In August of this year, the Office of Recovery and the Office of Tribal Affairs and Policy co-hosted a Tribal Recovery Summit in Dallas, Texas, in partnership with SAMHSA’s Region 6 Office. The focus of this Summit was to present pathways to recovery and highlight many ways to support American Indian/Alaska Native (AI/AN) people on the front lines of the opioid/fentanyl crisis. Nearly 300 participants attended the Summit either virtually or in person, including tribal chiefs, staff and heads of federal agencies, service providers and professionals.
This Summit was developed to highlight innovative practices used in Tribal programs. According to the 2022 National Survey on Drug Use and Health (NSDUH), SAMHSA’s comprehensive report on substance use and mental health indicators to date, AI/AN adults age 18 and older reported among the highest levels of marijuana use and illegal drugs in the past year and are among those most likely to have a substance use disorder. These issues have been exacerbated since the public health emergency COVID-19. Hence, efforts to uplift and empower Tribal citizens are of utmost importance. Presenters at the Summit covered a myriad of topics intended to assist AI/ANs in substance abuse recovery, assist those involved in the criminal justice system, support youth, families, veterans, and more.
How culture supports recovery
Many presenters at the Summit echoed a message that restoring cultural interventions and best practices is critical to recovery. Holly Echo-Hawk, an organizational behavior and health specialist with Kauffman & Associates, Inc., and a tribal citizen in the Pawnee Nation of Oklahoma, emphasized that connecting with culture supports both treatment and recovery from substance use enhancing social justice through Indigenous identity, traditional learning, cultural healing and environmental safeguards. While support is underway to strengthen Western interventions, treatment and recovery models, cultural best practices also require support. Tribal communities recognize that the absence of cultural protection practices only reinforces it historical trauma (PDF | 16.6 MB), such as changes in traditional family structure, child rearing and community cohesion. It is important to note that Tribes they draw strength from these traditions and their resilience is enhanced through culture, shared values, spirituality and a strong sense of identity, responsibility and accountability.
Following Ms. Echo-Hawk’s presentation, Nathan Billy, Director of Behavioral Health Programs at the National Indian Health Council and a citizen of the Choctaw Nation of Oklahoma, discussed the need for cultural care when helping Tribes. Culture-centered care focuses on the perspectives of tribal, indigenous, or indigenous communities, systems, and providers. It also prioritizes cultural humility (PDF | 142 KB) and includes cultural worldviews, paradigms, models and frameworks that underpin cultural activities. Thus, Native American culture is not seen as an alternative or supplement to caregiving, but rather as the primary component of caregiving.
Reinforcing the need for culturally focused care among AI/ANs were the sentiments of Debra Buffalo-Boy, Board Chair of the Oregon Mental Health and Addiction Certification Board and registered member of the Standing Rock Lakota Nation, and Jerrod Murray, Executive Director of Painted Horse Recovery and an Anishinaabe citizen from the Chippewa Cree tribe. Buffalo-Boy and Murray’s presentation highlighted the value of culturally based interventions (CBIs) and evidence-based culturally adapted practices. Both CBI and evidence-based practices may include activities such as drumming, beading, and preparing or eating traditional Tribal foods, dealing with collective trauma and unresolved intergenerational grief, or family involvement, among others methods.
One type of CBI highlighted was peer-based ‘lived experience’ interventions, also called ‘Peers’, dating back to the 1730s. Additionally, the term ‘lived experience’, which refers to one’s life experiences, as and in the wisdom of elders derived from real-life events, it is a traditional Native American value often respected more than academic knowledge. According to Buffalo-Boy and Murray, Peers recognize the holistic perspective of health and wellness that many AI/AN cultures have. In the Peers approach, substance use challenges and mental illness are not seen as imperfections. Instead, they are seen as symptoms of an imbalance in a person’s relationship with the world. Therefore, treatment and healing approaches must integrate all aspects of life, including spiritual, emotional, physical, social, behavioral, and cognitive.
The Role of the Community
One could argue that at the heart of Peers is community connection. It is well understood that among many AI/AN cultures their main orientation (PDF | 3.4 MB) it’s the community. Therefore, it is important that efforts to assist Tribes in recovery and harm reduction include this component. At the summit there were many presenters who touched on the role that community plays in recovery. Latisha Franks, Director of Youth Empowerment at Small Earth and member of the Red Lake Band of Ojibwe, presented the efforts of Little Earth, a US Department of Housing and Urban Development subsidized housing complex of nearly 1,200 residents, to create a culturally supportive, healthy and integrated community. Little Earth supports residents through all life cycles, with programs focused on youth, adult, and family empowerment.
To better promote community involvement and promote cultural connection, the Little Earth Youth Empowerment Program offers paid internships through Little Earth Urban Farm. During this internship, native youth learn teamwork, respect and responsibility, and experience traditional gardening processes. Of the Little Earth Adult and Family Empowerment Program (AFEP) believes that it takes empowered adults and healthy families to build and maintain empowered families and an empowered community. One area of AFEP worth noting is its focus on ceremonies. Depending on the month and season, the inhabitants of the Little Earth can participate in ceremonies such as the Naming Ceremony, the Water Ceremony, or the Full Moon Ceremony.
Courtney Trent, LCDR with the US Public Health Service Corps and Choctaw Nation’s Project Manager Warrior Wellness Program, also emphasized the importance of support for AI/AN veterans. LCDR Trent shared that Warrior Wellness differs from other veteran-centered programs because of its focus on providing culturally connected holistic services intended to enhance the mental, physical, spiritual and emotional health of Native veteran families. In this program, AI/AN veterans develop a sense of community through activities such as hiking, fishing, and kayaking. Families are invited to an annual family retreat.
Medications for Opioid Use Disorder
Opioid Use Disorder (MOUD) medication and housing support are offered and supported through SAMHSA’s Tribal Opioid Response (TOR) grant program and Homelessness Programs and Resources. Annette Hubbard, Addiction Medicine Manager at Ninilchik Community Clinic and member of the Aleut/Alutiiq tribe, addressed the stigma and misconceptions associated with MOUD. For example, there is reluctance in Tribes, as many believe that this proposed method of dealing with substance use is simply replacing one substance with another.
Hubbard also touched on the benefits of buprenorphine and methadone, drugs approved by the Food and Drug Administration (FDA) for opioid use disorder (OUD), and highlighted testimonials from actual patients in treatment. The benefits of MOUD were reiterated by Pehilomena Kebec, Economic Development Coordinator and member of the Bad River Band of Lake Superior Chippewa. Specifically, Kebec spoke about MOUD to help with opioid use disorder among incarcerated AI/ANs.
Closure
The Summit provided many opportunities for Tribal citizens and Tribal supporters to gain a better understanding of pathways to recovery and various methods of support. Despite the prevalence of substance use in AI/AN communities, there are many efforts to address these issues. SAMHSA continues to honor its mission to lead public health and service delivery efforts that promote mental health, prevent substance use, and provide treatments and supports to promote recovery while ensuring equitable access and better outcomes for AI/AN and other populations.
