After substance abuse treatment, then what? - Cultural Diversity, part 2

American Rehabilitation,  Summer, 1996  by Jeanette Hassin

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Few people today can claim they don't know someone who has or is currently misusing a chemical substance, be it in the form of drugs or alcohol. Even those who are "in recovery," particularly Native Americans, daily confront barriers to successful rehabilitation from substance abuse. Trying to address these cultural, social, and personal barriers that exist for Native Americans, particularly in obtaining vocational rehabilitation services (VR), is a real and significant problem, one that is strongly substantiated by Rehabilitation Services Administration (RSA) statistics. For example, in fiscal year 1993-94 the Salem and Portland, Oregon, state vocational rehabilitation (SVR) branch offices reported that only 3 of 12 Native American clients with alcohol abuse listed as a primary disability achieved successful closures ("26's") (Oregon RSA/VR Branch Offices, 1996, personal communication).

The impetus for the NARTC/Oregon Tribal and Vocational Rehabilitation Project ("Oregon Project") was a request from a member of the Native American substance abuse treatment community in Salem, Oregon, whose chief concern was that people recovering from alcohol dependency could not secure adequate employment, a situation that she saw as directly impacting their self-esteem and sobriety. Upon conferring with the state's regional vocational rehabilitation office, NARTC staff found that the Salem RSA/VR staff agreed with her assessment of the situation. The Salem RSA/VR staff acknowledged its difficulty in seeing Indian clients through to successful rehabilitation. Subsequent to these discussions, the Native American Research and Training Center (NARTC) submitted a grant and received funding from the National Institute on Disability and Rehabilitation Research (NIDRR) to develop a multidimensional aftercare program for Native Americans in the Salem and Portland, Oregon, greater metropolitan areas who had recently been through treatment for substance abuse. The purpose of the project was to offer participants an aftercare program critical to the stabilization of their recovery and to their acceptance into successful employment through the VR system.

The multidimensional project that developed as a result of these discussions linked Native American treatment programs with VR branch offices. The key element linking the treatment programs and the VR system was an intensive self-empowerment aftercare program sponsored by NARTC.

Presented as an auxiliary component to aftercare, the self-empowerment program provides the recovering substance abuser with a process for increasing his/her sense of self, sense of community, and employability. This is accomplished by learning how to release a way of thinking that is self-destructive to the person and that leads to negative emotions and feelings (e.g., low selfesteem, hopelessness, helplessness). The program also offers a workshop that helps individuals who may be disenfranchised from their culture to explore the unique strengths of their Native American heritage and by doing so to develop another bridge for succeeding in the dominant society.

As is true for most programs, the coordination of the program turned out to be far easier to put on paper than to put into practice. The NARTC staff found that it was breaking new ground because it was coordinating agencies that not only had never worked together but also in some cases had no idea of one another's existence. The staff also discovered that the commitment of the agencies at each program site was essential to the success of the program.

Issues to be Addressed

1. Well over a quarter of a million Native Americans live in urban areas; another 450,000 reside in suburban areas and outside reservation areas (American Indian Digest 1995). Many social services are tribal-land specific or are for specified tribal groups, a situation that disenfranchises the segment of the Native American population not on tribal lands from needed social services.

2. Alcohol abuse among American Indians and Alaska Natives has produced alcohol related mortality rates far exceeding that of the U.S. general population (10.S times as great for ages 25-34 and 6.5 times as great for ages 35-44) (Indian Health Service 1995). This behavior is part of a pattern of selfdestructive actions (violence, accidents) whose source is low self-esteem, a sense of hopelessness/helplessness, and post traumatic stress syndrome occurring as a result of the 500 years of interaction between Anglos and Native Americans.

3. Rates of recidivism among people treated for substance abuse run as high as 86 percent 2 years post-treatment, with the majority of relapses occurring within the first 6 months (Marlatt and Gordon 1985). For Native Americans, the high rates of recidivism are the outcome of a number of factors, including socio-economic issues, limited aftercare support, and an inability to see an alternative option to a lifestyle that supported their habitual behavior. These factors profoundly affect the person's ability to access and successfully complete the VR process.