The Role of Culture in Substance Abuse Treatment Programs for American Indian and Alaska Native Communities

Department of Psychiatry, University of Colorado, 13001 E. 17th St., MS F546, Building 500, Room E2322, Aurora, CO 80045, USA.
Psychiatric services (Washington, D.C.) (Impact Factor: 2.41). 05/2012; 63(7):686-92. DOI: 10.1176/
Source: PubMed


Culture figures prominently in discussions regarding the etiology of alcohol and substance abuse in American Indian and Alaska Native (AI/AN) communities, and a substantial body of literature suggests that it is critical to developing meaningful treatment interventions. However, no study has characterized how programs integrate culture into their services. Furthermore, reports regarding the associated challenges are limited.
Twenty key informant interviews with administrators and 15 focus groups with clinicians were conducted in 18 alcohol and substance abuse treatment programs serving AI/AN communities. Transcripts were coded to identify relevant themes.
Substance abuse treatment programs for AI/AN communities are integrating culture into their services in two discrete ways: by implementing specific cultural practices and by adapting Western treatment models. More important, however, are the fundamental principles that shape these programs and their interactions with the people and communities they serve. These foundational beliefs and values, defined in this study as the core cultural constructs that validate and incorporate AI/AN experience and world view, include an emphasis on community and family, meaningful relationships with and respect for clients, a homelike atmosphere within the program setting, and an “open door” policy for clients. The primary challenges for integrating these cultural practices include AI/AN communities' cultural diversity and limited socioeconomic resources to design and implement these practices.
The prominence of foundational beliefs and values is striking and suggests a broader definition of culture when designing services. This definition of foundational beliefs and values should help other diverse communities culturally adapt their substance abuse interventions in more meaningful ways.

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Available from: Rupinder Kaur Legha, Nov 09, 2015
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    • "Existing literature supports, on a macro-system level, that AI children are raised with cultural values of self-reliance and interdependence (Duran and Duran, 1995; Red Horse, 1980). Embedded within their socio-cultural structures, these children were negotiating their identities and adapting to their obesogenic landscapes (Lesane-Brown et al., 2010; Liebler, 2010), which, in turn, may be producing them as promising change agents (Legha and Novins, 2012; Zimmerman et al., 1998). Children's participation in community development as change agents reinforced their cultural identity and agency (James and James, 2008). "
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    ABSTRACT: This article presents research findings from the formative phase of OPREVENT, a pilot obesity prevention intervention trial for American Indian households on two reservations in the Upper Midwestern United States. We describe processes by which American Indian children acting as change agents influence adult food and physical activity behaviors on an Ojibwa and a Potawatomi reservation. This study borrows from Bronfenbrenner and Ceci’s socio-ecological model and extends Daniel’s resiliency theory for practice with vulnerable children. Using purposive sampling, we interviewed 168 community members, including 25 children between 6 and 13 years of age, using adult in-depth and paired-child interviews, household group interviews, focus groups, and community workshops. Results reveal that six American Indian children, 10–13 years old, were acting as change agents. We propose a socio-ecological conceptual framework to guide our understanding and application of a children as change agent approach for adult health behaviors which includes cultural identity (macro-system), institutional and community support (mezzo-system), family support through a secure base (micro-system), and children’s sense of belonging, self-esteem, self-efficacy, knowledge, and actions as change agents (intrapersonal factors). Resiliency and vulnerability are dynamic processes that intersect the multiple systems throughout children’s developmental stages to bolster their agency. We conclude with considerations for the OPREVENT pilot project and discuss future directions for developing a child as change agent theoretical framework for adult health behavior change.
    Childhood 06/2014; 22(3). DOI:10.1177/0907568214538290 · 1.10 Impact Factor
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    • "Phase 1 consisted of extensive Advisory Board discussions of the issues related to delivering quality substance abuse treatment services in AI/AN communities and the place of EBTs in these services [22]. Phase 2 consisted of “program case studies” involving visits to treatment programs and qualitative data collection about the communities served, services offered, challenges to delivering these services, and EBT use [24]. In the third and final stage of the project, clinical directors of 445 behavioral health programs nationwide were asked to complete a 45-minute survey about their program and experience with EBTs [25]. "
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    ABSTRACT: Background Substance abuse continues to exact a significant toll, despite promising advancements in treatment, and American Indian and Alaska Native (AI/AN) communities remain disproportionately impacted. Understanding the challenges to providing quality substance abuse treatment to AI/AN communities could ultimately result in more effective treatment interventions, but no multi-site studies have examined this important issue. Methods This qualitative study examined the challenges of providing substance abuse treatment services for American Indian and Alaska Native (AI/AN) communities. We conducted key informant interviews and focus groups at 18 substance abuse treatment programs serving AI/AN communities. Seventy-six service participants (21 individuals in clinical administrative positions and 55 front-line clinicians) participated in the project. Interview transcripts were coded to identify key themes. Results We found that the challenges of bringing effective substance abuse treatment to AI/AN communities fell into three broad categories: challenges associated with providing clinical services, those associated with the infrastructure of treatment settings, and those associated with the greater service/treatment system. These sets of challenges interact to form a highly complex set of conditions for the delivery of these services. Conclusions Our findings suggest that substance abuse treatment services for AI/AN communities require more integrated, individualized, comprehensive, and longer-term approaches to care. Our three categories of challenges provide a useful framework for eliciting challenges to providing quality substance abuse treatment in other substance abuse treatment settings.
    BMC Psychiatry 06/2014; 14(1):181. DOI:10.1186/1471-244X-14-181 · 2.21 Impact Factor
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