Addressing Substance Use and Social Needs of People of Color with Substance Use Disorders

Key Points: In this brief, we highlight the experiences and practices of substance use treatment providers
and their human services partners when serving people of color. We selected providers who
focused on serving people of color, and this study was not intended to assess outcomes or
effectiveness of any of the practices highlighted.

  • Treatment providers highlighted several practices that promoted active and positive
    participation in their programs by people of color:
    • Incorporate the community’s cultural values into organizational structures and
      treatment models.
    • Engage the community in designing programs and services and hire staff that
      reflect the community.
    • Address the comprehensive health, social, and economic needs of
      participants.
    • Incorporate harm reduction services and healing-centered approaches in the
      continuum of care.
  • Providers described several constraints when serving communities of color:
    • Structural barriers such as poverty, racism, and differential access significantly
      impede meeting clients’ social and economic needs.
    • Challenges retaining program staff with the appropriate language and cultural
      skills.
    • A complex patchwork of funding streams.
    • A lack of data and limited internal capacity for data analysis and program
      evaluation.
  • Providers emphasized that success required working with the strengths of the
    communities they serve and that every community has protective factors. More
    research is needed to understand how federal, state, and local policies and programs
    can maximize the strengths of communities of varied backgrounds, while also
    implementing evidence-based practices.

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Culturally tailored substance use interventions for Indigenous people of North America: a systematic review

Purpose– The purpose of the current study is to conduct a systematic review of peer-reviewed work on culturally tailored interventions for alcohol and drug use in Indigenous adults in North America. Substance use has been reported as a health concern for many Indigenous communities. Indigenous groups experienced the highest drug overdose death rates in 2015, the largest percentage increase in the number of deaths over time from 1999 to 2015 compared to any other racial group. However, few Indigenous individuals report participating in treatment for alcohol or drug use, which may reflect the limited engagement that Indigenous groups have with treatment options that are accessible, effective and culturally integrative. Design/methodology/approach– Electronic searches were conducted from 2000 to April 21, 2021, using PsycINFO, Cumulative Index to Nursing and Allied Health Literature, MEDLINE and PubMed. Two reviewers classified abstracts for study inclusion, resulting in 18 studies. Findings– Most studies were conducted in the USA (89%). Interventions were largely implemented in Tribal/rural settings (61%), with a minority implemented in both Tribal and urban contexts (11%). Study samples ranged from 4 to 742 clients. Interventions were most often conducted in residential treatment settings (39%). Only one (6%) intervention focused on opioid use among Indigenous people. Most interventions addressed the use of both drugs and alcohol (72%), with only three (17%) interventions specifically intended to reduce alcohol use. Originality/value– The results of this research lend insight into the characteristics of culturally integrative treatment options for Indigenous groups and highlight the need for increased investment in research related to culturally tailored treatment across the diverse landscape of Indigenous populations.

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Native Hawaiian Culturally Appropriate Substance Use Disorders Formative Program Evaluation

Abstract Substance use disorders (SUDs) disproportionately affects Native Hawaiians, yet conventional treatments often overlook the cultural, spiritual, and relational foundations of well-being for Native Hawaiians. This gap represents a human services problem, as it perpetuates health disparities, limits recovery, and slows social change within Native Hawaiian communities. The purpose of this qualitative single case study was to identify culturally relevant components for an SUD treatment program tailored to Native Hawaiians. The research question guiding this study was, what are culturally appropriate components for a SUD program for Native Hawaiians. The Nā Pou Kihi framework grounded the exploration of Indigenous approaches to healing that may be integrated into treatment models. Case data were gathered through an interview with a cultural practitioner and secondary sources, then analyzed using thematic analysis. Findings revealed that effective treatment affirms cultural identity, restores reciprocal relationships with ʻāina, promotes accountability and reconciliation through practices such as Hoʻoponopono, and embeds spirituality as a foundation for recovery. Results suggest that culturally grounded programs foster intergenerational healing, cultural resurgence, and community-level social change. Recommendations include increasing funding for culturally based services, training providers in Native Hawaiian health frameworks, and strengthening partnerships between licensed professionals and cultural practitioners to advance equity and contribute to long-term social change

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Scope and historical origins of substance use disorders among Native American communities

Abstract: American Indian and Alaska Natives (AIAN) are a rapidly growing and diverse population: There are 9.7 million AIANs in the United States (including 5.9 million people who identify as AIAN and one or more racial groups), constituting 2.9%of the total population. In 2018, 10.8% of AIANs were classified as having a substance use disorder (SUD) in the past year. As SUD rates continue to increase along with premature mortality, AIAN communities are deeply and actively committed to the health of future generations and to developing solutions that incorporate culturally meaningful strategies that push toward integrated, multilevel recovery and healing. This chapter provides an overview of substance use and SUDs in AIAN communities, including historical background and prevalence. It explores factors that may contribute to SUDs and highlights factors related to resiliency and recovery. Finally, the chapter provides an overview of some promising interventions and implications for policy and practice.

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Opioid Use Disorder and Racial/Ethnic Health Disparities: Prevention and Management

Purpose of review: This review aims to summarize risks and disparities associated with the prevalence and treatment of opioid use disorder in the perioperative and long-term setting, as well as evidence-based treatment and prevention targeted toward specific vulnerable populations.

Recent finding: There are significant demographic disparities in pain management and development and management of OUD in the chronic and surgical setting. While White patients traditionally receive more pain management, they are also at higher risk of developing OUD. Hispanic and Latin populations have the largest proportion of youth with OUD and often lack culturally appropriate translation services that allow for effective treatment. Native Americans have the second highest rate of OUD and often receive care in communities and healthcare settings that lack funding and resources to combat OUD. African Americans tend to suffer from the criminalization of OUD and are less able to seek treatment due to this, and furthermore, often lack community services that would benefit them. Additional vulnerable populations include homeless individuals that lack access to healthcare or health insurance. In addition, incarcerated individuals often lack access to naloxone and suffer from high rates of fatal overdose soon after being released to the community. People in rural settings lack needle-exchange programs and community-based interventions/support groups. Patients in the perioperative setting lack standard screening and pain management protocols. Interventions targeted toward each appropriate group can help decrease the rate of OUD and improve its treatment, and overarching interventions such as protocols, targeted funding, education and regulation can combat OUD for all populations.

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Exploring substance use disorder discussions in Native American communities: a retrospective Twitter infodemiology study

Abstract

Background The opioid epidemic has had a devastating impact on youth from American Indian and Alaska Native (AI/AN) Tribes and Villages, which also experience disparate suicide rates. The use of publicly available social media data originating from AI/AN communities may enhance public health response time to substance use disorder (SUD)-related overdose and augment Tribal public health surveillance systems, but these concepts have yet to be adequately explored. The goal of this exploratory analysis was to identify primary and secondary accounts of overdose and characterize relevant contextual factors in the AI/AN population on social media. Methods The Twitter application programming interface was queried for all Tweets containing geocoded data between March 2014 and June 2020 and filtered for the keyword [‘overdose’]. This sample of Tweets (n = 146,236) was then restricted to those geolocated from US Tribal lands (n = 619). Tweets were manually annotated for primary or secondary accounts of overdose as well as suicidal ideation, substance(s) used, stigma of drug use, and community-wide incidents. Results We collected a total of 146,235 tweets that were geocoded and contained the word ‘overdose,’ of which 9.5% were posted on Tribal lands (n = 619). 9.4% of these tweets (n = 58) met our study inclusion criteria and were mainly posted from Oklahoma (n = 26, 45%) and North Carolina (n = 13, 22.4%). Most Tweets (n = 41, 71%) described a primary account of an overdose and were mostly posted from 2014 to 2015. Less than half of the Tweets (n = 27, 46.5%) referenced a specific substance. Those substances mentioned included alcohol, marijuana, methamphetamine, heroin, laundry softener, cocaine, K2-Spice (synthetic cannabinoid), codeine, morphine, Nyquil, and Xanax. Discussion Though exploratory, our study identified SUD-related content self-reported by AI/AN communities on Twitter, especially in Oklahoma and North Carolina. These results may assist in the future design and detection of infodemiology trends and early warning signs that can better facilitate intervention specific to the ongoing Tribal opioid epidemic. While all data were collected from the public domain, additional care should be given to individual and community privacy.

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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.

NATIVE TRANSFORMATIONS IN THE PACIFIC NORTHWEST: A STRENGTH-BASED MODEL OF PROTECTION AGAINST SUBSTANCE USE DISORDER – PMC

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