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The Bicultural Competence Skills Approach is an intervention designed to prevent the abuse of tobacco, alcohol, and other drugs by Native American adolescents by teaching them social skills in a way that blends the adaptive values and roles of both the Native American and popular American cultures.
The intervention groups are led by two Native American counselors. Through cognitive and behavioral methods, 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 how subjects could turn down offers of tobacco, alcohol, and other drugs from their peers without offending their Native American and non–Native American friends. While the participants practice communication skills, leaders offer coaching, feedback, and praise. Coping skills include self-instruction and relaxation to help subjects deal with pressure and avoid substance use situations. Leaders suggest alternatives to using tobacco, alcohol, and other drugs and teach subjects to reward themselves for positive decisions and actions. Substance abuse awareness also is brought into the community. Families, schools, neighbors, law enforcement officials, and commercial establishments are included in a series of activities to raise awareness.
The first study used an experimental design with pretest, posttest, and follow-up waves. Subjects were voluntarily recruited and then (after pretesting by reservation site) randomly divided into prevention and control conditions. The sample of 137 Native American youths, whose average age was between 11 and 12, came from two western Washington State reservation sites in a population drawn from tribal and public schools. The evaluation established group equivalence at pretest on the children’s household composition, level of acculturation, and current place of residence. All subjects completed four outcome measures before, immediately following, and 6 months after intervention that analyzed culture-relevant peer influences on use of tobacco, alcohol, and other drugs; levels of substance abuse; and changes in substance abuse knowledge and attitudes relevant to Native American culture. The unit of assignment matched the unit of analysis (individual). The attrition analysis showed that attrition averaged 9 percent across the sample at 6-month follow-up, with no dropout differences identified between conditions.
The second study also used an experimental design with pretest and posttest measures, this time using 1,396 Native American youths with a mean age of 10.28. Youths were from 27 tribal and public schools in Native American communities. The youths were randomly assigned to three groups: a treatment group consisting of both the life skills training and community component, a treatment group consisting solely of the life skills training, and a control group consisting of no intervention. Booster sessions were administered to the treatment groups semiannually. Posttests were administered 6 months after the intervention and every 12 months thereafter for 3 years.
The first evaluation 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 held. 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. The outcomes on substances used in the previous 14 days showed that intervention youths reported lower levels of alcohol, marijuana, and smokeless tobacco use. 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 and reported significantly less use of smoked tobacco, smokeless tobacco, alcohol, marijuana, and inhalants in the last 14 days.
The second evaluation found that over the 3 years all youths increased their rates of tobacco, alcohol, and marijuana; however, rates of smokeless tobacco, alcohol, and marijuana use were lowest for those who received the life skills training (compared with the control group). Rates of cigarette use did not differ between these two groups. Youths receiving the life skills training plus community component had insignificantly lower rates of all substance use than the control arm but insignificantly higher rates of use than the other treatment group. The researchers speculate that the community component may have diluted the positive effects obtained by using the life skills training.
Schinke, Steven P., Gilbert J. Botvin, Joseph E. Trimble, Mario A. Orlandi, Lewayne D. Gilchrist, and Von S. Locklear. 1988. “Preventing Substance Abuse Among Native American Adolescents: A Bicultural Competence Skills Approach.” Journal of Counseling Psychology 35(1):87–90.
Schinke, Steven P., Lela Tepavac, and Kristin C. Cole. 2000. “Preventing Substance Use Among Native American Youth: 3-Year Results.” Addictive Behaviors 25(3):387–97.
Steven P. Schinke
Columbia University School of Social Work
622 West 113th Street
New York, NY 10025
Phone: (212) 851-2276
Fax: (212) 854-1570
E-mail: schinke@columbia.edu
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