Development and Pilot Test of Indigenist Relapse Prevention for American Indians

Map by Kristen Drumheller

Project Leader Monica Skewes, Ph.D.
MSU Department of Psychology
[email protected]

American Indians face significant disparities in the incidence of substance abuse across the United States, as well as disproportionately high frequency of related health risks such as depression, suicide, and domestic violence. In Montana, substance-related problems among American Indians are even more pronounced than in other states, according to the Montana Department of Public Health and Human Services.

As one of the leading researchers in Montana in the area of substance use disorder, Dr. Monica Skewes has worked with local partners on the Fort Peck Indian Reservation since 2015: first as leader of a CAIRHE pilot project, The Fort Peck Substance Abuse and Resilience Project, and next as principal investigator for one of CAIRHE's research projects during 2018-21: Development and Pilot Test of Indigenist Relapse Prevention for American Indians. In 2021 Skewes was awarded a $3.2 million R01 grant from the National Institute on Drug Abuse for her study Randomized Controlled Trial of Indigenous Recovery Planning for American Indians. This study is a direct outgrowth of her CAIRHE research.

Dr. Skewes's CAIRHE research project used a community-based participatory research (CBPR) framework to adapt and develop Indigenist Relapse Prevention (IRP), a culturally grounded intervention tailored from an existing evidence-based treatment for substance use disorder called Relapse Prevention (RP). This project was carried out by researchers from MSU and Fort Peck Community College in partnership with an existing Community Advisory Board on the Fort Peck Reservation.

From an assessment of community needs, Dr. Skewes's multi-year community partnership identified significant interest in relapse prevention support for people trying to change their substance use behavior. The research team used previous findings to identify aspects of RP that warranted cultural adaptation for this community. These included locally and culturally relevant risk factors for relapse that serve as barriers to recovery. Results from a larger randomized controlled trial could produce an effective intervention for widespread use across the state and region.

Related Publications and Presentations (Selected)

Skewes, M., & Blume, A. Understanding the link between racial trauma and substance use among American Indians. The American Psychologist. Forthcoming.

Gonzalez, V. M., & Skewes, M. C. (2016). Association of the firewater myth with drinking behavior among American Indian and Alaska Native college students. Psychology of Addictive Behaviors. 30(8): 838-849.

Gonzalez, V. M., & Skewes, M. C. (2018). Association of belief in the "firewater myth" with strategies to avoid alcohol consequences among American Indian and Alaska Native college students who drink. Psychology of Addictive Behaviors. 32(4): 401-409.

Skewes, M. C., Gardner, S. A., Salois, E. M., & FireMoon, P. (2016). Community Based Participatory Research to address substance abuse in a rural reservation community. Presentation at the American Public Health Association Annual Meeting, Denver, CO.

Skewes, M. C., Gardner, S. A., Salois, E. M., & FireMoon, P. (2016). Historical trauma and substance abuse in American Indian communities. Poster presentation at the American Public Health Association Annual Meeting, Denver, CO.

Skewes, M. C., & Lechuga, J. (chairs) (2016). Research on sensitive topics with ethnic minority communities. Symposium presented at the American Psychological Association Division 45 (Psychological Study of Culture, Ethnicity, and Race) Biannual Meeting, Palo Alto, CA.

Skewes, M. C., Gardner, S. A., Salois, E. M., & FireMoon, P. (2016). You have to know who you are: Identity and health. Presentation at the American Psychological Association Division 45 (Psychological Study of Culture, Ethnicity, and Race) Biannual Meeting, Palo Alto, CA.

Skewes, M. C. (2016). Beyond the firewater myth: Alcohol research with American Indian communities. Presentation at the American Psychological Association Division 45 (Psychological Study of Culture, Ethnicity, and Race) Biannual Meeting, Palo Alto, CA.

Skewes, M. C., & Lechuga, J. (2016). Communities in the driver’s seat: Partnering for better health. Roundtable discussion at the American Psychological Association Division 45 (Psychological Study of Culture, Ethnicity, and Race) Biannual Meeting, Palo Alto, CA.

Skewes, M. C., Blow, J. A., & Cooper, T. V. (2016). Perspectives on addictive behaviors: Harm reduction and ethnic minority psychology. Social Issues in Living Color: Challenges and Solutions from the Perspective of Ethnic Minority Psychology.

Gonzalez, V. M., & Skewes, M. C. (2016). Depression and suicide from the perspective of ethnic minority psychology. Social Issues in Living Color: Challenges and Solutions from the Perspective of Ethnic Minority Psychology.

Investigator Spotlight

Dr. Skewes has worked on the Fort Peck Reservation since 2014. Prior to that she worked in Alaska, studying substance use among college students—a subject she still examines, among others, in her REACH Lab at MSU.

Even with Skewes’s extensive experience studying smoking, drinking, and other addictive behaviors, she was surprised to find so many people at Fort Peck in recovery against all apparent odds—such as individuals recovering from methamphetamine addiction who live around current users and still somehow manage to avoid a relapse. “I can’t even conceive how they can do that,” she says. “There’s some resilience and strength that people there have, so I’m trying to understand what that is.”