Running head: SUBSTANCE ABUSE 1
Counseling Native Americans on substance abuse
Stephen King
Liberty University
SUBSTANCE ABUSE
Abstract
As a Human service professional, you will be challenged. As a counselor one will be required to
counsel those from unfamiliar cultures. The understanding of the Native American culture will
be essential to be effective as a counselor. A counselor will need to be cognizant of cultural
awareness, religious and spiritual practices and approaches to counseling. Alcohol, substance
abuse and suicide are a major concern to the culture and these problems has been known to start
at an early age. Unfortunately, substance abuse and addiction in Native American culture seem
to marry one another. Although, alcohol has created many forms of problems within the Native
American culture it is not the only vice. Substance abuse within the culture is not limited to any
specific age group. The effects that abuse can have on a person is some that is detrimental to
their physical and mental state of mind. Native Americans substance abuse issues are usually
referred by the criminal justice system. The eighth leading cause of death among Native
Americans is suicide. Counseling this particular group will require a balance when introducing
spirituality. The many tribes within the Native American culture have vastly different religious
views. Native Americans value spirituality and they are more inclined to use old tribal methods
when treating aliments both physical and mental. Counseling a Native American client will
require the knowledge of the culture to be effective.
Keywords: Native Americans, Culture, Substance Abuse, Addition
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Counseling Native Americans on substance abuse
“There are significant health disparities between American Indian and Alaska
Native (AI/AN) populations and the general U.S. population, including, but not limited to,
cardiovascular disease, tuberculosis, infectious diseases, diabetes, substance use disorders
(SUD), homicide, and suicide (Grim, 2003; Holman et al., 2011; O’Connell, Rong, Wilson,
Manson, & Acton, 2010),” (Salvador, Goodkind & Ewing, 2016). When counseling a client from
a different culture it is important to understand the culture to help establish a relationship with
your clients. In the Native American culture, it will be imperative to understand the culture to
plan the course of treatment. “Native peoples existed on this continent long before the arrival of
any other group of people and have struggled to strive and continued to thrive,” (Hays & Erford,
2018). “Native Americans represent a group of peoples with a steadily growing population of
more than 5.2 million,” (Hays & Erford, 2018). The fact is the perception and the information of
the culture needs to be understood better. Substance abuse and the Native American culture
unfortunately go hand and hand. The subject of substance abuse within this particular culture is
unfortunately is a necessity in counseling the group. Being aware that not all sub-cultures or
tribes have the same will also assist in the relationship trust needed in counseling. Addition or
substance abuse has become this nation’s leading issues and it affects not only the abuser but the
family as well.
Cultural Awareness
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Understanding the Native American culture and their struggles with substance abuse
will require and open mind. “Native American families are unique- intergenerational, nonblood
(fictive) kinship ties, and pervasive with a history of cultural adoptions,” (Hays & Erford, 2018).
As a counselor knowing your client’s makeup and historical background will be essential to the
treatment of those suffering from abuse. The understanding of the tribe’s culture make-up will
assist the counselor in tribes there are teachers, ceremonial providers, herbalists, elders and
consultants. “Traditional healing disciplines included the following categories and can be
understood overall to be individuals identified within their local community as having healing
and helping skills based in the traditional practices of that culture:
Teachers: healers who instruct individuals on cultural practices. Ceremonial providers:
healers who may employ prayer, meditation, counseling, and symbolic healing rituals or
ceremonies that include the use of a medicine wheel, sacred hoop, sand painting, dancing,
drumming, sacred stones, feathers, and rattles, among many others; Herbalists: healers who
specialize in the production and use of herbal medicines; Elders: senior members of the
community who provide support to program participants and broker connections with traditional
community resources; and. Consultants: healers who advice program staff on cultural issues in
assessment and treatment. (Rieckmann, Moore, Croy, Novins, & Aarons, 2016).
American Indians and Alaska Natives (AIANs) have the highest rates of binge drinking
(30.2%) and heavy alcohol use (8.5%) of all racial groups in the United States (Substance Abuse
and Mental Health Services Administration, 2013a) (Rieckmann, et al., 2016). As shown by this
research substance abuse and addition to other drugs in this culture is unfortunately quite
common. Native American communities or tribes profoundly affected by this problem because
of their culture and their low-income communities. Native American substance abuse is
significantly higher on reservations than not. The abuse not only affects the individual abuser
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but their families as well. “The cultural patterns created by Native Americans on the Great
Plains during the historical period might appear to exemplify the idea that cultural processes can
be a "melting pot" for existing traditions creating a level of uniformity via intergroup
transmission,” (Lycett, 2014).
Along with the substance abuse a counselor will also encounter a variety of health
concerns in this culture and will need to aware of these when counseling Native American
clients, families, couples or individual groups within the tribe. “Substance misuse is a major
component of health disparities for urban American Indians and Alaska Natives,” (AI/ANs;
Castor et al., 2006; Johnson, Bartgis, Worley, Hellman, & Burkhart, 2010; Urban Indian Health
Institute [UIHI], Seattle Indian Health Board [SIHB], 2011) (McFarland, Bentson, Walker &
Silk-Walker, 2017). “Alcohol abuse, domestic abuse and suicide are considered the greatest
problems faced by Native Americans. Alcohol and substance abuse are a concern for many
tribes and tends to start at an early age. “Heavy alcohol use is usually related with factors such
as hopelessness, powerlessness, low self-esteem, culture identity, peer pressure, and break down
of family units,” (Sue & Sue, 2016). This abuse unfortunately starts at an early age.
“Suicide is at epidemic proportions among Native Americans and there is a high
association between suicide and alcohol abuse along with other factors such as boredom, family
breakdown, poverty, and disconnection between culture and community,” (Sue & Sue, 2016).
The counselor must consider tribal social structure, family dynamic as well as the spiritual
practices when counseling a Native American client. Understanding, that Native Americans hold
a significant importance to their tribe whether they live on or off the reservation. Collectivism in
leu of individualism is held in high regard within this culture and may cause an individual not to
seek help outside their reservation.
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Counselors should try to gain an understanding of the history of the tribe to include the
national history, tribal history and anything of significance related to their client. The counselor
should also be aware of the language spoken within the tribe as well the history of counseling
techniques and heir success or failure rates. An abundant of Native Americans believe
spirituality and indigenous healing are methods used to cure ailments (physical and mental) and
a counseling professional should recognize and appreciate these beliefs when working with a
Native American client. “American Indians and Alaska Natives (AIANs) experience major
disparities in accessing quality care for mental health and substance use disorders,” (Rieckmann
et al., 2016). Understanding the etiology of abuse of illicit substances among the Native
Americans requires for a critical analysis of the several factors which play various roles among
these communities.
Counseling Approach
Understanding the culture of the Native American client will be a significant part to
acceptance into the tribe. Along with the cultural understanding it will be equally important to
know what approaches a counselor has used and the success rate of the approach to help with a
plan for counseling this group. The abundance of substance abuse within the Native American
population requires a counselor to be diligent in their approach. Unfortunately, Native
Americans have a less access to treatment and counseling on the reservation or in their area.
“Domestic, sexual, and physical abuse have been reported to be higher for Native American
women than any other ethnic group,” (Sue & Sue, 2016).
Most Native Americans cannot access or afford quality, culturally informed and
appropriate care, and the available professionals are often inadequately equipped to deal with the
multifaceted demands of these communities. This result in a spiraling rise in mental health issues
as substance abuse escalates, thereby affecting retention and recidivism among this group. Also,
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as a result of the substance abuse the rise of violent crime in often the outcome. “Native
Americans living on tribal lands are at a higher risk for exposure to violence than other
populations (Wahab & Olson, 2004), (Hardy & Brown-Rice, 2016). As a counselor a
combination of cognitive treatment and the tribal chosen way of counseling will help bridge the
gap of the two therapy approaches. Using the tribal or non-western based therapy will assist the
counselor in gaining trust within the tribe. “Cultural differences are already known to sometimes
limit the quality of interactions between NA (Native American) and their healthcare providers
(Gonzales et al., 2014, Johansson et al., 2006). (Cunningham, Solomon, & Muramoto, 2016).
Counselors must acknowledge the importance of story telling in their approach to assist their
Native American clients. Native Americans spirituality and indigenous healing are methods used
to cure ailments (physical and mental) and a counseling professional should recognize and
appreciate these beliefs when working with a Native American client. Establishing rapport with
the Native American client will require self-awareness and self-regulation allowing the client to
tell their story and relying on their traditions to provide the best approach to counseling them.
“Although many clinical approaches have been reported to exhibit limited effectiveness when
working with Native American populations, some researchers have attempted to expand on
empirically validated approaches in order to increase the likelihood of effectiveness with this
population. Bigfoot and Schmidt (2010) adapted cognitive behavioral therapy (CBT) approaches
to incorporate teachings from the traditional Native American Medicine Wheel, (Hardy &
Brown-Rice, 2016). “The Native American Medicine Wheel is comprised of four sections with
various concepts dedicated to each section. The wheel symbolizes how various elements in one's
life are separate, yet interconnected. When utilizing the wheel as an intervention tool, counselors
can focus on the sections dedicated to thoughts, emotions, behavior and spirituality,” (Hardy &
Brown-Rice, 2016).
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Religious and Spiritual Application
“Spirituality and religion are intertwined for many American Indians and viewed as
integral and inseparable expressions of their tribal cultural heritage, (Kulis, & Tsethlikai, 2016).
Native Americans may not have the same religious view as their counselor and that could cause a
conflict. “When counseling, our convictions regarding Scripture, science, Christianity, wisdom,
and the Holy Spirit do matter--a great deal,” (Greggo, 2016). As with cultural awareness and
counseling approach it will be necessary for a counselor to be able to continue to build trust with
their clients and adopt the religious practices of the tribe in conjunction with their own faith.
Spirituality will also be a great tool to continue to build the bridge of trust between the Native
American client and counselor. Spiritual beliefs of the Native American client will be centered
on the wellness and harmony of mind, body and spirit. The culture believes it is one’s own
responsibility to maintain this wellness. “Many traditional and spiritual practices have at their
core a mindfulness component (Linehan, 2015a, Linehan, 2015b). Consequently, mindfulness
can be the vehicle to incorporate traditional and spiritual practices into an evidence based
approach to mental health that utilizes mindfulness as part of a manualized treatment,”
(Beckstead, Lambert, DuBose, & Linehan, 2015).
Conclusion
Substance abuse within the Native American community is a on going issue. As a
counselor of the group it will be crucial to understand the history of the tribe. While the history
is important it will equally important to understand the ways of tribe. Looking at their methods
and being able to intertwine with your plans to form a cohesive plan in helping the client. 23
million American citizens are addicted users of illicit drugs. The prevalence of substance abuse is
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notably higher among Native Americans, and this is attributed to several factors, including
economic challenges, social problems, historical injustices, and broken family structures, among
other issues. The treatment of substance abuse within this group will require the counselor to be
aware of tribe tradition to effectively treat those suffering. Counseling a Native American client,
one must consider tribal social structure and understand that the client will hold collectivism
over individualism in high regard. An open-minded approach in regard to religious and spiritual
approach will be essential in assist the Native American client.
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