摘要：Objectives. We examined differences in substance abuse treatment outcomes between American Indians and their non–American Indian counterparts in California, during 2000 to 2002. Methods. A total of 368 American Indians and a matched sample of 368 non–American Indians from 39 substance abuse treatment programs in 13 California counties were assessed at multiple time points. Records on arrests, driving while under the influence of alcohol or drugs, and mental health care were obtained 1 year before and 1 year after treatment entry. Differences in pretreatment characteristics, services received, treatment satisfaction, treatment completion and retention, and outcomes were examined. Results. Pretreatment problems were similarly severe among American Indians and non–American Indians. About half in both groups either completed treatment or stayed in treatment more than 90 days; American Indians in residential care had significantly shorter treatment retention. American Indians received fewer individual sessions and out-of-program services, especially for alcohol abuse, but were nevertheless generally satisfied with their treatment. Both groups improved after treatment, with American Indians demonstrating greater reductions in arrests than non–American Indians. Conclusion. American Indians benefit from substance abuse treatment programs, although the type and intensity of services offered could be improved. The serious health consequences associated with substance abuse among American Indians 1 demand that policymakers examine American Indian utilization of drug and alcohol treatment services and its relationship to improving health conditions. National outcome studies make sparse reference to the benefits of substance abuse treatment for American Indians. Local studies that examine American Indian data from individual programs often have small rural samples, focus primarily on alcohol treatment, and lack a non–American Indian comparison group. Taking advantage of a large treatment outcome study recently completed in California, we compared a comprehensive set of substance abuse treatment outcomes among American Indians and non–American Indians. Although the patterns and treatment implications 2 – 4 of American Indian alcohol use have been well documented, posttreatment outcome studies are few, and results have been mixed. 5 Westermeyer’s 6 10-year follow-up of 45 hospitalized American Indians found that only 7 improved, whereas Shore and von Fumetti’s 7 4-year follow-up of 642 American Indian patients who received out-patient and residential care reported that slightly more than one quarter demonstrated clear improvement. Walker et al. 8 tracked an urban American Indian sample up to 2 years posttreatment and documented better outcomes among patients in outpatient care. Several other studies that followed American Indian patients for shorter time periods 9 – 11 found improvements such as decreases in alcohol consumption, adverse consequences, and social and legal problems. Other American Indian treatment research has focused on culturally infused interventions 12 , 13 and adolescent substance use and prevention strategies. 14 – 18 Very few studies have examined how American Indian adults entering treatment for alcohol and drug problems fare over time and if they do as well as other groups. California is in a unique position to contribute to the research on American Indians. About 4.1 million people in the United States are American Indian/Alaska Native (1.5% of all Americans) and California has the largest American Indian population with 627562 individuals. 19 Almost 6000 American Indians (accounting for more than 8000 admissions) annually receive substance abuse treatment in California. The present study capitalizes on the comprehensive data collected from patients in 39 treatment facilities that participated in the California Treatment Outcome Project (CalTOP). Specifically, we address 2 key research questions: (1) Aside from race/ ethnicity, are American Indians different from non–American Indians at treatment entry on general characteristics and problem severity? and (2) How do substance abuse treatment outcomes differ among American Indians and non–American Indians? Given the current literature on the need for culturally appropriate services 20 , 21 and substance abuse severity among some American Indian populations, we hypothesized that compared with other patients, American Indians would present more severe problems, particularly with alcohol; leave treatment earlier; and demonstrate less favorable outcomes at follow-up.
