While the opioid crisis is hurting communities across the state, there is no group as severely impacted as Minnesota’s American Indians. Five times more likely to die of a drug overdose than white Minnesotans, American Indians have been shown to be less likely than other groups to respond to conventional addiction treatment programs or behavioral health interventions.
Some people believe that in order to begin to solve this crisis, we have to be open to a different approach, one that has been around for generations.
Just ask Donna LaChapelle, elder-in-residence at the Minneapolis-based Native American Community Clinic (NACC). She believes that American Indians respond better to a different approach to addiction treatment, one that relies on traditional healing practices that have been passed down from their ancestors.
At NACC, one of LaChapelle’s roles is to work with clients at Wiinodewe (“It actually translates how it sounds, ‘We know the way,’” she explained), an outpatient treatment program designed to help American Indians facing addiction and mental illness achieve recovery through the use of traditional healing practices.
Wiinodewe is “a coed outpatient treatment program for community members,” LaChapelle explained. “It’s a beautiful program. It opened up in October. We’re serving across addictions.” The program is traditional to its core, she added: “Every day we start with prayer and smudge and a talking circle, and then later we move into a mental health group and education.”
LaChapelle was drawn to the program because of her own personal history of addiction and recovery. “I love the work,” she said. “It’s part of our cultural traditions to give back what we’ve learned and how we’ve healed, and that’s what I’m doing.”
Wiinodewe’s culturally specific approach has a strong impact on the program’s participants, LaChapelle said. Forced assimilation has made many American Indians feel disconnected from their cultural roots, and this tradition-laden approach has an almost elemental appeal, even to urban Indians whose families left the reservation decades ago.
“We’re finding that culture heals,” LaChapelle said. “It’s rich. It’s life-sustaining. It restores the soul. It’s been here for thousands of years and our ancestors put it before us. This community, I believe, is really hungry for culture, because we’ve been removed from the reservation, because of historical trauma.”
A proposal included in Gov. Tim Walz’s budget introduced earlier this year would give a leg up to approaches like the ones practiced by LaChapelle at Wiinodewe. Under the governor’s plan, money would be provided annually in grants to the state’s 11 tribal nations and five urban American Indian communities, offering more access to traditional healing programs for American Indian communities statewide. Though the provision wasn’t included in the House’s version of the opioids bill, HF 400, a Senate proposal in the House-Senate conference committee working on the issue would set aside $4 million for “culturally specific prevention grants and/or tribal healing” in the next two-year budget cycle.
Claire Wilson, deputy commissioner of the Minnesota Department of Human Services (DHS), said that Walz’s support for these approaches acknowledges that other treatment methods just aren’t working for the state’s American Indian communities. “We know that traditional healing has been a holistic approach for generations,” Wilson said. “It has worked. We also know that what’s not working for American Indians is conventional treatment methods.”
To illustrate, Wilson pointed to data showing decreased life expectancy and high overdose rates for American Indians statewide.
“All of our data shows us that conventional methods are not working,” she said. “Academic research has shown that traditional healing increases resilience and reduces addiction for American Indians. It’s pretty critical that, given the extent of the current crisis, we do everything we can as a state to collaborate with the tribes to design and fund healing methods that they believe will help people respond appropriately.”
Making the case
Wilson explained that Walz’s staff developed the proposal under the direction of the state’s American Indian Mental Health Advisory Council.
“We are advocating very hard for this right now because this is so unique and because this crisis is hitting the state’s American Indian community at very disproportionate rates,” she said. “When the American Indian Mental Health Advisory Council asked us to bring this proposal forward, we took that request very seriously.”
If approved, the program would start as a “really flexible grant program,” Wilson said, “to make sure that these programs are administered by the community, by the tribes.” In order for the program to succeed, she added, “It is very important that it is developed and implemented in complete collaboration between the state and the tribes.”
In the proposed granting format, programs like NACC and Wiinodewe would apply for individualized funding. The proposals would then be reviewed by DHS staff.
“They’d apply for the dollars,” Wilson explained. “There’d be a lot of flexibility in terms of how they would utilize them.”
This flexibility and independence are key to making the program a success, Wilson said.
“That’s really why this is such a unique program and why the governor and the department feel so strongly that it be included in this year’s opioid package,” Wilson said. “We need these funding streams that are culturally relevant and have enough flexibility to allow communities to design forms of healing that works for them. The American Indian community would drive the program’s development.”
While it is clear that Native communities know best how to administer these programs, Wilson added, a DHS staff member would be in charge of overseeing the granting program: “They’d be monitoring the contracts with the tribes,” she said. “They’d also be analyzing the outcome and trend data that’s provided, in order to think about making continuous improvements to the program. The staff person would act as a liaison to the American Indian Mental Health Advisory Council.”
Other states, including Arizona, California, New Mexico and Michigan, administer similar programs. These states are working to pursue Medicaid funding for traditional healing services. If Minnesota’s program is approved, Wilson said, “DHS and the council would work together to monitor the progress of these states as they work on a path to pursue Medicaid funding.” The state’s goal would be to do the same.
How traditional healing works
Traditional American Indian healing practices bear little or no resemblance to conventional addiction-recovery programs, LaChapelle said.
“A lot of American Indians have had many treatments but it never sustained their lives or cured their addictions. They often went back to using.”
LaChapelle, an Ojibwe-Dakota woman and an enrolled member of the White Earth Nation, grew up in the Twin Cities. Sitting with cup of coffee at her kitchen table, she explained that she has been using traditional healing practices since she was in her 20s.
“I’ve been using sage for many years,” she said. “It’s taught me a lot. I call it ‘the truth medicine’ because it’s not me that’s facilitating the process of the group. It’s the medicine and it helps people open up their story and their trauma so they can leave it and empty out the burdens that they’ve been carrying so they can make room for life.”
LaChapelle explained that there are seven traditional healing rites. “They were brought to the people,” she said. “Our sacred rites, our tobacco, our sage, our sweetgrass, our cedar are medicines — we use them every day.”
LaChapelle was joined by Ida Downwind, a retired educator who spent 49 years teaching in schools in South Dakota and Minnesota. Downwind, a member of the Leech Lake Band of Ojibwe, explained that she and LaChapelle met at Dream of Wild Health, a Hugo-based nonprofit focused on restoring health and well being to the Native community by expanding access to indigenous foods, medicines and lifeways.
At Dream of Wild Health, Downwind helps pour a sweat lodge for women. This centuries-old traditional rite helps many of the American Indian women who take part focus on their mental health and move away from addiction.
“The sweat lodge that Ida pours, it’s beautiful and many women have been coming,” LaChapelle said. “Some come just one time. Some keep coming back.”
Downwind said that traditional healing is powerful for many American Indians. She believes that these kinds of ceremonies saved her life on several occasions.
“The healing ceremonies carried me to it where I am today,” Downwind said. “It still does carry me in my work. I know from myself most certainly that this has saved my life: not once, not twice, but four different times.”
LaChapelle believes that traditional healing is particularly helpful in helping American Indians overcome addiction.
“The brain tricks the body into thinking I need this substance for my own survival,” she explained, “so we have to re-parent ourselves and learn about the beauty that our ancestors put before us — this beautiful life. We have everything that we need within us. We just have to clear the body of all the toxins. The healing rites help us do that.”
LaChapelle does not claim to have the answers to the addiction crisis. “I’m just a support, a helper,” she said. “I share what my elders have shared with me and the teachings that I’ve had because it changed my life. This is what I was searching for since I was a young girl. I was lucky to find this way of life for myself. I never look back.”
Jessica Gourneau, clinical director of the American Indian Family Center in St. Paul, and an enrolled member of the Turtle Mountain Band of Chippewa, said that traditional healing methods help American Indians who may have felt disconnected from their traditions uncover an inner strength and resilience that they didn’t know existed.
Through traditional healing methods, Gorneau said, “many Native Americans are able to manage their addictions and be able to deal with them in their own unique ways.” Because this approach speaks directly to a person’s history and experience, she added, “Research indicates that when Native Americans obtain sobriety, they tend to remain sober longer than any other group.”
Gourneau said that the American Indian Family Center’s traditional healing programs involve “a lot of teaching of those traditional values and knowledge.” The teaching unlocks historic traumas as well as positive memory, she added: “People become very emotional during these programs. They start talking about dreams. They get emotional when they start practicing those values, but once those values become part of their lives, they have larger results with more resiliency.”
Traditional healing can take many forms, Gorneau said.
“A traditional treatment plan does not look like a stereotypical Western model. It is tailored to the individual and the group and may involve traditional ceremonies in their treatment.” That tailored, individualized approach has made all of the difference, she said. “It’s the group that leads the program. Oftentimes the mental health therapist can end up being the least important person on the team.”
As illustration, Gourneau recounted a story about an American Indian client who was struggling to successfully exit therapy. This woman, who’d moved to the Twin Cities from out of state, went to American Indian Family Services for support and counseling. “She was experiencing significant grief and loss,” Gourneau said.
To help the woman find healing, Goruneau recalled that she and her colleagues researched her tribe. “She didn’t have anyone from her tribe here in the Twin Cities. Eventually we were able to locate a traditional healer from her tribe. He did a ‘Wiping of the Tears’ ceremony for her. After the ceremony, this woman was eventually able to leave therapy.”
Gorneau said that this traditional healing approach helped the woman in ways that conventional therapy could never achieve. A few years later, Gorneau got a call from her former client. “She was married,” Gorneau said. “She was parenting children. She was happy. She was able to pinpoint the ceremony as the thing that helped her climb over the edge and move on.”
A state grant program operated in close collaboration with tribes would make this kind of healing accessible to more struggling American Indians, Gourneau said. She thinks the results would be positive and long-lasting.
Traditional healing, Gourneau added, “speaks their language in a way many Native Americans understand in their hearts and in their heads. They have a sense of belonging. Everybody needs to belong, especially here in the Twin Cities.” And feeling like they belong can also give a person inner strength, she added: “When Native Americans implement these traditions, values and cultures within their lives, they are able to stay sober longer and decrease mental health symptoms.”
Is healing billable?
If this program is to survive long-term, participants will have to develop ways to code and bill for services that often defy clear definition and coding.
Traditional healing isn’t linear or clear-cut, Downwind explained. It is a uniquely American Indian practice, something that doesn’t usually fit neatly within government description or coding.
Downwind said that when she learned about the idea of traditional healing being tied to public funding, she felt uncomfortable. “When I first heard the word ‘healing’ connected to the government, I was thinking, ‘Ah, crap,’” she said.
Though she now supports the governor’s proposal, Downwind believes that it will be hard to categorize traditional healing practices in mainstream boxes or categories.
“It’s very hard to define what we do,” she said. “I was taught by someone else. I didn’t go out and think, ‘I’m going to go out and start pouring water.’ Stuff is not done like that. That’s how you heard about us, but that’s now how we hear about our healers. Your ego can get in your way. You say, ‘I did that.’ You can’t claim ownership to knowledge.”
Downwind explained that she doesn’t define her healing work as a job: It’s a spiritual calling. Because of that perspective, she doesn’t pour a sweat lodge for profit. “With my lens,” she said, “I don’t look through it in the same way as you do. Sometimes I’ll get reimbursed for my work, but our job is not to ask for that.”
Wilson said it’s not yet completely clear how the state would track and monitor the program for reimbursement. “The tracking is something we are going to design in collaboration with the tribes,” she said. “Some ways might be that they could use the dollars to support a full-time traditional healer to increase the capacity or hire traditional healers to support the workforce and increase access to traditional services.”
The American Indian Mental Health Advisory Council, in cooperation with DHS staff, is researching methods that states and countries have developed for funding traditional healing.
In New Zealand, Gorneau said, support for traditional healing methods is widespread: “There, traditional values and cultures are embedded within their social services network.”
Whatever shape funding eventually takes, Gorneau believes that the time is right for the legislature to take this step. “American Indians are the community that has been the most traumatized and experience the highest disparities in the State of Minnesota,” she said.
The way things are now is not working. “The definition of insanity is doing the same thing and expecting a different result,” Gorneau said. “But I do think the energy is shifting. I think we are on the cusp of real change. There is this energy I can feel in the air. More people are coming through who are open to this approach. Change will happen.”