American Indians and Alaska Natives with substance abuse disorders who participated in a 12-week drum-assisted therapy program experienced significant improvements in mental health and psychological characteristics, as measured by the Addiction Severity Index, Native American version.
The findings, which stem from the first federally funded study of its kind, hold promise as a way to weave cultural traditions into addiction treatment efforts. "Throughout the United States, tribal leaders, elders, substance abuse providers, and administrators who serve this population feel there’s a need for more cultural-based treatments in general for Native Americans, including drumming or sweat lodge or bead making," said Dr. Daniel L. Dickerson, an assistant research psychiatrist with the integrated substance abuse programs at the University of California, Los Angeles.
About 5 years ago, Dr. Dickerson, whose mother is an Alaska Native from the Inupiaq indigenous group, devised a plan with a substance abuse counselor to create a drum-assisted therapy program for American Indians/Alaska Natives. With a research grant from the National Center for Complementary and Alternative Medicine, a division of the National Institutes of Health, Dr. Dickerson and his colleagues conducted six focus groups and enrolled five men and five women in a program that incorporated drumming activities within a culturally relevant format that took place during 3-hour treatment sessions twice per week for 12 weeks. During the first session, the study participants built a powwow drum they used as the focus of their treatment.
"For Native Americans, the drum is a very sacred instrument," explained Dr. Dickerson, also an assistant research psychiatrist at the Semel Institute for Neuroscience and Human Behavior at UCLA. "It symbolizes what many Native Americans describe as being the heartbeat of Mother Earth, so to speak. The songs that are sung with drumming often have a sacred component relating to their ancestry, stories, and traditions.
"So when they make the drum, they have the opportunity to learn about the purposes and history of the tribal traditions in drumming. When they make the drum, they feel like they have a sense of ownership in their own recovery process."
Participants in the UCLA open trial ranged from 19 to 67 years of age and underwent assessments at baseline, 6 weeks, and 12 weeks, including urine drug screens and breathalyzer tests, and the Addiction Severity Index, Native American version, to assess mental health and psychosocial characteristics. By the end of the trial, all study participants demonstrated significant improvements in the ASI psychological and medical composite scores, and in fatigue and spirituality, as measured by the Functional Assessment of Chronic Illness Therapy (FACIT)–Fatigue (version 4) and the FACIT–Spiritual Questions Only–Expanded.
"I was surprised we had statistical significance with such a small sample size," Dr. Dickerson said. "It’s promising, and we would anticipate good results in a larger trial as well."
When the treatment sessions ended, many of the study participants expressed favorable impressions of the program. "A lot of American Indians and Alaska Natives have had limited opportunities to participate in their own cultural healing activities," Dr. Dickerson said. "The program participants said they felt a real connection with their culture and felt that really helped them with their recovery process. We had people say it helped them with their stress, with feeling less depressed, and feeling more spiritual.
"One of the participants said, ‘I’m grateful. It’s my time to reconnect with the cultural, traditional way of life and find out who I really am and where I come from.’ "
Most of the 10 people who enrolled in the trial "did not grow up with their tribal traditions," he noted. "Ideal candidates for this therapy may be people who do not have a lot of knowledge of their own tribal traditions or who have strayed away from their traditional practices. This offers them an opportunity to reconnect with their culture and use the wellness concepts for recovery. This program was for adults, but in the future, we’d like to try it with youth."
More than 560 federally recognized tribes are in the United States, Dr. Dickerson said, each with its own traditions. "That goes for drumming as well," he said. "We recommend that each tribal community use their own traditions."
Dr. Dickerson said gender plays a role in the way in which each patient participates in the therapy. "In most tribes, women don’t drum," he said. "They accompany the men in drumming with dancing or singing or both."
One factor that varies depending on the tribe is whether one large powwow drum or individual drums are used, he said. For the UCLA trial, patients used a single large powwow drum.