Evidence Rating: Promising – One study – for reducing substance abuse among Native American adolescents
The Cherokee Talking Circle (CTC) is a culturally based intervention targeting substance abuse among Native American adolescents. The program was designed for students who were part of the United Keetoowah Band of Cherokee Indians, the eighth largest tribe in Oklahoma. The goal of the CTC is to reduce substance abuse, with abstinence as the ideal outcome for students.
Native American adolescents have lower overall health statuses, compared with the general U.S. youth population, and significantly higher rates of depression, suicide, anxiety, and substance use. Native American youths are more likely to leave school before completion compared with their nonnative peers, and the death rate for Native American youths is double that of nonnative adolescents. Among Native American youth today, alcohol abuse is the leading risk factor contributing to higher death rates and other physical and emotional maladies (Lowe et al. 2012). The CTC program seeks to fill the gap for Native American youths experiencing substance use/abuse by providing them with a culturally specific and culturally sensitive intervention.
The intervention is aimed at Keetoowah–Cherokee students ages 13 to 18 who are in the early stages of substance misuse and who are also experiencing negative consequences as a result of their substance use.
The CTC program integrates Keetoowah–Cherokee values into the intervention and is based on the Cherokee concept of self-reliance. The Keetoowah–Cherokee use self-reliance as part of an overall worldview that all things come together to form a whole. Keetoowah–Cherokee leaders note that self-reliance is a way of life that directly affects health and helps maintain balance (Lowe et al. 2012). The Keetoowah–Cherokee believe that self-reliance comes from being three things: responsible, disciplined, and confident. Responsibility means one has a duty to care for oneself and others by getting assistance, respecting oneself, respecting others, and respecting one’s Creator. Being disciplined refers to setting and pursuing goals, taking the initiative to make decisions, and taking risks. Being confident means having a sense of identity and self-worth. Two major cultural themes cut across all three of the categories: 1) being true to oneself and 2) being connected, which means identifying and using the resources found in creation.
The program was designed in partnership with Keetoowah–Cherokee community representatives. A Keetoowah–Cherokee elder served as a community liaison/interventionist, who reviewed and revised intervention materials to ensure proper Cherokee language usage and also to ensure materials were culturally appropriate.
CTC is a school-based, manualized intervention that consists of 10 sessions. Keetoowah–Cherokee students meet weekly for 45-minute sessions over 10 weeks. They are led by a counselor and a cultural expert in the format of a talking circle. Students who participate in CTC pledge to the group that they will maintain confidentiality of what is shared during the sessions. The manual uses both English and Cherokee languages.
Lowe and colleagues (2012) found that the Cherokee Talking Circle (CTC) program was significantly more effective overall in reducing substance abuse and other related problem behaviors among Native American adolescents, compared with other non-culturally, standard substance abuse education (SE) programs.
Total Symptom Severity Scale
Native American youths in the CTC intervention group had significantly lower scores on the Total Symptom Severity Scale at the 3-month follow-up, compared with SE group youths.
General Life Problem Index
Native American youths in the CTC intervention group had significantly lowers scores on the General Life Problem Index at the 3-month follow-up, compared with SE group youths.
Internal Behavior Scale
Native American youths in the CTC intervention group had significantly lower scores on the Internal Behavior Scale at the 3-month follow-up, compared with youths in the SE group.
External Behavior Scale
Youths in the CTC group had significantly lower scores on the External Behavior Scaled, compared with youths in the SE group at the 3-month follow-up period.
Substance Problem Scale
Youths in the CTC intervention had significantly lower scores on the Substance Problem Scale at the 3-month follow-up, compared with youths in the SE group.
Lowe and colleagues (2012) used a community-based research approach over the course of 3 years. The intervention was planned and executed using a three-phase approach. The first phase, called the look-and-think phase, took place in year 1. During this time, community partnerships were developed and data was collected that was used to develop the Cherokee Talking Circle (CTC) intervention. This phase also included the creation of a Community Partnership Steering Committee (CPSC), which consisted of a panel of six Keetoowah–Cherokee community representatives. The CPSC group met monthly and was led by a Keetoowah–Cherokee elder who served as a community liaison/interventionist. The elder would contribute to monthly meetings by reviewing and revising intervention materials to ensure proper Cherokee language usage and also ensure materials were culturally appropriate. The community liaison/interventionist also selected and mentored a community member who would be used to help implement the program in years 2 and 3 (as described above in Program Description).
The study recruited 179 Cherokee students to participate. The recruited students had been referred for substance abuse counseling and were also enrolled at the participating high schools on the tribal land. Researchers randomly assigned 92 students to the CTC condition (33 females, 59 males), with the remaining 87 students (43 females, 44 males) assigned to receive the standard substance abuse education program (SE). There were no significant differences between the groups for age (CTC=16.53 years old, SE=16.37 years old) or gender. All eligible students had not participated in any other substance use/abuse programs or interventions. Students in the SE group were placed in a “Be a Winner” program, which is a variant of the “Drug Abuse Resistance Education (DARE)” program. Students in the SE group met once a week for 45 minutes over 10 weeks. They were led by a police officer who used a workbook to present drug and substance education in a classroom setting.
Data was gathered at pre-intervention, immediate post-intervention, and 90 days post-intervention. Several questionnaires were used to collect measures, including a routine demographics instrument, the Cherokee Self-Reliance Questionnaire, the Global Assessment of Individual Needs–Quick (GAIN–Q), and Written Stories of Stress. The GAIN–Q has four subscales: 1) the General Life Problem Index, 2) the Internal Behavior Scale, 3) the External Behavior Scale, and 4) the Substance Problem Scale. The combination of these scales creates the Total Symptom Severity Scale, which reflects an individual’s overall health problems. All of the instruments had been previously tested, using Native American populations with acceptable levels of test–retest reliability.
There is no cost information available for this program.
The materials required to implement this program are the Cherokee Talking Circle manuals. The manuals are available in English and Cherokee languages.
With regards to training requirements/provider certification, the group leader must identify as Keetoowah–Cherokee, be trained in the Cherokee Talking Circle, and be culturally engaged and involved in the Cherokee community. The leader needs to understand Keetoowah–Cherokee history and traditions and how these can be applied to the treatment of youths with substance use/abuse.
Evidence-Base (Studies Reviewed)
These sources were used in the development of the program profile:
Lowe, John, Huigang Liang, Cheryl Riggs, and Jim Henson. 2012. “Community Partnership to Affect Substance Abuse Among Native American Adolescents.” The American Journal of Drug and Alcohol Abuse 38(5):450–55.
Age: 13 – 18
Race/Ethnicity: American Indians/Alaska Native
Setting (Delivery): School, Reservation
Program Type: Classroom Curricula, Group Therapy, Leadership and Youth Development, Alcohol and Drug Prevention
Current Program Status: Active
Listed by Other Directories: Model Programs Guide
Christine E. Lynn College of Nursing, Florida Atlantic University
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