Culturally based substance abuse treatment for American Indians/Alaska Natives and Latinos.

Although it is generally accepted that substance abuse treatment programs and approaches for minority clients that are not culturally based would have limited effectiveness, there is great variance in what constitutes cultural relevance. For example, many extant treatment models are limited by more surface or superficial cultural mismatches between the program, providers, and clients (e.g., language/translation problems; not being able to establish a basic rapport with a client from a different cultural background). In addition, the larger paradigm of the treatment approaches (e.g., 12 Steps, etc.)--which is largely guided by Western assumptions--may be limited in more fundamental ways (e.g., not reaching “deep structure” changes; Resnicow, et al., 2000) if applied to certain ethnic minority clients. As a result, there has been increasing interest in incorporating into mental health and substance abuse-specific treatments culturally relevant interventions for US minority clients whose lifestyle and cultural orientation are strongly anchored to non-Western perspectives. Descriptions of some of these unique, culturally-based intervention modalities have been presented, but few studies have examined how these interventions have been adapted as promising or as evidence-based forms of “best practice.” The following selected papers in this collection are from presentations given at the conference, Culturally Based Substance Abuse Treatment for American Indians/Alaska Natives and Latinos, which was held April 17 – 19, 2006, in Tucson, Arizona. The purpose of this conference was to provide a forum for therapists, researchers, policy makers and community leaders to discuss the kinds of culturally relevant interventions that are promising or best practices in the treatment of substance abuse for many American Indians, Alaska Natives, and Latinos. Because of the geography of the conference, major emphasis was placed on southwestern tribal and Chicano/a and Mexican responsive programs and approaches, although we contend that many of the programs and approaches would have much broader relevance to other indigenous peoples, including Latino subgroups (e.g., Puerto Rican, Cuban, Dominican, Central American, South American decent) and other groups where the impact of colonization by a more dominant group has had lasting cultural and socioeconomic effects. The conference objectives, based on the questions raised by the conference planning committee, were as follows: To discuss the problem of addiction in a cultural context; To share information about the use of different cultural interventions by American Indian/Alaska Native counselors and by Latino counselors in the treatment of substance abuse in their respective populations; To discuss historical trauma as a factor in alcohol abuse and as a basis for the use of cultural interventions in the treatment of alcohol abuse/polysubstance abuse; To discuss gender issues in the treatment of alcohol abuse with specific emphasis on the use of cultural interventions; To discuss the policy implications (e.g., reimbursement issues) of the use of culturally based interventions in the treatment of substance abuse; and To provide epidemiological information about current rates of alcohol abuse among American Indian and Latino populations. The conference planning committee also suggested that a Proceedings of the conference be prepared for publication, and eight seminal papers were requested and submitted. The following discussion presents a context for these papers by providing a brief overview of the history and development of some of the culturally-based substance abuse treatment approaches incorporated into treatment plans for American Indian/Alaska Native and Latino clients in recovery.