The largest clinical trial on the behavioral health of urban Native young adults showed that a culturally centered virtual prevention program lowered drug and alcohol use among participants.

Alaska Native and American Indian adults face the highest risk for deadly overdoses and alcohol-induced deaths. More and more communities across Indian Country are centering culture in behavioral health care as a means of prevention, harm reduction and recovery from substance use disorders.

Elizabeth D’Amico, the study’s lead author, told Native News Online that the results reinforced what much of Indian Country already knows.

“Strength-based approaches work, and culture is protective,” she said.

The yearlong randomized trial was conducted in collaboration with the RAND Corporation, the University of California, Los Angeles, and the Sacred Path Indigenous Wellness Center in Long Beach and was funded by the National Institutes of Health (NIH). It involved 541 American Indian and Alaska Native (AI/AN) adults ages 18 to 25 living in urban areas across the United States. Participants represented more than 200 tribes and 37 states. The average age was 22.1, and about 83% of participants were female. Requirements included living in an urban area, speaking English and not having opioid use disorder.

“We know for young people, that 18- to 25-year period for development is really an important time when choices people make can affect choices later,” D’Amico said. “There’s a lot of issues that can come up, so getting people to think about their path at this developmental time point is really important.”

Participants were divided into two culturally centered virtual programs: Traditions and Connections for Urban Native Americans (TACUNA) and a health and wellness cultural intervention program. D’Amico said it was important for both groups to receive culturally centered intervention, as opposed to a mainstream intervention not tailored to Native communities or no intervention at all, as in many clinical trials.

“You can’t just go in and do a clinical trial with many populations because the reality is it is unfair for people to be a ‘control group’ and get nothing — that’s unacceptable, particularly in Indian Country,” she said. “We had two really active interventions. Clinical trials are the gold standard. When you’re doing this gold standard, you have to consider the community. You can’t just say, ‘you get nothing,’ because that doesn’t work.”

TACUNA spanned three group workshops held over Zoom that included motivational interviewing, substance-use prevention, social-network strategies and cultural practices, as well as access to a monthly virtual Wellness Circle. Cultural activities included storytelling about Native identity, traditional foods and cooking, prayer and sage ceremonies, drumming, dance and teachings related to the Medicine Wheel. The virtual health and wellness intervention was shorter and included culturally based education on opioid use prevention and pain self-management. Researchers collaborated with an elder advisory board to develop the cultural touchstones of each program.

The results showed promise not just in reducing the use of drugs and alcohol but also in abating mental health symptoms that can lead to substance abuse.

Feelings of anxiety and depression declined in both groups, with anxiety declining significantly in the TACUNA group. TACUNA participants reported significantly less alcohol and cannabis consumption over the 12-month trial. In the health and wellness group, while drinking and cannabis use showed little change, negative consequences from alcohol — like missing school, work or other obligations — decreased.

Both groups reported spending less time with people who drink alcohol and use opioids over the course of the study.

“It was so powerful for them to talk about their networks and whether it was family members putting them at risk or friends putting them at risk, or who to reach out to in terms of elders. That is a really powerful part of this intervention.”

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