Table 1 Characteristics of scoping study scientific and grey literature: program descriptions

Scientific literature

Anderson, 1992/CAN/ BC [40]

Community treatment centre: 6 week alcohol addiction program.

• Ceremonial practice (some smudging done each morning, but used more by staff than clients).

• Group sessions (the entire client population of six families per 6 week session, meet together 3-5 times a week for half a day. In this "circle," communication, listening and attending are established founded on mutual respect and unconditional positive regard).

• Land base activities (focus on healing qualities of the physical site).

• Family counseling.

• Social culture (community and social activities of community suppers, food shopping, chapel services, and recreational pursuits such as fishing and volleyball, helped clients relate as families and neighbors without alcohol).

• Alcoholics Anonymous meetings.

• Individual and couples counseling sessions and special work with children and young adults.

Boyd-Ball, 2003/US/ Pacific NW [41]

Residential: 8 week alcohol and drug addiction program in study known as Shadow Project. Comparison of (culturally supplemented) Treatment As Usual (TAU) and treatment with family-enhanced intervention.

• Sweat lodge.

• Individual therapy.

• Ceremonial practice (a Welcome Home ceremony involving family and community support- for the family-enhanced intervention; naming ceremony).

• Group therapy.

• Land base activities (wilderness outings, a Welcome Home ceremony involving family and community support for the family-enhanced intervention).

• 24-hour supervision.

• Traditional teachings- studied individual tribal histories.

• Psychiatric and psychological services.

• Singing.

• Assessment and referral.

• Cultural instruments (drumming).

• Life-skills counseling.

• Story-telling—used in the family-enhanced intervention only.

• Medical services.

• Art creation (crafts).

• Education programs.

• Elders (access to spiritual elders).

• Family programs.

• Aftercare planning.

Boyd-Ball et al, 2011/US/ Western regions (from 8 States) [42]

Residential: 7 week substance use treatment emphasizing traditional practices at the “WAIT” Center. Post-treatment substance use trajectories were correlated with self-report measure of general American Indian (AI) cultural involvement.

• Sweat lodge (“sweats”).

• Family management.

• Other ceremonial practice (not specified).

• Post-treatment social cultural participation (speculation that perhaps adolescents were prepared in treatment for greater involvement in tribal culture & traditions on returning home).

Dell & Hopkins, 2011/CAN/across Canada [43]

Residential: 4-6 month solvent use program.

• Fasting.

• Treatment and support based in resiliency theory.

• Land base activities (land-based cultural camps).

• Support for development of emotional intelligence, personal wellness care practices, and leadership skills (within a positive psychology framework).

• Traditional teachings (Elders’ teachings).

• Social culture (inclusion of community members in the treatment centers).

• Natural foods and medicines (ceremonial feasts).

• Elders (Elder guidance).

Dell et al, 2011/CAN ON [44]

Residential: 12 week 1 h per week, Equine assisted learning (EAL) curriculum added to a 4 month solvent use program at Nimkee NupiGawagan Healing Centre (NNHC).

• Land base activities (Equine Assisted Learning programs help make a connection to nature and the horse(s) within a natural environment).

According to Bresette (2009/2010), NNHC offers:

• Other cultural aspects to the program in addition to the equine therapy includes: Bi-weekly sweats, Welcoming Feasts, Full Moon ceremonies, Memorial Feasts, Spring Releasing ceremony, Spring and Fall Fasting, Youth Naming Ceremonies, Berry picking, Rites of passage ceremonies (i.e., Berry Fast), Pow-wows, Gardening, 1-1 cultural teachings, Traditional healer visits.

• Individual and group counseling therapy.

• Learning centre and work placements.

• Nutrition program.

• Health care.

• Recreation activities, including attending sporting events.

• Aftercare planning and follow-up.

Edwards, 2003/US/CA [45]

Residential: 90 day substance use program and 90 day aftercare program, at Friendship House.

• Sweat lodge.

• Individual and group counseling.

• Traditional teachings (the re-traditionalization process teaches clients about Native American values and traditions in classes such as "The Red Road" based on the work of Gene Thin Elk (1993) and "Native American Family Values").

• Co-dependency group work.

• Singing.

• Alcohol, drug, and HIV/AIDS education.

• Cultural instruments (drumming).

• Alcoholics Anonymous and Narcotics.

• Talking circle.

• Education about historical Native American traumas.

• Social cultural (Friendship House celebrations, personal relationships with the Native American staff members).

• Traditional healers (Medicine people).

Gossage et al, 2003/US/AZ [46]

Prison-based: Sweat lodge ceremony offered to prisoners to treat alcohol addiction.

• Sweat lodge.

• Alcohol education.

• Group psychotherapy.

D’Silva et al, 2011/US/MN [47]

Community-based: 4, 1 hr. individual or group tobacco cessation sessions paired with pharmacotherapy.

Culturally modified the American Lung Association’s ‘Freedom from Smoking’ program incorporating:

• Community outreach and education.

• Traditional teachings on how to use tobacco as a sacred item in ceremonies and offerings. These teachings are designed to help participants understand the difference between sacred tobacco use and commercial tobacco addiction.

• Clinical system referrals.

• Story-telling – cultural adaptations were made to counseling sessions based on suggestions from key community stakeholders, and included the addition of Ojibwe stories.

• Individual and group counseling.

• Language (use of Ojibwe language in treatment sessions).

• Access to nicotine replacement therapies (NRT) and prescription medications.

Lowe et al, 2012/US/OK [48]

Community-based: Two types of substance use interventions: 1) Cherokee Talking Circle (CTC), a culturally based, 10, 45 min intervention and 2) Be A Winner/Drug Abuse Resistance Education (DARE), 10, 45 min standard sessions.

The Cherokee Talking Circle intervention incorporated:

DARE education program:

• Language (the manual used both English and Cherokee languages).

• Promotes a school/law partnership approach to substances/ drug education.

• Talking circle.

¹Naquin et al, 2006/US/AK [49]

Residential: Alcohol addiction treatment program within the Ernie Treatment Centre, under the Cook Inlet Tribal Council (CITC) called the Therapeutic Village of Care. Treatment is organized into three phases: Orientation, Stabilization, and Right Living. The length of time in each phase depended on resident’s treatment plan or progress.

• Sweat lodge (steam bath similar to an American Indian sweat lodge).

CITC offers:

• Ceremonial practice (harvesting moose (road killed)).

• Street outreach.

• Social culture (residential treatment community functions as a large extended family: Members assume the roles of ‘aunties’ and ‘uncles’; mature members teach and mentor other, newer family members and help them reconnect with their family histories and culture by sharing their knowledge of tribal genealogies; staff participate as equals, modeling appropriate family roles and relationships. They also serve as guides, facilitating the healing process through role modeling and participation in, but not control of, the community).

• Case management.

• Elders (assume traditional role and are a constant reminder to residents of unspoken Native cultural norms).

• Screening and brief intervention.

• Art creation (carving).

• Assessment and brief treatment.

• Emergency care and detoxification.

• Intermediate residential, outpatient and continuing care.

¹Nebelkopf & Penagos, 2005/US/CA [50]

Residential, Health Centre, and Outpatient: HIV/AIDS, substance use, and mental health programs are offered under the Holistic Native Network (HNN).

There were seven projects that comprise the HNN. Four of these projects focus on substance use (Native Youth Circle, FH Healing Circle, Urban Native Youth, and Native Women). The remainder are concerned with mental health or HIV/AIDS. Types of cultural interventions and examples are provided below:

HNN offers:

• Sweat lodge (monthly gatherings where members of the community where members of the community come together in a spiritual way).

• Residential treatment.

• Natural foods and medicines (traditional herb consultations).

• Outpatient counseling (individual, group or family counseling).

• Cultural instruments (drum group).

• Case management.

• Talking circle.

• Community outreach.

• Traditional teachings (discuss the Red Road to Recovery).

• Risk-reduction counseling.

• Art creation (beading class).

• Psychotherapy.

• Social culture (Pow-wows, barbecues, dinners, ceremonies, give-aways, health fairs and other rituals are planned monthly and with the changing of the seasons).

• Art therapy.

• Traditional healers (a central component at community events).

• Home visits.

¹Nebelkopf & Wright, 2011/US/CA [51]

Community-based: Substance use treatment within the Native Men and Native Women Program.

The program is one of three described under the Family and Child Guidance Clinic (FCGC) of the Native American Health Center, Holistic System of Care (HSOC) for Native Americans in an Urban Environment. The other two are not of primary interest as they focus on prevention and children’s mental health. The HSOC model includes:

FCGC offers:

• Individual, group and family counseling.

• Sweat lodge.

• Care coordination.

• Ceremonial practice (seasonal ceremonies, smudging).

• Psychological assessment.

• Traditional teachings (discuss the Red Road to Recovery).

• Screening.

• Prayer.

• Alcohol and drug prevention programs for youth and adults.

• Social culture (four-day Gathering of Native Americans (GONA)).

• HIV/AIDS prevention.

• Story-telling.

• Youth Services program: Drop-in centre, after-school services, tribal athletics, and substance abuse prevention.

• Talking circle.

Saylors, 2003/US/CA [52]

Residential: Substance use treatment provided by the Women’s Circle at two Native American Health Centres.

Cultural interventions often occur at an individual level, with counselors assessing a client's desire or readiness to work with traditional ways. A counselor's initial clinical assessment contains spiritual/cultural domains that allow him/her to gauge a client's cultural affiliation and identification. This helps direct the development of a treatment plan which may include:

• Psycho-therapeutic practice.

• Sweat lodge.

• Family and Child Guidance Clinic provides the services of a nurse case manager and perinatal social worker.

• Singing.

• Cultural instruments (drumming).

• Natural foods and medicines (herbs and tobacco).

• Traditional healers (Native healers from different cultural backgrounds and traditions are brought in for several days at a time to work with clients).

• Prayer (some counselors pray with clients at the client's request).

• Ceremonial practice (sage, cedar or sweet grass smudges are often incorporated into a counseling session).

• Talking circles (held regularly at the clinic for clients and staff).

Wright et al, 2011/US/CA [53]

Residential and Outpatient: Mental health and substance use treatment at the Native American Health Center (NAHC) using the Holistic System of Care (HSOC) service provision framework.

Native American culture is integrated into treatment in the following ways:

HOSC offers:

• Sweat lodge.

• Treatment (mental health, substance use, medical, and family services).

• Ceremonial practice (seasonal ceremonies, smudging).

• Prevention (wellness education, positive parenting intervention, mental health promotions, addiction prevention, hepatitis prevention, and HIV/AIDS prevention).

• Traditional teachings (self-directed learning: Drawing on intertribal similarities, counselors also work with individuals to develop skills and use healing practices that includes individual backgrounds, traditions, practices, and stories).

• Recovery services (employment, housing life skills, and community service (giving back)).

• Natural foods and medicines (herbs).

• Peer support.

• Cultural instruments (drumming).

• Talking circle.

• Social culture (Pow-wows, women’s/men’s/youth societies, GONA, Positive Indian Parenting (OIO)).

• Prayer.

• Story telling.

• Traditional healers (Native healers from different cultural backgrounds and traditions are brought in for several days at a time to work with clients).

Grey Literature

Bresette, 2009/ 2010/ CAN/ON [54]

Residential: 4 month solvent addictions treatment provided at Nimkee NupiGawagan Healing Centre Inc.

• Sweat lodge (bi-weekly, staff sweats).

Centre offers:

• Fasting ceremony (spring and fall fasting).

• Individual and group counseling therapy.

• Ceremonial practice (Full Moon ceremonies, Spring Releasing Ceremony, youth naming ceremony, rites of passage ceremonies, smudging. Multicultural and certified staff (Anishnaabe, Haudenosaunee, Lenni-Lenape) accommodate specific cultural and healing experiences).

• Learning centre and work placements.

• Land base activities (gardening, equine program).

• Nutrition program.

• Traditional teachings (one to one cultural teachings).

• Health care.

• Social culture (Pow-wows).

• Recreation.

• Natural foods and medicines (welcoming feasts, memorial feasts, berry picking).

• Aftercare planning and follow-up.

• Singing.

• Community education and training.

• Cultural instruments (drumming).

• Prayer.

• Language (encourages and reinforces communication in original language).

• Traditional healers.

D’Hondt, no year/CAN/ON [55]

Residential: 21 day cycle substance use treatment cycles at the Centre for Addiction and Mental Health Addiction Program (CAMH).

• Ceremonial practice (smudging).

Document lists the following services for pilot program:

• Cultural instruments (drumming).

• Employment and housing for treatment graduates.

• Aftercare programs.

CAMH, in general, offers a variety of services (see: http://www.camh.ca/en/hospital/care_program_and_services/addiction_programs/Documents/3882ABS_brochurestnd.pdf

Including:

• Intake and assessment.

• Individual, couple and family counselling.

• Talking circles and group work.

• Telephone counselling.

• Training, consultation and capacity building.

• Inpatient and outpatient treatment programs.

• Referrals.

Kunic, 2009/CAN/across country [56]

Prison-based: Aboriginal Offender Substance Abuse Program (AOSAP) offered to male offenders involving four modules and 65 sessions.

• Sweat lodge.

AOSAP offers contemporary best-practices in substance use treatment, such as cognitive-behaviourism, social learning theory, and relapse prevention.

• Ceremonial practice (sacred sweat ceremonies plus other ‘traditional ceremonies’ relevant to the place in which they are conducted, however no detail as to what these ceremonies are is provided).

• Traditional teachings (particularly within the Modules 1 and 4, e.g., power of the circle of wellness).

• Natural foods and medicines (sacred medicines introduced in Module 4).

• Social culture (The Western Door (Module 3), which is 14 sessions in length, focuses on the history of consequences and the impact of substance use within Aboriginal communities. It also explores the devastating effects of substance use on Aboriginal individuals, families, and communities, and how changing individual behavior can result in the restoration of health, pride and culture). Module 2- Aboriginal spiritual engagement is facilitated through the introduction and exploration of the impact of trauma and how substance use was, and still is, a means by which Aboriginal people tried/try to cope with its effects).

• Talking circle.

McConnery & Dumont, 2010/CAN/QC [57]

Residential: 5 week alcohol and substance addiction treatment program at Wanaki Centre.

• Sweat lodge.

• Cognitive-behavioural therapy.

• Ceremonial practice (letting go ceremony after Sweat lodge. Have a Closing of the Sacred Fire ceremony with the Elder that provides closure for the entire treatment cycle. Smudging daily).

• Life skills training.

• Land base activities (teaching and experiences that build connections to creation/nature- clients go in the forest to collect cedar and balsam for the Sweat Lodge ceremony. Spending time in the woods with an Elder).

• Traditional teachings (delivered by an Elder: Sacred Fire, Pipe Keeper, four medicines, blessing of the water, teachings for women such as moon time and women’s dress, teaching of the lodge. Also have traditional Algonquin teachings. Adhere to the philosophy of 1) Red Road – involves a strict code of conduct and ethics, the foundation being respect for oneself and for other people and the environment in all its forms. 2) Medicine Wheel: Mental, emotional, spiritual, and physical).

• Social culture.

• Natural foods and medicines (have a cooking workshop to make traditional foods. A traditional meal is offered to clients, staff and guests at the graduation ceremony).

• Singing (songs are used with the Blessing of the Water teaching).

• Cultural instruments (drumming is used with the Blessing of the Water teaching).

• Language (use of Algonquin language).

• Talking circle (Sharing circle—the Eagle Feather is used here. Healing circles lead by Elder).

• Elders (Elders from the community and abroad deliver the teachings and traditional components of the program).

• Art creation (Grieving collage made of pictures cut out of magazines, representing images that touched them personally and they present their collage to the group. Create a family genogram showing family members who suffered from addictions. Make dream catchers and grieving bags).

• Prayer (daily).

¹The Tsow Tun Le Lum Society, no year/ CAN/BC [58]

Residential: 42 day alcohol and drug treatment program provided at the Tsow Tun Le Lum Society.

• Sweat lodge.

• Client outreach.

• Ceremonial practice (traditional food burnings at least twice per year).

• Community networking and development.

• Land base activities (spring-fed pond for traditional cleansing).

• AA and NA meetings.

• Singing.

• Aftercare.

• Dancing.

• Cultural instruments.

• Elders (Elders lead the morning “Spiritual Room” session that begins each program day. Healthy reconnection to “being Indian” is the goal of the unique Elder component).

• Prayer.