Use of the evidence base in substance abuse treatment programs for American Indians and Alaska natives: pursuing quality in the crucible of practice and policy

Abstract

BackgroundA variety of forces are now shaping a passionate debate regarding the optimal approaches to improving the quality of substance abuse services for American Indian and Alaska Native communities. While there have been some highly successful efforts to meld the traditions of American Indian and Alaska Native tribes with that of 12-step approaches, some American Indian and Alaska Natives remain profoundly uncomfortable with the dominance of this Euro-American approach to substance abuse treatment in their communities. This longstanding tension has now been complicated by the emergence of a number of evidence-based treatments that, while holding promise for improving treatment for American Indian and Alaska Natives with substance use problems, may conflict with both American Indian and Alaska Native and 12-step healing traditions.DiscussionWe convened a panel of experts from American Indian and Alaska Native communities, substance abuse treatment programs serving these communities, and researchers to discuss and analyze these controversies in preparation for a national study of American Indian and Alaska Native substance abuse services. While the panel identified programs that are using evidence-based treatments, members still voiced concerns about the cultural appropriateness of many evidence-based treatments as well as the lack of guidance on how to adapt them for use with American Indians and Alaska Natives. The panel concluded that the efforts of federal and state policymakers to promote the use of evidence-based treatments are further complicating an already-contentious debate within American Indian and Alaska Native communities on how to provide effective substance abuse services. This external pressure to utilize evidence-based treatments is particularly problematic given American Indian and Alaska Native communities' concerns about protecting their sovereign status.SummaryBroadening this conversation beyond its primary focus on the use of evidence-based treatments to other salient issues such as building the necessary research evidence (including incorporating American Indian and Alaska Native cultural values into clinical practice) and developing the human and infrastructural resources to support the use of this evidence may be far more effective for advancing efforts to improve substance abuse services for American Indian and Alaska Native communities.

Acceptability of a Web-Based Community Reinforcement Approach for Substance Use Disorders with Treatment-Seeking American Indians/Alaska Natives

“…An evidence-based intervention that is web-based and culturally-informed could address barriers to treatment access and dissemination among AI/AN communities, given its ease of implementation, limited staff training (given constricted resources), and flexibility in how TES is integrated into program curricula (Novins et al, 2011). Future research should focus on a collaborative, community-based adaptation process between intervention developers/researchers, treatment providers, and AI/AN community stakeholders.…”

Use of evidence-based treatments in substance abuse treatment programs serving American Indian and Alaska Native communities

“…In no part of American society is the need for quality substance abuse services greater than in American Indian and Alaska Native (AI/AN) communities, where the rates of substance use problems are higher than in the rest of the United States and access to care remains limited (Beals et al, 2006, 2005; O'Connell et al, 2005; Whitesell et al, 2012). While EBTs have the potential to improve substance abuse treatment services for AI/ANs, as they do for non-AI/AN populations, there have been a number of concerns raised by experts in this area regarding efforts to increase EBT use (Gone and Looking, 2011; Novins et al, 2011). These include longstanding concerns regarding the cultural appropriateness of many EBTs as well as a lack of guidance on how to adapt interventions for AI/AN populations while maintaining their effectiveness (Novins et al, 2011).…”

“…While EBTs have the potential to improve substance abuse treatment services for AI/ANs, as they do for non-AI/AN populations, there have been a number of concerns raised by experts in this area regarding efforts to increase EBT use (Gone and Looking, 2011; Novins et al, 2011). These include longstanding concerns regarding the cultural appropriateness of many EBTs as well as a lack of guidance on how to adapt interventions for AI/AN populations while maintaining their effectiveness (Novins et al, 2011). Furthermore, the imposition of policy mandates by federal and state authorities to use EBTs in order to receive funding may inadvertently make them even more controversial by placing their use in opposition to tribes’ continued efforts to maintain their sovereign status (Novins et al, 2011).…”

Intergenerational Patterns of Substance Abuse Among Urban American Indian Families

“…Despite national and state attention aimed at improving the state of substance abuse prevention and treatment (Indian Alcohol and Substance Abuse Interdepartmental Coordinating Committee, 2011), a debate continues about the appropriateness of adapting and applying evidencebased practices to AIs because, historically, these efforts have not been effective due to lack of fit with Indigenous ways of knowing (Novins et al, 2011).…”

“…Lack of funding to conduct evaluation research has also contributed to culturally specific treatments not being appropriately tested and validated; therefore, the effectiveness of such treatments may never be disseminated (Beauvais, 1998;Duran & Duran, 1995;Legaspi & Orr, 2007;Novins et al, 2011). There is a need for culturally specific prevention and treatment options for AIs that utilize and draw on cultural strengths (Walters, Simoni, & Evans Campbell, 2002;Weaver & Brave Heart, 1999;Whitbeck, 2006).…”