Background
Methods
Results
Yield
Characteristics of programs and interventions
Author and Location (Country/Region) | Program type and length | |
---|---|---|
Cultural interventions | Western interventions | |
Scientific literature
| ||
Anderson, 1992/CAN/ BC [40] | Community treatment centre: 6 week alcohol addiction program. | |
• Ceremonial practice (some smudging done each morning, but used more by staff than clients). | • Group sessions (the entire client population of six families per 6 week session, meet together 3-5 times a week for half a day. In this "circle," communication, listening and attending are established founded on mutual respect and unconditional positive regard). | |
• Land base activities (focus on healing qualities of the physical site). | • Family counseling. | |
• Social culture (community and social activities of community suppers, food shopping, chapel services, and recreational pursuits such as fishing and volleyball, helped clients relate as families and neighbors without alcohol). | • Alcoholics Anonymous meetings. | |
• Individual and couples counseling sessions and special work with children and young adults. | ||
Boyd-Ball, 2003/US/ Pacific NW [41] | Residential: 8 week alcohol and drug addiction program in study known as Shadow Project. Comparison of (culturally supplemented) Treatment As Usual (TAU) and treatment with family-enhanced intervention. | |
• Sweat lodge. | • Individual therapy. | |
• Ceremonial practice (a Welcome Home ceremony involving family and community support- for the family-enhanced intervention; naming ceremony). | • Group therapy. | |
• Land base activities (wilderness outings, a Welcome Home ceremony involving family and community support for the family-enhanced intervention). | • 24-hour supervision. | |
• Traditional teachings- studied individual tribal histories. | • Psychiatric and psychological services. | |
• Singing. | • Assessment and referral. | |
• Cultural instruments (drumming). | • Life-skills counseling. | |
• Story-telling—used in the family-enhanced intervention only. | • Medical services. | |
• Art creation (crafts). | • Education programs. | |
• Elders (access to spiritual elders). | • Family programs. | |
• Aftercare planning. | ||
Boyd-Ball et al, 2011/US/ Western regions (from 8 States) [42] | Residential: 7 week substance use treatment emphasizing traditional practices at the “WAIT” Center. Post-treatment substance use trajectories were correlated with self-report measure of general American Indian (AI) cultural involvement. | |
• Sweat lodge (“sweats”). | • Family management. | |
• Other ceremonial practice (not specified). | ||
• Post-treatment social cultural participation (speculation that perhaps adolescents were prepared in treatment for greater involvement in tribal culture & traditions on returning home). | ||
Dell & Hopkins, 2011/CAN/across Canada [43] | Residential: 4-6 month solvent use program. | |
• Fasting. | • Treatment and support based in resiliency theory. | |
• Land base activities (land-based cultural camps). | • Support for development of emotional intelligence, personal wellness care practices, and leadership skills (within a positive psychology framework). | |
• Traditional teachings (Elders’ teachings). | ||
• Social culture (inclusion of community members in the treatment centers). | ||
• Natural foods and medicines (ceremonial feasts). | ||
• Elders (Elder guidance). | ||
Dell et al, 2011/CAN ON [44] | Residential: 12 week 1 h per week, Equine assisted learning (EAL) curriculum added to a 4 month solvent use program at Nimkee NupiGawagan Healing Centre (NNHC). | |
• Land base activities (Equine Assisted Learning programs help make a connection to nature and the horse(s) within a natural environment). | According to Bresette (2009/2010), NNHC offers: | |
• Other cultural aspects to the program in addition to the equine therapy includes: Bi-weekly sweats, Welcoming Feasts, Full Moon ceremonies, Memorial Feasts, Spring Releasing ceremony, Spring and Fall Fasting, Youth Naming Ceremonies, Berry picking, Rites of passage ceremonies (i.e., Berry Fast), Pow-wows, Gardening, 1-1 cultural teachings, Traditional healer visits. | • Individual and group counseling therapy. | |
• Learning centre and work placements. | ||
• Nutrition program. | ||
• Health care. | ||
• Recreation activities, including attending sporting events. | ||
• Aftercare planning and follow-up. | ||
Edwards, 2003/US/CA [45] | Residential: 90 day substance use program and 90 day aftercare program, at Friendship House. | |
• Sweat lodge. | • Individual and group counseling. | |
• Traditional teachings (the re-traditionalization process teaches clients about Native American values and traditions in classes such as "The Red Road" based on the work of Gene Thin Elk (1993) and "Native American Family Values"). | • Co-dependency group work. | |
• Singing. | • Alcohol, drug, and HIV/AIDS education. | |
• Cultural instruments (drumming). | • Alcoholics Anonymous and Narcotics. | |
• Talking circle. | • Education about historical Native American traumas. | |
• Social cultural (Friendship House celebrations, personal relationships with the Native American staff members). | ||
• Traditional healers (Medicine people). | ||
Gossage et al, 2003/US/AZ [46] | Prison-based: Sweat lodge ceremony offered to prisoners to treat alcohol addiction. | |
• Sweat lodge. | • Alcohol education. | |
• Group psychotherapy. | ||
D’Silva et al, 2011/US/MN [47] | Community-based: 4, 1 hr. individual or group tobacco cessation sessions paired with pharmacotherapy. | |
Culturally modified the American Lung Association’s ‘Freedom from Smoking’ program incorporating: | • Community outreach and education. | |
• Traditional teachings on how to use tobacco as a sacred item in ceremonies and offerings. These teachings are designed to help participants understand the difference between sacred tobacco use and commercial tobacco addiction. | • Clinical system referrals. | |
• Story-telling – cultural adaptations were made to counseling sessions based on suggestions from key community stakeholders, and included the addition of Ojibwe stories. | • Individual and group counseling. | |
• Language (use of Ojibwe language in treatment sessions). | • Access to nicotine replacement therapies (NRT) and prescription medications. | |
Lowe et al, 2012/US/OK [48] | Community-based: Two types of substance use interventions: 1) Cherokee Talking Circle (CTC), a culturally based, 10, 45 min intervention and 2) Be A Winner/Drug Abuse Resistance Education (DARE), 10, 45 min standard sessions. | |
The Cherokee Talking Circle intervention incorporated: | DARE education program: | |
• Language (the manual used both English and Cherokee languages). | • Promotes a school/law partnership approach to substances/ drug education. | |
• Talking circle. | ||
1Naquin et al, 2006/US/AK [49] | Residential: Alcohol addiction treatment program within the Ernie Treatment Centre, under the Cook Inlet Tribal Council (CITC) called the Therapeutic Village of Care. Treatment is organized into three phases: Orientation, Stabilization, and Right Living. The length of time in each phase depended on resident’s treatment plan or progress. | |
• Sweat lodge (steam bath similar to an American Indian sweat lodge). | CITC offers: | |
• Ceremonial practice (harvesting moose (road killed)). | • Street outreach. | |
• Social culture (residential treatment community functions as a large extended family: Members assume the roles of ‘aunties’ and ‘uncles’; mature members teach and mentor other, newer family members and help them reconnect with their family histories and culture by sharing their knowledge of tribal genealogies; staff participate as equals, modeling appropriate family roles and relationships. They also serve as guides, facilitating the healing process through role modeling and participation in, but not control of, the community). | • Case management. | |
• Elders (assume traditional role and are a constant reminder to residents of unspoken Native cultural norms). | • Screening and brief intervention. | |
• Art creation (carving). | • Assessment and brief treatment. | |
• Emergency care and detoxification. | ||
• Intermediate residential, outpatient and continuing care. | ||
1Nebelkopf & Penagos, 2005/US/CA [50] | Residential, Health Centre, and Outpatient: HIV/AIDS, substance use, and mental health programs are offered under the Holistic Native Network (HNN). | |
There were seven projects that comprise the HNN. Four of these projects focus on substance use (Native Youth Circle, FH Healing Circle, Urban Native Youth, and Native Women). The remainder are concerned with mental health or HIV/AIDS. Types of cultural interventions and examples are provided below: | HNN offers: | |
• Sweat lodge (monthly gatherings where members of the community where members of the community come together in a spiritual way). | • Residential treatment. | |
• Natural foods and medicines (traditional herb consultations). | • Outpatient counseling (individual, group or family counseling). | |
• Cultural instruments (drum group). | • Case management. | |
• Talking circle. | • Community outreach. | |
• Traditional teachings (discuss the Red Road to Recovery). | • Risk-reduction counseling. | |
• Art creation (beading class). | • Psychotherapy. | |
• Social culture (Pow-wows, barbecues, dinners, ceremonies, give-aways, health fairs and other rituals are planned monthly and with the changing of the seasons). | • Art therapy. | |
• Traditional healers (a central component at community events). | • Home visits. | |
1Nebelkopf & Wright, 2011/US/CA [51] | Community-based: Substance use treatment within the Native Men and Native Women Program. | |
The program is one of three described under the Family and Child Guidance Clinic (FCGC) of the Native American Health Center, Holistic System of Care (HSOC) for Native Americans in an Urban Environment. The other two are not of primary interest as they focus on prevention and children’s mental health. The HSOC model includes: | FCGC offers: | |
• Individual, group and family counseling. | ||
• Sweat lodge. | • Care coordination. | |
• Ceremonial practice (seasonal ceremonies, smudging). | • Psychological assessment. | |
• Traditional teachings (discuss the Red Road to Recovery). | • Screening. | |
• Prayer. | • Alcohol and drug prevention programs for youth and adults. | |
• Social culture (four-day Gathering of Native Americans (GONA)). | • HIV/AIDS prevention. | |
• Story-telling. | • Youth Services program: Drop-in centre, after-school services, tribal athletics, and substance abuse prevention. | |
• Talking circle. | ||
Saylors, 2003/US/CA [52] | Residential: Substance use treatment provided by the Women’s Circle at two Native American Health Centres. | |
Cultural interventions often occur at an individual level, with counselors assessing a client's desire or readiness to work with traditional ways. A counselor's initial clinical assessment contains spiritual/cultural domains that allow him/her to gauge a client's cultural affiliation and identification. This helps direct the development of a treatment plan which may include: | • Psycho-therapeutic practice. | |
• Sweat lodge. | • Family and Child Guidance Clinic provides the services of a nurse case manager and perinatal social worker. | |
• Singing. | ||
• Cultural instruments (drumming). | ||
• Natural foods and medicines (herbs and tobacco). | ||
• Traditional healers (Native healers from different cultural backgrounds and traditions are brought in for several days at a time to work with clients). | ||
• Prayer (some counselors pray with clients at the client's request). | ||
• Ceremonial practice (sage, cedar or sweet grass smudges are often incorporated into a counseling session). | ||
• Talking circles (held regularly at the clinic for clients and staff). | ||
Wright et al, 2011/US/CA [53] | Residential and Outpatient: Mental health and substance use treatment at the Native American Health Center (NAHC) using the Holistic System of Care (HSOC) service provision framework. | |
Native American culture is integrated into treatment in the following ways: | HOSC offers: | |
• Sweat lodge. | • Treatment (mental health, substance use, medical, and family services). | |
• Ceremonial practice (seasonal ceremonies, smudging). | • Prevention (wellness education, positive parenting intervention, mental health promotions, addiction prevention, hepatitis prevention, and HIV/AIDS prevention). | |
• Traditional teachings (self-directed learning: Drawing on intertribal similarities, counselors also work with individuals to develop skills and use healing practices that includes individual backgrounds, traditions, practices, and stories). | • Recovery services (employment, housing life skills, and community service (giving back)). | |
• Natural foods and medicines (herbs). | • Peer support. | |
• Cultural instruments (drumming). | ||
• Talking circle. | ||
• Social culture (Pow-wows, women’s/men’s/youth societies, GONA, Positive Indian Parenting (OIO)). | ||
• Prayer. | ||
• Story telling. | ||
• Traditional healers (Native healers from different cultural backgrounds and traditions are brought in for several days at a time to work with clients). | ||
Grey Literature
| ||
Bresette, 2009/ 2010/ CAN/ON [54] | Residential: 4 month solvent addictions treatment provided at Nimkee NupiGawagan Healing Centre Inc. | |
• Sweat lodge (bi-weekly, staff sweats). | Centre offers: | |
• Fasting ceremony (spring and fall fasting). | • Individual and group counseling therapy. | |
• Ceremonial practice (Full Moon ceremonies, Spring Releasing Ceremony, youth naming ceremony, rites of passage ceremonies, smudging. Multicultural and certified staff (Anishnaabe, Haudenosaunee, Lenni-Lenape) accommodate specific cultural and healing experiences). | • Learning centre and work placements. | |
• Land base activities (gardening, equine program). | • Nutrition program. | |
• Traditional teachings (one to one cultural teachings). | • Health care. | |
• Social culture (Pow-wows). | • Recreation. | |
• Natural foods and medicines (welcoming feasts, memorial feasts, berry picking). | • Aftercare planning and follow-up. | |
• Singing. | • Community education and training. | |
• Cultural instruments (drumming). | ||
• Prayer. | ||
• Language (encourages and reinforces communication in original language). | ||
• Traditional healers. | ||
D’Hondt, no year/CAN/ON [55] | Residential: 21 day cycle substance use treatment cycles at the Centre for Addiction and Mental Health Addiction Program (CAMH). | |
• Ceremonial practice (smudging). | Document lists the following services for pilot program: | |
• Cultural instruments (drumming). | • Employment and housing for treatment graduates. | |
• Aftercare programs. | ||
CAMH, in general, offers a variety of services (see: http://www.camh.ca/en/hospital/care_program_and_services/addiction_programs/Documents/3882ABS_brochurestnd.pdf | ||
Including: | ||
• Intake and assessment. | ||
• Individual, couple and family counselling. | ||
• Talking circles and group work. | ||
• Telephone counselling. | ||
• Training, consultation and capacity building. | ||
• Inpatient and outpatient treatment programs. | ||
• Referrals. | ||
Kunic, 2009/CAN/across country [56] | Prison-based: Aboriginal Offender Substance Abuse Program (AOSAP) offered to male offenders involving four modules and 65 sessions. | |
• Sweat lodge. | AOSAP offers contemporary best-practices in substance use treatment, such as cognitive-behaviourism, social learning theory, and relapse prevention. | |
• Ceremonial practice (sacred sweat ceremonies plus other ‘traditional ceremonies’ relevant to the place in which they are conducted, however no detail as to what these ceremonies are is provided). | ||
• Traditional teachings (particularly within the Modules 1 and 4, e.g., power of the circle of wellness). | ||
• Natural foods and medicines (sacred medicines introduced in Module 4). | ||
• Social culture (The Western Door (Module 3), which is 14 sessions in length, focuses on the history of consequences and the impact of substance use within Aboriginal communities. It also explores the devastating effects of substance use on Aboriginal individuals, families, and communities, and how changing individual behavior can result in the restoration of health, pride and culture). Module 2- Aboriginal spiritual engagement is facilitated through the introduction and exploration of the impact of trauma and how substance use was, and still is, a means by which Aboriginal people tried/try to cope with its effects). | ||
• Talking circle. | ||
McConnery & Dumont, 2010/CAN/QC [57] | Residential: 5 week alcohol and substance addiction treatment program at Wanaki Centre. | |
• Sweat lodge. | • Cognitive-behavioural therapy. | |
• Ceremonial practice (letting go ceremony after Sweat lodge. Have a Closing of the Sacred Fire ceremony with the Elder that provides closure for the entire treatment cycle. Smudging daily). | • Life skills training. | |
• Land base activities (teaching and experiences that build connections to creation/nature- clients go in the forest to collect cedar and balsam for the Sweat Lodge ceremony. Spending time in the woods with an Elder). | ||
• Traditional teachings (delivered by an Elder: Sacred Fire, Pipe Keeper, four medicines, blessing of the water, teachings for women such as moon time and women’s dress, teaching of the lodge. Also have traditional Algonquin teachings. Adhere to the philosophy of 1) Red Road – involves a strict code of conduct and ethics, the foundation being respect for oneself and for other people and the environment in all its forms. 2) Medicine Wheel: Mental, emotional, spiritual, and physical). | ||
• Social culture. | ||
• Natural foods and medicines (have a cooking workshop to make traditional foods. A traditional meal is offered to clients, staff and guests at the graduation ceremony). | ||
• Singing (songs are used with the Blessing of the Water teaching). | ||
• Cultural instruments (drumming is used with the Blessing of the Water teaching). | ||
• Language (use of Algonquin language). | ||
• Talking circle (Sharing circle—the Eagle Feather is used here. Healing circles lead by Elder). | ||
• Elders (Elders from the community and abroad deliver the teachings and traditional components of the program). | ||
• Art creation (Grieving collage made of pictures cut out of magazines, representing images that touched them personally and they present their collage to the group. Create a family genogram showing family members who suffered from addictions. Make dream catchers and grieving bags). | ||
• Prayer (daily). | ||
1The Tsow Tun Le Lum Society, no year/ CAN/BC [58] | Residential: 42 day alcohol and drug treatment program provided at the Tsow Tun Le Lum Society. | |
• Sweat lodge. | • Client outreach. | |
• Ceremonial practice (traditional food burnings at least twice per year). | • Community networking and development. | |
• Land base activities (spring-fed pond for traditional cleansing). | • AA and NA meetings. | |
• Singing. | • Aftercare. | |
• Dancing. | ||
• Cultural instruments. | ||
• Elders (Elders lead the morning “Spiritual Room” session that begins each program day. Healthy reconnection to “being Indian” is the goal of the unique Elder component). | ||
• Prayer. |
Location
Type and length of treatment programs
Interventions provided
Study samples, designs and methods
Study | Samples | Designs | Methods |
---|---|---|---|
Scientific Literature
| |||
Anderson, 1992 [40] | 63 clients: 39 clients were 1-2 years out of treatment; another 24 clients had gone through the program less than a year before. | Qualitative: Ethnographic study whereby the author and another researcher resided in the community for two months. They observed and participated in the 6 week program. | Mixed methods—Interviews with clients post-treatment (open-ended, face-to-face, frequently with multiple interviews of the same persons and usually in family contexts), observations of treatment, personal testimonies and materials written by staff and clients. |
Boyd-Ball, 2003 [41] | 57 clients (and their families): 31 males; 26 females; mean age: 16 years old. | Quasi-experimental: Non-equivalent control group. Comparison of (culturally supplemented) Treatment As Usual (TAU) and TAU with culturally and historically family-enhanced intervention. | Surveys—All clients (and their families) followed up and assessed monthly for 11 months from the day they left treatment. Follow-ups were also done the third and final year of the study. |
Boyd-Ball et al, 2011 [42] | 57 clients (and their families): 32 males; 25 females; mean age: 16 years old. | Quasi-experimental: Time-series. Post-treatment substance use trajectories were correlated with self-report measure of general American Indian (AI) cultural involvement. | Mixed methods—Surveys, interviews, and observation. Data were collected in three waves: baseline, monthly for 11 months post treatment, and at exit interview 12 months following treatment. |
Dell & Hopkins, 2011 [43] | 154 youth. | Quasi-experimental: Time-series data used to provide insights into the Youth Solvent Abuse Program (YSAP) treatment program outcomes. | Surveys at 3, 6, 9 and 12 month intervals. |
Dell et al, 2011 [44] | 15 youth (two intakes of program): 7 males; 8 females; mean age: 14-15 years old; 6 treatment staff. | Qualitative: Exploratory, phenomenology study to understand the experiences of First Nations and Inuit youth participating in an Equine-Assisted Learning (EAL) program as part of their healing from solvent addiction while in a residential Treatment Centre. | Mixed methods—Interviews with youth and staff held during last week of program (semi-structured, face-to-face), researcher observations, written reflections by researchers, program facilitators and staff of EAL program, and journal responses by youth during the program. |
D’Silva et al, 2011 [47] | 317 adults. | Quasi-experimental: Time-series. A single-group design involving an evaluation of a culturally specific curriculum for tobacco dependence treatment. | Mixed methods—Self-reported tobacco use assessed at baseline, exit, and follow-up included current smoking behaviours and quit attempts; seven-day point-prevalence abstinence measured at exit and follow-up; and pharmacotherapy data obtained from program records. |
Edwards, 2003 [45] | 12 adults: 6 males; 6 females; age range: 23-51 years old. | Qualitative: Grounded theory study to understand and document the experience of substance use recovery from the perspective of the Native Americans in treatment. | Interviews—single, face-to-face, conducted after completion of the 90 day residential substance use treatment program. |
Gossage et al, 2003 [46] | 190 males: mean age: 30 years old. The sample was divided into two groups: IPsFU and IPsNFU. The size of each group varied by stage of measurement but generally there were equal numbers in both groups. | Quasi-experimental: Time-series and comparison between inmate/patients (IPs) who were followed-up (IPsFU) vs. those not followed-up (IPsNFU) to advance current knowledge about the efficacy of Sweat Lodge Ceremony. It is unclear what follow-up entailed. | Surveys—Four different surveys used at distinct stages: baseline; multiple times after sweat lodge experiences; and 3 and 9 months after release. |
Lowe et al 2012 [48] | 179 students: Intervention #1—92 students: 59 males; 33 females; mean age: 17 years old; Intervention #2—87 students; 44 males; 43 females; mean age: 16 years old. | Quasi-experimental: Non-equivalent control group. Two condition design: 1) Cherokee Talking Circle (CTC) and 2) Be A Winner/Drug Abuse Resistance Education (SE). | Surveys—Three instruments used to make comparisons at pre-intervention, immediate post-intervention, and 90 day post-intervention. |
2Naquin et al, 2006 [49] | 399 clients: 203 males; 196 females. | Pre-experimental: One-shot case study examining resident engagement with treatment process and outcomes at a single Treatment Centre. | Mixed methods—Time in treatment/retention rates compared to earlier years and national averages and Surveys—post-treatment perception of care; 6 month follow-up of level of employment and use of alcohol. |
1Nebelkopf & Penagos, 2005 [50] | 45 individuals: 39 males; 5 females; 1 transgender. | Pre-experimental: One group pretest-posttest examining changes in clients’ quality of life as a result of services received through the Holistic Native Network. | Survey—Pre-post survey at baseline and 3 months after care. |
1Nebelkopf & Wright, 2011 [51] | 490 adults: 142 males; 348 females. | Pre-experimental: One group pretest-posttest involving adult substance users to assess whether the Holistic System of Care for Native Americans is a viable model of treatment. | Survey—Pre-post survey at baseline and 6 months after care. |
Saylors, 2003 [52] | 742 females. | Pre-experimental: One group pretest-posttest to assess lessons learned and impact of the Substance Abuse Treatment Women’s Circle on clients. | Survey—Pre-post survey at baseline and 12 months follow-up. |
Wright et al, 2011 [53] | 490 participants: 142 male; 348 females; mean age: 36 years old. | Pre-experimental: One group pretest-posttest to assess preliminary outcome findings of substance abuse outpatient and residential treatment services for urban American Indians and Alaskan Natives under the Holistic System of Care model of treatment. | Survey—Pre-post survey at baseline and 6 months after care. |
Grey Literature
| |||
Bresette, 2009/ 2010 [54] | 27 clients: 9 males; 18 females, mean age: 16 years old. | Quasi-experimental: Time-series to execute an impact evaluation of the Nimkee NupiGawagan Health Centre Inc. pilot project involving treatment for youth, families, and their communities who suffer from solvent addiction. | Surveys—Pre-post survey at 3 and 6 month follow-up. |
D’Hondt, no year [55] | 12 clients. | Quasi-experimental: Time-series to evaluate a pilot residential substance use treatment program at the Centre for Addiction and Mental Health. | Mixed methods—Focus groups, and interviews and surveys at baseline, treatment completion, and follow-up. |
Kunic, 2009 [56] | 2,685 males. | Pre-experimental: One-shot multiple case studies comparing treatment outcomes among three treatment groups: 1) the Aboriginal Offenders Substance Abuse Program (ASOP), 2) the National Substance Abuse Program—High Intensity (NSAP-H) or 3) Moderate Intensity (NSAP-M). | Mixed methods—Comparison of post-release outcomes over an 18 month follow-up period among three treatment groups: Biochemical markers—urinalysis for evidence of drug use and program records—type of release and revocation. |
McConnery & Dumont, 2010 [57] | 15 clients: 10 males; 5 females. | Quasi-experimental: Time series to study the impact of an integrated addictions treatment program at Wanaki Treatment Centre. | Survey interviews—Repeated measures surveys (in person and by telephone) at baseline, end of treatment, and 3 and 6 months post treatment. |
The Tsow Tun Le Lum Society, no year provided [58] | 11 clients: 6 males; 5 females. | Quasi-experimental: Time series to assess the integrated alcohol and drug treatment program provided at the Tso Tun Le Lum Society. | Survey interviews—At admission, completion of program and 3 months post treatment. |
Samples
Designs
Methods
Survey [study where used] | What it measures | Administration: self-report = SR; caregiver = CG |
---|---|---|
Behavior and Symptom Identification Scale-32 (Basis-32) [55]. | Relationship to self and others, depression and anxiety, daily living skills, impulsive and addictive behaviors, and psychosis. | SR |
Global Assessment of Individual Needs – Quick GAIN-Q [48]. | Four major scales – General Life Problem Index (GLPI), Internal Behavior Scale (IBS), External Behavior Scale (EBS), and Substance Problem Scale (SPS). | SR |
The Cherokee Self-Reliance Questionnaire [48]. | Presence of Cherokee self-reliance. | SR |
Demographics; drug and alcohol use; family and living conditions; education, employment, and income; crime and criminal justice; mental and physical health problems; treatment/recovery; and social connectedness. | SR | |
Child Behavioral Checklist (CBCL) Behavioral and Emotional Rating Scale [51]. | Behavioral and emotional problems in children. | CG |
Caregiver Strain Questionnaire (CGSQ) [51]. | Strain such as feelings of anger and resentment about the child, disruption of family and community life, and caregiver feelings of worry, quilt, and fatigue. | CG |
Columbia Impairment Scale (CIS) [51]. | Global impairment for youth. | CG |
Behavioral and Emotional Rating Scale (BERS-2 Caregiver) [51]. | Interpersonal, intrapersonal, family, affective, school, and career strengths. | CG |
Quality of Life (QOL) Survey [50]. | Gender, ethnicity, education, presence of an AIDS diagnosis, and quality of life. | SR |
Form 90-DI: A Structured Assessment Interview for Drinking and Related Behaviors [42]. | Alcohol consumption and other related problems. | SR |
The American Indian Cultural Involvement Index (AICI) [42]. | Composite score based on two measures: 1) a child ethnic identity score and 2) count of traditional values practiced or believed. | SR |
Alcohol severity ratings on the Alcohol Dependence Scale (ADS) Problems Related to Drinking Scale [56]. | Alcohol dependence syndrome. | SR |
The extent of problems related to drinking as measured by the Problems Related to Drinking Scale (PRD) [56]. | Alcohol-related problems. | SR |
The drug severity ratings on the Drug Abuse Screening Test (DAST) [56]. | Severity of problems associated with drug use. | SR |
Wellness outcomes collected and main results
Study | Wellness outcomes | Main results | |||
---|---|---|---|---|---|
Spiritual | Mental | Emotional | Physical | ||
Scientific literature
| |||||
Anderson, 1992 [40] | √ | √ | • 1/3-1/2 of clients maintained sobriety for at least 1 year post treatment. | ||
• Clients established follow-up circles in their own community and those involved “do much better and feel more hopeful than those that are not” (p.11). | |||||
Boyd-Ball, 2003 [41] | √ | √ | • Family-enhanced group perceived high level of support of family members (94.2%) and nonfamily adults (90.6%) and positive peer support (66%). | ||
• % of days abstinent from substance use from month 1 to 12 was high for both (culturally supplemented) treatment as usual and family-enhanced intervention groups, ranging from 80-100% days abstinent. | |||||
• The highest gain in abstinence was from month 1 to 2 for both groups. | |||||
Boyd-Ball et al, 2011 [42] | √ | √ | √ | √ | • At 1 year follow-up: 23% relapsed into regular substance use; 77% showed low levels of substance use. |
• Post-treatment substance use trajectories indicated that membership in the relapser’s group showed less engagement in traditional cultural practices and identification with their American culture (mean = -.24) than those classified in the abstainers group (mean = .17). | |||||
Dell & Hopkins, 2011 [43] | √ | √ | • Half of the youth (49.62%) reported a completely abstinent lifestyle in 90 days following exit from the program and half of these youth (51%) reported to not have the urge to misuse volatile or other substances during this time. | ||
• At 6 months follow-up, 74% reported not using volatile or other substances and 68% of these reported not having to resist drug use. | |||||
• More than half of youth who completed the program (54.2%) reported attending school at 3 month follow-up and at 6 months this rate increased to 83.64%. | |||||
Dell et al, 2011 [44] | √ | √ | • Participating in the Equine-Assisted Learning program provided a culturally relevant space for youth and thus was beneficial to their healing in the program. | ||
• Three main themes explained the healing experience: spiritual exchange (calm presence, being in the moment, meaningful connection to the horse), complementary communication (ability to communicate with horse beyond verbal commands and helped with patience and leadership in communicating with others), and authentic occurrence (females showed compassion for pregnant mares and foals, interacting with horse let them experience healthy touching and expressing affection). | |||||
D’Silva et al, 2011 [47] | √ | • 63% of participants completed the program. | |||
• Upon completion, almost 1/3 of participants self-reported 7 day abstinence. | |||||
• Of those reached at follow-up, 47% reported abstinence at 90 days. | |||||
• The smoking quit rate was 21.8%. | |||||
• Continuing smokers cut their daily smoking by half (from 17-9 cigarettes). | |||||
• 88% reported an increase in self-efficacy for their next quit. | |||||
• 44% planned to quit within 30 days. | |||||
Edwards, 2003 [45] | √ | √ | √ | • 73 transformational (healing) experiences towards re-traditionalization were expressed by graduates of the treatment program. | |
• These were categorized into 12 themes (in descending order): Feeling cared for, spiritual experiences, insight, making a commitment, empowerment, releasing emotional pain, remorse, reconnecting to traditional values, forgiveness, relief, safety, and gratitude. | |||||
Gossage et al, 2003 [46] | √ | √ | √ | √ | • IPsFU (Inmate/patients followed-up) drank 1 to 1.5 drinks less per drinking occasion than before intake (5.4 vs. 6.8), although still considered to be problematic. |
• Analysis using the Wilks test reveals significant improvements in scores over 3 time periods (baseline, 3, 9 months after release) for relating to the animal world and human world (p < 0.02 and p < 0.03) respectively. | |||||
• Mean social support given to IP by his family increased before going to jail and at follow-up (from 6.5 to 8.3). | |||||
• One of five indicators of domestic violence (hit or throw things first, regardless of who started an argument) improved significantly from before going to jail to follow-up (x2 = 4.714, p = 0.030). | |||||
• Medical status scores improved before to follow-up (5.8 to 7.8 on a 10-point scale) and this was statistically significant (paired t-test, =3.3.16, p = 0.003). | |||||
• There was substantial and significant improvement in marital status (x2 = 108.127, 45 df, p = 0.000). | |||||
• 47% of IPs were rearrested at some point during the study. | |||||
Lowe et al, 2012 [48] | √ | √ | • Culturally based intervention (CTC) was significantly more effective for reducing substance use and related problems than the non-culturally-based intervention (SE) on the Global Assessment of Individual Needs—Quick (GAIN-Q) as follows: | ||
• The Total Symptom Severity Score (TSSS) showed differences between groups increased over time, and at 3 month follow-up, the difference remained and the magnitude increased (t = -5.35, p < .001). | |||||
• The General Life Problem Index (GLPI) showed differences between the CTC and SE groups becoming significant at post intervention (t = -2.63, p = .009) and 3 month follow-up (t = -5.05, p < .001). | |||||
• The Internal Behavior Scale (IBS) results show a significant difference between the two groups at post-intervention (t = -4.18, p < .001) and 3 month follow-up (t = -5.45, p < .001). | |||||
• External Behavior Scale (EBS) score differences between the two groups became significant at post-intervention (t = -3.58, p < .001) and 3 month follow-up, (t = -4.56, p < .001). | |||||
• The difference in the Substance Problem Scale (SPS) between the CTC and SE groups became significant at post-intervention (t = -3.89, p < .001) and 3 month follow-up, (t = -4.69, p = .001). | |||||
• Cherokee self-reliance scores showed that at post-intervention, the CTC group had higher scores than the SE group (t = 2.72, p = .007). At 3 month follow-up, the difference between the two groups became larger (t = 6.74, p < .001). | |||||
Naquin et al, 2006 [49] | √ | • Rate of residents completing the program rose dramatically from 2002-2005, from 55% in 2002 to 75% in 2005, and this level of retention is higher than the national experience of 35% for therapeutic communities and 33-38% for long-term care (over 30 days). | |||
• At 6 month follow-up, use of alcohol in the last 30 days dropped from 57% at intake to 20%. | |||||
• Full-time employment increased from 19.2% to 33.3%. | |||||
Nebelkopf & Penagos, 2005 [50] | √ | √ | • Mixed results in self-reported quality of life results owing to population that included HIV/AIDS clients, e.g., “how would you rate your overall health” decreased between baseline and follow-up (no data provided) whereas “feeling bad lately” decreased over that period of time (32% vs. 3% said “definitely true”; 29% vs. 18% said “mostly true”). | ||
Nebelkopf & Wright, 2011 [51] | √ | √ | √ | • Using the McNemar test: | |
• 24% reported using alcohol or drugs in the prior 30 days at baseline, with a decline to 5% six months later (p < .001). | |||||
• Experiences of stress, emotion, or activities resulting from substance use in the prior 30 days also showed a decreasing rate of change from 47% to 23% (p < .001). | |||||
• The number reporting either part or full-time employment increased from 11% to 20% (p < .001). | |||||
• The largest rate of change was seen in enrollment in school or a training program, moving from 7% to 17% (p < .001). | |||||
• The number reporting being arrested or committing a crime in the prior 30 days went from 31% to 5% (p < 0.001). | |||||
• Significant reductions were seen in the rates of non-substance use-related reports of: serious depression (p < .001), serious anxiety or tension (p < .001), hallucinations (p < .001), trouble understanding or concentrating (p < .001), trouble controlling violent behavior (p < .01), and suicide attempts (p < .01). | |||||
Saylors, 2003 [52] | √ | √ | • Within pre/post matched sample, alcohol use decreased 13% after 6 months and drinking alcohol to intoxication was reduced by 19%. | ||
• Women who reported using other drugs at intake, such as marijuana and inhalants, reported no use at 6 months. | |||||
• Heroin use was down 93%. | |||||
• At 12 month follow-up, the rate of full-time employment increased from 10% at intake, to 29%, and the clients who were legally employed doubled. | |||||
• There was an increase in the % of participants claiming good health and decreases of “fair” or “poor”. | |||||
• Positive change in clients’ living situations also resulted in fewer having contact with the criminal justice system and more being enrolled in school or job training programs. | |||||
• Culture was viewed as important at intake, with 5.7% reporting it was “not important”; 11.5% responding “important”, and 73% responding that their culture was “very important” to them. | |||||
Wright et al, 2011 [53] | √ | √ | √ | • Using the McNemar test: | |
• 80.2% decrease rate of change in alcohol and drug use from 116 (23.7%) in the prior 30 days at baseline to 23 (4.7%) six months later (p < .001). | |||||
• Experiences of stress, emotion, or activities resulting from substance use in the prior 30 days showed a decreasing rate of change of 51.8%, from 231 (47.1%) to 111 (22.7%) (p < .001). | |||||
• The number reporting either part or full-time employment increased from 55 (11.2%) to 100 (20.4%), with an 82.1% rate of change (p < .001). | |||||
• The largest rate of change (150.7%) was seen in enrollment in school or a training program, moving from 34 (6.9%) to 85 (17.3%) (p < .001). | |||||
• The number reporting being arrested or committing a crime (includes illegal substance use) in the prior 30 days went from 151 (30.8%) to 26 (5.3%) with an 82.8% rate of change (p < .001). | |||||
• Significant reductions were seen in reports of serious depression (p < .001), serious anxiety or tension (p < .001), hallucinations (p < .001), trouble understanding or concentrating (p < .001), trouble controlling violent behavior (p < .01), and suicide attempts (p < .01). | |||||
Grey literature
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Bresette, 2009/2010 [54] | √ | √ | √ | √ | Outcome #1: Increased sense of physical and mental well-being; feeling purpose and self-esteem: |
• Self-identity as a Native was much more positive at the end of treatment. | |||||
• 71% of clients stated that they feel very comfortable practicing their cultural beliefs. | |||||
• 93% of clients who entered the program did not have a spirit name and received one during their stay in the program. | |||||
• 100% of clients stated that they were completely comfortable using their native language both in their community and outside their community. | |||||
• 63% of clients stated that they had some connection to First Nations Culture, to family members or extended family. | |||||
• 58% of clients returned to their community and participated in cultural, social or artistic activities in their home community. | |||||
Outcome #2: Increased knowledge of drug-free lifestyles including cultural healing strategies: | |||||
• Increased knowledge of drug-free lifestyles including cultural healing strategies, such as connection with spiritual family through youth fasting, feasts, ceremonies and learning to help self with use of the spirit. | |||||
Outcome #3: More past clients pursued their education and/or life learning goals: | |||||
• Average grade level improvement in language arts (.98% grade improvement) and math (.99% grade improvement). | |||||
• Upon return to their communities, clients reported that they continue performing traditional cultural activities, e.g., smudging, leading prayer, assisting with dressing the drum, etc. | |||||
• 100% of clients stated that they volunteer once a month in their community. | |||||
• 33% stated when they call back to the Treatment Centre after discharge that they had increased their social activities. | |||||
Outcome #4: Clients have developed positive social networks and have passed on teachings to help peers and community members: | |||||
• 46% of the clients continued with culture either alone or with family, friends or community members. | |||||
• Clients have connected with peers via the internet after leaving treatment. | |||||
• Clients have identified a confidant (clients calling the NNHC on follow-up to treatment included 3 or 25% of the youth who were in the program within the last year. 15.2 hours total spent on the 24 hour, toll-free line with youth over 104 different contacts). | |||||
Outcome #5: Clients encountered fewer occurrences with the justice system. | |||||
• 37% of clients left treatment early, all were female and 60% left because of charges. | |||||
• Serious occurrences (e.g., assaults on staff/clients) average = 1.5/month vs. 4.75 benchmark. | |||||
• Incidents (e.g., physical attack/threats) average = 1.5/month vs. 6.3 benchmark. | |||||
D’Hondt, no year [55] | √ | √ | • High completion rate at 84.6% and 50.0% of patients continued to be engaged in aftercare programs at CAMH and elsewhere. | ||
• Reduced alcohol and drugs use in follow-up (30 days prior) compared to initial assessment (90 days prior). | |||||
• Pre- and post-treatment results showed a decrease in BASIS 32 scores, suggesting clinically important improvements in general mental health and functioning among the clients. | |||||
• At initial assessment (treatment entry), 10 out of 12 individuals (92%) reported having consumed alcohol to the point of blackout in the past 90 days. However, at follow-up, only 1 individual of the 9 contacted (11%) reported having drunk until blackout in the past 30 days. | |||||
Kunic, 2009 [56] | √ | • Those who participated in Aboriginal Offender Substance Program (AOSAP) were returned to custody at a lower rate during the follow-up period than the groups of Aboriginal offenders who participated in National Substance Abuse Program- High Intensity (NSAP-H), NSAP-M (Moderate Intensity), failed to complete a substance use program, or did not participate in a substance use program prior to release from custody. Aboriginal offenders who participated in versions 2 or 3 of AOSAP were returned to custody at the same rate as Aboriginal offenders who participated in version 1 of AOSAP. There was no statistical difference between versions of AOSAP. | |||
• Only 5% of the successful participants of AOSAP- V 2&3, and 6% of the participants of AOSAP version 1 were returned to custody because of a new offence or charge compared to 16% and 20% of the successful participants of NSAP-H and NSAP-M, respectively. | |||||
• Exposure to substance use treatment prior to release from custody was a relatively weak predictor of relapse to substance use (p = 0.07). However, some evidence suggested that successful participants of AOSAP and NSAP-M were less likely to incur a positive urinalysis result while on release than successful participants of NSAP-H. | |||||
• Those who participated in AOSAP were less likely than offenders from the other program exposure categories to test positive for drugs that are considered dangerous (e.g., cocaine, opioids). | |||||
McConnery & Dumont, 2010 [57] | √ | √ | √ | √ | Outcome #1: Achieve greater balance in the four aspects of life (mental, spiritual, emotional, and physical): |
• Not a clear increase over time in all aspects of wellness; however: | |||||
• Mental wellness of clients increased during treatment and 6 months after their treatment, but it was noted that there is “too much inaccuracy in the question to judge if there was a significant increase” (p.25). | |||||
• The only marked finding under spiritual wellness was the increase of practice and comfort associated with practicing this type of spiritually during the program, such as the daily smudge and praying. The spiritual aspect was mentioned a few times in the Talking Circle as something that participants thought would help them to remain sober once they returned to their community. But it is noted that “the spiritual aspect does not show considerable changes that could be interpreted as a general increase for participants, despite the fact that they name this as an important tool for their recovery” (p. 25). | |||||
• Authors noted: “The emotional aspect shows more clearly a decrease in feeling of sadness and crying” (p.25). | |||||
• Definite increase in the self-interpretation of physical good health with time from treatment to 3 months after treatment. There is a slight decrease between 3 months after treatment and 6 months after treatment. The authors note that “in the physical aspect there is a more evident decrease in the feeling of ill health” (p.25). | |||||
Outcome #2: Increase self-esteem and cultural pride: | |||||
• Slight increase in self-esteem from 6 months prior to treatment and 6 months after treatment, but authors note this is not significant. | |||||
• Cultural pride is about as high 6 months before treatment as it is 6 months after treatment. | |||||
Outcome #3: Achieve abstinence and influence peers in communities. | |||||
• 50% or more of the participants remained abstinent during the 6 months after treatment. | |||||
Outcome #4: Decrease the number of occurrences of client-related family violence: | |||||
• Slight decrease in violence from the pre-treatment to the post-treatment. | |||||
The Tsow Tun Le Lum Society [58] | √ | √ | √ | √ | Outcome #1: Clients are involved in more activities that contribute to their being “clean and sober” (at 3 months post treatment): |
• 2/3 (7 of 11) kept busy at daily activities every day or at least 3 times a week. | |||||
• Staying in the company of sober people remained the same as upon admission at 45% (5 of 11). | |||||
• 45% (5 of 11) requested help from AA/NA (a slight increase from admission). | |||||
• 64% (7 of 11) put into practice new ways of reacting to risky situations. | |||||
Outcome #2: Clients pride and dignity are empowered through participating in cultural, spiritual, and artistic events (at 3 months post treatment): | |||||
• 55% (6 of 11) were comfortable self-identifying as Aboriginal or Inuit (this is a drop from that at admission of 82%). | |||||
• 45% (5 of 11) had participated in cultural or traditional events (same as six months prior to admission). | |||||
• None were uncomfortable with practicing Aboriginal spiritual practice. | |||||
• 45% agreed or strongly agreed that a rich heritage of knowledge, wisdom, and traditional was passed to them (an increase over admission (36%) but a slight drop from the rate at completion (64%)). | |||||
Outcome #3: A decrease in demonstration of violent behaviors towards self and others: | |||||
• Significant drop in violent behaviors towards others, from 73% at admission to 29% at 3 months post treatment. | |||||
• Self-violent behavior dropped from 27% at admission to 14% at 3 months post treatment. | |||||
Outcome #4: Increased client’s self-esteem enhances their mental, physical, emotional, and spiritual well-being (at 3 months post treatment): | |||||
• 36% prefer to use and stay in the company of people in recovery every day. | |||||
• 36% have requested assistance from resources in their community (this % was double over the rate at admission). | |||||
• 18% (2 of 11) had difficulty sleeping; 55% (6 of 11) could sleep without medication; and 64% (7 of 11) felt calm and rested from sleep (these % were improvements over rates at admission). | |||||
Outcome #5: Increase awareness in communities around addictions and its impact on people: | |||||
• Since leaving the Treatment Centre, clients most frequently got support from a friend or family member. |
Outcomes collected
Main results
Discussion
Future directions
Conclusions
Endnotes
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Self-identify as Indigenous and are recognized and accepted by their community as a member
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Form non-dominant groups of society
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Resolve to maintain and reproduce their ancestral environments and systems as distinctive people and communities
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Demonstrate:
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Historical continuity with pre-colonial and/or pre-settler societies
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Strong links to territories and surrounding natural resources
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Distinct social, economic or political systems
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Distinct languages, cultures and beliefs.
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