Virtual intervention reduces substance use in American Indians and Alaska Natives

Tuesday, August 11, 2026

Virtual intervention reduces substance use in American Indians and Alaska Natives

Emerging adults who participated in workshops combining evidence-based interventions and traditional practices reported reduced cannabis, alcohol use, and anxiety.

A National Institutes of Health (NIH)-funded clinical trial funded by the National Institutes of Health (NIH) has demonstrated that a virtual prevention intervention reduced cannabis and alcohol use among American Indian and Alaska Native emerging adults. In this new study, researchers tested the efficacy of a new program, called Traditions and Connections for Urban Native Americans (TACUNA), that blends the evidence-based practices with traditional practices to both prevent substance use and bolster cultural connection.

Compared to other groups, American Indian and Alaska Native individuals face higher risk(link is external) of drug overdose death and report greater rates of cannabis use and psychological distress(link is external). Yet American Indian and Alaska Native people also have many strengths, including strong traditions, family and community connections, and Indigenous knowledge that can play a vital role in preventing substance use and supporting health and well-being.

"Supportive social environments and community engagement are an important component of substance use prevention. Yet few interventions have been designed specifically for American Indian and Alaska Native people living in urban areas who may feel disconnected from their tribal communities," said Nora Volkow, M.D., director of NIH's National Institute on Drug Abuse (NIDA). "This trial suggests that the multidimensional, cost-effective approach of TACUNA could be a powerful tool for reducing drug use and addiction within this population."

Previous studies(link is external) have tied participation in traditional practices and feelings of cultural connectedness to lower drug use and better mental health. Other work, including a long-term collaborative effort by researchers at RAND Corporation, the University of California, Los Angeles, and the Sacred Path Indigenous Wellness Center, Long Beach, has demonstrated that American Indian and Alaska Native teens benefit from collaborative, non-confrontational counseling such as motivational interviewing(link is external), an evidence-based intervention for preventing drug use and promoting healthy living.

More recently, these scientists developed TACUNA, a prevention intervention designed to tie these findings together in a single accessible program.

Composed of three different workshops and a wellness gathering, TACUNA combines motivational interviewing with traditional activities, such as cooking, storytelling, and prayer, into discussions about healthy choices and relationships.

To test the efficacy of their holistic approach, the study authors recruited 541 American Indian and Alaska Native emerging adults between 18 and 25, whom they randomly assigned to either participate in TACUNA or standard care, which amounted to a single opioid and pain cultural health and wellness workshop. Both interventions were delivered by American Indian and Alaska Native facilitators. Following the intervention, investigators surveyed participants about their substance use, mental health, and peer influences at three, six, and 12 months post-intervention.

While both groups reportedly used cannabis less frequently and demonstrated fewer negative consequences associated with alcohol and cannabis use after the intervention, only the TACUNA group reported decreases in their frequency and quantity of alcohol consumption and in the amount of cannabis they used.

TACUNA participants also indicated greater reductions in anxiety symptoms and less time spent around peers who were using cannabis or heroin than those who received standard care. Both groups seemingly maintained their sense of cultural connection throughout the following year.

"We initially designed TACUNA for in-person engagements at discrete locations, but the pandemic in 2020 had us pivot to a virtual format. We were excited to see that these remote sessions had such prominent effects, which is ultimately good news for accessibility," said first author Elizabeth D'Amico, Ph.D., a senior behavioral scientist at RAND.

This research was supported by NIH through NIDA grant UH3DA050235, part of the Helping to End Addiction Long-term (HEAL) Initiative. NIH HEAL Initiative and Helping to End Addiction Long-term are registered service marks of the U.S. Department of Health and Human Services.

About the National Institute on Drug Abuse (NIDA): NIDA is a component of the National Institutes of Health, U.S. Department of Health and Human Services. NIDA supports most of the world's research on the health aspects of drug use and addiction. The Institute carries out a large variety of programs to inform policy, improve practice, and advance addiction science. For more information about NIDA and its programs, visit https://www.nida.nih.gov(link is external).

About the National Institutes of Health (NIH): NIH, the nation's medical research agency, includes 27 Institutes and Centers and is a component of the U.S. Department of Health and Human Services. NIH is the primary federal agency conducting and supporting basic, clinical, and translational medical research, and is investigating the causes, treatments, and cures for both common and rare diseases. For more information about NIH and its programs, visit https://www.nih.gov.

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Reference

Elizabeth J. D'Amico et al. Virtual Culturally Grounded Interventions for Substance Use in Urban American Indian and Alaska Native Emerging Adults: A Randomized Clinical Trial. JAMA Network Open. August 11, 2026. DOI: 10.1001/jamanetworkopen.2026.27878(link is external)