TREATMENT IMPLICATIONS OF COMORBID PSYCHOPATHOLOGY IN AMERICAN-INDIANS AND ALASKA NATIVES

This paper discusses treatment implications of comorbid psychopatholog y in the context of American Indian and Alaska Native culture and in t he context of the Indian Health Service's Mental Health and Alcohol an d Substance Abuse Program Branches. Treatment of comorbidity in this p opulation is a particularly difficult problem due to numerous barriers to treatment and a poorly defined treatment system. As in other clini cal populations, these patients are high utilizers of the limited trea tment services available, but may not receive the type of treatment th ey need. After describing the extent of comorbidity in this population , we present an historical perspective of mental illness that provides an Indian's view of why we are where we are today in treating these p roblems, Next, we discuss Western and traditional treatment implicatio ns for comorbidity among adults and adolescents. Finally, we suggest d irections for future research in this area.