IN ANY DEMOGRAPHIC, binge drinking—defined by the Substance Abuse and Mental Health Services Administration (SAHMSA) as consuming five or more alcoholic drinks on the same occasion—is a troubling aspect of alcohol use with links to a long list of devastating physical, psychiatric, and social outcomes. In American Indian and Alaskan Native communities, the practice is of particular concern. Contrary to well-worn stereotypes, SAHMSA studies indicate that monthly alcohol consumption varies across American Indian and Alaskan Native (AI/AN) cultures and overall is actually less than national averages. But when it comes to binge drinking, the percentage of incidents in these populations far exceeds nationwide figures.
“Family dysfunction and upheaval, trauma that goes back generations, loss of hope, isolation from positive role models, racism, and the erosion of tribal languages, education, and traditions are important causal factors in binge drinking among AI/AN populations,” says the Harvard Medical School professor John A. Fromson, vice chair for Community Psychiatry at Boston’s Brigham and Women’s Hospital and chief of psychiatry at Brigham and Women’s Faulkner Hospital. In the search for effective treatments, Fromson notes, researchers and addiction counselors in the United States and Canada are increasingly targeting these cultural causes with therapies that use tribal traditions and beliefs to counter binge substance use.
Last fall, Fromson and the Harvard Medical School student Erica Rose Kiemele MD ’17 cochaired a Radcliffe Exploratory Seminar titled “American Indian/Alaska Native Binge Drinking: Reviewing Treatment and Developing Collaborative Methodologies to Measure Outcomes.” “Professionals in this field have known for a long time that tribal beliefs and practices can be important to binge drinkers in recovery,” says Kiemele, who plans to use her medical skills to provide emergency health care to Native populations. “But there hasn’t been a lot of cross-talk about how practitioners in different places are using these culturally based therapies or trying to measure the impact they may be having. That’s what we wanted to explore.”
US and Canadian experts in addiction psychiatry, public health, and education, along with AI/AN tribal leaders and healers, traveled to Cambridge for the gathering. “It was a chance for someone doing policy work at a health consortium in Anchorage, Alaska, for instance, to get to know a colleague who works one-on-one with youth at a wellness center in Arizona or a tribal liaison with a health department in Presque Isle, Maine,” Fromson says.
“Overcoming that geographical and functional separation is important—and not just for knowledge sharing,” he says. “The daily realities in this field are intense. In Native populations, binge drinking’s toll, in terms of alcohol-related deaths, suicides, accidental injuries, fetal alcohol syndrome, STDs, and other comorbidities, is significant. It’s encouraging to meet colleagues who understand your challenges.”
Creation Stories or Smudging?
There was widespread agreement at the seminar that, as Kiemele puts it, “There isn’t a ‘best way’ to apply Native practices to this problem, because each population is different.” In general, AI/AN tribal beliefs and practices are used in tandem with familiar addiction recovery approaches such as 12-step programs, counseling, and drug and alcohol education. “The intention is to use indigenous knowledge to help restore physical, emotional, and spiritual balance,” explains Kiemele, whose heritage is Blackfoot, Métis Nation (Canadians with mixed American Indian and European ancestry), and Taiwanese. “But traditions aren’t shared globally and don’t have universal meaning.”
For those in recovery who have spent time on tribal reservations, ceremonial customs and songs, talking circles, sessions with traditional healers, sweat lodges, or smudging (purifying a room with the smoke of sacred herbs) may have deep meaning and be tremendously beneficial. “But around 60 percent of Native people in Canada live in the city and have no ties to these kinds of traditions,” Kiemele stresses. “For them, being introduced to creation stories or to certain traditional foods might be more helpful.”
Differences aside, Fromson underscores an important distinction that indigenous treatment approaches have in common. “In Western medicine, pathology guides treatment,” he notes. “You’re looking at the patient through the deficit or the problem. Native approaches turn this paradigm on its head by recognizing culture as treatment; by emphasizing cultural identity, you’re tapping the healing power of the patient’s inner strengths.”
Culturally Competent Research
Measuring the efficacy of blended tribal and scientific treatment for AI/AN binge drinking is challenging. “You need to apply culturally competent research methodologies,” explains Fromson, “which means not just tracking outcomes, but also gathering information about how well the approaches honor the strengths and needs of individuals during their healing.”
Two seminar participants—Colleen Dell, a professor and research chair in substance abuse at the University of Saskatchewan, and Carol Hopkins, executive director of the Thunderbird Partnership Foundation in Bothwell, Ontario—are leaders in the field of addiction treatment for indigenous populations in Canada. At the Radcliffe seminar, they shared their progress toward the development of a reliable research protocol to ascertain the effects of interventions on wellness.
Based on data gathered at 12 Canadian addiction treatment centers as part of a project called Honoring Our Strengths: Culture as Intervention in Addiction Treatment, Dell’s and Hopkins’s ongoing work has given rise to a Native Wellness Assessment Tool, a groundbreaking survey for addiction clients that may lead to an evidence base for the effectiveness of indigenous culture in addressing substance use and promoting overall wellness.
“Dell and Hopkins are very prominent in this field,” says Kiemele. “Learning more about the details of their survey was a high point for me, and I think for others at the seminar. We don’t have a culturally based tool like that in the United States, and seeing the specific questions they asked really furthered my understanding and appreciation of what they’re doing more than just searching the literature did.”
Currently working with Kiemele, Dell, and others on a coauthored paper—titled “Reconciling America’s Research Response to Binge Drinking among American Indians and Alaskan Natives”—based on presentations at the meeting, Fromson credits the Exploratory Seminar format with evincing new possibilities in scholarship and practice. “I’d love to do something like this again in the future, maybe with behavioral specialists from the US Indian Health Services,” he ventures. “There’s so much value in having scholars and researchers in the same room with seasoned clinicians in their field. No matter where you are in your career, the intellectual chemistry at this kind of event is powerful.”
Deborah Blagg is a freelance writer.