American Indian Traditional Ceremonial Practices as a Potential Community-Informed Intervention Against Problem Substance Use

The impacts of historical and intergenerational trauma on American Indians and Alaska Natives (AIAN) are widely documented. While the rate of lifetime alcohol use for AIANs is lower than that of non-Hispanic Whites (NHW), AIAN individuals continue to report the highest rates of heavy alcohol and illicit drug use for any racial or ethnic group in the United States. In response to this trend, substance use programming for AIAN populations will often draw from evidence-based practices (EBP) developed for mostly non-AIAN populations. Sometimes, these EBPs are then adapted to integrate cultural approaches to decrease alcohol and illicit drug use in AIAN individuals and communities. In contrast, our study seeks to draw on practice-based evidence that has existed within AIAN communities for millennia to inform the development of an intervention that uses traditional ceremonial practices (TCP) to address trauma and reduce rates of problem substance use. Specifically, we explore the potential for this type of intervention to be successful in an urban, multi-tribal setting. Guided by Critical Indigenous Research Methodologies, we developed a sequential, mixed-method research design in partnership with All Nations Health Center. All Nations is a federally funded urban Indian health organization (UIHO) serving Missoula and Ravalli counties. In the first phase of our study, we collected information about the AIAN community. To do this, we delivered a survey questionnaire (N = 194) to adult AIAN community members. The survey asked respondents about their intent to participate in TCP as well as how they think and feel about these activities. Additionally, the survey asked about substance use behaviors over the past 12 months, including the use of alcohol, marijuana, methamphetamine, inhalants, and prescription medications. Demographic and socio-economic survey questions allowed us to consider how these variables might influence results. In the second phase of the study, we conducted interviews, using a semi-structured moderator’s guide, with 20 AIAN adults living in Missoula and Ravalli counties. The interview questions helped contextualize many of the close-ended responses from the survey. These conversations explored participant backgrounds with TCP as well as their vision of what a TCP-based substance use intervention could look like in an urban, multi-tribal setting. This perspective is significant in that an urban program would serve AIANs from many tribes from across the country. The interview data were analyzed to identify themes, which were merged with the survey data to inform the future development of a TCP-based problem substance use intervention for urban AIANs. Currently available TCP-based interventions have been developed largely for reservation-based communities, which are relatively homogeneous in terms of culture, language, and TCP. This is the first study of its kind to explore TCP among AIANs living in an urban setting in Montana. Additionally, this study explores the development of a holistic substance use intervention driven by TCP rather than incorporating TCP into an already defined substance use EBP. The results will guide All Nations, and others, to design, pilot, and implement an AIAN community-informed substance use intervention for urban AIANs