Culturally-Tailored Substance Use Interventions for Indigenous People of North America: A Systematic Review

Background: Substance use and addiction has been reported as a health concern for many Indigenous communities. Indigenous groups had the highest drug overdose death rates in 2015, and the largest percentage increase in the number of deaths over time from 1999-2015 compared to any other racial group. However, only a small number of Indigenous individuals report participating in treatment for alcohol or illicit drug use, which may reflect the limited engagement that Indigenous groups have with treatment options that are accessible, effective, and culturally integrative. A systematic review was conducted to describe what is known about the characteristics of culturally integrated treatment programs available to Indigenous populations across North America.

Methods: This review followed established methods for systematic reviews studies. Four databases from the scientific literature were searched from January 1, 2000 to April 21, 2021. We also checked references and hand searched reference lists of relevant papers, searched grey literature such as the Indian Health Service and NIHreporter websites, and contacted experts in the field. The 20 articles that met inclusion criteria for this review were analyzed both in terms of the cultural intervention itself (primary population, intervention, core tenets, substance use addressed, and intervention goals), location (country, region, and Tribal vs urban) and program length) and their study design.

Results: The search strategy yielded 1040 articles. Twenty (20) studies met inclusion criteria. Of these, most were conducted in the United States (90%), with only 10% conducted in Canada. Interventions were largely implemented in a Tribal/rural setting (60%), with a minority implemented in both Tribal and urban contexts (15%). The majority of interventions were located in the Western United States (40%), Alaska (20%), and the Southwest (20%). Study samples ranged from 4 to 742 clients. Randomized control trials (RCT) were the most common study designs (30%), followed by non-randomized experimental studies (20%) and program evaluations (20%). Interventions were most often conducted in residential treatment settings (35%), followed by intensive outpatient settings (15%). Surprisingly, only one intervention specifically focused on opioid use among Indigenous people. Most interventions addressed the use of drugs and/or alcohol (75%), with only four (20%) interventions intended to specifically reduce alcohol use.

Conclusions: The results of this research lend insight into the qualities of culturally integrative treatment options for Indigenous groups. In light of the diversity of Indigenous community characteristics and experiences, the concentration of Indigenous people in urban settings, and the efficacy of community-led interventions, increased investment in culturally relevant, accessible, and evidence-based treatment programs could facilitate meaningful change in the outcomes for Indigenous groups struggling with substance use disorders.