American adolescents regarding the risks of substance abuse but to also engage them in seeking treatment alternatives that are appropriate to meet their needs effectively and with lasting results.

Summary

The studies that have been examined in this discussion provide a framework for determining how to address substance abuse in the Native American population. These studies examined different aspects of this problem, including community-based approaches to addressing substance abuse, the development of new strategies to improve access to treatment, and education to support adolescent youth within this population to ensure that they are able to effectively contribute to society without substance abuse in their lives. These studies demonstrate the importance of developing ideas that will engage individuals and support their growth and maturity in the Native American culture, and to be effectively acclimated to their surroundings without significant complications. The articles reference a number of studies and concepts that are designed to determine how to address Native American adolescent youth within their own surroundings and to provide them with community-based support within this environment to alleviate their dependency and to improve their quality of life.

The studies support the need for an increased presence of community health nurses within the community and to recognize the value of developing intervention methods that will target this population effectively over time. It is necessary for community health nurses to be more involved with this process, particularly those who are of the Native American culture or who have experience with this population, as these efforts will facilitate an approach that recognizes outreach and education as key components of this process and how it will impact adolescent youth over time. The primary objective is to acclimate youth in this setting to community-based health nursing and interventions that will support their needs and that will recognize the importance of a solid and continuous support system for Native American adolescent youth to improve their potential and advance their general wellbeing.

References

Cheadle, J. E., & Whitbeck, L. B. (2011). Alcohol Use Trajectories and Problem Drinking Over the Course of Adolescence A Study of North American Indigenous Youth and Their Caretakers. Journal of health and social behavior, 52(2), 228-245.

Healthy People 2020. Adolescent health. Retrieved from http://www.healthypeople.gov/2020/topicsobjectives2020/overview.aspx?topicid=2

Katz, J. R., Martinez, T., & Paul, R. (2011). Community?based participatory research and American Indian/Alaska Native nurse practitioners: A partnership to promote adolescent health. Journal of the American Academy of Nurse Practitioners, 23(6), 298-304.

Lowe, J., Liang, H., Riggs, C., Henson, J., & Elder, T. (2012). Community partnership to affect substance abuse among Native American adolescents. The American journal of drug and alcohol abuse, 38(5), 450-455.

Lowe, J., & Nichols, L. A. (2013). Utilisation of a Native American nursing conceptual framework: Implications for practice and research.

Lowe, J., Riggs, C., & Henson, J. (2011). Principles for establishing trust when developing a substance abuse intervention with a Native American community. Creative nursing, 17(2), 68.

Novins, D. K., Spicer, P., Fickenscher, A., & Pescosolido, B. (2012). Pathways to care: Narratives of American Indian adolescents entering substance abuse treatment. Social Science & Medicine, 74(12), 2037-2045.

Ramirez, R., Hinman, A., Sterling, S., Weisner, C., & Campbell, C. (2012). Peer influences on adolescent alcohol and other drug use outcomes. Journal of Nursing Scholarship, 44(1), 36-44.