title: Challenges to providing quality substance abuse treatment services for American Indian and Alaska Native communities: perspectives of staff from 18 treatment centers.
abstract: BACKGROUND
  Substance abuse continues to exact a significant toll, despite promising advancements in treatment, and American Indian and Alaska Native (AI/AN) communities remain disproportionately impacted. Understanding the challenges to providing quality substance abuse treatment to AI/AN communities could ultimately result in more effective treatment interventions, but no multi-site studies have examined this important issue.
  
  
  METHODS
  This qualitative study examined the challenges of providing substance abuse treatment services for American Indian and Alaska Native (AI/AN) communities. We conducted key informant interviews and focus groups at 18 substance abuse treatment programs serving AI/AN communities. Seventy-six service participants (21 individuals in clinical administrative positions and 55 front-line clinicians) participated in the project. Interview transcripts were coded to identify key themes.
  
  
  RESULTS
  We found that the challenges of bringing effective substance abuse treatment to AI/AN communities fell into three broad categories: challenges associated with providing clinical services, those associated with the infrastructure of treatment settings, and those associated with the greater service/treatment system. These sets of challenges interact to form a highly complex set of conditions for the delivery of these services.
  
  
  CONCLUSIONS
  Our findings suggest that substance abuse treatment services for AI/AN communities require more integrated, individualized, comprehensive, and longer-term approaches to care. Our three categories of challenges provide a useful framework for eliciting challenges to providing quality substance abuse treatment in other substance abuse treatment settings.
authors.affiliation: Department of Psychiatry, University of Colorado, 13001 E, 17th St,, MSF546, Building 500, Aurora, CO 80045, USA. rlegha@pih.org.
authors.forename: Rupinder
authors.initials: R
authors.lastname: Legha
authors.forename: Ashley
authors.initials: A
authors.lastname: Raleigh-Cohn
authors.forename: Alexandra
authors.initials: A
authors.lastname: Fickenscher
authors.forename: Douglas
authors.initials: D
authors.lastname: Novins
mesh_terms: D000413:Alaska; D005006:Ethnicity; D017144:Focus Groups; D006801:Humans; D007198:Indians, North American; D008913:Minority Groups; D036301:Qualitative Research; D019966:Substance-Related Disorders / Q000628:therapy*