Dahanna is a 25-year-old Mescalero Apache Native American male who lives on a reservation in New Mexico. He works as an artist, creating Apache pottery, jewelry, and Native American tools used by his ancestors. He sells his art to the tourism industry in his state, making a good living. He feels a lot of pride in keeping his culture and heritage alive and in using his art to educate non-Apaches about his people. Dahanna is an active member of his tribe; his father is an elder. His mother's people are Chiricahua Apache, and Dahanna sometimes travels to see them in Arizona. Dahanna has always lived on the reservation and did not have the opportunity to finish high school. His family needed his financial help, so Dahanna left school early to work. Dahanna did not mind this sacrifice because he loves what he does and the tourism trade pays him well for his work. Dahanna suffers from clinical depression, but does not have access to mental health treatment on the reservation. Dahanna's reservation is isolated from any major population centers, and medical and mental health treatment is difficult to obtain. While the reservation does have medical facilities, they are often woefully understaffed. Dahanna often feels sad and hopeless. When asked what causes these feelings, he explains that there are a lot of things. He often thinks about the plight of his people and how life used to be for them. Sometimes, when tourists come onto the reservation, he feels like an animal kept within a zoo, even though he knows that he is free to go wherever he pleases. Most of the time, he feels that he was born in the wrong century, and he is unhappy with how his tribe and all Native Americans have been treated by the US government. He sometimes fantasizes that he is back in the time of his ancestors, and that he hunts and roams with them, living free and living off the land and being one with nature. He feels this way of life is now lost to him and his people. Sometimes, he is angry that the tourists want to buy his art, and he resents them and their money. At other times, he is grateful that he can provide for himself and his family and is filled with fear about what would happen to them if the tourists stopped coming. Dahanna often drinks alcohol and uses native herbs that influence his mind to help him forget his stress and pain. Many people on the reservation, especially those in Dahanna's age group, cope in the same way. Dahanna is often joined by his friends in these activities. They often go deep into the mountains to camp and pretend that it is like the old days. They often get drunk or high when doing so. On one such trip, his friend Nantan was cleaning his rifle while drunk in camp. The rifle went off and killed Dahanna's best friend, Bipin. Dahanna has never really gotten over his best friend's death; he and Bipin had been friends since they were small children.

1. What are the risk factors associated with acculturative stress in Native Americans, and how does this apply to Dahanna?

2. What are the risk factors associated with Dahanna's situation on the reservation?

3. What are the economic risk factors associated with Dahanna's situation on the reservation?

4. What mental health and substance use disorder risks are reflected in demographic statistics for Native Americans?

5. What cultural values regarding cooperation are generally found in most Native American societies, of which counselors should be aware when working with clients from these backgrounds?

6. What cultural values regarding noninterference are generally found in most Native American societies, of which counselors should be aware when working with clients from these backgrounds?

7. What cultural values regarding time orientation are generally found in most Native American societies, of which counselors should be aware when working with clients from these backgrounds?

8. What cultural values regarding spirituality are generally found in most Native American societies of which counselors should be aware when working with clients from these backgrounds?

9. What cultural values regarding humility are generally found in most Native American societies, of which counselors should be aware when working with clients from these backgrounds?