Despite a growing library of proven techniques, ever-revolutionizing technologies, and a more connected professional sphere of care providers, both addiction- and obesity-related deaths climb drastically year over year in the U.S. This is particularly noticeable in specific minority groups, such as Latinos, African-Americans, Alaskan Natives and Native Americans.
“Although the Native American Indian population of the United States is relatively small in comparison to other ethnic groups, Native American Indians struggle disproportionately with a vast range of health and social issues,” states a resource from the American Psychological Association. A mixture of deep socioeconomic issues has been a large part of the growing epidemic of substance dependency among Native American groups. One study (Lee, et al; 2015) found “75 percent of all outlets tested sold alcohol to young-appearing AI buyers at least once. Other research confirmed that underage AI youth may obtain alcoholic beverages … either directly through illegal sales to minors or indirectly through purchases by adult friends.” The isolation of their reservations also means their culture is closely confined, with most Americans understanding their culture only through rough characterizations and symbolism. Culturally competent care programs for Native Americans are few and far between outside of the reservations, in part because of these restrictions.
Programs such as the Wellbriety Movement are seeking to overcome those difficulties and provide more custom-tailored care for Native Americans. The Wellbriety Movement uses a program somewhat similar to the proven techniques used in Alcoholics Anonymous and similar recovery programs. It uses systematic clinical techniques to methodically help Native Americans go through the stages of recovery, and ultimately reach long-term sobriety. The difference in its technique is it uses culturally competent aspects to make the experience more approachable and engaging for Native Americans.
For example, whereas traditional recovery may use group therapy, Wellbriety might add the added aspect of a drum circle or dance. Meditation could be supplemented with sage smudges, while CBT and mindfulness activities can be enforced with a Naming Ceremony, providing more self-confidence in the activity. While programs such as Wellbriety are mostly limited to recovery programs within the reservations at this time, successful implementation will inevitably lead to more widespread adoption and more recovery options for Native Americans across the nation.
While these programs offer lots of promise, their rarity and confinement to very specific geographic regions and cultures means that they have the potential to be deeply influenced by local norms and customs, and their rates of success and retention are ultimately up to self-reporting. This means very little meaningful data can be extracted from individual care programs to understand the effectiveness of them as a whole, or to understand what aspects do and don’t work. Through comprehensive meta-analyses involving multiple similar programs, we’re able to achieve a slightly more cohesive analysis. One study (Legha R, Novins D; The Role of Culture in Substance Abuse Treatment Programs for American Indian and Alaska Native Communities; 2012) found that while culturally competent variations of programs could increase engagement and retention, it was ultimately the adherence to the traditional recovery options that led to sustained care. This means programs such as Wellbriety can effectively lower the barrier to entry for recovery programs, while a solid understanding of the mechanisms behind recovery actually lead to sustained sobriety.
Other groups, however, benefit from different approaches. For example, one meta-analysis of African-American patients in various recovery programs found that high-capacity programs that could offer comorbid HIV and mental health care resulted in the best rates of both sobriety and retention (Guerrero E, et al.; Paths to Improving Engagement Among Racial and Ethnic Minorities in Addiction Health Services; 2015).
Understanding how different recovery options resonate with different cultures will be an integral part of improving recovery services in 2019 and onward. With the understanding that some programs may offer unique benefits in specific communities, it’s important to strategize and coordinate with fellow professionals to make sure we’re offering optimal care to each patient.