Re-enculturation: culturally congruent interventions for Mäori with alcohol- and drug-use-associated problems in New Zealand

Healing and wellbeing outcomes of services for Aboriginal people based on cultural therapeutic ways: A systematic scoping review

Aboriginal Australians experience disproportionately high rates of mental health problems as the result of European colonisation, and Western evidence-based treatment has been strikingly ineffective in improving the situation. Cultural Therapeutic Ways is a culturally specific healing and wellbeing practice framework developed by the Victorian Aboriginal Child and Community Agency that focuses on culturally based practices, trauma awareness, and self-determination. Despite wide recognition of the importance of these elements in Indigenous healing and wellbeing programs, its measurable empirical impact is currently unclear. This paper summarises findings from a systematic scoping review to ascertain the published knowledge base for Cultural Therapeutic Ways and the gaps in knowledge that can inform future evaluation. Forty-two studies of programs that applied Cultural Therapeutic Ways with Indigenous participants from Australia, Canada, New Zealand, and the United States of America were identified from the literature search. Services based on Cultural Therapeutic Ways contributed to healing and wellbeing because they create safety, strengthen cultural connections, develop empowerment and provide opportunities to release emotion, and increase social and spiritual support. As the review set out to determine the published evidence base for Cultural Therapeutic Ways, other effective approaches may have been overlooked. To develop the evidence base for Cultural Therapeutic Ways, service design must clearly describe target groups, whether the program is delivered by Aboriginal people, the processes of Cultural Therapeutic Ways utilised in service delivery, and how they are blended with Western approaches. Research efforts could also productively be focused on identifying or constructing culturally appropriate outcome measures.

Modelling cultural embeddedness for colonised indigenous minorities: The implicit and explicit pathways to culturally valued behaviours

Colonised indigenous minorities around the world are constantly navigating the complex space between their heritage culture and mainstream society. In this paper, we explore how embeddedness in heritage cultural values, beliefs, and practises influence the behaviours of indigenous minorities, particularly during intercultural contact with the post-colonial majority where values, beliefs, and practises often clash. To support our theorising, we introduce the concept of cultural embeddedness, relating to enculturation in one’s heritage cultural values, beliefs, and practises. We then introduce the Dual-Pathways Model of Embeddedness to Culturally Valued Behaviours for Indigenous Minorities (DPM), which seeks to outline the two separate but interrelated pathways through which cultural embeddedness leads to culturally valued behaviours. The dual pathways include an implicit pathway, which begins with cultural values, and an explicit pathway, which begins with cultural practises. We use an indigenous approach, drawing on the first author’s experiences as an indigenous Māori in New Zealand to illustrate the concepts of the DPM. The model attempts to integrate the various ways in which cultural identity has been defined by indigenous authors into a single theory. We invite future qualitative and quantitative research, especially by indigenous scholars, to challenge and/or validate the DPM.

You just have to have other models, our DNA is different: the experiences of indigenous people who use illicit drugs and/or alcohol accessing substance use treatment

Objectives

In Canada, and elsewhere, indigenous peoples who use illicit drugs and/or alcohol (IPWUID/A) commonly experience vulnerability and a disproportionate burden of harm related to substance use. In Vancouver, Canada, there are concerns that inequitable access, retention, and post treatment care within substance use treatment programs may exacerbate these harms. This study sought to understand the policies and practices with the potential to produce inequities and vulnerabilities for IPWUID/A in substance use treatment, situate the vulnerabilities of IPWUID/A in substance use treatment within the context of wider structural vulnerability of IPWUID/A, and generate recommendations for culturally safe treatment options.

Methods

This research employed a qualitative indigenous-led community-based approach using the indigenous methodology of talking circles to explore experiences with substance use treatment. Under the participatory research framework, community researchers led the study design, data collection, and analysis. Talking circles elicited peers’ experiences of substance use treatment and were audio-recorded and transcribed.

Results

The talking circles identified three key themes that illustrated the experiences of IPWUID/A when accessing substance use treatment: (a) barriers to accessing detox and substance use treatment; (b) incompatible and culturally inappropriate structure, policies, and procedures within treatment programs, such as forced Christianity within treatment settings; and (c) the importance of culturally relevant, peer-led substance use treatment programming.

Discussion

Our work demonstrates that some IPWUID/A have limited access to or retention in mainstream treatment due to excessive waiting times, strict rules, and lack of cultural appropriate care while in treatment. However, IPWUID/A narratives revealed strategies that can improve IPWUID/A access and experiences, including those informed by the diverse perspectives of IPWUID/A and those that include trauma-informed and culturally safe practices.

Older Māori understandings of alcohol use in Aotearoa/New Zealand

BACKGROUND

The predominant framing of indigenous people's alcohol use as problematic has resulted in narrow understandings of indigenous alcohol use in general. In particular, there has been little exploration of how Māori, those indigenous to Aotearoa/New Zealand, contextualise and understand their alcohol use. To build on current understandings of Māori alcohol use, this study explored the broader and socially shared meanings of alcohol use from the perspectives of older Māori.

METHODS

Hui (meeting/s) were held with five kaupapa whānau (groups with a common purpose) comprising older Māori (n = 19) who shared their perspectives on Māori alcohol use. Data were analysed using a master/counter discursive narrative analytical framework.

RESULTS

The results show that older Māori drew on a number of discursive strategies to construct three cultural narratives of Māori alcohol use. These were: 'Not all Māori are problem drinkers', 'There is good Māori alcohol use', and 'Alcohol is not the problem'. These narratives simultaneously supported and challenged the dominant narrative that problematises Māori alcohol use.

CONCLUSION

These findings can be used to inform future research to show Māori understandings of alcohol use. Such research will support the development of culturally responsive alcohol policy and health promotion initiatives aimed at addressing alcohol related issues among Māori and thereby improve Māori health and wellbeing.

The Acceptability and Feasibility of Screening for Alcohol and Drug Misuse in a Hospital Emergency Department

Supplemental Digital Content is available in the text.

Objectives:

Screening and brief intervention (SBI) is an evidence-based technique for reducing harmful consumption of alcohol and other drugs, which has been shown to be effective in Emergency Departments (EDs). The feasibility of SBI in the ED, however, remains contentious and no studies have been conducted on this topic in a New Zealand ED.

Materials and Methods:

This study recruited 8 experienced ED nurses who attempted to provide SBI, using the ASSIST-Lite tool, to as many of their patients as possible over one calendar month. All nurses participated in a comprehensive 1-day training workshop on the administration and interpretation of the ASSIST-Lite and linked brief intervention.

Results:

Only 46 (11.79%) of the 390 eligible patients were given the opportunity to participate over the data collection period. Analysis of the data showed there was a significant, negative correlation between the number of patients in the ED and the average number of screens that were performed by the nurses, and that the number of screens waned immediately after SBI training. Following the data collection period, the nurse participants were interviewed about their experience. These interviews revealed 3 main themes that contextualized the willingness to, but inherent difficulty of, administering the SBI within the ED environment.

Conclusions:

High patient-to-nurse ratios in the ED currently preclude nurses from providing consistent SBI to all eligible patients; however, there are several practical considerations highlighted here that might help nurses increase the participation rate.

Drug and alcohol use and treatment for Australian Indigenous and non-Indigenous prisoners: demand reduction strategies

PURPOSE

The purpose of this paper is to compare the use of drugs and alcohol by Indigenous and non-Indigenous prisoners and examine relevant treatment in Australian prisons.

DESIGN/METHODOLOGY/APPROACH

Prison authorities were surveyed about alcohol and drug use by prisoners prior to and during imprisonment and drug and alcohol treatment programs in prison. The literature was review for information on alcohol and drug use and treatment in Australian prisons.

FINDINGS

In 2009, over 80 percent of Indigenous and non-Indigenous inmates smoked. Prior to imprisonment, many Indigenous and non-Indigenous inmates drank alcohol at risky levels (65 vs 47 percent) and used illicit drugs (over 70 percent for both groups). Reports of using heroin (15 vs 21 percent), ATS (21 vs 33 percent), cannabis (59 vs 50 percent) and injecting (61 vs 53 percent) were similarly high for both groups. Prison-based programs included detoxification, Opioid Substitution Treatment, counselling and drug free units, but access was limited especially among Indigenous prisoners.

RESEARCH LIMITATIONS/IMPLICATIONS

Drug and alcohol use was a significant issue in Australian prisons. Prisoners were over five times more likely than the general population to have a substance use disorder. Imprisonment provides an important opportunity for rehabilitation for offenders. This opportunity is especially relevant to Indigenous prisoners who were more likely to use health services when in prison than in the community and given their vast over representations in prison populations.

PRACTICAL IMPLICATIONS

Given the effectiveness of treatment in reducing re-offending rates, it is important to expand drug treatment and especially culturally appropriate treatment programs for Indigenous inmates.

ORIGINALITY/VALUE

Very little is known about Indigenous specific drug and alcohol programs in Australian prisons.

Links between ethnic identification, cannabis use and dependence, and life outcomes in a New Zealand birth cohort

OBJECTIVE

To examine the role of ethnic identity in cannabis use, and links between ethnic identity, cannabis use and life outcomes, in a birth cohort of >1000 young people studied to age 25.

METHODS

Data were gathered on cultural identification, cannabis use, socioeconomic factors, childhood adversity, and a range of life outcomes as part of a longitudinal study of a New Zealand birth cohort (Christchurch Health and Development Study).

RESULTS

Those reporting Maori identity had rates of cannabis use and dependence that were significantly higher (p<0.05) than rates for non-Maori. Regression analysis suggested that the elevated rates of cannabis use among Maori were largely explained by their higher exposure to socioeconomic disadvantage and childhood adversity. Further analyses examined the role of cannabis use in the links between ethnicity and a range of life outcomes, including education, income and employment, mental health, criminal offending, and intimate partner violence. These analyses showed that cannabis use made a small but detectable contribution to rates of Maori disadvantage in life outcomes, with this contribution being most evident in the areas of crime, education, and unemployment.

CONCLUSIONS

Maori ethnic identification was associated with increased risks of cannabis use and dependence. The higher rate of cannabis use by Maori could be largely attributed to a combination of socioeconomic factors and greater exposure to environmental factors known to influence risk of cannabis use. The higher rates of cannabis use by Maori made a small contribution to higher rates of early school leaving, crime, and unemployment among Maori.

Alcohol intoxication and sexual risk behaviors among rural-to-urban migrants in China

BACKGROUND

The migrant population in China is at high risk for sexual risk behavior and alcohol intoxication. Information about the prevalence of alcohol intoxication and its association with sexual risk behavior among migrants is needed for designing effective intervention prevention programs for reduction in alcohol abuse and HIV infection.

METHODS

Cross-sectional data were collected from 2153 sexually experienced young rural-to-urban migrants in Beijing and Nanjing, China, in 2002.

RESULTS

Approximately one-third of the participants had been intoxicated with alcohol at least once during the previous month, with more males than females reporting intoxication (40.2% versus 23.7%, p<0.001). Compared to non-intoxicated participants, respondents with alcohol intoxication in previous 30 days reported more psychological problems, including higher depression scores, lower levels of satisfaction with life and work, and higher perception of peer involvement in risk behavior. Intoxicated respondents were more likely to engage in premarital sex than non-intoxicated respondents (76% versus 60.2%, p<0.001), have multiple sexual partners (13.4% versus 5.2%, p<0.001), purchase sex (12.6% versus 4.9%, p<0.001), and sell sex (10.1% versus 3.7%, p<0.001). However, there was no association between alcohol intoxication and inconsistent/non-use of condoms. Multivariate analysis controlling for depression, peer risk involvement, age, gender, and other socio-demographic variables indicated that alcohol intoxication was independently correlated with premarital sex, multiple sexual partners, and buying and selling sex.

CONCLUSIONS

Compared to the general Chinese population, levels of intoxication were elevated among Chinese rural-to-urban migrants. Alcohol intoxication was associated with sexual risk behaviors. HIV/AIDS prevention and intervention efforts should include components of alcohol use/abuse prevention for an effective reduction of sexual risk among young rural-to-urban migrants in China.