Exploring the Cultural Experiences of Indigenous People Who Receive Treatment for Substance and Alcohol Abuse: A Qualitative-Interpretive Meta-Synthesis

Background and Purpose: There is a lack of evidence-based treatment that is culturally sensitive for treating substance and alcohol abuse among American Indians and Alaskan Natives (AI/AN). Historically, research on treatment interventions for AI/AN in recovery from substance use disorders focuses on explaining the relevance of improving the overall quality of healthcare for AI/AN communities. Despite the need for evidence-based treatment methods that are culturally sensitive to Indigenous persons, disparities in healthcare among American Indians and White Caucasians still exist. This study presents a qualitative interpretive meta-synthesis (QIMS) of existing cultural norms and values in AI/AN communities for substance and alcohol use disorders. The purpose of this study is to better understand AI and AN experience’s of traditional recovery supports for substance and alcohol abuse. The following research question was examined: what are the cultural values and traditional recovery supports among American Indian and Alaskan Natives who receive treatment for substance and alcohol abuse?

Methods: A qualitative interpretive meta-synthesis (QIMS) was conducted in four electronic databases (Psych INFO, PubMed, ProQuest, and JSTOR) to identify qualitative studies that address the cultural experiences of AI/AN in recovery from substance and alcohol abuse. The initial search produced 187 sources. Based on the inclusion and exclusion criteria, a total of n=8 peer-reviewed journal articles were included in the QIMS analysis. The author synthesized the themes manually, utilizing the process of triangulation. Triangulation of data collection included analyzing multiple qualitative studies, interviews and focus groups. The sample selection was collected from articles within the U.S. Participants in the studies were 18 years or older. There were no parameters on the publication dates of the articles selected.

Results: A synthesis of eight studies revealed four sub themes that described the cultural experiences of AI/AN in recovery from substance and alcohol abuse. These syntheses included: family and community as motivation for abstaining from drinking, the importance of elders, cultural tradition, and spirituality. 351 participants were analyzed, and 51 codes were extracted.4 new themes were created, and 11 sub themes were generated. Participants in this study expressed family and the community as being a major source of support in their recovery from substance and alcohol abuse. Among participants’ responses, family and community support were related to three categories or sublevels: (1) children as motivation, (2) family as a source of support and the intergenerational impacts of addiction, and (3)the support offered from the different tribes for those in recovery on the reservation.

Conclusions and Implications: The findings suggests that certain cultural traditions from AI/AN communities are influential for recovery. It’s important for social workers to get a clear understanding of the social norms and cultural conceptualizations of substance use within the AI/AN culture. This in turn, will help improve accessibility to evidence-based treatments that are culturally appropriate and acceptable. Social workers can use these findings to improve health care treatment for AI/AN individuals in recovery from SUD. Furthermore, social workers can use these findings to contribute to existing research on addiction in AI/AN in communities.