People who find themselves in a downward spiral from addiction and mental illness are not the only ones affected. Their loved ones may also deal with the individual’s substance abuse problems, including abusive and aggressive behaviors, financial issues, shame, uncertainty and relapses. Those in the Native American Community, although a small part of the country’s inhabitants, experience higher rates of substance abuse than the general population. Research shows that Native youth also experience a higher rate of substance abuse than their peers of other ethnic groups and also start using substances earlier. The stigma associated with mental illness can keep some people from seeking treatment.
Limited Treatment Resources
Native American families often find it difficult to locate treatment services due to limited resources and the lack of treatment centers in their communities. Native Americans living on or near reservations may not have jobs that provide health insurance benefits that cover mental health substance disorder treatment. It may also be difficult to find transportation to health care facilities, including mental health centers and drug abuse treatment programs.
A History of Trauma
Trauma can occur as the result of disturbing and hurtful events. People experience trauma from witnessing the effects of war, being victims of crime and abuse and being dehumanized through oppression from dominant groups. When a group of people experiences trauma due to intimidation, future generations can experience generational or secondary trauma.
During the westward expansion in the U.S., Native Americans endured years of mistreatment by dominating cultures. Atrocities inflicted on Native Americans included killing, confiscating their land, destabilizing families and introducing dangerous diseases such as smallpox and cholera into the population. During this oppression, Native Americans had their lives upended as they were forced to live on reservations where the quality of the land made it difficult to survive through hunting and fishing.
Native Americans who moved to urban areas found it hard to make a living and faced challenges such as being forced to assimilate into European-American culture, including children forced to attend boarding schools. For oppressed groups, trauma can extend to future generations as individuals struggle with their forefathers’ maltreatment as well as cultural and economic losses. Limited education and poverty contribute to substance abuse disorder in Native communities. Research suggests that historical trauma is a factor in drug abuse within the Native American community. Unfortunately, many Native American communities still experience generational trauma or secondary trauma, contributing to substance use disorder and mental health issues.
The Need for Trauma-Informed Care
One of the criticisms of the 12-step programs and other substance abuse services is that individuals must admit they’re powerless. Due to centuries of domination and oppression, some groups that suffer from substance use disorder already experience feelings of powerlessness and low self-esteem. Being encouraged to make such admissions may remind Native Americans of years of domination and oppression. The secondary trauma from remembering the dehumanization their forefathers suffered at the hands of oppressors can make 12-step programs less attractive.
Trauma-informed care considers the suffering of indigenous people and avoids traumatizing them again during the treatment experience. Being compassionate, nonjudgmental and respectful of Native Americans’ lived experiences can reduce the risk of repeat trauma. Returning power to individuals by encouraging them to identify their strengths and empowering them to make choices can help them develop the trust needed to complete a program.
Culture refers to the ways of life of groups or societies and includes art, beliefs, behaviors, dress, food, music, norms, religion and values. Societies pass their culture to future generations. Cultural symbols carry much meaning for the groups they represent. For example, a headdress is more than a fashion statement; it may symbolize bravery, spirituality, honor or authority. Human services workers who are culturally unaware may disrespect the sacredness of a group’s cultural symbols. Likewise, failing to understand Native American culture and addiction can leave a patient feeling confused and unwelcome.
Western treatment modalities for substance abuse disorder often don’t consider the cultural differences and spiritual needs of Native Americans. In many cultures, substances considered illicit from a Western point of view have been used historically for medicinal and ceremonial purposes. For example, individuals use plant-based fermented drinks to treat ailments. Among Native Americans, traditional tobacco (tobacco in its pure form) is a ceremonial and therapeutic substance.
Native American societies have used traditional tobacco for emotional well-being, healing and spiritual purposes. When used spiritually, the smoke from traditional tobacco is a way of sending prayers and thoughts to the Creator. Native American societies have regulated substances used medicinally, ceremonially and religiously to prevent abuse. Controlling these substances through tribal or community regulation also protects the population from addiction.
Colonization and the influence of Euro-Americans who introduced distilled alcohol and cigarettes to indigenous people have led to high cigarette and alcohol abuse rates among the population. Marketing modern cigarettes to Native Americans has led to high rates of smoking and the diseases associated with it. Illicit drug use is also a problem among Native Americans.
Culturally Informed Substance Abuse Treatment
In addition to the limited availability of treatment programs for Native Americans, the existing programs often don’t meet the needs of Native Americans, whose approaches to wellness and healing often differ from Western medicine. The U.S. government recognizes 574 Native American tribes in the lower 48 states and Alaska. While Native American tribes have some commonalities, it’s essential to realize that each group has its cultural norms and recognize how Native American culture influences addiction and mental illness.
Incorporating Native American Approaches to Well-Being into Treatment
Combining evidence-based treatment strategies with the cultural and spiritual connections valued by many Native Americans is one way to approach behavioral health and substance use disorder treatment. Many Native communities and tribes utilize healing strategies unknown to programs not traditionally associated with Native American Communities. For example, drum circles are a part of Native American culture that members find helpful for getting rid of negative feelings, stress and trauma. Drumming as a complementary therapy relaxes individuals and helps them release emotions. Drumming has shown promise in enhancing recovery.
Although not used in Ranch Creek Recovery’s program, the sweat lodge is another therapeutic option that’s helpful for some individuals in recovery. In Native American culture, the sweat lodge is a dome-shaped structure that works like a sauna. A pit inside the structure holds hot rocks. Pouring water over the stones releases steam and heats the lodge’s interior. As individuals in the lodge sweat, their bodies release toxins and impurities. The idea is to cleanse the body to get a fresh start. The sweat lodge offers a spiritual experience as it helps individuals find inner strength and connect with the Creator. Individuals fighting addiction, post-traumatic stress disorder and other mental health issues have found that sweat lodges have put them on the pathway to recovery.
Native Americans who face substance abuse and mental health challenges must have access to programs that include the therapeutic options from their culture. By working with the Indian Health Service and taking a culturally competent approach to mental health services administration, treatment programs can meld proven Western therapies with traditional Native American approaches to treatment. Doing so can strengthen psychiatric services and programs for drug addiction, giving all individuals the support they need to overcome their struggles.
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