Skip to main content

Table 4 Wellness outcomes and main results

From: Cultural interventions to treat addictions in Indigenous populations: findings from a scoping study

Study Wellness outcomes Main results
Spiritual Mental Emotional Physical
  Scientific literature
Anderson, 1992 [40]    • 1/3-1/2 of clients maintained sobriety for at least 1 year post treatment.
• Clients established follow-up circles in their own community and those involved “do much better and feel more hopeful than those that are not” (p.11).
Boyd-Ball, 2003 [41]    • Family-enhanced group perceived high level of support of family members (94.2%) and nonfamily adults (90.6%) and positive peer support (66%).
• % of days abstinent from substance use from month 1 to 12 was high for both (culturally supplemented) treatment as usual and family-enhanced intervention groups, ranging from 80-100% days abstinent.
• The highest gain in abstinence was from month 1 to 2 for both groups.
Boyd-Ball et al, 2011 [42] • At 1 year follow-up: 23% relapsed into regular substance use; 77% showed low levels of substance use.
• Post-treatment substance use trajectories indicated that membership in the relapser’s group showed less engagement in traditional cultural practices and identification with their American culture (mean = -.24) than those classified in the abstainers group (mean = .17).
Dell & Hopkins, 2011 [43]    • Half of the youth (49.62%) reported a completely abstinent lifestyle in 90 days following exit from the program and half of these youth (51%) reported to not have the urge to misuse volatile or other substances during this time.
• At 6 months follow-up, 74% reported not using volatile or other substances and 68% of these reported not having to resist drug use.
• More than half of youth who completed the program (54.2%) reported attending school at 3 month follow-up and at 6 months this rate increased to 83.64%.
Dell et al, 2011 [44]    • Participating in the Equine-Assisted Learning program provided a culturally relevant space for youth and thus was beneficial to their healing in the program.
• Three main themes explained the healing experience: spiritual exchange (calm presence, being in the moment, meaningful connection to the horse), complementary communication (ability to communicate with horse beyond verbal commands and helped with patience and leadership in communicating with others), and authentic occurrence (females showed compassion for pregnant mares and foals, interacting with horse let them experience healthy touching and expressing affection).
D’Silva et al, 2011 [47]     • 63% of participants completed the program.
• Upon completion, almost 1/3 of participants self-reported 7 day abstinence.
• Of those reached at follow-up, 47% reported abstinence at 90 days.
• The smoking quit rate was 21.8%.
• Continuing smokers cut their daily smoking by half (from 17-9 cigarettes).
• 88% reported an increase in self-efficacy for their next quit.
• 44% planned to quit within 30 days.
Edwards, 2003 [45]   • 73 transformational (healing) experiences towards re-traditionalization were expressed by graduates of the treatment program.
• These were categorized into 12 themes (in descending order): Feeling cared for, spiritual experiences, insight, making a commitment, empowerment, releasing emotional pain, remorse, reconnecting to traditional values, forgiveness, relief, safety, and gratitude.
Gossage et al, 2003 [46] • IPsFU (Inmate/patients followed-up) drank 1 to 1.5 drinks less per drinking occasion than before intake (5.4 vs. 6.8), although still considered to be problematic.
• Analysis using the Wilks test reveals significant improvements in scores over 3 time periods (baseline, 3, 9 months after release) for relating to the animal world and human world (p < 0.02 and p < 0.03) respectively.
• Mean social support given to IP by his family increased before going to jail and at follow-up (from 6.5 to 8.3).
• One of five indicators of domestic violence (hit or throw things first, regardless of who started an argument) improved significantly from before going to jail to follow-up (x2 = 4.714, p = 0.030).
• Medical status scores improved before to follow-up (5.8 to 7.8 on a 10-point scale) and this was statistically significant (paired t-test, =3.3.16, p = 0.003).
• There was substantial and significant improvement in marital status (x2 = 108.127, 45 df, p = 0.000).
• 47% of IPs were rearrested at some point during the study.
Lowe et al, 2012 [48]    • Culturally based intervention (CTC) was significantly more effective for reducing substance use and related problems than the non-culturally-based intervention (SE) on the Global Assessment of Individual Needs—Quick (GAIN-Q) as follows:
• The Total Symptom Severity Score (TSSS) showed differences between groups increased over time, and at 3 month follow-up, the difference remained and the magnitude increased (t = -5.35, p < .001).
• The General Life Problem Index (GLPI) showed differences between the CTC and SE groups becoming significant at post intervention (t = -2.63, p = .009) and 3 month follow-up (t = -5.05, p < .001).
• The Internal Behavior Scale (IBS) results show a significant difference between the two groups at post-intervention (t = -4.18, p < .001) and 3 month follow-up (t = -5.45, p < .001).
• External Behavior Scale (EBS) score differences between the two groups became significant at post-intervention (t = -3.58, p < .001) and 3 month follow-up, (t = -4.56, p < .001).
• The difference in the Substance Problem Scale (SPS) between the CTC and SE groups became significant at post-intervention (t = -3.89, p < .001) and 3 month follow-up, (t = -4.69, p = .001).
• Cherokee self-reliance scores showed that at post-intervention, the CTC group had higher scores than the SE group (t = 2.72, p = .007). At 3 month follow-up, the difference between the two groups became larger (t = 6.74, p < .001).
Naquin et al, 2006 [49]     • Rate of residents completing the program rose dramatically from 2002-2005, from 55% in 2002 to 75% in 2005, and this level of retention is higher than the national experience of 35% for therapeutic communities and 33-38% for long-term care (over 30 days).
• At 6 month follow-up, use of alcohol in the last 30 days dropped from 57% at intake to 20%.
• Full-time employment increased from 19.2% to 33.3%.
Nebelkopf & Penagos, 2005 [50]    • Mixed results in self-reported quality of life results owing to population that included HIV/AIDS clients, e.g., “how would you rate your overall health” decreased between baseline and follow-up (no data provided) whereas “feeling bad lately” decreased over that period of time (32% vs. 3% said “definitely true”; 29% vs. 18% said “mostly true”).
Nebelkopf & Wright, 2011 [51]   • Using the McNemar test:
• 24% reported using alcohol or drugs in the prior 30 days at baseline, with a decline to 5% six months later (p < .001).
• Experiences of stress, emotion, or activities resulting from substance use in the prior 30 days also showed a decreasing rate of change from 47% to 23% (p < .001).
• The number reporting either part or full-time employment increased from 11% to 20% (p < .001).
• The largest rate of change was seen in enrollment in school or a training program, moving from 7% to 17% (p < .001).
• The number reporting being arrested or committing a crime in the prior 30 days went from 31% to 5% (p < 0.001).
• Significant reductions were seen in the rates of non-substance use-related reports of: serious depression (p < .001), serious anxiety or tension (p < .001), hallucinations (p < .001), trouble understanding or concentrating (p < .001), trouble controlling violent behavior (p < .01), and suicide attempts (p < .01).
Saylors, 2003 [52]    • Within pre/post matched sample, alcohol use decreased 13% after 6 months and drinking alcohol to intoxication was reduced by 19%.
• Women who reported using other drugs at intake, such as marijuana and inhalants, reported no use at 6 months.
• Heroin use was down 93%.
• At 12 month follow-up, the rate of full-time employment increased from 10% at intake, to 29%, and the clients who were legally employed doubled.
• There was an increase in the % of participants claiming good health and decreases of “fair” or “poor”.
• Positive change in clients’ living situations also resulted in fewer having contact with the criminal justice system and more being enrolled in school or job training programs.
• Culture was viewed as important at intake, with 5.7% reporting it was “not important”; 11.5% responding “important”, and 73% responding that their culture was “very important” to them.
Wright et al, 2011 [53]   • Using the McNemar test:
• 80.2% decrease rate of change in alcohol and drug use from 116 (23.7%) in the prior 30 days at baseline to 23 (4.7%) six months later (p < .001).
• Experiences of stress, emotion, or activities resulting from substance use in the prior 30 days showed a decreasing rate of change of 51.8%, from 231 (47.1%) to 111 (22.7%) (p < .001).
• The number reporting either part or full-time employment increased from 55 (11.2%) to 100 (20.4%), with an 82.1% rate of change (p < .001).
• The largest rate of change (150.7%) was seen in enrollment in school or a training program, moving from 34 (6.9%) to 85 (17.3%) (p < .001).
• The number reporting being arrested or committing a crime (includes illegal substance use) in the prior 30 days went from 151 (30.8%) to 26 (5.3%) with an 82.8% rate of change (p < .001).
• Significant reductions were seen in reports of serious depression (p < .001), serious anxiety or tension (p < .001), hallucinations (p < .001), trouble understanding or concentrating (p < .001), trouble controlling violent behavior (p < .01), and suicide attempts (p < .01).
  Grey literature
Bresette, 2009/2010 [54] Outcome #1: Increased sense of physical and mental well-being; feeling purpose and self-esteem:
• Self-identity as a Native was much more positive at the end of treatment.
• 71% of clients stated that they feel very comfortable practicing their cultural beliefs.
• 93% of clients who entered the program did not have a spirit name and received one during their stay in the program.
• 100% of clients stated that they were completely comfortable using their native language both in their community and outside their community.
• 63% of clients stated that they had some connection to First Nations Culture, to family members or extended family.
• 58% of clients returned to their community and participated in cultural, social or artistic activities in their home community.
Outcome #2: Increased knowledge of drug-free lifestyles including cultural healing strategies:
• Increased knowledge of drug-free lifestyles including cultural healing strategies, such as connection with spiritual family through youth fasting, feasts, ceremonies and learning to help self with use of the spirit.
Outcome #3: More past clients pursued their education and/or life learning goals:
• Average grade level improvement in language arts (.98% grade improvement) and math (.99% grade improvement).
• Upon return to their communities, clients reported that they continue performing traditional cultural activities, e.g., smudging, leading prayer, assisting with dressing the drum, etc.
• 100% of clients stated that they volunteer once a month in their community.
• 33% stated when they call back to the Treatment Centre after discharge that they had increased their social activities.
Outcome #4: Clients have developed positive social networks and have passed on teachings to help peers and community members:
• 46% of the clients continued with culture either alone or with family, friends or community members.
• Clients have connected with peers via the internet after leaving treatment.
• Clients have identified a confidant (clients calling the NNHC on follow-up to treatment included 3 or 25% of the youth who were in the program within the last year. 15.2 hours total spent on the 24 hour, toll-free line with youth over 104 different contacts).
Outcome #5: Clients encountered fewer occurrences with the justice system.
• 37% of clients left treatment early, all were female and 60% left because of charges.
• Serious occurrences (e.g., assaults on staff/clients) average = 1.5/month vs. 4.75 benchmark.
• Incidents (e.g., physical attack/threats) average = 1.5/month vs. 6.3 benchmark.
D’Hondt, no year [55]    • High completion rate at 84.6% and 50.0% of patients continued to be engaged in aftercare programs at CAMH and elsewhere.
• Reduced alcohol and drugs use in follow-up (30 days prior) compared to initial assessment (90 days prior).
• Pre- and post-treatment results showed a decrease in BASIS 32 scores, suggesting clinically important improvements in general mental health and functioning among the clients.
• At initial assessment (treatment entry), 10 out of 12 individuals (92%) reported having consumed alcohol to the point of blackout in the past 90 days. However, at follow-up, only 1 individual of the 9 contacted (11%) reported having drunk until blackout in the past 30 days.
Kunic, 2009 [56]     • Those who participated in Aboriginal Offender Substance Program (AOSAP) were returned to custody at a lower rate during the follow-up period than the groups of Aboriginal offenders who participated in National Substance Abuse Program- High Intensity (NSAP-H), NSAP-M (Moderate Intensity), failed to complete a substance use program, or did not participate in a substance use program prior to release from custody. Aboriginal offenders who participated in versions 2 or 3 of AOSAP were returned to custody at the same rate as Aboriginal offenders who participated in version 1 of AOSAP. There was no statistical difference between versions of AOSAP.
• Only 5% of the successful participants of AOSAP- V 2&3, and 6% of the participants of AOSAP version 1 were returned to custody because of a new offence or charge compared to 16% and 20% of the successful participants of NSAP-H and NSAP-M, respectively.
• Exposure to substance use treatment prior to release from custody was a relatively weak predictor of relapse to substance use (p = 0.07). However, some evidence suggested that successful participants of AOSAP and NSAP-M were less likely to incur a positive urinalysis result while on release than successful participants of NSAP-H.
• Those who participated in AOSAP were less likely than offenders from the other program exposure categories to test positive for drugs that are considered dangerous (e.g., cocaine, opioids).
McConnery & Dumont, 2010 [57] Outcome #1: Achieve greater balance in the four aspects of life (mental, spiritual, emotional, and physical):
• Not a clear increase over time in all aspects of wellness; however:
• Mental wellness of clients increased during treatment and 6 months after their treatment, but it was noted that there is “too much inaccuracy in the question to judge if there was a significant increase” (p.25).
• The only marked finding under spiritual wellness was the increase of practice and comfort associated with practicing this type of spiritually during the program, such as the daily smudge and praying. The spiritual aspect was mentioned a few times in the Talking Circle as something that participants thought would help them to remain sober once they returned to their community. But it is noted that “the spiritual aspect does not show considerable changes that could be interpreted as a general increase for participants, despite the fact that they name this as an important tool for their recovery” (p. 25).
• Authors noted: “The emotional aspect shows more clearly a decrease in feeling of sadness and crying” (p.25).
• Definite increase in the self-interpretation of physical good health with time from treatment to 3 months after treatment. There is a slight decrease between 3 months after treatment and 6 months after treatment. The authors note that “in the physical aspect there is a more evident decrease in the feeling of ill health” (p.25).
Outcome #2: Increase self-esteem and cultural pride:
• Slight increase in self-esteem from 6 months prior to treatment and 6 months after treatment, but authors note this is not significant.
• Cultural pride is about as high 6 months before treatment as it is 6 months after treatment.
Outcome #3: Achieve abstinence and influence peers in communities.
• 50% or more of the participants remained abstinent during the 6 months after treatment.
Outcome #4: Decrease the number of occurrences of client-related family violence:
• Slight decrease in violence from the pre-treatment to the post-treatment.
The Tsow Tun Le Lum Society [58] Outcome #1: Clients are involved in more activities that contribute to their being “clean and sober” (at 3 months post treatment):
• 2/3 (7 of 11) kept busy at daily activities every day or at least 3 times a week.
• Staying in the company of sober people remained the same as upon admission at 45% (5 of 11).
• 45% (5 of 11) requested help from AA/NA (a slight increase from admission).
• 64% (7 of 11) put into practice new ways of reacting to risky situations.
Outcome #2: Clients pride and dignity are empowered through participating in cultural, spiritual, and artistic events (at 3 months post treatment):
• 55% (6 of 11) were comfortable self-identifying as Aboriginal or Inuit (this is a drop from that at admission of 82%).
• 45% (5 of 11) had participated in cultural or traditional events (same as six months prior to admission).
• None were uncomfortable with practicing Aboriginal spiritual practice.
• 45% agreed or strongly agreed that a rich heritage of knowledge, wisdom, and traditional was passed to them (an increase over admission (36%) but a slight drop from the rate at completion (64%)).
Outcome #3: A decrease in demonstration of violent behaviors towards self and others:
• Significant drop in violent behaviors towards others, from 73% at admission to 29% at 3 months post treatment.
• Self-violent behavior dropped from 27% at admission to 14% at 3 months post treatment.
Outcome #4: Increased client’s self-esteem enhances their mental, physical, emotional, and spiritual well-being (at 3 months post treatment):
• 36% prefer to use and stay in the company of people in recovery every day.
• 36% have requested assistance from resources in their community (this % was double over the rate at admission).
• 18% (2 of 11) had difficulty sleeping; 55% (6 of 11) could sleep without medication; and 64% (7 of 11) felt calm and rested from sleep (these % were improvements over rates at admission).
Outcome #5: Increase awareness in communities around addictions and its impact on people:
• Since leaving the Treatment Centre, clients most frequently got support from a friend or family member.