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Drum-Assisted Recovery Therapy for Native Americans (DARTNA)
Drum-Assisted Recovery Therapy for Native Americans (DARTNA) was compared to enhanced usual care for alcohol and other drugs
The DARTNA intervention is a Tribally adaptable therapeutic drum behavior therapy that incorporates drumming, talking circles, and uses the 12 Steps of AA/NA programs within the conceptual framework of the Northern Plains Medicine Wheel. This test of the feasibility of providing the intervention in an urban setting used a randomized controlled trial comparing DARTNA to usual care for alcohol and other drug use plus a multimedia health educational program. Initially DARTNA was to have been administered to participants for 12 3-hour sessions. Due to low recruitment numbers the study team decreased the number of sessions to six 2-hour sessions. This feasibility study was underpowered to detect clinically significant outcome differences and planned to utilize effect sizes as a means of estimating outcomes.
Outcomes
Small to moderate effects sizes for fewer drinks per day for the DARTNA group at the end of treatment. Moderate effect size for increased drinks per day for DARTNA participants at 3-month follow up.
Given the small sample size of the study, effect sizes were employed as indicators of outcomes. There were no reports of significant differences between the two groups on any alcohol or substance use at end of treatment or 3-month follow up. At the end of treatment, DARTNA showed a small-to-moderate effect size over usual care plus and a medium effect size for lower odds of cannabis use in the past 30 days. However, at the 3-month follow-up there was a medium effect size suggesting that DARTNA participants reported more drinks per day than the usual care plus.
Costs
Costs are considered to be medium for both start-up and ongoing.
Intervention start-up and maintenance requires 2 days of training and supervision of moderately paid staff to conduct the 6-week sessions. Intervention can be integrated into existing Tribal healthcare or inpatient or outpatient substance abuse treatment centers and services. Costs are also necessary for making drums.
Cultural Engagment
Cultural and Tribal engagement were high.
There was a lot of involvement and focus group input from knowledgeable Native specialists, Elders, and participants. Since a major part of the intervention is Native American drumming and the framework is based on the Medicine Wheel, the cultural inclusion is high. The development of the drumming intervention involved traditional leaders of the urban American Indian community, which informed cultural perspectives on gender-roles and appropriateness and importance of culturally relevant treatments for substance use disorders. A community advisory board was comprised of urban American Indian leaders and DARTNA was reviewed and informed by AI/AN substance abuse providers.
Participants
Young Adult, Adult, Senior; Native; Female, Male
Setting
Clinical/Healthcare, Urban
Delivery
Small Group, Medium Group, Face-to-Face
Urban American Indian/Alaska Native, mostly male adults from 33 Tribes participated.
Participants were 63 American Indian/Alaska Native adults from urban areas (ages 20–65, mean age 39.37 years) and mostly male (92%) representing 33 Tribes. The interventions took place at two American Indian/Alaska Native health organizations within one urban area in Southern California. Most of the participants were in residential treatment at the time of the intervention.
Staffing Needs
Community Leader
Recognized community leaders and traditional culture-bearers delivered the intervention, one with a high school diploma and one with a bachelor’s degree.
The staff delivering the intervention were recognized community leaders and traditional culture-bearers. One of these individuals had a high school diploma and the other a bachelor’s degree. Each of the two-study staff received a 2-day training led by an Indigenous Ph.D. trained psychiatrist.
Research Design
Randomized controlled experimental design
Developmental stage of research
This was a feasibility and acceptability study of DARTNA compared to usual care plus.
There has been a considerable effort dedicated to developing this manualized intervention that can be delivered in 6, 12, or 24 sessions. This is an early stage feasibility trial, which was limited by the small sample size making it impossible to interpret significance levels of the outcomes. While this study found that DARTNA is feasible to deliver in an urban treatment setting with low to moderate effect sizes at the end of treatment, there was an increase in drinking days at three-month follow up. More work with bigger samples is necessary to move to the next stage of development.
Potential
There is potential for the intervention to decrease drinking in urban AI/ANs.
While the post treatment results of the study were promising, participants in the DARTNA increased their drinking at the three-month follow-up. These results may be due to the limited number of DARTNA sessions and recruiting their small sample from both inpatient and outpatient treatment settings. Nevertheless, AI/AN participants reported being highly satisfied with DARTNA, a treatment intervention that can be easily adapted, disseminated, and implemented in other Tribal communities.
References
Dickerson DL, D’Amico EJ, Klein DJ, et al. Drum-Assisted Recovery Therapy for Native Americans (DARTNA): Results from a feasibility randomized controlled trial. J Subst Abuse Treat. 2021;126:108439. https://pubmed.ncbi.nlm.nih.gov/33966952. https://doi.org/10.1016/j.jsat.2021.108439.
Dickerson DL, Venner KL, Duran B, Annon JJ, Hale B, Funmaker G. Drum-Assisted Recovery Therapy for Native Americans (DARTNA): Results from a pretest and focus groups. Am Indian Alsk Native Ment Health Res. 2014;21(1):35-58. https://pubmed.ncbi.nlm.nih.gov/24788920. https://doi.org/10.5820/aian.2101.2014.35.
Dickerson D, Robichaud F, Teruya C, Nagaran K, Hser YI. Utilizing drumming for American Indians/Alaska Natives with substance use disorders: A focus group study. Am J Drug Alcohol Abuse. 2012;38(5):505-510. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3725997. https://doi.org/10.3109/00952990.2012.699565.
Dickerson DL, Venner K, Duran B. Clinical trials and American Indians/Alaska Natives with substance use disorders: Identifying potential strategies for a new cultural-based intervention. J Public Ment Health. 2014;13(4):175-178. https://www.emerald.com/insight/content/doi/10.1108/JPMH-01-2014-0003/full/html. https://doi.org/10.1108/JPMH-01-2014-0003.
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