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

ABSTRACT 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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    • "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). "
    Childhood 06/2014; 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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    ABSTRACT: American Indian and Alaska Native (AIAN) communities experience alarming health disparities, including high rates of substance use disorders (SUDs). Psychological services for AIANs, including SUDs treatment, are primarily funded by the federal Indian Health Service and typically administered by tribal governments. Tribal administration of SUDs treatment programs has routinely involved either inclusion of traditional cultural practices into program activities or adaptation of conventional treatment approaches to distinctive community sensibilities. In this article, we investigate a third possibility: the collaborative, community-based development of an alternative indigenous intervention that was implemented as a form of SUDs treatment in its own right and on its own terms. Specifically, in July of 2012, we undertook a trial implementation of a seasonal cultural immersion camp based on traditional Pikuni Blackfeet Indian cultural practices for 4 male clients from the reservation's federally funded SUDs treatment program. Given a variety of logistical and methodological constraints, the pilot offering of the culture camp primarily served as a demonstration of "proof of concept" for this alternative indigenous intervention. In presenting and reflecting on this effort, we consider many challenges associated with alternative indigenous treatment models, especially those associated with formal outcome evaluation. Indeed, we suggest that the motivation for developing local indigenous alternatives for AIAN SUDs treatment may work at cross-purposes to the rigorous assessment of therapeutic efficacy for such interventions. Nevertheless, we conclude that these efforts afford ample opportunities for expanding the existing knowledge base concerning the delivery of community-based psychological services for AIANs. (PsycINFO Database Record (c) 2015 APA, all rights reserved).
    Psychological Services 05/2015; 12(2):83-91. DOI:10.1037/ser0000013 · 1.08 Impact Factor


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