Pathways of Substance Use Risk and Resilience across Three Generations

Alcohol and other drug use has had devastating impacts for many American Indian (AI) communities and families. This project will move beyond “risk-factor” epidemiology that largely ignores differences in substance use patterns and drivers that has failed to materialize into substantial changes in health outcomes. We will focus on identifying what matters most and to whom by examining relative impacts of predictors of substance use over the life-course and across generations of AI families. This competitive renewal application builds on our existing community-based participatory research with 8 Tribal communities (or nations). We propose to continue computer-assisted survey interviews with existing Healing Pathways “target participants” (baseline N = 735) for whom we already have 11 waves of developmental data spanning childhood and early adulthood. We will enroll their own children in the study for multiple generations of epidemiological information on substance use disorder, recovery and resilience. We will also collect qualitative information to capture nuanced community perspectives on the contexts and mechanisms of substance use. Results of this research will increase awareness of the nature, etiology, and consequences of alcohol and other drug use problems and recovery in reservation communities. Another outcome is enhanced precision in identifying predictors of substance use and positive lifespan development. Thus, the results of this project have potential to optimize the timing of and targets of intervention and prevention programs and policies with communities.