Table 1:

Common Themes Across All Three Sites

Themes	Specifics
Drugs of Greatest Concern	• Alcohol, Marijuana, Prescription Medications, some mention of cocaine, meth, heroin, and over-the-counter medications
Community Concerns	• Increase in usage, availability, and social acceptability of alcohol and drugs
	• Negative effects of substance use on familial relationships and the degradation of the traditional family structure
	• Substance use issues not being addressed directly in the communities
	• Shame around the issue and a general unwillingness to acknowledge the deeper roots of the problem that paralyze the development of prevention and treatment programs
	• Lack of opportunities and positive alternative activities that would steer people away from drugs and alcohol
Concerns for Adolescents	• Larger problems facing youth including not having adequate coping skills, sense of self-sufficiency, morality, positive role models, or hope for the future
	• Some youth feel lost which causes them to turn to drugs as a way to cope, form social bonds, and escape a sometimes harsh reality
	• Legal consequences of criminal behavior associated with underage drinking and drugs that limit future opportunities for young people
Opinions about Services Available	• Services were viewed as inadequate and largely ineffective to address the large scope of the problem
	• Common programs for youth including school counseling, awareness education (DARE), and one-on-one mentorship programs
	• Treatment programs and AA groups are available, but there are a lack of prevention programs
	• Need for more integrated programs and widespread reinforcement across many sectors of the community, parents, and tribal leadership
	• Most services offered are not designed to be effective for youth and are not culturally tailored to American Indian people in general
Effective Strategies	• Promote dialogue between many generations of community members including youth, parents, and elders
	• Include community-based activities that promote positive social relationships in the community, develop traditional skills, incorporate traditional cultural activities and teachings, and draw on cultural sources of resilience
	• Focus on the consequences of substance use and teaching with real life situations that are common and relatable to youth
	• Design programs to address a wide array of social issues that get to the larger roots of the problem