In August of this year, the Office of Recovery and the Office of Tribal Affairs and Policy jointly hosted a Tribal Recovery Summit in Dallas, TX, partnering with SAMHSA’s Region 6 Office. The focus of this Summit was to showcase pathways to recovery and highlights multiple ways to support American Indian/Alaska Native (AI/AN) Tribes on the frontlines of the opioid/fentanyl crisis. Nearly 300 participants attended the Summit either virtually or in person, including Tribal leaders, federal agency staff and leaders, service providers, and practitioners.
This Summit was developed to highlight innovative practices employed in Tribal programs. Per the National Survey on Drug Use and Health’s (NSDUH) 2022 report, SAMHSA’s comprehensive report on substance use and mental health indicators to date, AI/AN adults aged 18 and older reported among the highest marijuana and illicit drug use levels in the past year and are among those most likely to have a substance use disorder. These issues were exacerbated in the aftermath of the COVID-19 public health emergency. Therefore, efforts to uplift and empower Tribal citizens are of the utmost importance. Presenters at the Summit covered a myriad of topics meant to aid AI/ANs with substance use recovery, help those involved with the criminal justice system, support youth, families, veterans, and more.
How Culture Supports Recovery
Multiple presenters at the Summit echoed a message that restoring cultural interventions and best practices is crucial for recovery. Holly Echo-Hawk, an Organizational Behavior and Behavioral Health Subject Matter Expert with Kauffman & Associates, Inc., and a Tribal citizen with the Pawnee Nation of Oklahoma, stressed that a connection to culture supports both treatment and recovery from substance use by reinforcing social justice through one’s indigenous identity, traditional learning, cultural healing, and environmental safeguards. While support is underway to reinforce Western interventions, treatment, and recovery models, cultural best practices also require support. Tribal communities recognize that the absence of culture-protective practices only reinforces historical trauma (PDF | 16.6 MB), such as changes to traditional family structure, child rearing, and community cohesiveness. It is important to note that Tribes draw strength from these traditions and their resilience is reinforced 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 Board and a citizen of the Choctaw Nation of Oklahoma, discussed the need for culturally centered care when helping Tribes. Culturally centered care focuses on the perspectives of Tribal, Native, or Indigenous communities, systems, and providers. It also prioritizes cultural humility (PDF | 142 KB) and includes cultural worldviews, paradigms, models, and frameworks that ground cultural activities. Thus, Native American culture is not seen as alternative or complementary to care, but rather the main component of care.
Reinforcing the need for culturally centered care among AI/ANs were the sentiments of Debra Buffalo-Boy, Board President of the Mental Health and Addiction Certification Board of Oregon and an enrolled 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 underscored the value of culture-based interventions (CBIs) and culturally adapted evidence-based practices. Both CBIs and the evidence-based practices can include activities such as drumming, beading, and the making or consumption of traditional Tribal foods, addressing collective trauma and intergenerational unresolved grief, or family involvement, among other methods.
One type of CBI highlighted was peer-based “lived-experience” interventions, also called “Peers,” which dates back to the 1730s. Additionally, the term “lived-experience,” referring to one’s life experiences, as well as elder wisdom derived from real-life occurrences, is a traditional Native American value oftentimes respected more than academic knowledge. According to Buffalo-Boy and Murray, Peers acknowledges the comprehensive perspective of health and wellness that many AI/AN cultures hold. In the Peers approach, substance use challenges and mental illness are not viewed as imperfections. Instead, they are considered symptoms of imbalance in an individual’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 Community
One can argue that at the heart of Peers is a connection to community. It is well understood that among many AI/AN cultures their primary orientation (PDF | 3.4 MB) is the community. Therefore, it is important that efforts to assist Tribes with recovery and harm reduction include this component. At the Summit there were multiple presenters who touched on the role community plays in recovery. Latisha Franks, Youth Empowerment Director at Little Earth and a member of the Red Lake Band of Ojibwe, presented on the efforts of Little Earth, a U.S. Department of Housing and Urban Development subsidized housing complex with nearly 1,200 residents, to create a culturally supportive, healthy, and unified community. Little Earth supports residents throughout all cycles of life, with programs that focus on youth, adult, and family empowerment.
To better promote community involvement and foster cultural connectedness, Little Earth’s Youth Empowerment Program offers paid internships via the Little Earth Urban Farm. During this internship, Native youth learn teamwork, respect, and accountability and experience traditional gardening processes. Little Earth’s Adult and Family Empowerment Program (AFEP) believes that empowered adults and healthy families are needed to build and sustain empowered families and an empowered community. An area of the AFEP worth noting is its focus on ceremonies. Depending on the month and season, Little Earth residents can participate in ceremonies such as Naming Ceremony, Water Ceremony, or Full Moon Ceremony.
Courtney Trent, LCDR with U.S. Public Health Service Commissioned Corps and Project Manager at Choctaw Nation’s Warrior Wellness Program, also stressed the importance of support for AI/AN veterans. LCDR Trent shared that Warrior Wellness differs from other veteran-centered programs due to its focus on providing culturally connected holistic services meant 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 centered retreat.
Medications for Opioid Use Disorder
Medications for opioid use disorder (MOUD) and housing support are both offered and supported through SAMHSA’s Tribal Opioid Response (TOR) grant program and Homelessness Programs and Resources. Annette Hubbard, Addiction Medicine Case Manager with Ninilchik Community Clinic and an Aleut/Alutiiq Tribal member, touched on the stigma and misconceptions associated with MOUD. For instance, hesitancy is observed within Tribes, as many believe this proposed method of treating substance use is merely replacing one substance with another.
Hubbard also touched on the benefits of buprenorphine and methadone, both Food and Drug Administration (FDA) approved medications for opioid use disorder (OUD) and highlighted testimonials by real patients undergoing treatment. The benefits of MOUD were echoed by Pehilomena Kebec, an Economic Development Coordinator and member of the Bad River Band of Lake Superior Chippewa. Specifically, Kebec spoke of MOUD to help with opioid use disorder among incarcerated AI/ANs.
The Summit provided many opportunities for Tribal citizens and those who support Tribes to gain better understanding of pathways to recovery and various methods of support. Despite the prevalence of substance use within AI/AN communities, there are numerous 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 foster recovery, while ensuring equitable access and better outcomes for AI/AN and other populations.