Native Americans suffer disproportionately compared with other groups in the United States from diseases and death due to alcohol, drugs and substance abuse.

In 1992, the Robert Wood Johnson Foundation (RWJF) launched a national program — Healthy Nations®: Reducing Substance Abuse Among Native Americans — to help Native American and Alaskan Native people find ways to address the problem of substance abuse in their communities.

During the first phase of the program, 15 tribes and community organizations received two-year planning grants to design their projects. Fourteen tribes or organizations received four-year implementation grants. (For a list of project participants, see Appendix 2.) For links to four project reports, go to the Project List.

Overall Results of the Program
According to interviews with national program staff, RWJF personnel, local project staff and national advisory committee members, the Healthy Nations national program had these overall results:

• Governing bodies and major employers in some communities enacted new rules and policies aimed at reducing substance use and abuse. For example, tribal leaders passed resolutions prohibiting substance use among leaders and employees.
• A group of new community leaders was trained; many have gone on to more responsible positions in areas that address substance abuse and other health issues facing their communities.
• Communities formed coalitions that are still working together to solve health issues.
• Healthy Nations projects implemented an average of 722 activities and events over the life of their projects, and served an average of 10,000 people annually, according to the national program office. The following are examples of activities in each of four primary project areas:
  • Public Awareness. Project staff raised awareness about the problem of substance abuse through newspaper articles, radio shows and billboards, as well as high-profile public events, such as annual walk-a-thons and relay runs.
  • Community-Wide Prevention. Much of this work drew on Native American cultural traditions in the hopes that as people identified more with their heritage they would be less likely to abuse alcohol, drugs or other substances.
  • Early Identification and Treatment. Projects sought to intervene with youth and adults when they first got in trouble. Some organizations worked with the court system to refer youth and adults to projects focused on substance abuse, parenting and cultural traditions.
  • Substance Abuse Treatment and Aftercare. Projects focused on providing social options for people returning from treatment, such as support groups and drug-free sports leagues. Some projects also helped recovering alcoholics, addicts and at risk youth to find jobs or enter training programs.

Key Evaluation Findings
A formal assessment of Healthy Nations started several years after the program began. In 2003, the team of evaluators produced a report that looked at the program from three perspectives:

• A narrative report on each of the 14 sites that provides a history of the projects, a description of their activities and an overview of their challenges and accomplishments.
• A quantitative analysis, for seven sites, of social indicators on alcohol and other substance use trends in project communities.
  • On its face, the assessment of social indicator trends does not support the notion that an intervention, such as the Healthy Nations program, has had a positive influence on substance abuse among Native Americans and Alaska Natives. See Evaluation Findings for details, and some encouraging signs.
• A comparison of alcohol and drug abuse variables in two Healthy Nations sites and two reservations that did not participate in the Healthy Nations program.
  • The Healthy Nations reservation respondents were more likely to report bicultural identity (identified both with their Native American culture and the white culture) than those from the comparison group. Bicultural identity, as reported in the literature, is a protective factor against substance abuse.
  • On alcohol consumption variables, there were limited differences but those that exist may be important.
  • It appears that while frequency of drinking may not have been affected by Healthy Nations, the quantity consumed per occasion was affected for males and somewhat less for females.
  • There was no difference in treatment experience between Healthy Nations sites and the comparison sites, but the Healthy Nations sites report significantly lower rates of DWI and fewer blackout episodes.
  • The Healthy Nations respondents were much more likely to link loss of Native American culture to alcohol and drug problems.

Evaluation Conclusions
The evaluators concluded, "Without pre-program, baseline information on these variables from which to determine magnitude of change, it is impossible to link these differences directly to the Healthy Nations activities. However, most of the variables on which differences were found were those emphasized by Healthy Nations.

"The program encouraged participation in traditional ceremonies for alcohol- and drug-abuse prevention. The program emphasized abstinence and/or moderation of drinking practices….

"Almost all of the variables cluster in these areas, which lends support to the efficacy of the Healthy Nations Initiative…. There is at least a perceptual or normative difference in these two groups, some of which may be attributable to the RWJ Healthy Nations activities."

Administration
The American Indian and Alaska Native Programs at the University of Colorado Health Sciences Center in Denver, Colo., served as the national program office for the program.

Funding
In October 1991, the RWJF Board of Trustees authorized up to $13.5 million in funds for the national program.