Effective prevention programs employ a variety of approaches and interventions in a variety of settings. A common element of successful programs is that they foster caring, supportive relationships with one or more adults. Successful programs create opportunities for youth to develop feelings of self-efficacy and competence.
Youth in the general population who have the following characteristics are less likely to use substances such as drugs or alcohol:
Differences by tribal group, culture, degree of Indian ancestry, and reservation/urban residency make it impossible to prescribe a general prevention approach for all American Indian youth, even if that were desirable. Successful approaches, however, will incorporate ethnic and cultural components into prevention programs to promote the characteristics stated above.
One of the strengths of American Indian culture is a strong belief in family relationships and the extended family. Successful prevention programs are built on the foundation of the family, and transmit the cultural values held by the family.
Strong families provide a secure and stable environment where youth have a chance to learn competencies, develop strengths, and incorporate cultural norms. Cultural norms are behavior patterns learned from parents, teachers, peers, and many others whose values, attitudes, beliefs, and behaviors take place in the context of their own organizational culture. Some norms are healthy and some are not.
Cultural norms are often so strongly ingrained in an individual's daily life that the individual may be unaware of certain behaviors. Until these behaviors are viewed in the context of a different culture with different values and beliefs, the individual may have difficulty recognizing and changing them.
The goal of prevention is to understand and improve cultural norms, and thereby reduce alcohol, tobacco, and other drug (ATOD) use.
The cultural approach incorporates ceremony and ritual. Many American Indian prevention programs invite community elders to participate. Elders, medicine men, and women are indispensable to youth relearning Indian cultural values because they are the transmitters of the culture. Typically, a person may not participate in ceremonies until he or she has been drug and alcohol-free for a prescribed amount of time. This repulsion of alcohol and drugs extends to the objects used and clothing worn in ceremonies. Medicine men and women, healers, and healing ceremonies are invaluable cultural resources for dealing with life crises.
The cultural approach implies awareness of underlying spiritual principles. In the worldview of the Indian culture, everything has a purpose, including trees, animals, and rocks. One of life’s most important developmental tasks is discovering one’s own life purpose, and American Indian culture has many culturally sanctioned practices for accomplishing this.
Some definitions of primary prevention consider the community to be the proper basis for all prevention efforts.
The Center for Substance Abuse Prevention operates on the principle that primary prevention should be implemented from within the community rather than from the top down by federal agencies.
More than a decade ago, the Center for Substance Abuse Prevention brought together a group of tribal visionaries to design a curriculum to provide training and support for community partnership programs. This group of professionals in substance abuse prevention and health education brought indigenous thought, perspective, and ownership to a national level curriculum called the Gathering of Native Americans (GONA). Their goals and philosophies ensured that the curriculum would provide training that offered hope, encouragement, skills transfer, and a positive basis for indigenous community action based on values inherent in traditional indigenous cultures. The curriculum laid the groundwork for community advocacy and community development on indigenous terms, in indigenous ways, for indigenous people.
Over the years, the Center for Substance Abuse Prevention has developed prevention materials that are adaptable to different tribes and tribal groups. Probably the best example is the GONA program manual (Center for Substance Abuse Prevention and Indian Health Services, 1999). Community healing of historical and cultural trauma is the central theme of the GONA approach. The GONA curriculum was developed in 1992–94 under contract with the Center for Substance Abuse Prevention by a team of American Indian trainers and curriculum developers from across the United States. The GONA manual is a culturally specific prevention tool that can provide structure to communities addressing the effects of alcohol and other substance abuse.
Although the GONA manual has stimulated interest in many tribal communities, communities, like individuals, differ in their stages of readiness for intervention and it is often necessary to prepare a community for collective action and change. Examples of preparing a community include holding prevention training for service providers, writing grants to support needs analysis, strategic planning, program development and implementation, and disseminating information on prevention programs.
One factor to consider is that American Indian substance abuse programs treat the link between prevention and treatment differently than non-Indian programs. Non-Indian practitioners tend to see prevention as one step on a continuum that progresses from primary prevention through intervention to treatment and aftercare/rehabilitation. In contrast, American Indian practitioners see primary prevention as part of a cycle that moves through intervention, treatment, aftercare/rehabilitation, and back to primary prevention.
Just as there is no single American Indian drinking pattern, there is no single American Indian prevention strategy. It is not a matter of choosing between culturally based prevention strategies and other prevention strategies. Rather, American Indians can create more effective substance abuse prevention programs by combining ethnic and cultural components with other proven prevention strategies. Taking this action as a matter of course will make prevention programs more effective in the long run by enhancing protective factors and mitigating risk factors in the lives of American Indian youth.
* Information presented on Indian Cultures: Diversity, Tribal Sovereignty, and Historic Perspective, are attributable to "Culture Card" A Guide to Build Cultural Awareness, American Indian and Alaska Native produced by SAMSHA. This publication may be downloaded or ordered at WWW.SAMSHA.Gov/SHIN.