Centering culture in the treatment of opioid use disorder with American Indian and Alaska Native Communities: Contributions from a National Collaborative Board

American Indian/Alaska Native (AI/AN) communities are disproportionally impacted by the opioid overdose epidemic. There remains a dearth of research evaluating methods for effectively implementing treatments for opioid use disorder (OUD) within these communities. We describe proceedings from a 2-day Collaborative Board (CB) meeting tasked with developing an implementation intervention for AI/AN clinical programs to improve the delivery of medications to treat OUD (MOUD). The CB was comprised of Elders, cultural leaders, providers, individuals with lived experience with OUD, and researchers from over 25 communities, organizations, and academic institutions. Conversations were audio-recorded, transcribed, and coded by two academic researchers with interpretation oversight provided by the CB. These proceedings provided a foundation for ongoing CB work and a frame for developing the program-level implementation intervention using a strength-based and holistic model of OUD recovery and wellbeing. Topics of discussion posed to the CB included engagement and recovery strategies, integration of extended family traditions, and addressing stigma and building trust with providers and clients. Integration of traditional healing practices, ceremonies, and other cultural practices was recommended. The importance of centering AI/AN culture and involving family were highlighted as priorities for the intervention.     

Alleviating the distress of caregivers of Alzheimer's disease patients: A rational-emotive therapy model

Caring for a person with senile dementia of the Alzheimer type places an enormous emotional burden upon the caregiver. Common responses of caregivers include denial, anger, guilt, self-pity and depression. These negative emotions exacerbate the difficulties of caring for the patient, as well as constrict the caregiver's ability to develop appropriate coping skills for his/ her own life. Rational-emotive therapy (RET) specifies the maladaptive cognitions which elicit and sustain maladaptive emotions and behaviors, and provides a model for cognitive, affective and behavioral change. Excerpts from therapy sessions are presented to illustrate the process.Rose Oliver, private practice; Graduate Fellow and Supervisory Faculty, Institute for Rational Emotive Therapy, 45 East 65th Street, New York, NY 10021. Frances A. Bock, private practice; Adjunct Associate Professor, Psychology Department, Hofstra University, Hempstead, NY 11550; Graduate Fellow and Supervisory Faculty, Institute for Rational Emotive Therapy, 45 East 65th Street, New York, NY 10021.     

CROSS-CULTURAL COMPARISONS ON PSYCHOSEMANTICS OF ICONS AND GRAPHICS

This study is to report a cross-cultural comparison on perceptions of icons and graphics and their relationships. Data were ratings of 10 icons and 10 graphics against 21 bipolar semantic differential scales from 325 college students in three countries, Mexico, Columbia, and Japan. Cross-cultural factor analyses resulted in the identification of four semantic (three affective and one denotative) features, three icon factors, and three graphic factors. Indigenous cultural means of these iconic and graphic factors were computed and used to probe cross-cultural similarities and differences in perceptions. Psychosemantics of icon factors were further predicted by graphic factors through canonical correlation. This study concludes the importance of implicit cultural meanings of nonverbal figures in intercultural communications. The implications of this study are also discussed.     

Book reviews

Thirty‐Five Oriental Philosophers. Diane Collinson & Robert Wilkinson, 1994, London and New York, Routledge, vi + 205 pp., £35

Essays on Indian Philosophy Traditional and Modern. J. N. Mohanty (edited by Purushottama Bilimoria), 1993, Delhi, Oxford University Press, xxxvii + 347 pp., Rs. 500

Gates of Light (Sha'are Orah). Rabbi Joseph Gikatilla, 1994, London, Harper Collins, 400 + xxxiv pp., $30     

The patient-physician relationship and the allocation of scarce resources: a law and economics approach

Patients with insufficient financial resources place physicians in a conflict of interest between the patients' needs and the financial interests of the physician, other patients, and society. Not only must physicians act ethically, but they must avoid liability for violating their legal duties to their patients. The traditional rules of contract and malpractice law that govern the patient-physician relationship do not provide satisfactory guidelines. Better answers are found in the rules of fiduciary law, but only with regard to direct conflicts between patients and physicians and only at the risk of reducing patient access to care. Certain types of legislative action can resolve these conflicts by altering the traditional legal rules, but care must be taken to preserve patient-physician trust, which the legal rules were designed to enhance.     

The Impact of Sex and Gender Role Self-Perception on Affective Reactions to Different Types of Film

To what extent do differences in biologicalsexand psychological gender identity influence affectivereactions to different genres of film? In order toaddress this question, this investigation examined the impact of sex and gender roleself-perceptions on viewers' responses to neutral,melodramatic, and violent film segments. Working with apredominantly Caucasian population (93% Caucasian) at asoutheastern university, the results emphasize theimportance of sex and gender role self-perceptions onviewers' affective responses to media entertainment. Theimplications of these findings are discussed.