An evidence-based mandate for addiction services: American Indians and sovereignty

Background: In 2003, Oregon's legislature mandated state agencies purchase evidence-based practices (EBPs). The state substance abuse authority required treatment programs to use EBPs. Oregon's tribes are sovereign self- governing nations eligible for state funding and were therefore impacted by this mandate. Purpose: This study documents experiences and unique challenges that American Indian/Alaska Native (AI/AN) tribal communities and urban treatment programs face while trying to comply with a state-level EBP policy mandate. Data and Methods: Focus groups and semi-structured interviews conducted in 2005, as the policy went into effect, and again in 2008, after two years of implementation, provide qualitative data on tribal implementation. Participants included substance abuse treatment directors (n=7 in 2005; n=7 in 2008), counselors (n=10 in 2005; n=18 in 2008) and stakeholders (n=5 in 2005; n=3 in 2008) from tribal communities in Oregon. Analysis employed coding with Atlas.ti qualitative software, followed by a team based-iterative approach for theme identification and interpretation. Results: Several recurrent themes emerged from the interviews and focus groups with tribal substance abuse treatment staff. Participants reported feeling that the State Legislature disregarded tribal sovereignty during the development and implementation of the legislation. The lack of culturally congruent practices emerged as a prominent theme, and EBP implementation barriers included limited resources, poor access to trainings, and anxiety about possible reductions in funding. Discussion: Results highlight the importance of tribal sovereignty, community involvement in policy development and support for development, adaption, and resource allocation for culturally appropriate practices for AI/AN communities.