This health services research study is motivated by health disparities such as the high rates of morbidity and mortality related to alcohol use among American Indians. As Dr. Walker testified to Congress in 1996, “among (American Indian) adults, mortality associated with alcoholism is nearly four times that of other races.” Other statistics: American Indians have an age-adjusted mortality rate due to chronic liver disease and cirrhosis five times that of other racial groups. There are three to four times more age-adjusted motor vehicle deaths for natives. Hospitalizations for alcohol related health problems are 60% higher in Indian Health Service hospitals.

The proposed project is designed to take advantage of the interest in research shown by the Seattle Indian Health Board and the Native American Rehabilitation Association of the Northwest in Portland, primarily serving urban American Indians, providing numerous treatment modalities and supporting ongoing research. Both agencies have adapted for Native people and incorporated standardized therapies including Motivational Enhancement and Cognitive-Behavioral Treatment into their treatment programs.

Outcomes include abstinence, number of drinking days, alcohol-related problems, and satisfaction with services. Interviews with clients and providers, observations of treatment sessions, and reviews of taped treatment encounters will be used to describe treatment services.

This project will be the first in decades to examine relationships between treatments and outcomes for urban American Indians with alcohol problems. It is also the first to compile a catalog of traditional healing services for native people with chemical dependency.

Results from the study will be of considerable interest to federal and tribal officials concerned about health care for American Indians. The information generated will be useful in devising optimal treatments for planning randomized clinical trials. The research team, which includes tribal members, will disseminate results in collaboration with the One Sky Center American Indian and Alaska Native National Resource Center on Substance Abuse Prevention and Treatment located on the OHSU campus and under the direction of Dr. Walker.