Challenges to providing quality substance abuse treatment services for American Indian and Alaska Native communities: perspectives of staff from 18 treatment centers.

Alexandra Fickenscher,Douglas Novins,Rupinder Legha,Ashley Raleigh-Cohn

doi:10.1186/1471-244x-14-181

Abstract

BackgroundSubstance abuse continues to exact a significant toll, despite promising advancements in treatment, and American Indian and Alaska Native (AI/AN) communities remain disproportionately impacted. Understanding the challenges to providing quality substance abuse treatment to AI/AN communities could ultimately result in more effective treatment interventions, but no multi-site studies have examined this important issue.MethodsThis qualitative study examined the challenges of providing substance abuse treatment services for American Indian and Alaska Native (AI/AN) communities. We conducted key informant interviews and focus groups at 18 substance abuse treatment programs serving AI/AN communities. Seventy-six service participants (21 individuals in clinical administrative positions and 55 front-line clinicians) participated in the project. Interview transcripts were coded to identify key themes.ResultsWe found that the challenges of bringing effective substance abuse treatment to AI/AN communities fell into three broad categories: challenges associated with providing clinical services, those associated with the infrastructure of treatment settings, and those associated with the greater service/treatment system. These sets of challenges interact to form a highly complex set of conditions for the delivery of these services.ConclusionsOur findings suggest that substance abuse treatment services for AI/AN communities require more integrated, individualized, comprehensive, and longer-term approaches to care. Our three categories of challenges provide a useful framework for eliciting challenges to providing quality substance abuse treatment in other substance abuse treatment settings.

Highlights

Substance abuse continues to exact a significant toll, despite promising advancements in treatment, and American Indian and Alaska Native (AI/AN) communities remain disproportionately impacted
This study’s primary aims are to: a) describe the use of specific evidence-based treatments (EBTs) in substance abuse treatment programs serving American Indian and Alaska Native communities; b) describe the factors associated with the implementation of evidence-based treatments in these programs; and c) identify methods for more effective dissemination of evidence-based treatments to substance abuse treatment programs serving American Indian and Alaska Native communities
We identified three sets of challenges for bringing effective substance abuse treatment to AI/AN communities: challenges associated with providing clinical support, challenges associated with the infrastructure of the treatment settings, and challenges associated with the service/treatment system

Summary

Introduction

Substance abuse continues to exact a significant toll, despite promising advancements in treatment, and American Indian and Alaska Native (AI/AN) communities remain disproportionately impacted. Despite promising advances in biopsychosocial treatments, substance use disorders continue to significantly impact the health of people worldwide, due in part to the treatment gap between optimal care and currently available services [1]. In the United States, the Institute of Medicine’s 2006 Improving the Quality of Health Care for Mental and Substance-Use Conditions concluded that improper dissemination of and critical gaps in the existing evidence base result in ineffective treatment practices [2]. Though substance abuse disorders are chronic conditions often associated with complex medical and psychiatric comorbidities as well as severe impairment in multiple areas of functioning [8,9], the current service model provides inadequate, short-term services that fail to address patients’ long-term addiction treatment and social support needs [10,11,12]. There are too few programs available to those who need treatment [13]

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Results

Discussion

Conclusion