Integrating Motivational Interviewing and Traditional Practices to Address Alcohol and Drug Use Among Urban American Indian/Alaska Native Youth

Abstract

American Indians/Alaska Natives (AI/AN) exhibit high levels of alcohol and drug (AOD) use and problems. Although approximately 70% of AI/ANs reside in urban areas, few culturally relevant AOD use programs targeting urban AI/AN youth exist. Furthermore, federally-funded studies focused on the integration of evidence-based treatments with AI/AN traditional practices are limited. The current study addresses a critical gap in the delivery of culturally appropriate AOD use programs for urban AI/AN youth, and outlines the development of a culturally tailored AOD program for urban AI/AN youth called Motivational Interviewing and Culture for Urban Native American Youth (MICUNAY). We conducted focus groups among urban AI/AN youth, providers, parents, and elders in two urban communities in northern and southern California aimed at 1) identifying challenges confronting urban AI/AN youth and 2) obtaining feedback on MICUNAY program content. Qualitative data were analyzed using Dedoose, a team-based qualitative and mixed methods analysis software platform. Findings highlight various challenges, including community stressors (e.g., gangs, violence), shortage of resources, cultural identity issues, and a high prevalence of AOD use within these urban communities. Regarding MICUNAY, urban AI/AN youth liked the collaborative nature of the motivational interviewing (MI) approach, especially with regard to eliciting their opinions and expressing their thoughts. Based on feedback from the youth, three AI/AN traditional practices (beading, AI/AN cooking, and prayer/sage ceremony) were chosen for the workshops. MICUNAY is the first AOD use prevention intervention program for urban AI/AN youth that integrates evidence-based treatment with traditional practices. This program addresses an important gap in services for this underserved population.

Cultural Identity Among Urban American Indian/Alaska Native Youth: Implications for Alcohol and Drug Use

“…We conducted focus groups (FGs) in two large urban communities located in northern and southern California that provide services to the AI/AN community (Dickerson et al, 2015). We collaborated with community representatives to plan focus groups, including the sampling approach.…”

“…Our goal during the focus groups was to inform the development of a culturally relevant and developmentally appropriate AOD intervention for urban AI/AN youth. This paper focuses specifically on focus group discussions of Native cultural identity; the details of intervention development are discussed elsewhere (Dickerson, Brown, Johnson, Schweigman, & D’Amico, 2015). The advantages of this CBPR approach to exploring AI/AN cultural identity (and its utility for intervention development) include discovering and leveraging common experience and building a platform for “deep” (as opposed to surface level) cultural adaptation of prevention and intervention efforts (Jumper-Reeves, et al, 2014).…”

A pilot randomized trial of Motivational Interviewing compared to Psycho-Education for reducing and preventing underage drinking in American Indian adolescents

“…MI may be particularly useful in AI/AN populations when cultural adaptions are made to: use AI/AN therapists, emphasize respect for the study participant’s language and spirituality, their relationship with extended family and clan, as well as their tribes’ unique history and culture (Venner et al, 2016). Several groups have developed methodology to implement MI in AI/AN populations as well as demonstrate its acceptance by AI/AN communities (Dickerson, Brown, Johnson, Schweigman, & D’Amico, 2016; Gilder et al, 2011; Venner, Feldstein, & Tafoya, 2008). …”

“…A recent review of evidence-based treatments in substance abuse treatment programs serving AI/AN communities found that only two treatments, MI and Relapse Prevention Therapy, were deemed culturally appropriate by the programs that had utilized them (Dickerson et al, 2016; Novins, Croy, Moore, & Rieckmann, 2016; Spillane, Greenfield, Venner, & Kahler, 2015). For this reason, there have been several groups that have begun to develop programs to incorporate MI within a framework of treatment for substance use disorders in AI/AN health care settings (Dickerson et al, 2016; Gilder et al, 2013; Venner et al, 2008).…”

“…For this reason, there have been several groups that have begun to develop programs to incorporate MI within a framework of treatment for substance use disorders in AI/AN health care settings (Dickerson et al, 2016; Gilder et al, 2013; Venner et al, 2008). Few studies to date have been developed specifically for AI/AN youth.…”