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“Nemi’simk, Seeing Oneself” Intervention Program
A culturally adapted cognitive behavioral intervention for at-risk adolescent First Nations youth drinkers.
The “Nemi’simk, Seeing Oneself” Intervention Program integrated traditional cultural knowledge and teachings with cognitive behavioral strategies to reduce alcohol use among First Nation youth who are currently drinking. The manualized intervention approach identified drinkers at risk for problem drinking based on personality types associated with increased risk for alcohol use. Youths were assigned to participate in two separate 90-minute group intervention sessions, tailored to address motivation for drinking based on personality type. Youth were assessed prior to the intervention and at a 4-month post-treatment follow-up. A non-random control group consisted of participants who completed both sets of measures, but did not receive the intervention.
Outcomes
Significant improvements on drinking indices and reduction in marijuana use.
There was a significant decrease in usual drinking frequency and marijuana consumption, as well as significantly more abstinence and less binging and alcohol-related problems in the youths that received the intervention. There were no significant improvements in a “quasi” control group comprising students who, although eligible to receive the intervention, failed to participate in the group sessions, but provided baseline and follow-up data.
Costs
High costs due to professional training on intervention followed by medium ongoing costs.
Initial costs are high due to the training on the intervention being performed by certified professionals with advanced degrees. Ongoing costs, which include the use of school space and the co-facilitator staffing, are thought to be less expensive.
Cultural Engagment
High community involvement in adapting and delivering intervention.
Local adult and youth First Nations community members were highly involved in the process of developing and delivering the intervention. The intervention manual was adapted to include colors, artwork, and sacred teachings from the Mi’kmaq culture.
Participants
Adolescent, Young Adult; Native; Female, Male
Setting
Rural, School
Delivery
Small Group, Face-to-Face
First Nations adolescents from rural schools.
First Nations youth (ages 14-18) who reported current drinking and evidenced personality profiles associated with increased risk for problem drinking were selected from four schools located in two rural communities in southeastern Canada. A total of 41 First Nations youth (26 females, 15 males) were identified as eligible and willing to participate in the study. Of those, 29 youth (20 females, 9 males) received the intervention; 12 eligible youth who did not attend sessions for various reasons served as a non-random quasi-control group.
Staffing Needs
Advanced Degree (post BA) Professional, Certified Professional, Community Leader
First Nations school guidance counselors and Aboriginal and Diversity Police Services members trained as co-facilitators.
Training on the intervention was delivered by a licensed clinical psychologist and a doctoral-level researcher with experience in school-based substance use prevention programming. First Nations school guidance counselors and members of the Aboriginal and Diversity Policing Services of the Royal Canadian Mounted Police force were trained as co-facilitators.
Research Design
Quasi experimental design
Developmental stage of research
Small sample early stage study with quasi-control comparison group.
This study had a small sample size with limitations in group equivalence, control of extraneous variables, and the design of the analysis (e.g., not intent to treat analysis, 39% lost to follow-up). Feasibility of the use of this intervention was demonstrated, but with a limited ability to draw strong conclusions.
Potential
Culturally adapted cognitive behavioral intervention for risky drinking personality types may prove useful as an early intervention.
This research suggests the possibility for the study of personality risk factor profiles and a process for cultural content inclusion into such interventions and research. This study should be replicated with appropriate controls, a larger sample size of participants, and a more rigorous design. This may be a promising intervention strategy if adapted for use in other Indigenous communities.
References
Mushquash CJ, Comeau MN, Stewart SH. An alcohol abuse early intervention approach with Mi'kmaq adolescents. First Peoples Child Fam Rev. 2007;3(2):17-26. https://fpcfr.com/index.php/FPCFR/article/view/34. https://doi.org/10.7202/1069458ar.
Mushquash CJ, Comeau MN, McLeod BD, Stewart SH. A four-stage method for developing early interventions for alcohol among aboriginal adolescents. Int J Ment Health Addict. 2010;8:296-309. https://ir.lib.uwo.ca/cgi/viewcontent.cgi?article=1187&context=aprci. https://doi.org/10.1007/s11469-009-9240-2.
Mushquash C. A brief description of an early alcohol use intervention for First Nations adolescents. Can Psychol. 2014;55(1):48-49. https://psycnet.apa.org/record/2014-08136-010. https://doi.org/10.1037/a0035474.
Conrod PJ, Stewart SH, Comeau N, Maclean AM. Efficacy of cognitive-behavioral interventions targeting personality risk factors for youth alcohol misuse. J Clin Child Adolesc Psychol. 2006;35(4):550-563. https://pubmed.ncbi.nlm.nih.gov/17007600. https://doi.org/10.1207/s15374424jccp3504_6.
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