AMERICAN INDIAN TRADITIONAL CEREMONIAL PRACTICES: ADDRESSING PROBLEM SUBSTANCE USE IN A MULTI-TRIBAL URBAN COMMUNITY

Background: Traditionally, American Indian and Alaska Native (AIAN) communities and individuals held ecological knowledge that supported holistic wellness for their tribal members through a variety of medicines and ceremonies. Contemporary Western healthcare systems have largely alienated AIAN people from access to traditional ceremonial practices (TCPs). Despite decades of cultural adaptation of evidence-based practices (EBPs), the deleterious effects of historical and intergenerational trauma are widely documented. This includes disproportionately high rates of problem substance use in both reservation and urban AIAN community settings. Purpose: In contrast to deficit-based paradigms, Reziliency posits that protective factors, approaches, and methods used within AIAN communities when faced with adversity or trauma create an environment for individuals to demonstrate resiliency. This study explored the potential for an intervention that draws on the protective role of TCPs to reduce problem substance use within an urban, multi-tribal setting. Methods: We developed a sequential, mixed-methods study design in partnership with an urban Indian health center. Study One was a systematic review of the literature that identified existing evidence and knowledge about TCP-based substance use interventions in AIAN communities. Study Two was a cross-sectional investigation of TCP-related factors and substance use behaviors in the urban AIAN community. Study Three was a qualitative descriptive investigation in which members of the target AIAN community were interviewed about their experience and background with TCPs as well as their thoughts about how to design an effective TCP-based substance use intervention in an urban, multi-tribal setting. Results: The systematic review yielded 10 eligible articles with quantitative evidence highlighting the association between TCPs and substance use reduction. In the cross-sectional survey (N = 194), 54.6% of respondents reported positive TCP protective factors and 36.7% reported high levels of intent to participate in TCPs. Respondents with more positive protective factors or greater intent to participate in TCPs were significantly less likely to report alcohol or other drug use. Interview (N = 11) themes highlight a strong belief that TCP-based interventions can be successful at reducing problem substance use in an urban, multi-tribal setting, that tribal elders should guide a process in identifying which ceremonies and spiritual practitioners should be employed, and that variation in ceremonies and tribal perspectives is important. Conclusions: This research project demonstrates the potential for a community-informed, TCP-based problem substance intervention to be effective in an urban, multi-tribal setting, while underscoring the need for greater research in this area