Interventions for the Prevention of Alcohol Misuse

This section of NativeAIR presents interventions designed to reduce or prevent alcohol misuse among American Indian/Alaska Native (AI/AN) populations. Prevention is consistent with AI/AN traditional approaches to health. The empowering of wellness is viewed as preferable to addressing ill health whenever possible.

Many of these interventions are geared toward children and/or adolescents, reflecting Native leaders’ interest in the health of the next generation. Adolescence is a time of increasing independence and behavioral experimentation accompanied by widespread changes in the brain. The nature of these rapid changes may increase the adolescent brain’s vulnerability to alcohol exposure , particularly relevant as people often start to drink alcohol during this time period.

As a result, prevention interventions emphasize delaying onset of use, regular use, and intoxication. Shifting the trajectory to lower use or later onset indicates a beneficial effect, even if alcohol use increases between baseline and follow-up.

The following interventions were selected from published peer-reviewed studies according to a rigorous set of criteria. This review was led by Natives and non-Natives conducting alcohol research in Native populations. About NativeAIR describes the intervention selection criteria and coding scheme, which includes elements of cultural or Tribal inclusion.

Interventions can be filtered and sorted by different variables to help needs. The Description of Intervention Variables page contains a description of all the intervention variables.

**Be Under Your Own Influence (BUYOI-AI)**BUYOI-AI, is a school-based substance use prevention intervention for middle-school American Indian youth focused on strengthening their sense of personal autonomy, identity, and relatedness with others.
Outcomes	Medium/Mixed Level of Change
Costs	Start-Up Cost: Medium Ongoing Cost: Low
Cultural Engagement	Cultural Inclusion: High Tribal Inclusion: High
Setting	Reservation, School
Participants	Child, Adolescent; Native, Non-Native; Female, Male
Delivery	Small Group, Large Group, Face-to-Face
Staffing Needs	Community Member, Educator
Research Design	Randomized controlled experimental design
Developmental stage of research	Mid Stage

**Living in 2 Worlds (L2W)**Living in 2 Worlds (L2W) is a substance use prevention program for urban American Indian (AI) students in 7th and 8th grades.
Outcomes	No Change
Costs	Start-Up Cost: Low Ongoing Cost: Low
Cultural Engagement	Cultural Inclusion: High Tribal Inclusion: High
Setting	School, Urban
Participants	Child, Adolescent; Native; Female, Male
Delivery	Medium Group, Face-to-Face
Staffing Needs	Educator
Research Design	Quasi experimental design
Developmental stage of research	Early Stage

**Motivational Interviewing and Culture for Urban Native American Youth (MICUNAY)**A culturally based motivational interviewing intervention to reduce alcohol and drug use among urban Native youth.
Outcomes	No Change
Costs	Start-Up Cost: Medium Ongoing Cost: Medium
Cultural Engagement	Cultural Inclusion: High Tribal Inclusion: High
Setting	Community Center, Urban
Participants	Adolescent; Native; Female, Male
Delivery	Small Group, Medium Group, Face-to-Face
Staffing Needs	Community Member
Research Design	Randomized controlled experimental design
Developmental stage of research	Mid Stage

**Native Voices**An HIV/AIDS, substance abuse, and hepatitis prevention program delivered at a 4-day Gathering of Native Americans (GONA) event.
Outcomes	Low Level of Change
Costs	Start-Up Cost: Medium Ongoing Cost: Medium
Cultural Engagement	Cultural Inclusion: High Tribal Inclusion: Medium
Setting	Community Center, Urban
Participants	Adolescent, Young Adult; Native, Non-Native; Female, Male
Delivery	Large Group, Face-to-Face
Staffing Needs	Community Member
Research Design	Pre-/post-intervention data
Developmental stage of research	Early Stage

**Qungasvik**Qungasvik is a culture-based, community-driven intervention to prevent suicide and alcohol misuse among Yup’ik Alaskan youth.
Outcomes	Medium/Mixed Level of Change
Costs	Start-Up Cost: Medium Ongoing Cost: Low
Cultural Engagement	Cultural Inclusion: High Tribal Inclusion: High
Setting	Community Wide, Rural
Participants	Child, Adolescent; Native; Female, Male
Delivery	Multi-level, Face-to-Face
Staffing Needs	Community Leader, Community Member
Research Design	Randomized controlled experimental design
Developmental stage of research	Mid Stage

**Seventh Generation**An after-school alcohol prevention program for urban American Indian (AI) youth that blends mainstream prevention approaches with culturally appropriate messaging.
Outcomes	Medium/Mixed Level of Change
Costs	Start-Up Cost: Medium Ongoing Cost: Medium
Cultural Engagement	Cultural Inclusion: High Tribal Inclusion: Medium
Setting	Urban
Participants	Child; Native; Female, Male
Delivery	Face-to-Face
Staffing Needs	Community Member
Research Design	Quasi experimental design
Developmental stage of research	Mid Stage

**Ho’ouna Pono**A culturally grounded, video-enhanced, school-based substance use prevention program providing drug resistance strategies to rural Hawai’ian youngsters.
Outcomes	No Change
Costs	Start-Up Cost: High Ongoing Cost: Low
Cultural Engagement	Cultural Inclusion: Medium Tribal Inclusion: High
Setting	Rural, School
Participants	Child, Adolescent; Native, Non-Native; Female, Male
Delivery	Medium Group, Face-to-Face
Staffing Needs	Certified Professional, Educator
Research Design	Randomized controlled experimental design
Developmental stage of research	Mid Stage

**Skills Training**Skills Training is a culturally adapted substance use prevention intervention for Native American elementary schoolchildren.
Outcomes	Medium/Mixed Level of Change
Costs	Start-Up Cost: Medium Ongoing Cost: Medium
Cultural Engagement	Cultural Inclusion: Medium Tribal Inclusion: None Reported
Setting	Community Wide, Reservation, School
Participants	Child; Native; Female, Male
Delivery	Medium Group, Multi-level, Face-to-Face
Staffing Needs	Not Specified
Research Design	Randomized controlled experimental design
Developmental stage of research	Mid Stage

**Multilevel Prevention on Southern California Reservations**This community-wide and individual-level intervention to reduce underage drinking consists of community-wide mobilization and awareness efforts, reducing alcohol sales to minors (Rewards and Reminders), and brief motivational interviewing or psycho-education for youth.
Outcomes	Medium/Mixed Level of Change
Costs	Start-Up Cost: Medium Ongoing Cost: Medium
Cultural Engagement	Cultural Inclusion: Medium Tribal Inclusion: Medium
Setting	Community Wide, Clinical/Healthcare, Reservation
Participants	Adolescent, Young Adult; Native; Female, Male
Delivery	Individual, Small Group, Large Group, Multi-level
Staffing Needs	Community Member
Research Design	Quasi experimental design
Developmental stage of research	Mid Stage

**Culturally Focused Wellness Intervention With Skills Building**A culturally based cognitive-behavioral skills building (CBSB) enhanced wellness intervention promoting health using social support and discussion of cultural and historic issues.
Outcomes	Medium/Mixed Level of Change
Costs	Start-Up Cost: Medium Ongoing Cost: Medium
Cultural Engagement	Cultural Inclusion: Medium Tribal Inclusion: High
Setting	Reservation
Participants	Young Adult, Adult; Native; Female
Delivery	Medium Group, Face-to-Face
Staffing Needs	Community Member
Research Design	Quasi experimental design
Developmental stage of research	Early Stage

**Fitness Training**Fitness Training intervention to improve fitness and self-esteem while decreasing substance use among First Nation adolescents.
Outcomes	Low Level of Change
Costs	Start-Up Cost: Low Ongoing Cost: Low
Cultural Engagement	Cultural Inclusion: Low Tribal Inclusion: Low
Setting	Reservation, School
Participants	Child, Adolescent; Native; Female, Male
Delivery	Medium Group
Staffing Needs	Certified Professional, Community Member
Research Design	Quasi experimental design
Developmental stage of research	Early Stage

**Reward and Reminder (R&R)**A program to reduce convenience store alcohol sales to Native American minors by reminding clerks of laws and rewarding them for requesting ID.
Outcomes	Medium/Mixed Level of Change
Costs	Start-Up Cost: Low Ongoing Cost: Low
Cultural Engagement	Cultural Inclusion: Low Tribal Inclusion: Medium
Setting	Community Wide, Reservation, Rural
Participants	Adult; ; Female, Male
Delivery	Individual, Face-to-Face
Staffing Needs	Community Member
Research Design	Pre-/post-intervention data
Developmental stage of research	Early Stage

**Banning Alcohol**Banning Alcohol is a policy intervention to limit community access to alcohol.
Outcomes	Medium/Mixed Level of Change
Costs	Start-Up Cost: Low Ongoing Cost: Low
Cultural Engagement	Cultural Inclusion: None Reported Tribal Inclusion: None Reported
Setting	Community Wide, Rural
Participants	Adolescent, Young Adult, Adult, Senior; Native, Non-Native; Female, Male
Delivery	Large Group
Staffing Needs	N/A
Research Design	No pre-intervention data, Pre-/post-intervention data
Developmental stage of research	Early Stage

**Behavioral Self-Control Training (BSCT)**A school-based alcohol misuse prevention intervention for at-risk Native high school students.
Outcomes	Medium/Mixed Level of Change
Costs	Start-Up Cost: Medium Ongoing Cost: Low
Cultural Engagement	Cultural Inclusion: None Reported Tribal Inclusion: None Reported
Setting	School
Participants	Adolescent, Young Adult; Native; Female, Male
Delivery	Individual, Small Group, Medium Group, Face-to-Face
Staffing Needs	Community Member
Research Design	Randomized controlled experimental design
Developmental stage of research	Early Stage

**Positive Action (PA)**A school-based, positive youth development program to prevent substance use, violent behavior, and sexual activity among Hawaiian elementary schoolchildren.
Outcomes	Medium/Mixed Level of Change
Costs	Start-Up Cost: Medium Ongoing Cost: Medium
Cultural Engagement	Cultural Inclusion: None Reported Tribal Inclusion: None Reported
Setting	School
Participants	Child; Native; Female, Male
Delivery	Multi-level, Face-to-Face
Staffing Needs	Certified Professional, Educator
Research Design	Randomized controlled experimental design
Developmental stage of research	Mid Stage

**Combined CONNECT and Communities Mobilizing for Change on Alcohol (CMCA)**CONNECT, a school-based screening and brief intervention, and CMCA, an environmental intervention targeting commercial and social access to alcohol, were implemented at the same time to prevent alcohol use among underage youth.
Outcomes	Medium/Mixed Level of Change
Costs	Start-Up Cost: High Ongoing Cost: Medium
Cultural Engagement	Cultural Inclusion: None Reported Tribal Inclusion: Medium
Setting	Community Wide, Rural, School
Participants	Adolescent; Native, Non-Native; Female, Male
Delivery	Multi-level, Face-to-Face
Staffing Needs	Advanced Degree (post BA) Professional, Community Leader, Community Member
Research Design	Randomized controlled experimental design
Developmental stage of research	Mid Stage

**CONNECT**CONNECT combines a school-based screening and brief intervention plus a media campaign to prevent alcohol misuse among American Indian and non-Native youth.
Outcomes	Medium/Mixed Level of Change
Costs	Start-Up Cost: Medium Ongoing Cost: Medium
Cultural Engagement	Cultural Inclusion: None Reported Tribal Inclusion: Low
Setting	Rural, School
Participants	Adolescent; Native, Non-Native; Female, Male
Delivery	Individual, Multi-level, Face-to-Face
Staffing Needs	Advanced Degree (post BA) Professional
Research Design	Randomized controlled experimental design
Developmental stage of research	Mid Stage

**Communities Mobilizing for Change on Alcohol (CMCA)**CMCA is a citizen-driven community organizing intervention targeting community-level alcohol policy, police enforcement, and underage acquisition of alcohol.
Outcomes	Medium/Mixed Level of Change
Costs	Start-Up Cost: Medium Ongoing Cost: Medium
Cultural Engagement	Cultural Inclusion: None Reported Tribal Inclusion: High
Setting	Community Wide, Rural
Participants	Adolescent, Young Adult; Native, Non-Native; Female, Male
Delivery	Multi-level
Staffing Needs	Community Member
Research Design	Randomized controlled experimental design
Developmental stage of research	Mature Stage