1. Journeys of the Circle
A Culturally Relevant Life Skills Intervention for Adolescent Indian Drinking
Research Society on Alcoholism Vancouver, B.C., June 28, 2004

2. A Collaborative Effort
University of Washington,
Department of Psychology,
Addictive Behaviors Research Center
AND
The Seattle Indian Health Board

3. PROJECT FUNDING
National Institute on Alcohol Abuse and Alcoholism (AA12321)
Robert Wood Johnson Foundation

4. Seattle Indian Health Board (SIHB)
Seattle non-profit serving the Native Community for over 30 years
Offering a wide spectrum of health services for adults, youth, and children

5. Seattle Indian Health Board Team
Executive Director
Assistant Executive Director
Operations Coordinator
Community Services Manager
Ralph Forquera, MPH
Rebecca Gonzales Corpuz
Crystal Tetrick, MPH
Steve Gallion

6. University of Washington Team
Principal Investigator
Co-Principal Investigators
Project Post-Docs
Research Coordinator
Research Assistants
G. Alan Marlatt, PhD
Mary Larimer, PhD
Patricia Mail, PhD, MPH
Lillian Huang Cummins, PhD
Heather Lonczak, EdD
Jessica Cronce
June La Marr
Sandra Radin
Karen Chan
Kelly Burns

7. UW and SIHB Partnership
In 1997, SIHB youth activities program staff approached members of the Addictive Behaviors Research Center (ABRC), University of Washington about the possibility of collaborating on a grant to develop a brief clinical intervention for adolescent clients of SIHB
The ABRC had several Native students enrolled in the Clinical Psychology program who were enthusiastic about the proposal

8. Native American Youth
Alcohol use appears to begin at an earlier age among Native adolescents (Beauvais, 1992)
Perhaps as many as one-third of American Indian youth having consumed alcohol by age 11(May, 1986)
Over ½ report having been intoxicated at least once by age 15 (Beauvais, 1996)

9. Culturally Specific Risk Factors
Ethnic Dislocation (May, 1982; Oetting, Beauvais &Velarde, 1982; Trimble Padilla, & Bell, 1987)
Acculturation Stress (LaFromboise, 1988)
Alienation from the Larger Culture (Moncher et al., 1990)
Unstructured time on reservations, during which drinking is also a response to boredom (Edwards & Edwards, 1988)

10. Project Beginnings
Native youth were recruited for Focus Groups to provide input about the program
Community Elders were consulted
Meetings between UW and SIHB continued
Specific Aims developed

11. Initial Project Challenges
Hiring appropriate intervention staff
Gaining community trust
Gathering community and youth input on assessments and intervention materials
Recruiting youth

12. Canoe Journey, Life’s Journey
Project Development
Canoe Journey,
Life’s Journey

13. The Canoe Journey
Pacific Northwest Coast people preferred water travel to any other means of transportation Drucker (1955)
Early explorers, missionaries and traders all commented on the Indian canoes, their size, utility, and manufacture (Gunther, 1972; Sproat, 1966)
Canoes were usually made from the straight-grained cedar trees (Drucker, 1955; Sproat, 1966

14. The Canoe Journey
Canoe clubs were formed for interested adolescents and young adults, but designed to accommodate and include families and, eventually, the whole community

15. Reestablishing the Canoe Tradition
Canoe Families
Powerful Primary Intervention
All canoes are DRUG and ALCOHOL Free
Strengthen Native Identity
Involve members of the community
Canoe Clubs

16. Quinault Indian Nation Ocean Canoe Paddle

22. Canoe Journey Life's Journey a metaphor for
Journeys of the Circle Addictive Behaviors Research Center Journeys of the Circle
Seattle Indian Health Board Journeys of the Circle University of Washington
Canoe Journey
a metaphor for
Life's Journey

23. Canoe Journey, Life’s Journey
Development of Culturally Relevant Life Skills Manual
Canoe Journey as a metaphor for life’s journey
Use of other traditionally Native symbols, particularly the Medicine Wheel
Medicine Wheel generally understood to have similar meaning across tribal boundaries

24. Canoe Journey, Life’s Journey
The Wheel is often used to represent the four directions: North, South, East, West
Four Seasons: Summer, Fall, Winter, Spring
Four parts of self: Physical, Mental, Emotional, Spiritual

25. Canoe Journey, Life’s Journey The Manual Sessions
1. The Medicine Wheel/Canoe Journey as a metaphor for Health
2. Who Am I? Beginning at the Center
3. Community Help and Support: Help on the Journey
4. The Quest: Goal Setting
5. Overcoming Obstacles: Solving Problems
6. Effective Communications: Listening to Others & Expressing Self
7. Moods and Coping with Negative Emotions
8. Strengthening our Body and Spirit

26. Canoe Journey, Life’s Journey The Manual Sessions
The manual sessions are taught by a lead facilitator, and a co-facilitator
The facilitators involve participants through role-plays, practice of skills, and reflective journal writing
The courses can be taught individually or in a group setting
The courses can be taught in one hour blocks or divided into two 3-4 hour sessions

27. Sample Population
Participants, age 13-19, were initially recruited from Seattle Public Schools and eventually through Outpatient Services at the Seattle Indian Health Board

28. Sample Population Demographics
Geographic Region n=88
Urban n (%)
Suburban
Rural
Education Status n=93
In School
Graduated High School
Not Attending or Dropped Out
61 (65.6)
25 (26.9)
2 (2.2)
82 (88.2)
5 (5.4)
6 (6.5)

29. Sample Population Alcohol and Drug Use Ever Used n=92
Tobacco n (%)
Alcohol
Cannabis
Cocaine
Amphetamines
Barbiturate/Sedatives
Inhalants
Hallucinogens
Opiates
50 (53.8)
55 (59.1)
49 (52.7)
10 (10.8)
7 (7.5)
1 (1.1)
5 (5.4)
9 (9.7)

30. Sample Population Alcohol and Drug Use Age of First Regular Use
Tobacco n=34
Alcohol n=13
Cannabis n=29
12.62 (SD=2.42)
13.08 (SD=1.61)
13.07 (SD=1.81)

31. Sample Population Alcohol and Drug Use Problems Associated with Use4
Used while in a dangerous situation n=93; n (%)
Had accidents or was injured n=93
Had repeated legal problems n=92
Consistently used instead of going to school n=92
4 Includes non-users, coded as zero
13 (14)
7 (7.5)
4 (4.3)
12 (12.9)

32. Sample Population Alcohol and Drug Use Problems Associated with Use4
Blacked out due to alcohol n=92
Experienced withdrawal symptoms n=92
Perceives him/herself as maybe or definitely having a substance use problem n=92
4 Includes non-users, coded as zero
14 (15.1)
10 (10.8)
12 (12.9)

33. Participants: Demographics (N = 50)
Age
15.24 years (SD = 1.61)
Female
27 (54%)
Native American
32 (64%)
Native and Other
16 (32%)
Identifies with a tribe
40 (80%)
Recruited from SIHB
28 (56%)
Data I am presenting are from 50 participants that completed the life skills intervention, baseline and follow-up
Age right in the middle of recruitment population
Mostly female
Nearly all identified as Native with the largest group identifying as solely Native American and another 1/3 identifying as Native and another ethnic group
Most identified with a tribe
A little more than half were recruited from health clinics

34. Assessment Measures Comprehensive Adolescent Severity Index (CASI)
Past month substance use: tobacco, alcohol, marijuana, any drugs excluding tobacco
Rutgers Alcohol Problem Index (RAPI)
Alcohol-related consequences
Situational Confidence Questionnaire (SCQ)
Confidence to resist the urge to drink heavily
CASI: structured interview, days used in past month
RAPI: paper and pencil that measures the experience of negative consequences related to drinking (sample items)
SCQ: paper and pencil that measures confidence to resist the urge to drink in a variety of contexts (sample items)

35. Past Month Substance Use
days used in past 30 days
how many days did you use any drugs other than tobacco?
all decreased but not significantly
tobacco increased but not significantly

36. Alcohol-Related Consequences
significant decrease in RAPI scores
p < .05

37. Confidence to Resist Urge to Drink
increases in confidence for all contexts but not significant

38. Summary of Results
Trends towards reduced alcohol, marijuana, and other drug use and increased confidence to resist the urge to drink in multiple contexts
increased tobacco use?
Participants reported a significant decrease in alcohol-related consequences at follow-up
Trends but not significant
increased tobacco use - other research has also found this, intervention not targeted specifically towards tobacco, is tobacco a special case? would it have increased more?
Was significant change in consequences

39. Implications/Issues Environment: Urban versus Reservation
After School Intervention v. Camp setting
Transportation and Food
Can there be one program that works successfully across different Native communities?