Natural history of alcohol dependence and remission events for a Native American sample.

OBJECTIVE Examining the progression of a disorder cross- culturally may help distinguish elements common to addictions from those that are differentially shaped by culture. This study sought to construct a combined sequence of both problem emergence and recovery efforts with Native Americans. METHOD In a cross-sectional sample, 44 adult Native Americans (61% men) who had resolved alcohol dependence completed face-to-face interviews at a research center. The Alcohol Related Behaviors Survey and the Change Effort Card-sorts along with measures of alcohol involvement and current quality of life were administered. RESULTS This sample's sequence of alcohol-related events was compared to that reported for Jellinek's historical white male sample (r(s) = .46, p = .001), a recent Navajo sample (r(s) = .33, p = .024), and a recent Mission Indian sample (r(s) = .28, p = .24). This sample's sequence of change efforts was compared to that in the Navajo sample (r(s) = .33, p = .182). CONCLUSIONS Despite the small sample size precluding generalizability, there was greater concordance between this intertribal sample and Jellinek's white male sample than between this sample and a Mission Indian sample, indicating both cross-cultural and intracultural variation. In addition, change efforts begin during the development of alcohol problems rather than waiting until the person "hits bottom," as suggested by previous research. Integrating the pathology of substance- use disorders with the process of resolving those disorders extends our understanding of the course of alcohol dependence.