Our Working Statement of Purpose: This review will discuss the issues with delivering treatment to AI/AN s

Author Abbreviated Study Question/Purpose Methods & Usefulness

Title
Campbell et. Acceptability Do Computerized, web- 20 participents completed a
All of a web-based delivered interventions have brief screen to assess
... [for] AI/AN the ability to give quality eligibility
treatment and improve patient (with verbal consent),
outcomes remotely in AI/AN followed by full study consent
communities? and a baseline assessment.
Participants then completed
8 weeks of web-based TES
Croff et. All Provider + This article discusses findings The
usingstudy uses
onsite a quantitative
computers. A
state from "interviews with 22 survey andassessment,
follow up qualitative
perspectives program directors and 18 interviews
including atoqualitative
look at culture
on representatives from Single based models of care, what
interview,
implementing State Authorities on substance level of collaberation
was completed 1 weekexisted
after
cultural-based abuse." They assessed between state and
the intervention tribes, how
phase.
models of care "provider and state efforts to effective cultural competency
for AI/AN increase AI/AN client training there was (if it was
Dickerson et. Integrating
patients with The development
engagement and toofimprove -community
present), andbased
how these
All motivational
substance use Motivational
the quality of Interviewing
care through interviewing,
improved qualityinteractive
of care group
for
interviewing
disorders and Culture
culturally for Native
relevant interviewing
AI/AN patients.in the form of
and traditional American Youth
interventions." focus groups, FG's consist of
practices... (MICUNAY) as a tool for youth, parents, city members.
urban AI/AN prevention of AOD becuase
youth this population lacks cultural
inclusive Evidence based
Ehlers et. All Evidence for a Knowing that substance
practice, programs. In a review of the liturature,
genetic abuse has a high risk of the authors examine "evidence
component for heritablity and that substance for a genetic component in the
substance abuse is a major health risk in etiology of substance
dependence in AI/AN communties, this dependence in Native
NA study seeks to examine the Americans, including studies
role of genetics in the risk for of heritability, linkage
substance abuse in AI/AN analyses, and candidate
Ehlers et. All Measuring This study examines how
communities. Participants
genes." assessed with the
historical much the frequency of Semi-Structured Assessment
trauma in AI thoughts of historical loss and for the Genetics of Alcoholism
sample: ... associated symptoms in the (SSAGA), The Historical Loss
AI/AN community are Scale and The Historical Loss
influenced by: "current Associated Symptoms Scale,
traumatic events, post the Stressful-Life-Events
traumatic stress disorder Scale, and the Orthogonal
(PTSD), cultural Cultural Identification Scale
identification, percent Native (OCIS)
American Heritage, substance
dependence, affective/anxiety
disorders, and conduct
disorder/antisocial personality
disorder (ASPD)"
Kropp et. All Characteristics This study seeks to examine The study used the Addiction
of northern the substance abuse rates in Severity Index-Native
plains AI ... in Northern Plains AI groups in American Version with
an urban, non- a non-Native substance abuse suplimental AI-Relevent
tribal clinic: A treatment setting through the questions, a cultural
descriptive Methamphetamine and Other adaptation of the Addiction
study Drug project, developedby Severity Index, and was
the National Institute on Drug administered by trained
Legha Challenges to This
Abusestudy seeksTrials
Clinical to They conducted
interviewers. Thekey informant
data was
providing ... understand the challenges
Network (NIDA CTN). to interviews and focus groups at
analyzed using
for AI/ANs: providing quality substance 18 substance
descriptive abuse treatment
statistics for
Perspectives of abuse treatment to AI/AN programs serving AI/AN
selected variables; then
staff from 18 communities. communities,
participants werethe split
interviews
into
treatment were
three then transcribed
groups accordingandto
centers coded
lifetimetosubstance
identify keyusethemes.
patterns
and their characteristics were
Novins et. All Use of EBTs in The purpose of this study is to Data
testedwas
for collected via survey:
between group
substance examine the prevelance of participants
differences. (clinicians or
abuse evidence-based treatments clincal administrators) were
treatment (EBTs) in AI/AN serving surveyed on their "awareness
programs treatment facilities. of, attitudes toward, and use of
serving 9 psychosocial and 3
AI/ANs medication EBTs."

Rieckmann A nat. study of To examine workforce and Methods & Usefulness

et. All AI/AN programmatic differences
substance between clinics located in
abuse urban/suburban and rural
treatment: AI/AN communities. Also
Provider and explored were the correlates
program of openness toward using
characteristics evidence-based treatments
Running Bear Alcohol detox To examine the factors
(EBTs). They examined 3 critical
et. All completion...a associated with detoxification
points on the substance abuse
mong AN treatment completion and the
continuum of care by using
people transition to substance abuse
data from "three multiple
treatment following logistic regression models
detoxification among Alaska
estimated the adjusted
Native people. associations of each outcome
separately
Running Bear Impact of This study examines Using a retrospective cohort
withdemographic/psychosocial
et. All adaptive predictors associated with study, the studyclinical
characteristics, examined 383
functioning on readmission to detoxification adult AN patients
characteristics, useinrelated
inpatient
readmission to in a sample of AN inpatient detoxification
behaviors, andunit to estimate
health care
alcohol detox alcohol detoxification readmission
utilization." within one year.
among ANs patients.
Walsh + AI substance This review assessed Preferred Reporting Items for
Baldwin abuse substance abuse prevention Systematic Reviews and Meta-
prevention (SAP) efforts in AI/AN Analyses (PRISMA)
efforts: A communities from 2003-2013 guidelines were used to assess
review of to examine of there was a a total of 18 articles covering
programs disconnect between SAP 31 programs on topics of
theories that are used to "program location and method,
develop AI/AN prevention participant characteristics,
Walsh-Buhi Theoretical This studyand
programs uses"culturally
qualitative In-depth
describedinterviews identified
program cultural
perspectives of research to explore
appropriate theoretical components of Indigenous
elements, use of theory,
AI/AN perceptions
constructs ofofAI/AN
theory by SAP theoretical perspectives,
program outcomes, program
substance researchers
worldviews." in AI/AN including
measures, cultural elements
and future
abuse communities. such as balance, social
recommendations."
prevention cohesion, and belonging as
programs being particularly significant
and currently absent from
many SAP programs.
Recommendations for
conducting metatheory studies
and operationalization of
Indigenous perspectives into
guiding theoretical
underpinnings for future SAP
programming are provided.
delivering treatment to AI/AN substance abuse communties.

Conclusions or Findings Remaining Questions or Relation to Review Topic

Uncertanties (limitations)
"Findings The program could be Discusses potential options to
from this pilot study suggest that core improved and better recieved increase accessability and
TES content and with the addition of content relevancy of treatments in
web-delivery format are acceptable representative of "traditional AI/AN communities.
among a diverse AI/ practices, culture and native
AN client population receiving peoples". Factors such as
treatment in urban settings." "provider attitudes, funding
(including reimbursement for
Their results suggest that care providers During the study,services),
non face-to-face issues such and Discusses the successfulness
were most successful when they as "gaps in internet
broadband statetribal
access [...] of culturally relevant
employed "flexibility and originality to collaborations" and "inter-
in rural or reservation-based interventions in AI/AN
cultural-based programs by broadening group complexities
treatement programs" such
areasall substance abuse treatment, and
established practices, adopting outside staff-based
factors that tensions" created shows factors that can inhibit
must be considered
traditions, and creating new ones to fit in-facility issues, while "a
in future studies. their success.
client needs." widening generational divide"
and "blurred consensus of
Results indicate that AI/AN adoloscents The MICUNAY
'tradition'" program
were other was Discusses the apparent need
factors
face many factors contributing to their at created but now
that affected careneeds results
quality, and for culturally based treatment
risk behavior and implemantaion of of
needimplementation
to be expanded to upon
yeild in for the AI/AN adoloscent
integerated practice including cultrally results
further of significance and
research. population and inquires the
sound and evidenced practice programs success for this population. nescessity for prevention
could benefit the prevention of AOD Also a program like programs in the community.
behviors. MICUNAY would need to be MICUNAY is the first of its
created for other AI/AN kind in refernece to AOD
The results found that "evidence for the This study focused
populations exclusively
across the nation Discusses
treatment .genetic potential
Important for our
heritability of alcohol and drug on genetic potential
becuase this progeram wasfactors, causes for the
research topic* prevelance of
dependence was found", as well as the and did and
created not acknowledge
specifically the AI/AN substance abuse issues,
presense of related genes influencing the role that socio-economic
implemented for CA. which is important to help
risks for "body mass index (BMI), drug factors could play in AI/AN patients recieve early
tolerance, EEG patterns, and substance abuse. intervention.
externalizing traits". The studies also
showed that most AI/AN's lack
They foundgene
protective thatvariants
thoughtsagainst
about There is debate if the current This article discusses on of the
historical
alcoholismlosses were
that are common,
seen in otherand the socio-economic state of potential sources for the
presence of these thoughts are
populations. AI/AN communities could be prevelance of substance abuse
associated with "Native American contributing more than in the AI/AN community that
Heritage, cultural identification, and historical trauma, or if the is often not acknowledged.
substance dependence." current issues in the
community could even be
causing further dwelling on
these issues.
This study found that though the use of Because the clients were This study assists fills in gaps
amphetamines, cocaine, and prescription enrolled in an urban, non- in the knowledge regarding
opioids were present, alcohol and Native treatment center, they substance use patterns,
marijuana were used earlier, longer, and may not be representative of associated challenges, and
by more treatment-seeking clients. There AI substance users who are on resources, especially in urban-
was also a high rate of heavy tabacco reservations or wish to seek based clinics.
use. It was found that age of substance treatment that is based in
use initiation was lower for clients using traditional Native healing
Found
alcohol3plus
major types
illicit of challenges
drugs than for Because
practices.the study
These focusesalso
findings on Perfectly frames many of the
facing AI/ANclients.
alcohol-only servingBased on this programs that provide
only represent a specific issues that need to be
facilities:challenges
finding, it appears that associated
prevention with
efforts innovated
geographicservices,
area. the addressed currently in the
providing
should startclinical
prior to support,
age 13 challenges
and should findings may be less AI/AN treatment facility.
associated
target both with
alcoholthe and
infrastructure
illicit drugofuse. applicable to more traditional
treatment settings, and challenges programs. Also, clients and
associated with the service/treatment community members were not
system as a whole. interviewed, meaning this
Despite the controversal nature of EBTs The study isislimited
perspective lost. because it This is relevant to our research
in the AI/AN treatment communities, relies on the reports of because it shows that, despite
EBTs were used prevelantly, with program staff members, the reluctance and seemed
Cognitive Behavioral Therapy, because it is non-experimental resistance/ineffectiveness of
Motivational Interviewing, and Relapse and cross sectional (potentially EBTs in AI/AN communities,
Prevention Therapy being the most muddying engagement the treatment community still
common psychosocial EBTs, and with further), because it combines relies heavily on them,
medications for psychiatric comorbidity EBTs into psychosocial and possibly perpetuating the cycle
The
beingrural
mostprograms
commonly were significantly This
implemented study relies
medication heavily
treatments on
(which This study has baseline
of failed
less likely than
medication urban providers to have program
treatment. affects thestaff member reports; workforce
regression and program level
treatment/readmission.
culturally relevant and general not all reports
analyses), and and staff the
because data that can be used to better
resources, but were significantly more members are createdwas
survey participation equal.
low understand differences in
likely to employ elders, offer AA-open for the general population programs, changes in access
group recovery services, and collect data (63%, though this is very high and quality for AI/AN over
on treatment outcomes. The study for a AI/AN community.) time, and the use of EBT over
correlated greater EBT openness to a time.
They
largerfound that
clinical "higher
staff beingglobal
led by The author admits that Relation to Review Topic
assessment
directors who functioning
perceivedscores,
a gap inlonger
access "Patients could have entered
lengths
to EBTsofwho stay, and older
worked ages ofthis
to remove first substance abuse treatment
alcohol use" programs
gap, though correlatedthatto completing
provide early post-discharge; these
detoxification. Secondary
intervention services showed drugless admissions would have been
diagnoses
openness. were linked to not completing unrecorded" and that "the
detoxification. Groups that were more extent these limitations were at
likely to accept substance abuse referrals work in the present analyses,
They foundthose
were men, that 42%
with of patients
legal were Because
problems, this was
the observed a
relationships may This study examines further
readmitted
and those with a longer length of stay. be underestimated" In addition the factors of readmission in
within one year; An increase retrospective study that relied
in Global Assessment Functioning upon
to this,EMR data, therelie
the analyses data on AI/AN communties, giving
(GAF) was associated with a decrease in recorded treatmentin the so
data, EMRtheymay not statistical evidence of the
cannot
readmission, but low GAF scores were include important indicators of current/recent state of
cultural variables
associated with readmission. readmission;
which are a majorthe analyses
concern in treatment in the community.
relied
AI/ANonresearch.
several variables that
were patient self-reported to
detoxification unit staff,
making them potentially
inconsistant, on top of the fact
that some patients may have
been reluctant to report certain
types of information.
Results indicated that SAP programs in Limitations include that this This gives a good
AI/AN communities vary widely in their study identified theories used, representation of the average
"use of theory, implementation but not whether or not a types of theories and practices
strategies, view and definition of program was "theoretically used in the AI/AN treatment
cultural constructs, overall evaluational driven." Without access to community, allowing for
rigor, and reporting methods", but more actual program materials, it is assessment of prevelance of
research is needed to integrate difficult to state what the appropriateness of techniques.
appropriate theory and cultural elements specific program approaches,
Participants academic training often
into the programs. Because
methods,theandstudy is small,the
elements might This shows staff perspectives,
correlated to their ideas. "For example, findings are not intended
have been. In addition, this to isbe but also notes what many
those who were trained in their doctoral "generalizable to all
far from a comprehensive federally studies either don't examine or
programs in psychology had a tendency recognized
review of alltribes,
of thestate tribes,
liturature; refuse to acknowledge: people
to describe individual, psychological SAP researchers working
descriptive pieces were left with invested in traditional SAP's
theories as being the most effective, AI/AN communities, or
out, and pieces that may haveSAP by way of training are less
rigorous, and useful for addressing SAP programs
had data butoperating in AI/AN
were focused willing to acknowledge gaps in
in AI/AN communities, regardless of communities." Also,
elsewhere were excluded. issues of the treatments; there is also a
whether or not these theories truly were self-selection bias were possibly racialized element
effective and useful in SAP in AI/AN possible. here, in the sense that those
communities. These participants were who feel they do not need to
also more likely to state that theory tailor to AI/AN communities
integration in SAP in AI/AN are overwhelmingly non-
communities was actively occurring and native.
were less likely to see a need for
tailoring of theories for AI/AN
communities.[...] "The majority of those
participants trained in psychology who
viewed theory use and effectiveness in
this way were overwhelmingly non-
Native"