Weaving Healthy Families: An Indigenous-Centered, Family-Based Approach to Reducing Alcohol Misuse across Generations

Background and Purpose: U.S. Indigenous Peoples continue to experience disproportionate risks for alcohol and other drug (AOD) use disorders, post-traumatic stress disorder (PTSD), and violence, rooted in settler colonial historical oppression. Despite lower or comparable AOD use rates relative to other groups, Indigenous communities experience more severe consequences due to systemic inequities, including reduced access to care, cultural disruption, and intergenerational trauma. Alcohol, weaponized through colonization, continues to shape social determinants of health, but mainstream research often overlooks these sociopolitical contexts, perpetuating stigma and colonial narratives.

To address these health inequities and promote wellness, Indigenist approaches like the Framework of Historical Oppression, Resilience, and Transcendence (FHORT) center Indigenous knowledge and cultural strengths. Guided by FHORT, the Weaving Healthy Families (WHF) program integrates culturally grounded teachings, healing practices, and evidence-based strategies in a holistic, family-centered prevention model. Developed over a decade of community-based participatory research, WHF aims to prevent AOD misuse and support mental, emotional, physical, and relational wellness among Indigenous adults and youth.

Methods: This longitudinal dynamic open cohort stepped wedge trial included 218 adults and 354 youth from U.S. Indigenous communities. Participants engaged in 2.5-hour weekly sessions that combined psychoeducational and experiential activities, beginning with a shared family meal and incorporating lessons on nutrition, communication, cultural values, and promotive family rituals. Data were collected at five time points: pre-test, post-test, and 6-, 9-, and 12-month follow-ups. Measures included the Alcohol Use Disorders Identification Test (AUDIT) and individual indicators of alcohol and substance use. Analyses employed multilevel longitudinal modeling, adjusting for baseline scores and sex.

Results: Among adults, participation in WHF was associated with significant reductions in alcohol misuse, including decreases in alcohol use disorder symptoms (B = -0.67, p < 0.001), overall AUDIT scores (B = -0.32, p = 0.0002), and the number of drinks consumed in the past month (B = -0.09, p = 0.0001). Additional declines were observed in the past 30-day alcohol use (B = -0.53, p < 0.0001) and marijuana use (B = -0.27, p = 0.03). Sex differences emerged in both AUD symptoms and feelings of guilt, suggesting varied pathways of change across gender. Among youth, a significant postintervention reduction in AUD symptoms was also observed (B = -0.09, p < 0.03), with sex differences approaching significance (B = -0.09, p < 0.057), indicating that females may have experienced greater benefit.

Conclusions and Implications: Findings from this trial provide robust evidence for the WHF program’s effectiveness in reducing alcohol misuse and supporting intergenerational healing among Indigenous families. The program’s integration of Indigenous cultural knowledge with family-based prevention strategies offers a replicable model for addressing alcohol-related health disparities. These results highlight the critical importance of centering Indigenous voices and values in the development and evaluation of behavioral health interventions and point to the value of relational, community-driven frameworks for long-term wellness.