Culturally-Informed Interventions for Substance Abuse Among Indigenous Youth: A Systematic Review

Background and Purpose: Alcohol and other drug (AOD) abuse is a pressing health concern for Indigenous youth (ages 9-18). Treatment generally follows a non-Indigenous approach and has proven to be less effective and even harmful, yet, few published studies, and meta-analyses or literature reviews focus on the use of culturally-informed interventions. Given the disproportionately high levels of alcohol and other drug abuse, the purpose of this systematic review was to explicate the current state of empirically-based and culturally-informed substance abuse prevention and intervention programs for Indigenous youth in the U.S.

Method: Using nine social science databases, this systematic review includes peer-reviewed empirical research published between 1988 and 2016 focusing on AOD abuse intervention programs that are culturally-informed and aimed at Indigenous youth in the U.S. Inclusion criteria included articles that: (a) were peer reviewed; (b) incorporated a culturally-informed intervention, c) provided outcomes evaluating the intervention; and (d) addressed AOD. The initial 148 articles obtained from the initial search were reduced to 14 articles after applying inclusion criteria. These were analyzed both in terms of the cultural intervention itself and their evaluation approach.

Results: A variety of culturally-informed interventions are currently addressing Indigenous youth AOD use and abuse with success, including those consisting of community-events (n=3), the use of media-projects like photovoice (n=1), the use of curriculum-based interventions (n=4), and the use of peer groups (n=14). The culturally-informed components of such interventions included the use of talking circles (n=3), family or community involvement (n=9), and traditional ceremonies and rituals (n=5). Seven studies adapted existing western interventions to include an Indigenous component. Nine studies involved the community in the developed of the intervention itself. Five interventions include other goals in addition to AOD prevention. Interventions took place in both urban and rural contexts, and across the United States (with the largest number (n=9) in the Western region). Seven studies took place in schools and three at community centers.  Data on sample size ranged from 20 to 1000 participants and ten studies did not report gendered outcomes. Interventions lasted from a few days (n=2) up to a full academic year or longer (n=1). All studies reported at least partial improvement in prevention or reduction of AOD. Five used a mixed-methods approach in their evaluation, and eight studies did not use a RCT format. Seven interventions used Focus groups.

Conclusion and Implications: This study is unique in being the first to systematically investigate the state of culturally-informed AOD prevention and intervention programs for Indigenous youth. Some of these promising areas of future research and interventions include bringing communities and families into treatment and prevention, and developing culturally-informed curriculums for school settings. However, a lack of consistency in reporting study findings and protocols complicates efforts to compare intervention strategies and develop strong Evidence Based Practices. This is concerning since most funders require this evidence and because of the demonstrated need for these culturally-informed interventions.  This review is a valuable resource for social work practitioners seeking an up-to-date review of which interventions are currently being utilized.