"Guide them to have a future orientation": qualitative findings in developing a reinforcement-based intervention to address alcohol use with American Indian emerging adults

Authors

• Katherine A. Hirchak, Elson S. Floyd College of Medicine
• Kellie Webb, Tribal Healing Center
• Sharon Wagon, Tribal Healing Center
• Kelsey Bajet, Elson S. Floyd College of Medicine
• Allyson Kelley
• James G. Murphy, College of Arts & Sciences
• Kamilla L. Venner, The University of New Mexico

Abstract

Background: The present study used qualitative research methods to assess interest in contingency management (CM; where incentives are provided after the return of an alcohol negative urine sample) enhanced with substance-free activities among emerging adults residing on a rural reservation. The research informs the future development and implementation of a clinical trial to address alcohol use among American Indian and Alaska Native (AI/AN) 18-29-year-olds. Methods: Semi-structured qualitative interviews and two focus groups were conducted at a rural reservation outpatient treatment healing center. Participant- relatives (i.e., study participants) were 18-29 years old and currently using alcohol or in recovery; family members of emerging adults who were currently using alcohol or in recovery; or Elders and healthcare professionals (N = 32). Applying the Healing Center Medicine Wheel (i.e., a framework that focuses on holistic health related to the physical, mental, emotional, and spiritual as well as the structural factors impacting health), a codebook was developed using a qualitative descriptive approach and data analyzed under the guidance of a Community Advisory Board (CAB). Results: Five themes were identified: (1) Importance of Culture and Ceremony; (2) Substance-Free Activities with Higher Levels of Enjoyment-Physical, Mental, Emotional and Spiritual; (3) Substance Free Activities: Barriers and Engagement; (4) Family Impact on Alcohol Use and Recovery; and (5) Views on Health and Recovery. Conclusion: Through community-driven strategies, frameworks and CAB guidance, a culturally responsive CM intervention was developed and is ongoing. This research provides a culturally informed process template for other Indigenous communities interested in addressing alcohol use among younger adults.

Publication Title

Frontiers in Public Health

Recommended Citation

Hirchak, K., Webb, K., Wagon, S., Bajet, K., Kelley, A., Murphy, J., & Venner, K. (2026). "Guide them to have a future orientation": qualitative findings in developing a reinforcement-based intervention to address alcohol use with American Indian emerging adults. Frontiers in Public Health, 14, 1745254. https://doi.org/10.3389/fpubh.2026.1745254