A National Institutes of Health (NIH)-funded clinical trial funded by the National Institutes of Health (NIH) has demonstrated that a virtual prevention intervention reduced cannabis and alcohol use among American Indian and Alaska Native emerging adults. In this new study, researchers tested the efficacy of a new program, called Traditions and Connections for Urban Native Americans (TACUNA), that blends the evidence-based practices with traditional practices to both prevent substance use and bolster cultural connection.
Compared to other groups, American Indian and Alaska Native individuals face higher risk of drug overdose death and report greater rates of cannabis use and psychological distress . Yet American Indian and Alaska Native people also have many strengths, including strong traditions, family and community connections, and Indigenous knowledge that can play a vital role in preventing substance use and supporting health and well-being.
"Supportive social environments and community engagement are an important component of substance use prevention. Yet few interventions have been designed specifically for American Indian and Alaska Native people living in urban areas who may feel disconnected from their tribal communities," said Nora Volkow, M.D., director of NIH's National Institute on Drug Abuse (NIDA). "This trial suggests that the multidimensional, cost-effective approach of TACUNA could be a powerful tool for reducing drug use and addiction within this population."
Previous studies have tied participation in traditional practices and feelings of cultural connectedness to lower drug use and better mental health. Other work, including a long-term collaborative effort by researchers at RAND Corporation, the University of California, Los Angeles, and the Sacred Path Indigenous Wellness Center, Long Beach, has demonstrated that American Indian and Alaska Native teens benefit from collaborative, non-confrontational counseling such as motivational interviewing , an evidence-based intervention for preventing drug use and promoting healthy living.
More recently, these scientists developed TACUNA, a prevention intervention designed to tie these findings together in a single accessible program.
Composed of three different workshops and a wellness gathering, TACUNA combines motivational interviewing with traditional activities, such as cooking, storytelling, and prayer, into discussions about healthy choices and relationships.
To test the efficacy of their holistic approach, the study authors recruited 541 American Indian and Alaska Native emerging adults between 18 and 25, whom they randomly assigned to either participate in TACUNA or standard care, which amounted to a single opioid and pain cultural health and wellness workshop. Both interventions were delivered by American Indian and Alaska Native facilitators. Following the intervention, investigators surveyed participants about their substance use, mental health, and peer influences at three, six, and 12 months post-intervention.
While both groups reportedly used cannabis less frequently and demonstrated fewer negative consequences associated with alcohol and cannabis use after the intervention, only the TACUNA group reported decreases in their frequency and quantity of alcohol consumption and in the amount of cannabis they used.
TACUNA participants also indicated greater reductions in anxiety symptoms and less time spent around peers who were using cannabis or heroin than those who received standard care. Both groups seemingly maintained their sense of cultural connection throughout the following year.
"We initially designed TACUNA for in-person engagements at discrete locations, but the pandemic in 2020 had us pivot to a virtual format. We were excited to see that these remote sessions had such prominent effects, which is ultimately good news for accessibility," said first author Elizabeth D'Amico, Ph.D., a senior behavioral scientist at RAND.
This research was supported by NIH through NIDA grant UH3DA050235, part of the Helping to End Addiction Long-term (HEAL) Initiative . NIH HEAL Initiative and Helping to End Addiction Long-term are registered service marks of the U.S. Department of Health and Human Services.
