Largest U.S. Trial Shows Culturally Centered Virtual Program Cuts Alcohol and Cannabis Use Among Urban Native Young Adults

The largest randomized trial to investigate behavioral health among urban American Indian and Alaska Native (AI/AN) young adults found that a culturally centered virtual prevention program reduced alcohol and cannabis use and eased anxiety symptoms. The yearlong, NIH-funded study enrolled 541 participants from more than 200 tribes across 37 states.

Study Design and Participants

Conducted in partnership with the RAND Corporation, UCLA and the Sacred Path Indigenous Wellness Center in Long Beach, the trial randomly assigned AI/AN adults ages 18–25 to one of two culturally grounded virtual programs. Participants represented over 200 tribes, lived in 37 states, had a mean age of 22.1 years, and were approximately 83% female. Eligibility required living in an urban area, speaking English and not having an opioid use disorder.

Interventions

Both study arms were deliberately culturally centered rather than using a mainstream or no-treatment control group — an approach the research team emphasized as ethically important in Indian Country. An elder advisory board helped shape both programs.

TACUNA (Traditions and Connections for Urban Native Americans) consisted of three group workshops delivered over Zoom. It combined motivational interviewing, substance-use prevention strategies, social-network approaches and cultural practices, plus access to a monthly virtual Wellness Circle. Cultural elements included storytelling about Native identity, traditional foods and cooking, prayer and sage ceremonies, drumming, dance and teachings connected to the Medicine Wheel.

Health and Wellness was a shorter culturally based virtual intervention focused on opioid prevention education and pain self-management, with culturally relevant content incorporated.

Key Findings

Both programs produced improvements in mental health and behavior over 12 months. Key outcomes included:

• TACUNA participants reported significant reductions in alcohol and cannabis consumption and a significant decline in anxiety symptoms.
• The shorter health and wellness intervention showed little change in overall drinking and cannabis levels but produced meaningful reductions in alcohol-related harms (for example, missing school, work or other obligations).
• Both groups reported spending less time with people who drink alcohol or use opioids, and both groups experienced declines in anxiety and depression symptoms overall.

Strength-based approaches work, and culture is protective. — Elizabeth D'Amico, lead author

Why This Matters

The trial demonstrates that culturally grounded, virtual prevention programs can be effective in urban AI/AN populations and that integrating cultural practices and community input enhances both ethical conduct and intervention relevance. The results point to scalable, community-informed approaches for preventing substance misuse and supporting mental health among young urban Native adults.

Funding and Collaboration: The study was funded by the National Institutes of Health and carried out with the RAND Corporation, UCLA and Sacred Path Indigenous Wellness Center.