A complex psychosocial portrait of substance use disorders among Indigenous people in the United States: A scoping review

Abstract

AbstractBackground and ObjectivesThere has been a prevailing but erroneous belief in the medical community that there is a biological vulnerability in the American Indian/Alaskan Native (AI/AN) community to substance use disorders (SUDs), with alcohol use disorder (AUD) being the most prevalent. This scoping review aimed to examine what possible psychosocial issues could lead to the development of the perpetuation of SUDs in the AI/AN population.MethodsThe protocol for this scoping review followed Arksey and O'Malley's methodological framework. There were 405 articles included for full‐text review. Further inclusion criteria were applied which included: Directly looking at participants who had a SUD, including either in the discussion or conclusion a statement linking their data to psychosocial issues as a possible explanation for their data, and having measured the psychosocial issue with a research device. The final review included 15 studies.ResultsFour psychosocial themes were uncovered using an inductive process, where recurring words related to identity, prejudice, isolation, discrimination, and self‐concept in the literature. These themes were trauma/historical loss, mood, and discrimination/self‐esteem. All of these themes are interrelated, and all influence the development or sustainment of a SUD.Discussion and ConclusionsComplex psychosocial factors in the AI/AN community are associated with SUDs. This trauma and historical loss should be addressed with culturally tailored treatments.Scientific SignificanceThere are not many manuscripts that specifically look at the interplay of mood, trauma, self‐worth, and discrimination with SUD in the AI/AN community. This scoping review aims to highlight these issues as well as discuss how culture should play a part in treatment.