Weaving Healthy Families Program to Prevent Substance Use, Anxiety, Depression, and Suicide: Pilot Results

Overview: The purpose of research is to examine pilot results testing the Chukka Auchaffi' Natana program (in Choctaw) or Weaving Healthy Families (WHF) prevention program to see how the participation in program is associated with changes in alcohol and drug use, and symptoms of anxiety, depression, and suicidal ideation.Proposal text:

Background: U.S. Indigenous experience a disproportionate burden of substance use disorder, anxiety, depression, and suicide, both as youth and adults (Brody et al., 2018; Çayır et al., 2017; Indian Health Service, 2019; Ka’apu, & Burnette, 2019; Liddell & Burnette, 2018; Radin et al., 2015), yet the scant interventions available to prevent and treat SUD tend to approach substance use from an ahistorical framework that fail to acknowledge historical oppression or incorporate the tremendous cultural strength that have sustained Indigenous peoples for centuries (Brave Heart et al., 2016; Gone & Trimble, 2012; Liddell & Burnette, 2018).

Purpose: The purpose of paper presentation is to report pilot results testing the Chukka Auchaffi' Natana program (in Choctaw) or Weaving Healthy Families (WHF) prevention program that targets alcohol and other drug use and violence, while promoting mental health, wellness, and resilience. The WHF integrates the Indigenous based framework of historical oppression, resilience, and transcendence (FHORT), which follows the recommended wellness approach and frames risk and protective factors across the ecological levels (Burnette & Figley, 2017). In paper, we examine mental and behavioral outcomes that have been shown to be the primary drivers of impaired health equity for Indigenous peoples, namely alcohol and drug use, and symptoms of anxiety, depression, and suicidal ideation. Given sex differences have been found to pervade across such behavioral health outcomes, such differences are also investigated.

Methods: This nonrandomized intervention pilot program utilized a nonexperimental longitudinal (pretest, posttest, and 6, 9, and 12 month postintervention surveys) design with 8 Indigenous families (n =24 adult and youth). We used repeated measures regressions with generalized estimating equations (GEE; Schober & Vetter, 2018) were utilized to examine significant changes over time in the following key outcomes: alcohol and drug use, dysfunctional attitudes, and symptoms of anxiety and suicidal ideation.

Results: We observed significant declines in alcohol use, with a nearly three-fold decline over the course of the study (B = -2.78, p < 0.0001), as well as in drug use (B = 0.53, -20.12, p < 0.0001). Dysfunctional attitudes also declined significantly over time (B = -0.54, p < 0.0001), as did symptoms of anxiety (B = -0.50, p < 0.05) and suicidal ideation (B = -0.08, p < 0.05). While smaller in magnitude, these decreases over time held even after controlling for sex, with the exception of suicidal ideation. We observed sex differences, with greater decline alcohol use (B = -4.29, p < 0.0001) and dysfunctional attitudes (B = -1.69, p = 0.0108) for men than women.

Conclusions and Implications: With reductions in alcohol use, drug use, dysfunctional attitudes associated with depression, symptoms of anxiety, and suicidal ideation, results demonstrate promising pathways toward enhance wellness through the WHF program. The WHF targets outcomes directly and indirectly through experiential and psychoeducation activities focused on preventing substance use and risky attitudes for depression, while promoting skills associated with optimum wellness and behavioral health, including emotional regulation, resilience, and culturally relevant protective factors, communication, and healthy relationships.