Drug and alcohol abuse intervention in American Indian communities.

American Indian tribes are seen as an anachronism by many non-Indian people. Most would acknowledge that Indians provided a colorful chapter in American history, but apart from contemporary Indian arts and crafts little serious thought is given to their way of life. In fact, however, Indian culture has survived a period of strong attack and today it is vital and growing. The historical conflicts between Indian and White ways of life are still not totally resolved, and there are major differences in thinking as to whether tribes should be assimilated into the larger culture or allowed to pursue an alternate cultural path. In its ambivalence toward Indian people the federal government has fostered a state of dependency which has made problem resolution extremely difficult. Federal policy has vacillated between paternalistic and repressive, which has led to much inertia within both Indian communities and those groups intended to help them. Currently there is a strong activist climate on Indian reservations and the result is a vigorous move toward self-determination. Not only are Indian people asking for self-government, but they are attempting to revitalize their traditional culture and maintain a unique alternative to the beliefs, values, and customs of the larger society. Within this historical/cultural context, drug and alcohol abuse exist as major problems for Indian people. Extant data point to alcoholism as perhaps the number one health problem for many tribes. The consequences of drug abuse are not as well documented, but recent survey data from Indian school students point to an extremely serious situation. Drug use rates are above national norms and appear to be rapidly increasing. Interventions in Indian communities must be congruent with the current movement toward self-determination. Externally imposed solutions, at a minimum, will not work and probably will only add to the sense of failure experienced by Indian people. The dynamics of drug and alcohol use are rooted in the health of the community. Where there is cynicism, despair, and a withering of the basic human spirit, substance abuse will prevail. Alternately, if the spirit of the community can be bolstered and hope developed through communal action and mutual support, solutions to abuse problems will be forthcoming. When the community has clearly decided its position on the use of chemicals it will be in a position to construct programs and request external assistance. Substance abuse intervention is a local problem and can be resolved best through local initiative.(ABSTRACT TRUNCATED AT 400 WORDS)