substance abuse and effective treatment for adult american indians and alaska natives: culture and...
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Substance Abuse and Effective Treatment for Adult American Indians and Alaska Natives: Culture and Resilience over Addiction
MICHELE HENSON, B.S., C.H.E.S.
MPH CANDIDATE, UNIVERSITY OF ARIZONA
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Abstract
From a life-course perspective, adults play an important role in shaping proximal environments
Substance abuse has a bi-directional relationship with health disparities
Substance abuse rates vary greatly among AIAN communities
Overall substance abuse rates have not changed in decades
Many have concluded that the lack of culture in substance abuse treatment is a downfall in current treatment regimes
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Methods
Literature search of PubMed Central using the search term “adult American Indian Alaska Native substance abuse treatment programs”
Inclusion criteria were:
(1) written in English
(2) discuss substance abuse treatment
(3) population of interest is adult American Indians and/or Alaska Natives
(4) peer reviewed publications between 1970-2013
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Results
A total of 26 articles met
all criteria and were
included in this literature
review
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Results: 4 Main Themes Emerged from a Nominal Classification
Persistent Challenges
Protective/Recovery Factors
Current Trends in Treatment
Culture in Treatment
Culture as Treatment
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Protective/Recovery Factors
Positive family relationships
High degree of social support and spiritual involvement as both a protective and recovery factor
Brave Heart, 2011
More likely to recover if:
Married
Gilder et al., 2010
Have children
Torres Stone et al., 2005
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Protective/Recovery Factors
Enculturation
“…Enculturation serves as a resiliency factor that may protect against alcohol misuse or serve as an important curative factor in alcohol treatment programs”
Torres Stone et al. (2006)
Those with low traditional culture orientation were 4+ times more likely to drink heavily
Herman Stahl et al. (2003)
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Protective/Recovery Factors
Biculturalism Feeling comfortable in identifying with both traditional culture
and the majority culture
The lowest rates of substance abuse were found in AIANs who processed healthy biculturalism
Blume & Escobedo (2005)
Szlemko et al. (2006)
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Trends in Current Treatment
General requirement for the use of Evidence-Based Treatments (EBTs) Required for grant funding and Indian Health Service and
Medicaid reimbursement
AIANs are typically not included in study population of the evaluation of EBTs
Sklemko et al. (2006); Novins et al. (2011)
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Trends in Current Treatment
Problems with the use EBTs in the AIAN population: Culturally inappropriate
Naquin et al. (2008); Hartmann & Gone (2011); Novins et al, (2011); Wexler (2011)
Self-reported feelings of incompatibility and lack of comfort Walls et al. (2006); Hartmann & Gone (2011); Novins et al, (2011); Wexler
(2011)
“No room” for culture in EBTs Sklemko et al. (2006); Novins et al., (2011)
Many AIANs have stated preference for cultural (non-EBT) treatment that is rooted in traditional healing and indigenous knowledge
Walls et al. (2006); Hartmann & Gone (2011)
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Culture in Treatment
Inherent within AIAN culture are traditional ways of healing and
ways of knowing
Many AIANs who have successfully recovered attribute that
success to a return to his or her tradition culture
Torres Stone et al. (2006); Walls et al. (2006); Gone and Calf Looking
(2011)
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Culture in Treatment
AIANs identify with their traditional cultures in
different ways and to different degrees
AIANs may not want to abandon the use of Euro-
American (‘western’) models of treatment completely
Appropriate treatment will depend on degree of
personal cultural identification
Choices between or integrating both healing methods
is preferred and necessary
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Culture as Treatment
High substance abuse rates are a result of loss of traditional beliefs and culture
Szlemko et al. (2006)
Brave Heart (2011)
Culture revitalization has the potential to create health benefits beyond sobriety including: Ability to relieve stress and treat co-morbidities
Root causes of substance addiction
Strengthen AIAN families (protective factor)
Create healing effects on entire AIAN communities Trauma (a root cause of substance abuse) is shared by AIAN populations
and communities
Brave Heart (2011); Gone and Calf Looking (2011)
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Successful Treatment Recommendations
Increase the capacity to incorporate culture into treatment Culture as a dominant force in treatment
Bicultural skills training
Shift community social norms (passive acceptance)
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Resilience in AIANs in regards to Substance Use
Remission rates of AIAN substance abusers have been reported to be as high as 75%
Successful AIAN driven sobriety movements: Eskimo Spirit Movement (Inupiaq Ilitqsat)
Ceremonies sponsored by the Native American Church
Handsome Lake Movement
Red Road Sobriety movement
AIAN communities self-determining alcohol policies
Many AIAN communities report higher rates of abstinence than the general population
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Discussion
35% listed the lack of accessible health care and substance abuse treatment as a major barrier to reducing substance abuse rates
58% outlined the efficacy of culture incorporation in AIAN substance abuse treatment
38% made the claim that EBTs are not improving but limiting the successful outcomes of substance abuse treatment
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Discussion- Where do we go from here?
EBTs are not the best treatment method for everyone
EBT requirement are limiting innovative treatment practices
If the EBT requirement is to remain, some have suggested testing cultural healing and substance treatment practices
Problems with ‘testing’ cultural substance abuse treatment methods: Some AIAN communities may not feel comfortable ‘testing’ their sacred
healing methods Differences/uniqueness of cultures
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Recommendation
Reevaluate the EBT requirement for funding and reimbursement for AIAN substance abuse treatment regimes Move from ‘Evidence-based’ to ‘Practice-based’ requirement Enables AIANs to access treatment that works for them Allows for further AIAN self-determination
Seek out those who have successfully recovered from addiction and identify factors that contributed to recovering Give voice to those who have recovered in peer-reviewed
literature
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Contact Info and Special ThanksMichele Henson [email protected]
Special thanks to the Center for American Indian Resilience
This work was supported by the Center for American Indian Resilience (CAIR) a NIH-NIMHD P20 Exploratory Center of Excellence
(1P20MD006872) awarded to Northern Arizona University with subcontracts to University of Arizona and Dine College
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SourcesBlume, A.W., Escobedo, C.J. (2005). Best Practices for Substance Abuse Treatment Among American Indians and Alaska Natives: Review and Critique in Best Practices in Behavioral Health Services for American Indians and Alaska Natives. One Sky National Resource Center For American Indian and Alaska Native Substance Abuse Prevention and Treatment Services, 77-94
Brave Heart, M. Y. H. (2011). The Historical Trauma Response Among Natives and Its Relationship with Substance Abuse: A Lakota Illustration. Journal of Psychoactive Drugs 35 (1), 7-13.
Gilder, D.A., Lau, P., Corey, L., Ehlers, C. (2008). Factors Associated with Remission from Alcohol Dependence in an American Indian Community Group. American Journal of Psychiatry 165(9), 1172-1178.
Gone, J.P., Calf Looking, P.E. (2011). American Indian Culture as Substance Abuse Treatment: Pursing Evidence for a Local Intervention. Journal of Psychoactive Drugs 43(4), 291-296
Hartmann, W.E., Gone, J.P. (2012). Incorporating Traditional Healing Into an Urban American Indian Health Organization: A Case Study of Community Member Perspectives. Journal of Counseling and Psychology 59(4), 542-554.
May, P.A. (2005). History and Challenges in Substance Abuse Prevention Among American Indian Communities in Best Practices in Behavioral Health Services for American Indians and Alaska Natives. One Sky National Resource Center For American Indian and Alaska Native Substance Abuse Prevention and Treatment Services, 1-24.
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SourcesNaquin, V., Manson, S.M., Curie, C., Sommer, S., Daw, R., Maraku, C., Lallu, N., Meller, D., Willer, C., Deaux, E. (2008). Indigenous Evidence-Based Effective Practice Model: Indigenous Leadership in Action. The International Journal of Leadership in Public Services 4(1), 14-24.
Novins, D. K., Aarons, G.A., Conti, S.G., Dahlke, D., Daw, R., Fickenscher, A., Fleming, C., Love, C., Masis, K., Spicer, P. for the Centers for American Indian and Alaska Native Health’s Substance Abuse Treatment Advisory Board (2011). Use of the evidence base in substance abuse treatment programs for American Indians and Alaska natives: pursing quality in the crucible of practice and policy. Implementation Science 6(63). 1-12.
Szlemko, W. J., Wood, J.W, Thurman, P.J. (2006). Native Americans and Alcohol: Past, Present, and Future. The Journal of General Psychology 133(4), 435-451.
Torres Stone, R., Whitbeck, L.B., Chen, X., Johnson, K., Olson, D.M. (2006). Traditional Practices, Traditional Spirituality, and Alcohol Cessation Among American Indians. Journal of Studies on Alcohol 67(2), 236-244.
Walls, M.L., Johnson, K.D., Whitbeck, L.B., Hoyt, D.R. (2006). Mental Health and Substance Abuse services Preferences among American Indian People of the Northern Midwest. Community Mental Health Journal 42(6), 521-5356. 3
Wexler, L. (2011). Behavioral Health Services “Don’t Work for Us”: Cultural Incongruities in Human Services Systems for Alaska Native Communities. American Journal of Community Psychology 2011(47), 157-169.
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Questions?