Our Working Statement of Purpose: This review will discuss the issues with delivering treatment to AI/AN s
Author Abbreviated Study Question/Purpose Methods & Usefulness
Title Campbell et. Acceptability Do Computerized, web- 20 participents completed a All of a web-based delivered interventions have brief screen to assess ... [for] AI/AN the ability to give quality eligibility treatment and improve patient (with verbal consent), outcomes remotely in AI/AN followed by full study consent communities? and a baseline assessment. Participants then completed 8 weeks of web-based TES Croff et. All Provider + This article discusses findings The usingstudy uses onsite a quantitative computers. A state from "interviews with 22 survey andassessment, follow up qualitative perspectives program directors and 18 interviews including atoqualitative look at culture on representatives from Single based models of care, what interview, implementing State Authorities on substance level of collaberation was completed 1 weekexisted after cultural-based abuse." They assessed between state and the intervention tribes, how phase. models of care "provider and state efforts to effective cultural competency for AI/AN increase AI/AN client training there was (if it was Dickerson et. Integrating patients with The development engagement and toofimprove -community present), andbased how these All motivational substance use Motivational the quality of Interviewing care through interviewing, improved qualityinteractive of care group for interviewing disorders and Culture culturally for Native relevant interviewing AI/AN patients.in the form of and traditional American Youth interventions." focus groups, FG's consist of practices... (MICUNAY) as a tool for youth, parents, city members. urban AI/AN prevention of AOD becuase youth this population lacks cultural inclusive Evidence based Ehlers et. All Evidence for a Knowing that substance practice, programs. In a review of the liturature, genetic abuse has a high risk of the authors examine "evidence component for heritablity and that substance for a genetic component in the substance abuse is a major health risk in etiology of substance dependence in AI/AN communties, this dependence in Native NA study seeks to examine the Americans, including studies role of genetics in the risk for of heritability, linkage substance abuse in AI/AN analyses, and candidate Ehlers et. All Measuring This study examines how communities. Participants genes." assessed with the historical much the frequency of Semi-Structured Assessment trauma in AI thoughts of historical loss and for the Genetics of Alcoholism sample: ... associated symptoms in the (SSAGA), The Historical Loss AI/AN community are Scale and The Historical Loss influenced by: "current Associated Symptoms Scale, traumatic events, post the Stressful-Life-Events traumatic stress disorder Scale, and the Orthogonal (PTSD), cultural Cultural Identification Scale identification, percent Native (OCIS) American Heritage, substance dependence, affective/anxiety disorders, and conduct disorder/antisocial personality disorder (ASPD)" Kropp et. All Characteristics This study seeks to examine The study used the Addiction of northern the substance abuse rates in Severity Index-Native plains AI ... in Northern Plains AI groups in American Version with an urban, non- a non-Native substance abuse suplimental AI-Relevent tribal clinic: A treatment setting through the questions, a cultural descriptive Methamphetamine and Other adaptation of the Addiction study Drug project, developedby Severity Index, and was the National Institute on Drug administered by trained Legha Challenges to This Abusestudy seeksTrials Clinical to They conducted interviewers. Thekey informant data was providing ... understand the challenges Network (NIDA CTN). to interviews and focus groups at analyzed using for AI/ANs: providing quality substance 18 substance descriptive abuse treatment statistics for Perspectives of abuse treatment to AI/AN programs serving AI/AN selected variables; then staff from 18 communities. communities, participants werethe split interviews into treatment were three then transcribed groups accordingandto centers coded lifetimetosubstance identify keyusethemes. patterns and their characteristics were Novins et. All Use of EBTs in The purpose of this study is to Data testedwas for collected via survey: between group substance examine the prevelance of participants differences. (clinicians or abuse evidence-based treatments clincal administrators) were treatment (EBTs) in AI/AN serving surveyed on their "awareness programs treatment facilities. of, attitudes toward, and use of serving 9 psychosocial and 3 AI/ANs medication EBTs."
Rieckmann A nat. study of To examine workforce and Methods & Usefulness
et. All AI/AN programmatic differences substance between clinics located in abuse urban/suburban and rural treatment: AI/AN communities. Also Provider and explored were the correlates program of openness toward using characteristics evidence-based treatments Running Bear Alcohol detox To examine the factors (EBTs). They examined 3 critical et. All completion...a associated with detoxification points on the substance abuse mong AN treatment completion and the continuum of care by using people transition to substance abuse data from "three multiple treatment following logistic regression models detoxification among Alaska estimated the adjusted Native people. associations of each outcome separately Running Bear Impact of This study examines Using a retrospective cohort withdemographic/psychosocial et. All adaptive predictors associated with study, the studyclinical characteristics, examined 383 functioning on readmission to detoxification adult AN patients characteristics, useinrelated inpatient readmission to in a sample of AN inpatient detoxification behaviors, andunit to estimate health care alcohol detox alcohol detoxification readmission utilization." within one year. among ANs patients. Walsh + AI substance This review assessed Preferred Reporting Items for Baldwin abuse substance abuse prevention Systematic Reviews and Meta- prevention (SAP) efforts in AI/AN Analyses (PRISMA) efforts: A communities from 2003-2013 guidelines were used to assess review of to examine of there was a a total of 18 articles covering programs disconnect between SAP 31 programs on topics of theories that are used to "program location and method, develop AI/AN prevention participant characteristics, Walsh-Buhi Theoretical This studyand programs uses"culturally qualitative In-depth describedinterviews identified program cultural perspectives of research to explore appropriate theoretical components of Indigenous elements, use of theory, AI/AN perceptions constructs ofofAI/AN theory by SAP theoretical perspectives, program outcomes, program substance researchers worldviews." in AI/AN including measures, cultural elements and future abuse communities. such as balance, social recommendations." prevention cohesion, and belonging as programs being particularly significant and currently absent from many SAP programs. Recommendations for conducting metatheory studies and operationalization of Indigenous perspectives into guiding theoretical underpinnings for future SAP programming are provided. delivering treatment to AI/AN substance abuse communties.
Conclusions or Findings Remaining Questions or Relation to Review Topic
Uncertanties (limitations) "Findings The program could be Discusses potential options to from this pilot study suggest that core improved and better recieved increase accessability and TES content and with the addition of content relevancy of treatments in web-delivery format are acceptable representative of "traditional AI/AN communities. among a diverse AI/ practices, culture and native AN client population receiving peoples". Factors such as treatment in urban settings." "provider attitudes, funding (including reimbursement for Their results suggest that care providers During the study,services), non face-to-face issues such and Discusses the successfulness were most successful when they as "gaps in internet broadband statetribal access [...] of culturally relevant employed "flexibility and originality to collaborations" and "inter- in rural or reservation-based interventions in AI/AN cultural-based programs by broadening group complexities treatement programs" such areasall substance abuse treatment, and established practices, adopting outside staff-based factors that tensions" created shows factors that can inhibit must be considered traditions, and creating new ones to fit in-facility issues, while "a in future studies. their success. client needs." widening generational divide" and "blurred consensus of Results indicate that AI/AN adoloscents The MICUNAY 'tradition'" program were other was Discusses the apparent need factors face many factors contributing to their at created but now that affected careneeds results quality, and for culturally based treatment risk behavior and implemantaion of of needimplementation to be expanded to upon yeild in for the AI/AN adoloscent integerated practice including cultrally results further of significance and research. population and inquires the sound and evidenced practice programs success for this population. nescessity for prevention could benefit the prevention of AOD Also a program like programs in the community. behviors. MICUNAY would need to be MICUNAY is the first of its created for other AI/AN kind in refernece to AOD The results found that "evidence for the This study focused populations exclusively across the nation Discusses treatment .genetic potential Important for our heritability of alcohol and drug on genetic potential becuase this progeram wasfactors, causes for the research topic* prevelance of dependence was found", as well as the and did and created not acknowledge specifically the AI/AN substance abuse issues, presense of related genes influencing the role that socio-economic implemented for CA. which is important to help risks for "body mass index (BMI), drug factors could play in AI/AN patients recieve early tolerance, EEG patterns, and substance abuse. intervention. externalizing traits". The studies also showed that most AI/AN's lack They foundgene protective thatvariants thoughtsagainst about There is debate if the current This article discusses on of the historical alcoholismlosses were that are common, seen in otherand the socio-economic state of potential sources for the presence of these thoughts are populations. AI/AN communities could be prevelance of substance abuse associated with "Native American contributing more than in the AI/AN community that Heritage, cultural identification, and historical trauma, or if the is often not acknowledged. substance dependence." current issues in the community could even be causing further dwelling on these issues. This study found that though the use of Because the clients were This study assists fills in gaps amphetamines, cocaine, and prescription enrolled in an urban, non- in the knowledge regarding opioids were present, alcohol and Native treatment center, they substance use patterns, marijuana were used earlier, longer, and may not be representative of associated challenges, and by more treatment-seeking clients. There AI substance users who are on resources, especially in urban- was also a high rate of heavy tabacco reservations or wish to seek based clinics. use. It was found that age of substance treatment that is based in use initiation was lower for clients using traditional Native healing Found alcohol3plus major types illicit of challenges drugs than for Because practices.the study These focusesalso findings on Perfectly frames many of the facing AI/ANclients. alcohol-only servingBased on this programs that provide only represent a specific issues that need to be facilities:challenges finding, it appears that associated prevention with efforts innovated geographicservices, area. the addressed currently in the providing should startclinical prior to support, age 13 challenges and should findings may be less AI/AN treatment facility. associated target both with alcoholthe and infrastructure illicit drugofuse. applicable to more traditional treatment settings, and challenges programs. Also, clients and associated with the service/treatment community members were not system as a whole. interviewed, meaning this Despite the controversal nature of EBTs The study isislimited perspective lost. because it This is relevant to our research in the AI/AN treatment communities, relies on the reports of because it shows that, despite EBTs were used prevelantly, with program staff members, the reluctance and seemed Cognitive Behavioral Therapy, because it is non-experimental resistance/ineffectiveness of Motivational Interviewing, and Relapse and cross sectional (potentially EBTs in AI/AN communities, Prevention Therapy being the most muddying engagement the treatment community still common psychosocial EBTs, and with further), because it combines relies heavily on them, medications for psychiatric comorbidity EBTs into psychosocial and possibly perpetuating the cycle The beingrural mostprograms commonly were significantly This implemented study relies medication heavily treatments on (which This study has baseline of failed less likely than medication urban providers to have program treatment. affects thestaff member reports; workforce regression and program level treatment/readmission. culturally relevant and general not all reports analyses), and and staff the because data that can be used to better resources, but were significantly more members are createdwas survey participation equal. low understand differences in likely to employ elders, offer AA-open for the general population programs, changes in access group recovery services, and collect data (63%, though this is very high and quality for AI/AN over on treatment outcomes. The study for a AI/AN community.) time, and the use of EBT over correlated greater EBT openness to a time. They largerfound that clinical "higher staff beingglobal led by The author admits that Relation to Review Topic assessment directors who functioning perceivedscores, a gap inlonger access "Patients could have entered lengths to EBTsofwho stay, and older worked ages ofthis to remove first substance abuse treatment alcohol use" programs gap, though correlatedthatto completing provide early post-discharge; these detoxification. Secondary intervention services showed drugless admissions would have been diagnoses openness. were linked to not completing unrecorded" and that "the detoxification. Groups that were more extent these limitations were at likely to accept substance abuse referrals work in the present analyses, They foundthose were men, that 42% with of patients legal were Because problems, this was the observed a relationships may This study examines further readmitted and those with a longer length of stay. be underestimated" In addition the factors of readmission in within one year; An increase retrospective study that relied in Global Assessment Functioning upon to this,EMR data, therelie the analyses data on AI/AN communties, giving (GAF) was associated with a decrease in recorded treatmentin the so data, EMRtheymay not statistical evidence of the cannot readmission, but low GAF scores were include important indicators of current/recent state of cultural variables associated with readmission. readmission; which are a majorthe analyses concern in treatment in the community. relied AI/ANonresearch. several variables that were patient self-reported to detoxification unit staff, making them potentially inconsistant, on top of the fact that some patients may have been reluctant to report certain types of information. Results indicated that SAP programs in Limitations include that this This gives a good AI/AN communities vary widely in their study identified theories used, representation of the average "use of theory, implementation but not whether or not a types of theories and practices strategies, view and definition of program was "theoretically used in the AI/AN treatment cultural constructs, overall evaluational driven." Without access to community, allowing for rigor, and reporting methods", but more actual program materials, it is assessment of prevelance of research is needed to integrate difficult to state what the appropriateness of techniques. appropriate theory and cultural elements specific program approaches, Participants academic training often into the programs. Because methods,theandstudy is small,the elements might This shows staff perspectives, correlated to their ideas. "For example, findings are not intended have been. In addition, this to isbe but also notes what many those who were trained in their doctoral "generalizable to all far from a comprehensive federally studies either don't examine or programs in psychology had a tendency recognized review of alltribes, of thestate tribes, liturature; refuse to acknowledge: people to describe individual, psychological SAP researchers working descriptive pieces were left with invested in traditional SAP's theories as being the most effective, AI/AN communities, or out, and pieces that may haveSAP by way of training are less rigorous, and useful for addressing SAP programs had data butoperating in AI/AN were focused willing to acknowledge gaps in in AI/AN communities, regardless of communities." Also, elsewhere were excluded. issues of the treatments; there is also a whether or not these theories truly were self-selection bias were possibly racialized element effective and useful in SAP in AI/AN possible. here, in the sense that those communities. These participants were who feel they do not need to also more likely to state that theory tailor to AI/AN communities integration in SAP in AI/AN are overwhelmingly non- communities was actively occurring and native. were less likely to see a need for tailoring of theories for AI/AN communities.[...] "The majority of those participants trained in psychology who viewed theory use and effectiveness in this way were overwhelmingly non- Native"