Cultural interventions to treat addictions in Indigenous populations: findings from a scoping study

Abstract

BackgroundCultural interventions offer the hope and promise of healing from addictions for Indigenous people.a However, there are few published studies specifically examining the type and impact of these interventions. Positioned within the Honouring Our Strengths: Culture as Intervention project, a scoping study was conducted to describe what is known about the characteristics of culture-based programs and to examine the outcomes collected and effects of these interventions on wellness.MethodsThis review followed established methods for scoping studies, including a final stage of consultation with stakeholders. The data search and extraction were also guided by the “PICO” (Patient/population, Intervention, Comparison, and Outcome) method, for which we defined each element, but did not require direct comparisons between treatment and control groups. Twelve databases from the scientific literature and 13 databases from the grey literature were searched up to October 26, 2012.ResultsThe search strategy yielded 4,518 articles. Nineteen studies were included from the United States (58%) and Canada (42%), that involved residential programs (58%), and all (100%) integrated Western and culture-based treatment services. Seventeen types of cultural interventions were found, with sweat lodge ceremonies the most commonly (68%) enacted. Study samples ranged from 11 to 2,685 clients. Just over half of studies involved quasi-experimental designs (53%). Most articles (90%) measured physical wellness, with fewer (37%) examining spiritual health. Results show benefits in all areas of wellness, particularly by reducing or eliminating substance use problems in 74% of studies.ConclusionsEvidence from this scoping study suggests that the culture-based interventions used in addictions treatment for Indigenous people are beneficial to help improve client functioning in all areas of wellness. There is a need for well-designed studies to address the question of best relational or contextual fit of cultural practices given a particular place, time, and population group. Addiction researchers and treatment providers are encouraged to work together to make further inroads into expanding the study of culture-based interventions from multiple perspectives and locations.

Reclaiming Indigenous identities: Culture as strength against suicide among Indigenous youth in Canada

“…As part of a larger three-year study, Rowan et al engaged in a scoping review of cultural interventions to treat problematic substance use among Indigenous populations that incorporated both Western and Indigenous knowledge and assessed at least one of four holistic outcomes (e.g., spiritual, physical/behavioural, mind/mental, heart/social/emotional). 14 Using an Indigenized methodology -the "Two-Eyed Seeing" approach 15 -19 studies included interventions demonstrating considerable variability across each of the measured domains but all of them supporting the development of "culturally-based instruments to meaningfully measure wellness arising from participation in cultural interventions offered in the context of addictions treatment for Indigenous people." 14 Another example in the United States is the partnership between academics and the Blackfeet reservation.…”

“…14 Using an Indigenized methodology -the "Two-Eyed Seeing" approach 15 -19 studies included interventions demonstrating considerable variability across each of the measured domains but all of them supporting the development of "culturally-based instruments to meaningfully measure wellness arising from participation in cultural interventions offered in the context of addictions treatment for Indigenous people." 14 Another example in the United States is the partnership between academics and the Blackfeet reservation. Together they established a pilot project to address high levels of substance and alcohol use among its community members through cultural revitalization.…”

Postcolonial healing landscapes and mental health in a remote Indigenous community in subarctic Ontario, Canada

“…We focus on an Indigenous reserve in Northern Ontario, a region of the Canadian Subarctic, by exploring the importance of spaces and places to create postcolonial therapeutic landscapes in order to treat the wounds inflicted by colonialism. The present paper is important because it demonstrates that there are Indigenous ways of knowing that may challenge Western perceptions of health, place and identity (Marsh 2015;Rowan 2014;Willox 2012;Kirmayer et al 2011;Wilson 2003).…”

Health and wellbeing outcomes of programs for Indigenous Australians that include strategies to enable the expression of cultural identities: a systematic review

“…Consistent with this, supporting Indigenous people to practise culture is a key component of the Australian Government's current plan to improve Indigenous health (Commonwealth of Australia 2013). Nonetheless, little measurable outcome data from cultural healing interventions is available from Australia or elsewhere (Brady 1995;Berry et al 2012;Rowan et al 2014;Dell and Acoose 2015). The purpose of this systematic review is to examine whether interventions, which entail strategies to enable expression of cultural identities for Australian Indigenous peoples, are associated with measurable improvements in health and wellbeing.…”

“…A review of cultural interventions to treat addictions in Canadian First Nation populations concludes that cultural activities contribute to healing (Rowan et al 2014;Dell and Acoose 2015).…”