Dr. Kay Foland Introduces Section 2 Concepts Since the first introduction of “alcoholic spirits” into the New World… Indians and non-Indians alike have sought ways to counter the effects and consequences of alcohol use by individuals…as well as within communities.

A hallmark in recent years has been the expansion of treatment availability, prevention activities, and education directed at communities. 

The IHS and BIA began a collaborative approach in 1986 with the passage of the Indian Alcohol and Substance Abuse Prevention and Treatment Act. 

Surf to the Tribal Court Clearinghouse for a detailed list of information.

Hundreds of Indian prevention programs have been funded through the Center for Substance Abuse Prevention.

Once an elder accepts a diagnosis of substance abuse and agrees to treatment, options are selected on the basis of the severity of the problem, and the support system available. 

Let's examine the treatment options that are available for the Native American Elder.

Remember that no one approach is best for all elders instead, treatment needs to be individualized and based on what each particular elder needs.

Several Indian communities have begun their own approaches to prevention and treatment and have developed culturally appropriate materials that have powerful Indian themes and images. 

One example is called the Four Worlds Program. It is a holistic health promotion project based on a community development approach to health promotion.  It utilizes such elements as:

• involving key community leaders in decision making...

• encouraging participation by those individuals whose lives are being targeted for change...

• constructing a community organization...

• and then taking action to resolve issues.

Treatment services need to be available and used. 

Unfortunately, quite often treatment services are not very comprehensive or in many cases they’re simply non-existent.

Let’s listen to Hap Carlin and Madonna Blue Horse Beard as they describe the treatment problems and needs that they have recognized in the Aberdeen area Indian Health Service.

As you can see, providing the services that are necessary for the Native population is difficult, even with the best of intentions. Many communities find it difficult to plan prevention programs until basic treatment needs are first met. There is consensus that the most promising treatment programs for Native Americans make sure to include Indians in their planning, implementing, and organizing on a community level. 

Suggestions for more effective programs include:

• the use of traditional native healing methods, such as sweats or Talking Circles including Native Americans on the treatment staff...

• the creation of links between Indian organizations and allowing for maximum Indian participation in the programs. 

• revitalizing religious activities...

• restoring traditional ceremonies...

• and staffing community-service programs for the elderly with adolescents.

Clearly, there is not one single solution to this challenging problem. A variety of resources and programs will provide the best answer. 

Now I’d like to look at a different problem that comes up when treating Native American elders.

It is important to consider that the elder may be ambivalent about accepting services from agencies and professionals.  While that kind of assistance has provided many social and health benefits, improving the lives of Native Americans, it also conflicts with many Native beliefs, such as being useful, providing for themselves, and relying on spiritual powers to chart the course of their own life.

At this point, I’d like you to hear what Hap Carlin has to say about which therapies have worked best to treat Indians who are dealing with alcohol problems. 

Next, I would like to discuss some other factors that you should be aware of.

Remember, Native Americans strongly believe that individuals have the right to make decisions affecting their own lives. Therefore, the typical nursing assessment may itself be seen as offensive by Native patients.

They may view probing questions, and your evaluation of their responses as inappropriate and disrespectful behavior during the interview. 

Native Americans often will seem to remain calm and controlled, even in the most difficult circumstances so it is important that providers not mistakenly interpret this behavior as the absence of feeling, caring, or discomfort. 

So be sure to pay careful attention during the interview process to the manner in which you present your questions as well as to the way that they respond.

As nurses, you can play an important role in the prevention, assessment, and treatment of substance abuse in the Native American elder. 

As you can see, nurses must be prepared to routinely assess elders for alcohol and drug abuse problems. 

Recognition of subtle clues can result in early intervention and that can improve the short and long-term outcomes for the patient. 

So, what can nurses do to help an elder with substance abuse? Nurses must use their assessment skills and implement interventions. Take a look at the PowerPoint Presentation to find the answer to the question.

Any pre-existing depression may also be an underlying emotional difficulty to be overcome when you care for elders who resist alcohol treatment programs. 

In a clinical setting, nurses should be prepared to conduct a complete history and physical examination...

using the client, family, and significant others as information sources. 

Start with a history, including an initial assessment for:

• a history of falls or accidents...
• acute onset dementia...
• symptoms of neglect including nutritional deficiencies and weight loss...
• or a recent loss or change in living situations…such as from the death of a loved one.

Following the history, a screening will provide additional information. 

Some screening and assessment tools which may provide important information include:

• The Geriatric Depression Scale

• The CAGE Questionnaire 

• The MAST-G 

• Alcohol Use Disorders Identification Test

• Nutritional screening is important

While screening elders, you can preface questions about substance abuse with a link to a medical condition. 

For example, you might say:

“Did you know that having a few drinks could affect your diabetes?”...

or...

“Did you realize that one medication can affect how well another is working? 

and...

So let’s talk about the drugs you’re taking and see if we can figure this problem out.”

Following the screening, you can then continue the evaluation process by assessing physical and any laboratory results that are available. 

For a number of years now, the prevalence of alcohol or drug abuse among Native American elders has been a matter of great concern. Nurses must remember that drinking behaviors and signs of intoxication in elders differ from those of younger abusers. Alcoholism in the elderly is often hidden, as are other health and social problems. 

As a nurse, you are a critical link in the chain of successful assessment, intervention, and ultimately, the quality of care that’s provided to this population. 

Finally, I’d like you to consider these recommendations:

• First, be sure to value elders, including them in activities, and paying attention to those most vulnerable to loneliness and depression. This approach can help to prevent many problems of alcohol and drug abuse.

• Next, it is important to break the barrier of silence that surrounds this issue and to talk with elders about alcohol abuse. 

It is also very important to increase the acceptability of support groups. While groups such as Alcoholics Anonymous (or AA) may be very effective for some Native American elders, many need a support group that is more in tune with their cultural beliefs. 

For example, an AA group for elders conducted at senior centers may be particularly useful. And finally, never lose sight of the fact that substance abuse is a chronic disease. Therefore recovery is a lifelong process. 

I would like you to listen to Madonna Blue Horse Beard one last time as she describes what lies at the bottom of the addiction process and how – for many - drinking can mean the loss of self.

Family, friends, and community members need to be prepared not to give up even if the elder takes a step backwards during recovery. 

Although substance abuse, and especially alcohol abuse, has been a problem for Native Americans for over 200 years, it does not have to continue to be a problem of such magnitude in the next century. 

Toward that end, nation-wide goals have been set. 

These include specific objectives for American Indians which are found in the United States health promotion plan, known as Healthy People 2010.

It may be unreasonable to expect that alcohol and other substance misuse will disappear entirely among Native Americans and their elders. 

But within Indian cultures, there are remarkable strengths and strategies that can be brought to bear to resolve the problem of substance abuse.

With your dedicated help and on-going awareness of this substance abuse problem as well as your compassionate approach to nursing for the Native American elder true advances and dynamic achievements are possible.

Other online resources regarding Native American Elders and Aging can be found at the following sites:

Health Promotion Programs

This ends Section 2 of Module 3.  To review, we have defined and elaborated on the following concepts.
 

Before we end, I would specifically like to thank Margie Hesson, faculty member at the South Dakota State University, College of Nursing, West River Program for her assistance with developing the content for these past two sections. 

Thank you for your time and attention.  Please be sure
to take the Post-Test for Section 2.

Module 3, Section 3 and 4 will address the Prevention and Treatment of another critical health care issue, the Abuse of Elders.

Proceed to Section 3.