Culturally centering alcohol use assessments: insight from indigenous adults with lived and living experience

There are high rates of both alcohol abstinence and hazardous drinking among American Indian and Alaska Native (AI/AN) communities compared with non-Hispanic Whites. Few measures exist that examine alcohol use consequences within a relevant historical and cultural context for Indigenous populations, hindering the ability of communities, researchers, and practitioners to effectively address alcohol misuse. In the present study, we discuss a research collaboration to culturally re-center alcohol-use consequence measures among AI/AN adults.

We convened a national and local Scientific Review Panel (SRP) with AI/AN research and clinical experts to reexamine the Drinker Inventory of Consequences (DrInC) and the companion measure, the Short Inventory of Problems (SIP; N = 5). We then completed 20 interviews with AI/AN adults currently in alcohol recovery or misusing alcohol. Interview questions included the alignment of items within measures to be more culturally relevant, identifying missing content, and a review of the research team's adaptations. We completed a thematic analysis.

The SRP focused their adaptations on re-centering culture, assessing risk and protective factors, and important missing item content elements. Ultimately, the SRP recommended removing 20 items from the DrInC and adding 12 items to the SIP and adding 3 sub-scales, with an emphasis on the addition of items that were strengths-based and removal of stigmatizing language. Interviews were then completed to further refine the measures. In total, three themes emerged from these data: (1) Direct Reflections on Original and Adapted Items; (2) Negative Alcohol Consequences Specific to AI/AN Communities; and (3) Recovery Supports.

Findings underscored the need to emphasize culture, prevention, and recovery supports when addressing alcohol misuse with AI/AN adults. The SRP also identified areas to expand the culturally centered framing of these measures by removing stigmatizing language, focusing on systemic factors, and prioritizing strengths-based approaches. The subsequent culturally centered tools will be validated with 150 nationally recruited AI/AN adults.