Cultural Specific Treatment Model

Meetings transcribed and edited

By

Cecil White Hat Ph.D.

Workgroup Facilitator

Executive Summary

The cultural specific treatment model proposed by the AIAC work group is meant to be a framework that will integrate cultural specific treatment guiding principles, values, customs, and modalities into all aspects of treatment programming. These guiding principles will cascade into the organizational culture of the treatment center to effect policies & procedures, job descriptions, and is meant to permeate operations and programming that impacts the recovery process for Native Americans who suffer from chemical dependency. The integration of this treatment model is believed to enhance the recovery process by utilizing cultural strengths that bring meaning and depth to our relationships with ourselves, families, communities and clarifies world views that guide the living process. -Wayne Dupuis, Workgroup Chair

“Over time, I have noticed that those people who live their culture every day have no problems with alcohol or drugs.” (Mike Smith, Ojibwe Elder, Fall 2008)

Introduction

In August of 2008 a workgroup was convened to reactivate member participation from an earlier workgroup that had become temporarily inactive and whose purpose was to generate some guiding principles as to what constituted culturally specific treatment for American Indians particular to substance abuse treatment.

Timeliness

The timeliness of these guiding principles are further supported by Minnesota Administrative Rules, in Definitions, where it states:

9530.6605 Subp. 13. Culturally specific programs. "Culturally specific programs" means programs or subprograms:

A. designed to address the unique needs of individuals who share a common language, racial, ethnic, or social background;

B. governed with significant input from individuals of that specific background; and

C. that employ individuals to provide individual or group therapy, at least 50 percent of whom are of that specific background.

Furthermore, the holistic nature of this culturally driven documentis evident in that it mirrors the guiding principles of recovery from SAMHSAwhich are noted below:

  • Recovery is person-driven.
  • Recovery occurs via many pathways.
  • Recovery is holistic.
  • Recovery is supported by peers and allies.
  • Recovery is supported through relationships and social networks.
  • Recovery is culturally based and influenced.
  • Recovery is supported by addressing trauma.
  • Recovery involves individual, family, and community strengths and responsibility.
  • Recovery is based on respect.
  • Recovery emerges from hope.

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Lastly, this cultural specific treatment model goes further than western science by putting forth a new paradigm in treating addiction with American Indians by utilizing the rich cultural heritage available to each tribe, where cultural teachings requires us to ultimately define for ourselves our purpose in life. Vine Deloria Jr. aptly describes this process, “The real interest of the old Indians was not to discover the abstract structure of physical reality but rather to find the proper road along which, for the duration of a person’s life, individuals were supposed to walk…That is to say, there is a proper way to live in the universe: There is a content to every action, behavior, and belief…Nothing has incidental meaning and there are no coincidences.”(Deloria, 46).

Workgroup membership

Many of the members are active members of the American Indian Advisory Council (AIAC) with a few members who are in leadership positions with existing alcohol and drug programs serving American Indians primarily in Reservation communities. Members of this workgroup are considered to be a sub-committee of the (AIAC). Workgroup members are; 1) Gary Adams - Bois Forte, 2) Katy Laitinen - Bois Forte, 3) Chet Welch- Fond du Lac, 4) Wayne Dupuis - Fond du Lac, 5) Henry Fox - White Earth 6) Pat Moran - White Earth, 7) Gloria Mellado - Leech Lake, 8) Joe Nayquonabe - Mille Lacs, 9) Jody Good Thunder, Lower Sioux, and 10)Tom Barrett - Red Lake. DHS staff who participated in the meetings were Denise EsteyLindquist, and Cecil White Hat who served as a facilitator for the workgroup.

All members are of American Indian descent, Alcohol and Drug Professionals, and the majority of the members have in excess of 20 years in the alcohol and drug field. All were in agreement that a Cultural Specific Treatment Model was needed to more adequately meet the needs of American Indians entering treatment. It was also a group consensus that existing treatment models did not meet the needs of American Indians undergoing treatment since culture was not adequately addressed in treatment or was merely an add-on to existing traditional treatment regimens.

It became necessary and important that theexpertise of the membership with their collective years in the field be utilized to address and correct the existing problem of inadequate cultural practices within current treatment strategies, and provide for American Indian programs a Cultural strength-based approach to treatment. It was also a consensus of the members that the lack of a cultural specific treatment model contributed to the continuing rampant addiction in Indian communities across Minnesota. For instance, although American Indians make up only 1.1% of the population of the state, 8.1% of treatment placements in Minnesota in 2008 were American Indian, (Moldenhauer, 2009). More striking is that 42% of American Indian deathsbetween 2000 to 2007 in Minnesota were alcohol related (Moldenhauer, 2010).

“We are finding that what we had, and was taken from us was strong and beautiful, and we are going back to it.” (Marcida Eagle Bear, Lakota, Treatment Director,Spring2008)

Research from an Indian Perspective

This document is not intended to be a research paper or a literature review. It is totally coming from the field, as it should be, regarding this topic. Although from a western science perspective it must be noted that the following method of data gathering closely resembles a Participatory Action Research Model where a problem is identified and a committee is formed to developstrategies to correct the problem. However, it is more accurate to say that the process taken with this method of data gathering is a testament to the veracity of Oral Tradition, as gathering information is only one form of Oral Tradition. Deloriagives an excellent example of this culturally intrinsic research methodology by recording an interaction between John G. Neihardtand Black Elk:

The Nebraska poet John Neihardt interviewed Black Elk, The Oglala Sioux

medicine man, about the beliefs and practices of the old days. During

their conversations, Black Elk told Neihardt how the Sioux received the

sacred White Buffalo Calf Pipe, the central religious object of the Plains

Indians. The story involved the appearance of a woman who instructed the

people in moral, social, and religious standards and showed them how to

communicate with the higher powers through the use of the pipe in ceremonies.

After finishing his story, Black Elk paused, was silent for a time, and said:

‘This they tell, and whether it happened so or not, I do not know; but if you

think about it, you can see that it is true.’ This is not only a statement of faith:

It is a principleof epistemological method.” Deloria goes on to further validate,

stories and observations given by American Indians, “In the Indian system, all

data must be considered, the task is to find the proper pattern of interpretation

for the great variety of ordinary and extraordinary experiences we have.

Ordinaryand extraordinary must come together in one coherent comprehensive

story line. Sometimes this narrative will deal with human behavior and some-

times with the behavior of higher powers. But it will have a point to it and will

always represent a direction of future growth.” (Deloria, 45,46)

This culturally specific premise provides the backdrop for what follows. It is also important to note that the purpose of any external resources included in this document is merely intended to support the dialogue of the workgroup members.

Workgroup Sessions

The initial meetings involved brainstorming sessions where workgroup members responded to some basic questions that were important to the information gathering process of this project.

The responses from the sessions follow:

Possible treatment philosophy, mission statements:

  1. An observation was made that any mission statement needed to include the culture to indicate a major shift in treating the American Indian addict.
  2. That any mission statement needed to emphasize that all cultures are to be respected as well as religious expression.
  3. A consensus vote endorses the following mission statement “To provide for the American Indian clients a cultural specific treatment program model that will address their underlying causes and greatly enhance their potential for long term sobriety from their addiction.”

Underlying causes and what needs to happen:

  1. Alcoholism is a symptom for an underlying condition.
  2. You need to include oppression.
  3. The continued wounding that is happening across generations need to be broken.
  4. Separation from the Creator. A reconnection needs to happen.
  5. Denial of non-Indian and Indians about the reality of what happened to Native People. Give accurate information about the culture.
  6. Unraveling the emotions that bind us.
  7. Re-integration of body, mind, spirit through reconstruction of metaphysical-spiritual reclamation of individual identity and collective (tribal) identity.

Cultural specific issues that clients are bringing into treatment.

  1. Confusion about their spirituality.
  2. Chronic bereavement.
  3. Loss of identity.
  4. Loss of hope.
  5. Lack of awareness of roles for men and women.
  6. Shame connected to the Great Spirit – Separation.
  7. Shame of being Indian, guilt, anger, and depression.
  8. All of the above dynamics impact clients at intake. Additionally, there is an inherent collective trauma that impacts individuals and is manifested through chemical abuse. The components include; historical trauma, intra-community trauma, spiritual bankruptcy, family degeneration and disconnection of the individual to the ways of Tribal life through our collective conscious, or often termed “The good life.”

Necessary precautions that need to considered in the development of this model.

1.When spiritual leaders and elders are part of the treatment regimen, it is appropriate to do background checks. (e.g. sexual abuse has occurred in the Sweat Lodge)

2.When counseling; ensure that the client has free choice regarding spiritual/religious preference.

3.To be aware that the client is on a cultural continuum. They may be fully assimilated in the white world, or they may be acculturated where they have retained some of their cultural values, or they may be totally traditional. Respecting the client in that continuum is important.

What workgroup members would like to see in this Culturally Specific Treatment Model.

  1. The most up to date information with alcohol and drug education.
  2. American Indian Spirituality.
  3. Grief and Loss work.
  4. Traditional roles for men and women.
  5. Family involvement (adopted family), through education and counseling.
  6. Work on underlying conditions.
  7. Providing venues to actively pursue rites of passage. One example could be the Lakota rite of passage of Zuya Mani or the ‘journey to find oneself.’ The Ojibwe also have their own ways of becoming mature men and women.
  8. Traditional food (fry bread not being one).
  9. Recreate a cultural environment in a treatment setting.

a)Ceremonies.

b)Living the values.

c)Diet.

  1. Right Brain Activities – look at metaphors, stories, art, games, visual, music, and dance.
  2. Unbound – get to true self-cultural identity.
  3. Facilitate connection to collective conscious regarding values, beliefs, ways of being in the world.
  4. The treatment of Post-Traumatic Stress Disorder (PTSD) stemming from both cultural and military related distress.

In a group exercise, workgroup members were asked to think of an elder that they respected, and name some spiritual characteristics, cultural qualities that the elder demonstrated. The responses follow:

1. Living a good life / 2. Not quick to judge / 3. Patience
4. Forgiving / 5. One mate for life / 6. They laugh and cry easy
7. Walk their talk / 8. Integrity / 9. They have love for their people.
10. Connection/Creator / 11. Unconditional love / 12. Good listener
13. Good teacher / 14. See the good in everything / 15. Emotionally available
16. Positive / 17. Wisdom and knowledge / 18. Ability to provide spiritual guidance.
19. Someone you can trust / 20. Conveys respect

Two other focus groups were conducted where the same question was asked of prevention and treatment counselors, of what qualities they admired in an Elder. Their responses follow:

1. Fortitude / 2. Language was important to them. / 3. They love life
4. Humor / 5. They have compassion / 6. Selfless service
7. They have the heart of a young person / 8. They are honest / 9. Ability to mobilize
10. They support individuality / 11. Knowledge and respect for their Culture / 12. Display integrity/ethical behavior
13. Patience / 14. Willing to pass on Tradition / 15. Walk the talk
16. Live by example / 17. Love for the people / 18. Listen from the heart
19. Wise and observant / 20. Good listener / 21. Sensitive to emotions
22. Self-determined / 23. They have the capacity to empower communities, youth through elders with the sharing of their traditional cultural knowledge

Note from the facilitator:

This exercise of identifying spiritual and cultural qualities of elders is intended to draw out those values that we admire, respect and oftentimes aspire to. More importantly they are culturally based. The values listed in the workgroup and focus group exercises can serve as a foundation or guiding force for a culturally specific treatment model. This culture based value system can further serve other capacities within this model; as a code of ethics, or it can be a primary focus of job descriptions, and also, using the cultural values in treatment planning is strongly recommended.

In further discussionsregarding cultural values, the Lakota/Dakota/Ojibweworkgroup members did not see a conflict as there were more commonalities than differences with the two tribal groups represented. A sampling of the cultural values the Ojibwe and Dakota share are taken from a Native American Curriculum that is currently being taught in Minnesota to Alcohol and Drug Professionals.

The Sharing of Values

Dakota/Lakota/Nakota – Seven ValuesOjibwe – Seven Grandfathers

Woc’ekiya - PrayingZaagi’idiwin – Love

Woksape - WisdomNibwaakawin – Wisdom

Wao’hola - RespectManaaji’idiwin – Respect

Wah’wala - HumilityDabasendizowin – Humility

Waon’sila - Caring and compassionDeb wewin – Truth

Wawokiye - Generosity and helpingZoongidw’iwin – Courage

Wowijake - Honesty and TruthGwayakwaadiziwin– Honesty

(Dr. Duane Mackey Curriculum, 2004)(Rose Robinson revisions, 2010)

Guiding Principles for a Culturally Specific Treatment Model

After the workgroup members felt that enough meetings and discussion had taken place to warrant the development of guiding principles that would accurately portray the framework for a culturally specific treatment model, several culturally specificthemes emerged that can be termed “guiding forces” that would make it culturally specific to American Indians. It must be said at this point that the following guiding forces are the interpretation of the facilitatoras a result of the meetings that were held with the workgroup members. The themes presented as recommended guiding principles follow:

Culturally Specific Treatment Model

Guiding Principle 1: Is Providing a Healing Environment for the Client.

The setting is important. It starts with the facility,its’ purpose and mission must be driven by the culture. The value system must serve as a foundation to this model, readily apparent and visible. The furnishings, décor, all play a part. First contact is important, it must be welcoming. If the first contact is by phone, you should never say “can I put you on hold for a few minutes?” It should be conveyed to the client in that initial face to face contact that here at this treatment facility; they will be assured safety, privacy and with the help of the culture, an opportunity to heal. The client should be able to say “Here is a place I would like to get well in.”

Guiding Principle 2: Ensure that the Cultural and Spiritual practices are prominently woven (embedded) into the treatment process.

  • This will ensure that healing can come from the culture. Seeing cultural values demonstrated can oftentimes be an eye-opener for clients.
  • With culture, hope for a better future can be attained.
  • Remember; in times past the culture was so strong that we never had any need for jails, orphanages, and social service agencies.

Guiding Principle 3: Provide accurate information of Cultural and Spiritual Practices

The following examples are but a few;

  • Women’s roles, Men’s roles.
  • Oral Tradition.
  • Cultural Values.
  • Spiritual Practices.
  • Become familiar with the medicines, water, sage, cedar, sweet grass, and tobacco. It goes without saying that the use of the medicines in a clinical setting be a collaboration between the client and counselor of record.

Guiding Principle 4: Treating the Client as a Relative.

This will require a realignment of your counselor toolkit. Whereas in your counseling the addict textbook you were taught to be objective, apart, and not become emotionally involved, now, to be Culturally Specific requires one to be more subjective, more emotionally involved, and be part of the healing process. It is totally appropriate to show that you care and that you have compassion. In other words, your counseling approach must come from the heart. Cognitively, you can make an offering of one of the medicines in your counseling sessions, i.e. water, tobacco, sage, sweet grass, cedar. It is important to get the permission of the client before these traditional practices take place.

Guiding Principle 5: The counselors and staff can role model culturally responsive counselor traits.

  • Unconditional love.
  • Caring.
  • Compassion.
  • Good Listener.
  • Humility.
  • Being Patient.
  • Be comfortable with long silences.

Guiding Principle 6: Offer encouragement, support and most important, offer choices.

For millennia, offering choices was our method of education, we were told a story and we were expected to verbalize the lesson(s) learned from the story and make appropriate choices and behavior changes. Counselors can also help to celebrate the culture by acknowledging weekly benchmarks of changed behaviors from the negative to positive culture-related behaviors. Certificates can be given. Clients can choose a behavior they can work on for the week. It can be for;