SAN FRANCISCO – The foundational beliefs of American Indian and Alaska Native communities play a key role in innovative substance abuse treatment programs, research has shown.
That’s a novel finding that could challenge conventional notions of culturally based care, Dr. Douglas K. Novins said at the annual meeting of the American Academy of Child and Adolescent Psychiatry.
Dr. Douglas Novins
In an ongoing study, he conducted hour-long interviews with 20 administrators and 15 focus groups with clinicians lasting 90 minutes each at 18 alcohol and substance abuse treatment programs serving American Indian and Alaska Native communities. The programs were chosen by an advisory board on the basis of their reputations for innovative services and to ensure a diversity of programs in the study.
Dr. Novins and his associates found that the programs included traditional practices and Western models of treatment, as has been reported in previous studies. The traditional practices might include crafts or jewelry making, drumming, singing, or fishing by bringing in tribal elders or Native American occupational therapists. The Western element typically included something similar to 12-step programs. That merging of 12-step approaches and traditional practices has been controversial among some American Indian and Alaska Native people.
The new finding is the emphasis that these programs place on the foundational beliefs of their cultures – the importance of community and family, meaningful relationships with clients and respect for clients, a homelike atmosphere in the program setting, and an open door policy that never turns clients away (Psychiatr. Serv. 2012;63:686-92).
These core values validate and incorporate the world view of American Indian and Alaska Native cultures, which see individuals as contained in a circle of family, within a circle of community, within a circle of the spirit world. "Many Native peoples will tell you that substance abuse is a sign of broken circles," said Dr. Novins of the University of Colorado, Aurora.
Previous research suggests that the long history of multigenerational traumas experienced by Native Americans as their cultures have been eradicated by nonnatives is a primary cause of substance abuse, he said. Almost all the programs studied incorporate Wellbriety (a treatment model that tries to merge 12-step treatment approaches with Native American beliefs and culture), but the programs made informal adjustments as they went along, Dr. Novins said. They addressed the historical trauma of Native Americans and incorporated culturally specific images, medicine wheels, and circles.
There are many challenges to basing treatment on the fundamental beliefs and values of Native peoples. The open-door policy, especially, "is tough if you come from an allopathic place," he said. Cultural competence in this regard means not turning away someone who comes to you without an appointment. You see them or ask them to wait until you’re done with what you’re doing, and then see them. It means that when a client telephones to say the police are at his house and he wants you to come talk to them, you go, he said.
The great diversity of Native tribes and their general lack of resources also create challenges to disseminating these innovative treatment models. There is great pressure to implement evidence-based practices, clinician burnout is a problem, and the socioeconomic hurdles might seem insurmountable. The success of substance abuse treatment programs might depend on blending evidence-based practices with the Native American cultural emphasis on community, family, relationships, and respect, Dr. Novins said.
Ten of the programs in the study are on reservations, three are in nonreservation rural areas, and five are in urban areas, where most Native American people live today. Only approximately 2% of the Indian Health Service budget goes to urban areas, Dr. Novins noted.
Participants in the study’s interviews received up to $300 worth of educational and clinical materials of each program’s choosing.
The investigators now are finishing the final phase of the study – a survey of 193 tribal substance abuse and treatment programs across the United States.
Dr. Novins reported that he had no relevant financial disclosures. The National Institute on Drug Abuse is funding this research.
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