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Journeys of the Circle. A Culturally Relevant Life Skills Intervention for Adolescent Indian Drinking. Research Society on Alcoholism Vancouver, B.C., June 28, 2004. A Collaborative Effort. University of Washington, Department of Psychology, Addictive Behaviors Research Center AND - PowerPoint PPT Presentation
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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?