Growth and Empowerment for Indigenous Australians in Substance Abuse Treatment

  • Stacey L. Berry
  • T. P. Crowe
  • F. P. Deane
  • M. Billingham
  • Y. Bhagerutty
Article

Abstract

This paper describes psychosocial outcomes of an Indigenous residential substance abuse rehabilitation centre in Australia, examines the sensitivity to change of the new Growth and Empowerment Measure (GEM), and explores the degree to which service users value cultural components of the treatment program. Participants were 57 Indigenous and 46 non-Indigenous male clients from Oolong House. Intake, 8-weeks, and 16-weeks (program completion) measures of Kessler 10 Psychological Distress Scale (K10), Drug Taking Confidence Questionnaire (DTCQ-8), and GEM were completed. The Treatment Component Evaluation (TCE) was completed at 16-weeks. There were significant improvements for participants, with a decrease in psychological distress and increases in refusal self-efficacy and empowerment. Effect sizes for GEM were medium to large across the time-points (r = 0.61 to 0.70 for all four subscales from baseline to 8-weeks; r = 0.44 to 0.70 for three subscales from 8-weeks to 16-weeks), indicating sensitivity to change. Indigenous participants rated cultural components of treatment significantly more helpful than did non-Indigenous participants. Implications for future research and substance abuse interventions for Indigenous Australians are discussed.

Keywords

Indigenous Australian Empowerment Treatment effectiveness Sensitivity to change Culture 

References

  1. Anderson, P. (1996). Priorities in Aboriginal health. In G. Robinson (Ed.), Aboriginal health: Social and cultural transitions: proceedings of a conference, 29–31 September, 1995, The Northern Territory University, Darwin (pp. 15–18). Darwin: NTU Press.Google Scholar
  2. Annis, H. M., Sklar, S. M., & Turner, N. E. (1997). The drug-taking confidence questionnaire user’s guide. Toronto: Addiction Research Foundation of Ontario.Google Scholar
  3. Antonovsky, A. (1993). The structure and properties of the sense of coherence scale. Social Science and Medicine, 36, 725–733.PubMedCrossRefGoogle Scholar
  4. Arndt, S., Turvey, C., & Andreason, N. C. (1999). Correlating and predicting psychiatric symptom ratings: Spearman’s r versus Kendall’s tau correlation. Journal of Psychiatric Research, 33, 97–104.PubMedCrossRefGoogle Scholar
  5. Atkinson, J., Graham, J., Pettit, G., & Lewis, L. (2002). Broadening the focus of research into the health of Indigenous Australians. The Medical Journal of Australia, 177, 286–287.PubMedGoogle Scholar
  6. Australian Institute of Health and Welfare. (2002). Australia’s health 2002. Canberra: AIHW.Google Scholar
  7. Australian Institute of Health and Welfare. (2003). Australia’s health 2003. The sixth biennial welfare report of the Australian Institute of Health and Welfare. Canberra: AIHW.Google Scholar
  8. Australian Institute of Health and Welfare (2005). 2004 National Drug Strategy household survey: detailed findings (Drug Statistics Series No. 16. Cat. No. PHE 66). Canberra: Australian Institute of Health and Welfare (AIHW).Google Scholar
  9. Australian Institute of Health and Welfare (2006). Statistics on drug use in Australia (Drug Statistics Series No. 18. Cat. No. PHE 80). Canberra: AIHW.Google Scholar
  10. Beck, A. T., Wright, F. D., Newman, C. F., & Liese, B. S. (1993). Cognitive therapy of substance abuse. New York: The Guildford Press.Google Scholar
  11. Berry, S. L., & Crowe, T. P. (2009). A review of engagement of Indigenous Australians within mental health and substance abuse services. Australian e-Journal for the Advancement of Mental Health, 8, www.auseinet.com/journal/vol8iss1/berry.pdf
  12. Berry, S. L., Crowe, T. P., & Deane, F. P. (2012). Preliminary development and content validity of a measure of Australian Aboriginal cultural engagement. Ethnicity and Health. doi:10.1080/13557858.2011.645157.
  13. Brady, M. (1995). Culture in treatment, culture as treatment: a critical appraisal of developments in addictions programs for indigenous North Americans and Australians. Social Science and Medicine, 41, 1487–1498.PubMedCrossRefGoogle Scholar
  14. Brady, M. (2002). Indigenous residential treatment programs for drug and alcohol problems: Current status and options for improvement. Discussion paper for Centre for Aboriginal Economic Policy Research, paper no. 236.Google Scholar
  15. Brooks, R. T., Beard, J., & Steel, Z. (2006). Factor structure and interpretation of the K10. Psychological Assessment, 18, 62–70.PubMedCrossRefGoogle Scholar
  16. Brunette, M. F., Drake, R. E., Woods, M., & Hartnett, T. (2001). A comparison of long-term and short-term residential treatment programs for dual diagnosis patients. Psychiatric Services, 52, 526–528.PubMedCrossRefGoogle Scholar
  17. Brunette, M. F., Mueser, K. T., & Drake, R. E. (2004). A review of research on residential programs for people with severe mental illness and co-occurring substance use disorders. Drug and Alcohol Review, 23, 471–481.PubMedCrossRefGoogle Scholar
  18. Burgess, C. P., Berry, H. L., Gunthorpe, W., & Bailie, R. S. (2008). Development and preliminary validation of the ‘Caring for Country’ questionnaire: Measurement of an Indigenous Australian health determinant. International Journal for Equity in Health, 7(26), http://www.equityhealthj.com/content/7/1/26
  19. Butler, S. F., Budman, S. H., McGee, M. D., Davis, M. S., Cornelli, R., & Morey, L. C. (2006). Addiction severity assessment tool: development of a self-report measure for clients in substance abuse treatment. Drug and Alcohol Dependence, 80, 349–360.CrossRefGoogle Scholar
  20. Chenhall, R. (2006). Psychotherapy with indigenous Australians: group work in a residential alcohol and drug treatment setting. Psychotherapy in Australia, 13, 62–68.Google Scholar
  21. Clark-Carter, D. (2004). Quantitative psychological research: A student’s handbook (2nd ed.). New York: Psychology Press.Google Scholar
  22. Cleworth, S., Smith, W., & Sealey, R. (2006). Grief and courage in a river town: a pilot project in the Aboriginal Community of Kempsey, New South Wales. Australasian Psychiatry, 14, 390–394.PubMedGoogle Scholar
  23. Cohen, J. (1988). Statistical power analysis for the behavioural sciences (2nd ed.). Hillsdale: Erlbaum.Google Scholar
  24. Department of Health and Ageing (2007). Alcohol treatment guidelines for indigenous Australians. National Alcohol Strategy.Google Scholar
  25. Dockery, M. (2009). Cultural wellbeing: The case of Indigenous Australians. Curtin Business School: Curtin University.Google Scholar
  26. Dockery, M. (2011). Traditional culture and the wellbeing of Indigenous Australians: An analysis of the 2008 NATSSIS. Curtin Business School: Curtin University.Google Scholar
  27. Dudgeon, P., Wright, M., Paradies, Y., Garvey, D., & Walker, I. (2010). The social, cultural and historical context of Aboriginal and Torres Strait Islander Australians. In N. Purdie, P. Dudgeon, & R. Walker (Eds.), Working together: Aboriginal and Torres Strait Islander mental health and wellbeing principles and practice (pp. 25–42). Australian Government Department of Health and Ageing.Google Scholar
  28. Edwards, Y. (2003). Cultural connection and transformation: substance abuse treatment at Friendship House. Journal of Psychoactive Drugs, 35, 53–63.PubMedCrossRefGoogle Scholar
  29. Gone, J. P. (2011). The red road to wellness: cultural reclamation in a Native First Nations community treatment center. American Journal of Community Psychology, 47, 187–202.PubMedCrossRefGoogle Scholar
  30. Gone, J. P., & Calf Looking, P. E. (2011). American Indian culture as substance abuse treatment: pursuing evidence for a local intervention. Journal of Psychoactive Drugs, 43, 291–296.PubMedCrossRefGoogle Scholar
  31. Haswell, M., Kavanagh, D., Tsey, K., Reilly, L., Cadet-James, Y., Laliberte, A., et al. (2010). Psychometric validation of the Growth and Empowerment Measure (GEM) applied with Indigenous Australians. Australian and New Zealand Journal of Psychiatry, 44, 791–799.PubMedGoogle Scholar
  32. Human Rights and Equal Opportunity Commission. (1997). Bringing them home: A report of the National inquiry into separation of Aboriginal and Torres Strait Islander children from their families. Sydney: Human Rights and Equal Opportunity Commission.Google Scholar
  33. Hunter, E. (1993). Aboriginal health and history. Power and prejudice in remote Australia. Melbourne: Oxford University Press.CrossRefGoogle Scholar
  34. Janelle, A., Laliberte, A., & Ottawa, U. (2009). Promoting traditions: an evaluation of a wilderness activity among First-Nations of Canada. Australasian Psychiatry, 17, 108–111.CrossRefGoogle Scholar
  35. Kessler, R. C., Andrews, G., Colpe, L. J., Hiripi, E., Mroczek, D. K., Normand, S. L. T., et al. (2002). Short screening scales to monitor population prevalences and trends in non-specific psychological distress. Psychological Medicine, 32, 959–976.PubMedCrossRefGoogle Scholar
  36. Kingsley, J., Townsend, M., Phillips, R., & Aldous, D. (2009). “If the land is healthy…it makes the people healthy”: the relationship between caring for country and health for the Yorta Yorta Nation, Boonwurrung and Bangerang Tribes. Health & Place, 15, 291–299.CrossRefGoogle Scholar
  37. Kirmayer, L., Simpson, C., & Cargo, M. (2003). Healing traditions: culture, community and mental health promotion with Canadian Aboriginal peoples. Australasian Psychiatry, 11, S15–S23.CrossRefGoogle Scholar
  38. Laliberte, A., Haswell-Elkins, M., & Reilly, L. (2009). The healing journey: empowering Aboriginal communities to close the health gap. Australasian Psychiatry, 17, S64–S67.PubMedCrossRefGoogle Scholar
  39. Laudet, A. B. (2007). What does recovery mean to you? Lessons from the recovery experience for research and practice. Journal of Substance Abuse Treatment, 33, 243–256.PubMedCrossRefGoogle Scholar
  40. Leenaars, A. A., Anawak, J., Brown, C., Hill-Keddie, T., & Taparti, L. (1999). Genocide and suicide among Indigenous people: the North meets the South. Canadian Journal of Native Studies, 9, 337–363.Google Scholar
  41. National Health and Medical Research Council (2002). Report to the Aboriginal and Torres Strait Islander Research Agenda Working Group (RAWG): Final report of community consultations on the RAWG road map October 2002.Google Scholar
  42. Mobbs, R. (1991). In sickness and health: The sociocultural context of Aboriginal wellbeing, illness and healing. In J. Reid & P. Trompf (Eds.), The health of Aboriginal Australia (pp. 292–325). Sydney: Harcourt Brace Jovanovich.Google Scholar
  43. Moran, J. R., & Bussey, M. (2007). Results of an alcohol prevention program with Urban American Indian youth. Child and Adolescent Social Work Journal, 24, 1–21.CrossRefGoogle Scholar
  44. Nagel, T., & Thompson, C. (2007). Yarning about mental health manual. Darwin: AIMHI, Menzies School of Health Research.Google Scholar
  45. O’Dea, K. (1984). Marked improvement in carbohydrate and lipid metabolism in diabetic Australian Aborigines after temporary reversion to traditional lifestyle. Diabetes, 33, 596–603.PubMedCrossRefGoogle Scholar
  46. O’Shane, P. (1995). The psychological impact of white colonialism on Aboriginal people. Australasian Psychiatry, 3, 149–153.CrossRefGoogle Scholar
  47. Parker, R. (2010). Australian Aboriginal and Torres Strait Islander mental health: an overview. In N. Purdie, P. Dudgeon, & R. Walker (Eds.), Working together: Aboriginal and Torres Strait Islander mental health and wellbeing principles and practice (pp. 3–11). Australian Government Department of Health and Ageing.Google Scholar
  48. Perkins, J. J., Sansom-Fisher, R. J., Blunden, S., Lunnay, D., Redman, S., & Hensely, M. J. (1994). The prevalence of drug use in urban Aboriginal communities. Addiction, 89, 1319–1331.PubMedCrossRefGoogle Scholar
  49. Roxbee, L., & Wallace, C. (2003). Emotional and social well-being: national policy context. Australasian Psychiatry, 11, S45–S50.CrossRefGoogle Scholar
  50. Schneider, U., Kroemer-Olbrisch, T., Wedegartner, F., Cimander, K. F., & Wetterling, T. (2004). Wishes and expectations of alcoholic patients concerning their therapy. Alcohol & Alcoholism, 39, 141–145.CrossRefGoogle Scholar
  51. Sklar, S. M., & Turner, N. E. (1999). A brief measure for the assessment of coping self efficacy among alcohol and other drug users. Addiction, 94, 723–729.PubMedCrossRefGoogle Scholar
  52. Sklar, S. M., Annis, H. M., & Turner, N. E. (1998). Development and validation of the Drug Taking Confidence Questionnaire: a measure of coping self-efficacy. Addictive Behaviors, 22, 1–18.Google Scholar
  53. Slattery, G. (1994). Transcultural therapy with Indigenous families: working with the belief system. Australian & New Zealand Journal of Therapy, 8, 61–70.Google Scholar
  54. Swan, P., & Raphael, B. (1995). ‘Ways forward’: National consultancy report on Aboriginal and Torres Strait Islander mental health. Canberra: Australian Government Publishing Service.Google Scholar
  55. Torres Stone, R. A., Whitbeck, L. B., Chen, X., Johnson, K., & Olson, D. M. (2006). Traditional practices, traditional spirituality, and alcohol cessation among American Indians. Journal of Studies on Alcohol, 67, 236–244.Google Scholar
  56. Tsey, K., Patterson, D., Whiteside, M., Baird, L., Baird, B., & Tsey, K. (2003). Indigenous men taking their rightful place in society? A follow up report. Australian Journal for Rural Health, 11, 285–286.CrossRefGoogle Scholar
  57. Tsey, K., Wenitong, M., McCalman, J., Whiteside, M., Baird, L., Patterson, D., et al. (2004). A participatory action research process with a rural Indigenous men’s group: monitoring and reinforcing change. Australian Journal of Primary Health, 10, 130–136.CrossRefGoogle Scholar
  58. Tsey, K., Whiteside, M., Daly, B., Deemal, A., Gibson, T., Cadet-James, Y., et al. (2005). Adapting the ‘Family Well-being’ empowerment program to the needs of remote indigenous school children. Australian and New Zealand Journal of Public Health, 29, 112–116.PubMedCrossRefGoogle Scholar
  59. Wendt, D. C., & Gone, J. P. (2012). Rethinking cultural competence: insights from indigenous community treatment settings. Transcultural Psychiatry, 49, 206–222.PubMedCrossRefGoogle Scholar
  60. Westerman, T. (2004). Engagement of Indigenous clients in mental health services: what role do cultural differences play? Australian e-Journal for the Advancement of Mental Health, 3, 1–6.Google Scholar
  61. Whitbeck, L. B., Chen, X., Hoyt, D. R., & Adams, G. W. (2004). Discrimination, historical loss, and enculturation: culturally specific risk and resiliency factors for alcohol abuse among American Indians. Journal of Studies on Alcohol, 65, 409–418.PubMedGoogle Scholar
  62. Wright, S., Nebelkopf, E., King, J., Maas, M., Ptel, C., & Samuel, S. (2011). Holistic system of care: evidence of effectiveness. Substance Use and Misuse, 46, 1420–1430.PubMedCrossRefGoogle Scholar
  63. Ypinazar, V. A., Margolis, S. A., Haswell-Elkins, M., & Tsey, K. (2007). Indigenous Australians’ understandings regarding mental health and disorders. Australian and New Zealand Journal of Psychiatry, 41, 467–478.PubMedCrossRefGoogle Scholar
  64. Zimmerman, M., Ramirez-Valles, J., Washienko, K. M., Walter, B., & Dyer, D. (1994). The enculturation hypothesis: Exploring direct and positive effects among Native American youth. In H. I. McCubbin, E. A. Thompson, A. I. Thompson, & J. E. Fromer (Eds.), Resiliency in ethnic minority families: Native and immigrant American families, vol. 1 (pp. 199–200). Madison: Centre for Excellence in Family Studies, University of Wisconsin-Madison.Google Scholar

Copyright information

© Springer Science+Business Media, LLC 2012

Authors and Affiliations

  • Stacey L. Berry
    • 1
  • T. P. Crowe
    • 1
  • F. P. Deane
    • 1
  • M. Billingham
    • 2
  • Y. Bhagerutty
    • 2
  1. 1.Illawarra Institute for Mental HealthUniversity of WollongongWollongongAustralia
  2. 2.Oolong Aboriginal Corporation IncorporatedNowraAustralia

Personalised recommendations