Review of studies and articles on culturally based and community-based aboriginal alcohol and substance abuse treatment programs
| STUDY OR ARTICLE | LEVEL OF EVIDENCE | N | TYPE OF STUDY OR ARTI CLE | FINDINGS OR COMMENTS |
|---|---|---|---|---|
| Fisher et al,13 1996 | II | 791 | Quantitative: measured retention rates | Inclusion of traditional Native activities increased retention rates in Native and non-Native clients |
| Boyd-Ball,14 2003 | II | 63 | Quantitative: interviews and observation | Family-enhanced intervention decreased alcohol consumption |
| Scott and Myers,15 1988 | II | 76 | Quantitative: assessment of fitness, self- evaluation, and substance use | Increased self-efficacy after fitness training; relationship noted between low self-enhancement and substance use |
| Kahn and Fua,16 1992 | II | 145 | Quantitative: program completion and postprogram employment | Increased rate of employment after program; number of aboriginals treated increased with aboriginal treatment providers |
| Ellis,17 2003 | II | 50 000 | Quantitative | Mentoring effort between 2 communities to develop policies and initiatives led to a 150% decrease in motor vehicle collisions in the mentored community |
| Franks,18 1989 | II | 54 | Quantitative | Patrols by community members and community involvement in intervention and setting norms for acceptable behaviour decreased no. of solvent sniffers from 54 to 1 |
| Mohatt et al,12 2004 | II | 152 | Qualitative: interviews | Deeper level of inquiry when community members involved in the development of research process |
| Robinson et al,9 2006 | II | 31 | Qualitative: interviews | Treatment staff found holistic family and community approaches to be more effective than individual approaches |
| Noe et al,19 2003 | II | 8 communities | Qualitative: program description and assessment | Community programs improved community interest, engagement, capacity, and organizations’ policies for addressing substance abuse and infrastructure |
| Chong and Herman- Stahl,5 2003 | II | 30 | Mixed methods: interviews | Substantial reduction in frequency of drinking following 6 mo of telephone aftercare |
| Parker et al,20 1991 | II | 34 | Mixed methods: interviews and self-report | Correlation between cultural activities and decreased substance use rates |
| Flores,10 1985 | II | 73 | Survey | Difference in values between non-Natives and Natives |
| Ekos Research Associates,1 2004 | II | 1606 | Survey | 84% of on-reserve youth perceived alcohol to be dangerous |
| Aboriginal Peoples Survey,2 1993 | II | 25 122 | Survey | 86% of communities rated alcohol abuse as a serious problem |
| First Nations Regional Health Survey,3 2003 | II | 270 communities | Survey | Alcohol abstinence and heavy drinking higher in the First Nations population than the general Canadian population |
| Wiebe and Huebert,6 1996 | III | NA | Description of treatment model | Community involvement and mobilization develops intervention appropriate to community |
| Chamberlin,8 1991 | III | NA | Program description | Rates of sobriety in CMT higher than traditional off- reserve treatment |
| Smye and Mussell,21 2001 | III | NA | Discussion of programs | Community-based and culturally based programs use holistic approaches: spiritual, community components |
| Mills,22 2003 | III | NA | Program description | Including traditional activities in treatment increases cultural identity and validates Native culture |
| Hitchen,23 2001 | III | NA | Program description | Employment correlated with sobriety; 800% increased employment with vocational rehabilitation aftercare program |
| Edwards et al,24 2000 | III | NA | Discussion of model | Community readiness model is used to assess and respond to community needs |
| Alberta Alcohol and Drug Abuse Commission,25 1989 | III | NA | Handbook for CMT model | CMT model is community based and community driven; it should be flexible to respond to each community |
| Coates,26 1991 | III | NA | Program description | Community-based day programs are cost effective and accessible |
| Saskatchewan Alcohol and Drug Abuse Commission,27 1989 | III | NA | Handbook for CMT model | CMT is a cost-effective alternative to residential treatment; community involvement and support in treatment and aftercare creates a supportive substance- free environment |
| Abbott,28 1998 | III | NA | Literature and program review | No RCTs; differences between worker and client belief systems; community healing involves entire community |
| Gray et al,29 1995 | III | NA | Literature and program review | Evaluation requires community involvement, flexible techniques, cultural appropriateness, and inclusion of descriptive qualitative methods |
| Health Canada,7 1998 | III | NA | Literature review | Contemporary programs emphasize community involvement to achieve community well-being |
| May,30 1986 | III | NA | Literature review | Creative solutions are required to reduce harm, increase knowledge, and improve rehabilitation |
| Gray et al,31 2000 | III | NA | Literature review | Culturally appropriate models should use an array of techniques for comprehensive program evaluation |
| Novins et al,32 2000 | III | NA | Review | Addictions services need improved rates of service utilization and locally relevant programming; increased research efforts are essential for improving services |
| Beauvais,11 1992 | III | NA | Opinion piece | Substance abuse requires local solutions and grassroots community involvement |
| May,33 1992 | III | NA | Opinion piece | Broad-based community action and comprehensive policies based on local, community-specific data are required to change norms of values of communities |
| Thurman et al,34 2003 | III | NA | Opinion piece | Community readiness model assesses stages of readiness to develop community-driven models; requires community partnerships and draws on strengths of the community |
| Mail,35 1992 | III | NA | Opinion piece | Solutions should be community driven; increased cross- cultural training and sensitivity is required for nonaborigi- nal treatment staff |
CMT— community mobile treatment, NA—not applicable, RCT—randomized controlled trials.