Relationship between social support and substance use among American Indian people with substance use disorder

Abstract

American Indians and Alaska Natives (AI/ANs) have endured trauma over generations and still experience systemic racism and oppression today. Historical trauma has contributed to health problems among AI/ANs, including high rates of substance use disorder. Social support is a protective factor for substance use in other populations; however, little is known about the role of social support and substance use in AI/AN communities. The current study employed secondary data analysis to understand the relationship between social support and substance use among AI/AN adults with substance use disorder. Using a Community-Based Participatory Research framework, a cross-sectional survey was conducted in partnership with an AI reservation community in Montana to examine risk and protective factors for substance use. Participants were 198 tribal members who self-identified as having a substance use problem. Social network characteristics were assessed using a modified version of the Important People Drug and Alcohol (IPDA) interview and substance use was assessed using the Timeline Followback. Consistent with previous research, the current study found that network substance use behavior was a better predictor of participant substance use outcomes than general support, substance specific support, or support for recovery/treatment. Variables associated with greater drug and alcohol abstinence among participants included living in larger household, having a greater percentage of the household that is sober, not having attended boarding school, having a larger percentage of the social network that does not accept one's substance use, having a smaller percentage of the social network rated as moderate or heavy substance users, and having a smaller percentage of the social network that uses substances frequently. An additional analysis was conducted to test whether the association between social support and participant substance use was moderated by the substance use behavior of the network, but the interaction was not significant. Contrary to prior research, the size, general supportiveness, and importance of the social network were not significantly associated with participant substance use. Results suggest that the IPDA may benefit from modifications to improve its usefulness in addiction research with AI/ANs. Implications for tribal members with substance use problems, their loved ones, and community leaders are discussed.