ABSTRACT: Substance use among American Indians (AIs) is a critical health issue and accounts for many health problems such as chronic liver disease, cirrhosis, behavioral health conditions, homicide, suicide, and motor vehicle accidents. In 2013, the highest rates of substance use and dependence were seen among AIs when compared to all other population groups, although these rates vary across different tribes. Among AI adolescents, high rates of substance use have been associated with environmental and historical factors, including poverty, historical trauma, bi-cultural stress, and changing tribal/familial roles. Our project, the Intertribal Talking Circle intervention, involved adapting, tailoring, implementing, and evaluating an existing intervention for AI youth of three tribal communities in the United States.
Resource
Native Transformations in the Pacific Northwest: A Strength-Based Model of Protection Against Substance Use Disorder
This paper presents findings from the Native Transformations Project, an exploratory community-based participatory research study that aims to identify sources of strength and protection against substance use disorder in three tribal communities in the coastal Pacific Northwest. Preliminary results from the study describe the specific settings, acts, and behaviors that build strengths and provide protection at the family, community, individual, and spiritual levels within coastal Pacific Northwest local tribal cultures. Findings from this study give voice to stated community preferences for grassroots Native intervention programs based in local cultural knowledge, worldviews, values, and theories of change, that operate at the local level on their own terms.
Integrating traditional practices and social network visualization to prevent substance use: study protocol for a randomized controlled trial among urban Native American emerging adults
The study focuses on the rising concerns regarding opioid use and opioid-related disorders among American Indian/Alaska Native (AI/AN) emerging adults living in urban areas. These individuals face a higher risk of opioid misuse compared to those living in rural areas.
The study aims to address this issue by implementing a prevention program called Traditions and Connections for Urban Native Americans (TACUNA). In the study, urban AI/AN emerging adults aged 18-25 will participate in a randomized controlled trial. They will either receive the TACUNA program, which consists of three virtual workshops incorporating motivational interviewing, social network visualization, traditional practices, and a wellness circle, or a single virtual workshop on culturally sensitive opioid education. The effects of the interventions will be evaluated over a 12-month period by analyzing the frequency of opioid, alcohol, and cannabis use, as well as social network characteristics and cultural connectedness. The project aims to provide culturally appropriate support to address opioid, alcohol, and cannabis use among urban AI/AN emerging adults. By integrating traditional practices and culturally sensitive strategies into the program, the study hopes to enhance resiliency and reduce substance use within this population. This research can improve substance use interventions and contribute to the well-being of AI/AN communities. The study is registered with ClinicalTrials.gov under the identifier NCT04617938, with the aim of expanding opioid, alcohol, and cannabis services for urban AI/AN emerging adults while addressing the opioid epidemic and substance use at both community and individual levels.
Exploring substance use disorder discussions in Native American communities: a retrospective Twitter infodemiology study
The study looked at how social media, specifically Twitter, can help in detecting and responding to substance use disorder (SUD)-related issues, such as overdoses, within American Indian and Alaska Native (AI/AN) communities.
Researchers analyzed over 146,000 tweets that mentioned ‘overdose,’ focusing on those geolocated from US Tribal lands. They found that 9.4% of these tweets met the study criteria, with most coming from Oklahoma and North Carolina. The majority of the tweets described firsthand accounts of overdose, and some mentioned specific substances like alcohol, marijuana, and heroin. While these findings are preliminary, they could help in identifying trends and warning signs related to the opioid epidemic among AI/AN populations. It is crucial to protect the privacy of individuals and communities when using such data for public health purposes.
Quantifying opioid use disorder Cascade of Care outcomes in an American Indian tribal nation in Minnesota
The opioid use disorder (OUD) epidemic has significantly affected American Indian communities in Minnesota. A public health framework called the Cascade of Care helps measure OUD risk, treatment engagement, retention, and recovery outcomes. However, no studies have measured this framework within tribal communities.
This study used data from the Minnesota Drug and Alcohol Abuse Normative Evaluation System (DAANES) to quantify the Cascade of Care for an American Indian tribal nation in Minnesota and the state as a whole. In 2018, 269 individuals in the tribal community received treatment for opioid-related issues. Of those, an estimated 65-99% started medications for OUD, and an estimated 13-41% stayed in treatment for at least 180 days. The existing state-level data can provide insight into OUD care stages for American Indian communities, but more data sources are needed to understand population-level OUD risk, recovery, and factors influencing treatment and recovery.
Health Equity for Abenaki Indigenous People: Improving Access to Quality Mental Health and Substance Use Services
In this study, researchers explored how members of the Abenaki Indigenous communities in Vermont access mental health and substance abuse services.
They conducted two focus groups in the spring of 2020 with community members and tribal leaders from various Abenaki Bands. Participants shared their perspectives on the challenges they face due to the loss of their culture and a lack of trust in community support services. The study found that these factors impact how the Abenaki community views health and wellness, affecting parenting, youth substance use, and opioid misuse. The results suggest that recruitment of Abenaki individuals into the healthcare workforce could help address these challenges. Additionally, efforts to support and preserve Abenaki culture may aid in substance use and suicide prevention within the community.
The mediation and moderation effect of social support on the relationship between opioid misuse and suicide attempts among native American youth in New Mexico: 2009-2019 Youth Risk Resiliency Survey (NM-YRRS).
The study focused on American Indian and Alaska Native (AI/AN) high-school students in New Mexico to understand the impact of social support (SS) on the relationship between opioid misuse and suicide attempt.
Data from the NM Youth Resiliency and Risk Survey (2009-2019) were analyzed using statistical methods to explore this association. The results showed that 12.0% of AI/AN students reported opioid misuse, while 14.0% reported suicide attempts. High social support was associated with lower odds of suicide attempts among students who misused opioids. This effect was stronger for males than females. Social support was found to be protective in various community settings, including off-reservation, rural, and both rural and off-reservation communities. The study found that social support played a significant role in mediating and moderating the relationship between opioid misuse and suicide attempts among AI/AN students. The mediation effect was lowest for rural, on-reservation schools. The findings suggest the importance of allocating more resources to enhance social support in these settings to promote health and reduce the risk of suicide attempts associated with opioid misuse.
IHS Opioid Stewardship Hospital Plan Builder
This template is designed to assist sites and committees with evaluation of current opioid prescribing practices and facilitate discussion surrounding opportunities for improvement. The interactive tool is designed to guide team discussions as users consider core elements of opioid stewardship programs.
Native Harm Reduction Toolkit
This toolkit was imagined and created by Arlene Brown, member of the Bishop Paiute Tribe, with support from NHRC staff, including Jessica Smith. It has been informed by Tribal and Urban Native people from across California and brings together resources from Indigenous harm reduction leaders from across the country and beyond.
Indigenous Evaluation Toolkit: An Actionable Guide for Organizations Serving American Indian / Alaska Native Communities through Opioid Prevention Programming
Seven Directions, with the support of the Centers for Disease Control & Prevention and the National Network of Public Health Institutes, has produced an Indigenous Evaluation Toolkit. This Toolkit provides step-by-step guidance, worksheets and concrete examples to support communities looking to Indigenize and decolonize their program evaluation. All examples in this edition of the toolkit focus on opioid overdose prevention.