Content Analysis Informing the Development of Adapted Harm Reduction Talking Circles (HaRTC) with Urban American Indians and Alaska Natives Experiencing Alcohol Use Disorder

Prior studies with Native populations have highlighted concerns about the cultural acceptability of highly directive, Eurocentric approaches-such as cognitive behavioral therapy and 12-step programs-in treating alcohol use disorder (AUD). When asked in a prior qualitative study how they would redesign AUD treatment, urban American Indian and Alaska Native (AI/AN) participants reported wanting more low-barrier, harm reduction recovery approaches; Native treatment providers; and culturally relevant practices. Talking Circles, which are gatherings where people share what is on their hearts, were the most requested Native cultural practice. After developing and piloting an initial iteration, researchers, community members, and traditional health professionals collaborated on the present qualitative research study to further refine an adapted Harm Reduction Talking Circle (HaRTC) protocol for people with AI/AN heritage living in urban areas, who meet DSM-5-defined criteria of AUD. This study features a conventional content analysis of 31 patient interviews, 6 key informant interviews with management and traditional health professionals, and 5 staff and provider focus groups to inform the development of the HaRTC. Specifically, this study describes staff, management, traditional health professional, provider, and patient participants' (a) perspectives on HaRTC, including potential benefits, risks and mitigating factors; (b) preferred traditional medicines and practices; (c) preferred approaches/Circle Facilitator stance for engagement and facilitation; and (d) HaRTC logistics (e.g., timing, frequency). Analyses indicated a central tendency preference for eight weekly HaRTC sessions. Based on pilot study participant input, the goal of the HaRTC was to create low-barrier and compassionate space for people who met DSM-5-defined criteria of AUD and were seeking balance of their being. Although many participants expressed concerns about the potential inclusion of intoxicated people in HaRTC sessions, a large majority of staff, management, and patient participants felt it was important to have the HaRTC be as inclusive and accepting of community members as possible. Participants provided suggestions for how to structure facilitation of the HaRTC and mitigate risks of intoxication and patient escalation, while reducing stigma around active use. Participants preferred an approach that is acceptance-based, respects individuals' autonomy and culture, and creates a safe space for recovery, connection, balance, and harmony. Most participants felt the specific traditions and medicines applied in the HaRTC should be maximally inclusive, to honour the diversity of tribal affiliations and backgrounds represented among urban AI/ANs. In conclusion, participants largely supported an integration of harm reduction principles and the Turtle Island Indigenous tradition of the Talking Circle to provide a compassionate, culturally appropriate healing practice to a larger spectrum of AI/ANs with AUD. (C) 2022 The Authors.