Rates of alcohol dependence that are 2–6 times the percentages seen in the general population are still evident in some Native American communities (see Beals et al., 2005
; Ehlers et al., 2004
; Kunitz, 2006
; Leung et al., 1993
; Robin et al., 1998
; Walker et al., 1985
). American Indian communities are experimenting with several approaches to prevention and treatment of substance use disorders including: traditional spirituality, prohibition of drinking on reservations, allopathic medicine, traditional healing experiences, as well as Alcoholics Anonymous, pharmacotherapy and other approaches such as community mobile treatment (see Coyhis and Simonelli, 2008
; Jiwa et al., 2008
; Kovas et al., 2008
; O’Malley et al., 2008
; Westermeyer, 2008
). Most of these programs have not specifically targeted underage youth or suggested specific programs for this age group.
MI offers several advantages as an intervention technique aimed at underage youth. MI is effective in adolescents and young adults (Monti et al., 1999
; Spirito et al. 2004
). In some studies, one session MI has been shown to be significantly more effective than a control intervention (McCambridge and Strang, 2004
) and to have significantly increased effects persisting for 1–2 years post intervention (Marlatt et al., 1998
) in alcohol using teens. MI is able to address the broad spectrum of patients who are using alcohol, not only those who have been using for long periods of time, who have developed major life problems, or who meet criteria for alcohol dependence (Tevyaw and Monti, 2004
). Although reduction in drinking is emphasized, MI also takes a harm reduction approach (Colby et al., 2004
; Monti et al., 1999
), something particularly important for alcohol-related morbidity in underage drinkers.
MI has also been tried to a limited extent in Native American settings. Analysis of treatment response of 25 adult Native Americans in the Project MATCH study found superiority of the MI as compared to cognitive-behavioral and 12-step facilitation interventions (Villanueva et al., 2007
). Woodall and colleagues (2007)
found that a treatment intervention incorporating MI principles for first time adult DWI offenders in a primarily Native American sample was associated with significantly greater reductions in alcohol consumption compared to no intervention. A family component joined with individual MI may increase the effectiveness of MI for Native American youth because the collectivistic ethos of many Native American communities and/or the large extended families found on some reservations render the peer group vs. family influences less distinct than they are in Euro-American community (Spillane and Smith, 2007
). A recent meta-analysis of 72 clinical trials using MI indicated a greater treatment effect size for MI in minority as compared to Euro-American samples (Hettema et al., 2005
) and Miller and colleagues (2008)
have shown that cross-cultural training in MI with African American, Native American, and Spanish-speaking addiction treatment providers is effective. Other individual approaches to modifying demand in young adults, primarily in college students, including cognitive-behavioral skills-based and normative re-education programs, have shown some success (for a review, see Larimer and Cronce, 2007
). None of these studies involved youth ages 13–17 years old and none involved alcohol using Native American underage youth.
Data from the current survey collected in a Native American community suggest that MI may be well suited as an intervention to prevent underage drinking and that a MI research program to reduce underage drinking would be generally well tolerated in this reservation community. Specifically, the data suggest that tribal leader and member participants believe that although a substantial percentage of reservation youth would be willing to accept MI for behavior change for behaviors youth already want to change, for behaviors others want youth to change, and with family involvement, relatively fewer youth are actually ready to change. Thus, the findings in the current study are consistent with the hypothesis that most of the reservation youth in this community are in the “pre-contemplation” stage of readiness to change with respect to their drinking. If that is the case, MI may be an ideally suited intervention to prevent underage drinking in this community, particularly for drinking behaviors that others, but not the youth themselves, want youth to change. These findings are also consistent with the belief that youth would accept a research MI intervention involving family, suggesting that a family component to the MI intervention would be appropriate. Lower acceptance of audio- or video-taping for research purposes indicate that these components are unlikely to be accepted by reservation youth and therefore would not be useful parts of a MI intervention.
More men than women believed that youth would be ready to change behaviors others wanted youth to change. This difference may reflect gender differences in how motivation to change is conceptualized, parenting roles within the culture, and/or in experiences of successfully effecting behavior change in youth.
The results of this study should be seen in the light of several limitations. The results may not be representative of all tribal leaders and members on the reservations from which the survey sample was drawn and may not be representative of other Native American communities. The study was limited in its ability to assess potentially significant covariates which might have been associated with participants’ responses. These include socio-demographic variables other than gender as well personal and family histories of alcohol and other substance use related morbidity which might have affected the participants’ beliefs about acceptance of MI and readiness for behavior change in youth. In the Chi-Square analyses of gender differences in readiness to change, as well as in the analysis of acceptance of audio-taping in the sample as a whole, small cell sizes (i.e. <5) render the interpretation of significance of the results tentative. Finally, since this study gathered data from a sample of tribal leaders and tribal members willing to participate in the survey, as opposed to the youth themselves, the findings may not represent how youth themselves would respond to an MI research program. Overall, however, the findings suggest that a MI research program to reduce underage drinking would be feasible in this reservation community.