Culture in treatment, culture as treatment. A critical appraisal of developments in addictions programs for indigenous North Americans and Australians.

Indigenous people in Australia and in North America have been creating innovative interventions in the addictions field for several years now--incorporating traditional healing practices and cultural values into otherwise western programs--although this process is more developed in Canada and the U.S. than it is in Australia. Through a process of cultural diffusion, Australian Aborigines have incorporated many ideas from Native Canadian treatment models. As a result, residential treatment utilizing adapted forms of the 12 steps of Alcoholics Anonymous is being promoted by indigenous Australians. This paper examines comparative material on the uses of culture as a form of healing and traces the rationale for the argument that cultural wholeness can serve as a preventive, or even curing agent in drug and alcohol abuse. This is a qualitative leap from the now universally accepted notion that treatment and rehabilitation for native people should be culturally appropriate. There are, however, certain dilemmas confronting native treatment directors attempting these syncretic approaches, given aspects of cultural contexts which can serve to foster drug and alcohol use rather than discourage it. Additionally, North American Indians have at their disposal a rich heritage of communal healing techniques; some (such as the sweat lodge) have been adapted and incorporated into the treatment both of solvent abuse by adolescents, and alcohol abuse by adults. In Australia on the other hand, traditional healing techniques have been less amenable to adaptation. On neither continent are indigenous people attempting to adapt recent mainstream models of intervention to suit their needs (such as Brief Intervention) which is currently receiving international attention in addictions research and treatment.