Attitudes About Alcohol Misuse Among Alaska Native People in a Tribal Health Care System.

Objectives: Attitudes about alcohol misuse influence help-seeking behaviors. We assessed attitudes among Alaska Native/American Indian (AN/AI) patients, providers, and leaders to inform outreach, prevention, and treatment.

Methods: Participants included a cross-sectional sample of 72 AN/AI providers/leaders and 704 AN/AI adult patients in randomly selected clinics within a tribal health care system. Attitudes associated with addiction models (Psychosocial, Moral, Disease, Environment, Nature) were assessed using a survey developed for AN/AI people. Independent variables included role (patient, provider/leader), sex, age, residence type (urban, rural, mixed, other), alcohol misuse or behavioral health issue in self, family, or friends, and alcohol or behavioral health help-seeking.

Results: Attitudes corresponding to Psychosocial and Disease models were more highly endorsed than Nature or Moral models. The Environment model was moderately endorsed. The Disease model was more highly endorsed by AN/AI patients with alcohol help-seeking but less endorsed by providers/leaders. AN/AI patients who were male, had rural residence, and a self-reported behavioral health issue had higher endorsement of the Moral model. Male patients and providers/leaders more highly endorsed the Nature model. Roughly one-third (35%) of patient participants were men.

Conclusions: Efforts to counteract moralistic attitudes about alcohol misuse among male and rural AN/AI people, as well as beliefs that alcohol misuse will spontaneously resolve, may facilitate prevention and treatment efforts. Leaders should also be aware of the potential negative impacts of local laws restricting alcohol. Holistic treatment approaches that address psychosocial factors and contextual issues are indicated. Oversampling of male AN/AI patients may also be warranted.