In response to widespread problems of alcohol and substance abuse, all tribal WtW programs make counseling and treatment available, but they often struggle to get participants connected with available services. Tribal WtW administrators report that significant numbers of those attempting to make their way off the TANF rolls face problems of addiction themselves or have a family member with debilitating substance abuse problems. These problems are often deep-seated, stretching back over several generations and affecting multiple family members, and pose a significant barrier to employment. Problems with addiction often are long-standing and are not readily acknowledged by participants coming into programs. Administrators report that many individuals with serious substance abuse problems are in denial about the extent of their addiction and resist seeking or accepting help.
As part of the assessment process and ongoing case management, WtW project staff typically ask about past or current problems with substance abuse, as well as mental health and family violence problems. Two of the 10 tribal WtW sites visited (Cherokee and Three Affiliated Tribes) administer a formal drug-screening test.(4)
Other sites depend primarily upon participants to offer information on problems with drugs and alcohol, and on staff to observe the erratic behavior, poor attendance, or loss of jobs that might suggest an addiction problem.(5) In some instances, private-sector employers detect substance abuse problem in drug tests that are part of their hiring process.
Tribal WtW programs generally refer participants with suspected alcohol and substance abuse problems to the tribal alcohol and substance abuse treatment programs for evaluation and, if appropriate, counseling and treatment. WtW programs do not typically have substance abuse counselors on their staff, though case managers are well versed in identifying individuals with suspected problems and knowing what resources are available on and off of the reservation for counseling and treatment. The tribal WtW programs in the study are well connected with residential and outpatient treatment facilities--most programs indicate that, if there is a serious problem and participants want help, they can usually get individuals into treatment within a week or less. Despite availability of a range of treatment alternatives, WtW staff report that it was not unusual to encounter resistance on the part of the participants or other family members to obtaining such help. Even individuals who seek and receive treatment often come back to the same environment or family situation that contributed to their addiction in the first place and find it difficult to avoid relapsing into addiction.
1. After about a year of conducting screenings, Three Affiliated Tribes' 477 program stopped referring individuals to the Circle of Life for alcohol and substance abuse screening. 477 program staff indicated concern that up to three-quarters of those referred never showed up for the screening and that many of those screened were reluctant to take part in the treatment programs. While it was not clearly stated why the screenings were stopped, lack of follow-through by those referred and, perhaps, budgetary constraints appeared to be contributing factors.
2. Six of the WtW programs in the study were small, with 30 or fewer active participants and one or two staff working part-time on WtW and other programs. The multiple responsibilities of such staff make it difficult to interpret case manager/client ratios.
3. Most 477 program participants enroll in two-year programs offered through FBCC. Some of the most popular course offerings at FBCC are computer science, licensed practical nursing, early childhood development, construction trades, elementary or secondary education, and business administration. The 477 participants may also choose to enroll in certificate or degree programs in other localities in and outside of North Dakota. A popular choice is the United Tribes Community College in Bismarck (operated by the four tribes in North Dakota), which offers programs in nursing, policing, plumbing, welding, early childhood development, and other occupational training.
5. In many tribal WtW programs, the lack of a standard screening for alcohol and substance abuse is mitigated, to some degree, because people with actual or suspected alcohol and substance abuse problems are generally known as such in the community.