Ka Wai Ola - Office of Hawaiian Affairs, Volume 39, Number 9, 1 September 2022 — A New System of Care for Native Hawaiians and Substance Use [ARTICLE+ILLUSTRATION]

A New System of Care for Native Hawaiians and Substance Use

V I OLA LOKAHI V ^ TO THRIVE TOGETHER IN UNITY "

By Lilinoe Kauahikaua In Spring 2020, the Hawai'i State Department of Health Aleohol and Drug Abuse Division (ADAD) reached out to subject matter experts across Hawai'i to provide meaningful and intentional input surrounding the planning for their upcoming state strategic plan. Papa Ola Lōkahi, the Native Hawaiian Health Board, was asked to participate in this endeavor, offering a chapter entitled "Conceptualizing a New System of Care in Hawai'i for Native Hawaiians and Substance Use." Native Hawaiians of all age groups experience a higher prevalence of substance use than other ethnic groups in Hawai'i. Research shows that this inequitable health status results ffom several complex and interconnected social determinants of heahh, including historical trauma, discrimination, and lifestyle changes. Current western prevention, treatment, recovery, and harm reduction services are siloed and often ineffective for Native Hawaiians. Due to their individualistic approach to healing, these siloed methods often fail to resonate with Indigenous peoples and Indigenous healing. Before European contact, Native Hawaiians understood that balanced nutrition, physical activity, social relationships, and spirituality were fundamental to maintaining optimal heahh. Western influences triggered an imhalanee in Native Hawaiian society, shifting the paradigm of Native Hawaiian family systems. Historical and cultural trauma affects muhiple generations and is linked to Native Hawaiian heahh disparities. Cultural trauma is defined as "the loss of identity and meaning that negatively

affects group consciousness. It marks and changes them in fundamental and irreversible ways, often resulting in the loss of language, lifestyles, and values." The remedy for cultural trauma, as identified by loea (expert) Lynette Paglinawan, is eultural reclamation. Historical trauma is defined as psychosocial trauma experienced by Indigenous groups as a result of colonization, war, genocide, or cultural, social, and polhieal subjugation. The outcomes of these traumas have reached across generations and are reflected in higher rates of heahh disparities, including mental heahh, addiction, and incarceration, all of whieh have affected the social determinants of heahh and have a significant impact on individual, 'ohana, keiki, and community heakh. Research indicates that re-centering healing for the native population, utilizing cultural connection and methodologies that speak to native perspectives, is more influential in creating positive heahh outcomes for native peoples. Papa Ola Lōkahi's chapter provides recommendations that would reduce silos and incorporate cultural aspects to improve outcomes for Native Hawaiians receiving services. We must begin to re-envision the existing continuum of care, embrace culturally grounded approaches, and begin to see the entire continuum as cyclical rather than linear, with eaeh area of focus informing the next. We hope that this chapter is a first step toward working together with Hawai'i's ADAD in building a system of care that reduces silos and incorporates cultural aspects to improve outcomes for Native Hawaiians receiving services. ■ A webinar describing our jindings and recommendations from the special chapter will bepresented September 7 at 12:00 p.m. Please eheek Papa Ola Lōkahi's social mediafor the zoom link. Lilinoe Kauahikaua, MSW, is a population heahh specialist - addictions, mental health, socialjustice with Papa Ola Lōkahi.