The Bicultural Competence Skills Approach is an intervention designed to prevent abuse of tobacco, alcohol, and other drugs by Native American adolescents by teaching them social skills.
The program draws on bicultural competence and social learning theories. A bicultural competence approach teaches American Indian individuals to draw on both Native American and popular American cultures—instead of identifying with only one culture—to better adapt to, interact with, and thrive within both cultures. Social learning theory suggests the utility of developing skills in problem solving, decision making, nonverbal and verbal communication, and social network building.
Intervention groups are led by two Native American counselors, and ten to fifteen 50-minute sessions are delivered. Through cognitive and behavioral methods tailored to the cultural prerogatives and reality of the lives of Native American youth, participants are instructed in and practice communication, coping, and discrimination skills. Communication skills are introduced with biculturally relevant examples of verbal and nonverbal influences on substance use. For instance, leaders model refusing offers of tobacco, alcohol, and other drugs from their peers without offending their Native American and non–Native American friends. While participants practice communication skills, leaders offer coaching, feedback, and praise. Participants learn discrimination skills to better identify and avoid situations that encourage or support substance use and to learn about healthy alternatives to high-risk behaviors. Coping skills include self-instruction and relaxation to help subjects handle pressure and avoid substance use situations. Participants also learn about building networks of prosocial peers, family, and tribal members. Leaders suggest alternatives to using tobacco, alcohol, and other drugs and teach participants to reward themselves for positive decisions and actions. All sessions include Native American values, legends, and stories.
Two 50-minute booster sessions are delivered semiannually and include developmentally appropriate content and strategies.
In some versions of the program, substance abuse awareness is also brought into the community. Families, schools, neighbors, law enforcement officials, and commercial establishments are included in a series of activities to raise awareness. Activities include media releases, flyer and poster distribution to community businesses and organizations, and informational sessions at local schools.
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Knowledge and Attitudes About Substance Use
Schinke et al. (1988) found significant results at immediate posttest measurement and at 6-month follow-up in favor of the program group. At posttest, program students were significantly more knowledgeable about substance use and abuse and held less favorable attitudes about substance use in the Native American culture than their control group counterparts. At the 6-month follow-up, intervention participants continued to score higher on measures of knowledge of substance abuse.
The intervention group youths also had significantly higher ratings for self-control, assertiveness, and the ability to generate alternative suggestions to peer pressure–based encouragement to use substances. At the 6-month follow-up, intervention participants continued to score higher on measures of knowledge of substance abuse, self-control, alternative suggestions, and assertiveness.
The outcomes on substances used in the previous 14 days showed that intervention youths reported lower levels of alcohol, marijuana, nonmedical drug, and smokeless tobacco use. At the 6-month follow-up, intervention participants reported less use of smoked tobacco, smokeless tobacco, alcohol, marijuana, and inhalants in the previous 14 days.
Schinke, Tepavac, and Cole (2000) found that over the 3 years, youths in all three groups increased their rates of tobacco, alcohol, and marijuana use; however, rates of smokeless tobacco, alcohol, and marijuana use were lower by 43 percent, 24 percent, and 53 percent, respectively, for those who received the life skills training compared with the control group. Rates of cigarette use did not differ between these groups. Youths receiving the life skills training plus community component had insignificantly lower rates of all substance use than the control arm and insignificantly higher rates of use than the other treatment group receiving the skills intervention alone. The researchers speculate that the community component may have diluted the positive effects obtained by using the life skills training.
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