Utilization of Drumming for Native Americans with
Substance Use Disorders: A Discussion on the
Role of Complementary and Alternative Medicine in
Substance Abuse Treatment
Daniel Dickerson, D.O., M.P.H., Inupiaq
Assistant Research Psychiatrist
UCLA, Integrated Substance Abuse Programs (ISAP)
Addiction Psychiatrist
United American Indian Involvement, Inc. (UAII)
East Tennessee State University, Dept. Psychiatry Grand Rounds
January 20, 2012
Agenda
• The role of drumming in American Indian/Alaska Native (AI/AN)
cultures
• The neurobiological effects associated with drumming
• The potential role of drumming in substance abuse treatment for
AI/ANs
• Drum-Assisted Recovery Therapy for Native Americans (DARTNA)
R-21 study review
• Discussion on the role of Complementary and Alternative Medicine
in the field of substance abuse
Historical Perspective of Drumming
Rock Art (Univ. Arkansas)
American Indians/Alaska Natives and
Drumming
• The drum is a sacred instrument within AI/AN cultures.
• The drumbeat symbolizes heartbeat of Mother Earth, the
heartbeat of Indigenous Nations.
• Used in religious ceremonies, social dances, feasts,
special ceremonies, in preparation for hunting.
• It was and still is used to help heal the sick and as a way
of carrying songs and prayers.
• A way of bringing people together.
Drumming and AI/ANs
• May offer a connection with the spirit world, ancestors, and culture
and identity.
• A sick person’s psychological and physiological states are believed
to be altered by the rhythmic drumbeats and accompanying song.
• Every tribe has their own sets of rules when it comes to how the
materials for drums are gathered, who has the right to prepare a
drum, and what types of behavior are allowed near a drum.
• The drumbeat evokes many powerful forms of energy and is an aid
in helping to focus one’s attention and to see clear intentions.
Drumming and
Alaska Natives
• The drum, called the suayaq or kilaun, has a driftwood frame which
is steamed and bent into an oval shape, then covered with a
stretched walrus stomach, the lining of a whale’s liver, or scraped
caribou hide.
• The oral history of Inupiaq culture has survived in songs, stories and
legends passed on from one generation to the next on dark winter
evenings, accompanied by drumming.
• The Inupiaq Shaman's use of the drum in ceremonies and to
communicate with spirits disturbed missionaries and was
subsequently “forbidden.”
• Songs and drumming are often used to tell of stories and hunting
traditions.
AI/AN and cultural identity
• Many U.S. historical actions, i.e., removals and
relocation acts, have resulted in a fragmented AI/AN
community
• Many American Indians strongly believe that their
problems with alcohol stem from their sudden
disconnection with traditional American Indian culture
• American Indian traditions, customs, rituals, and values
may assist in discovering positive coping strategies
during recovery.
• Denying AI/ANs the opportunity to rely on those
strategies may contribute to ongoing drug/alcohol use.
(Native Peoples Magazine, 2009)
Therapeutic effects of drumming
• Several studies have demonstrated physical and psychological
effects associated with drumming (Winkelman, 2003).
• Drumming may also have biological effects that may mitigate
various behaviors.
• Rhythmic auditory stimuli (including drumming, singing, and
chanting) may generate auditory drive leading to increased alpha
and theta wave production, which may contribute to a desired
meditative state (Wright, 1991; Maxfield, 1991; Winkelman, 2000; Mandell, 1980).
• This response is produced by activation of the limbic brain's
serotonergic circuits to the lower brain. These slow-wave discharges
produce strongly coherent brain-wave patterns that synchronize the
frontal areas of the brain with ascending discharges, integrating
nonverbal information from lower brain structures into the frontal
cortex and producing insight.
Electroencephalography (EEG):
Brain Wave Activity
Limbic Brain and Frontal Lobe
connections
Group drumming Research by
Barry Bittman, M.D.
• Natural Killer cell activity and Cytokines activity
were compared between a group of group
drummers vs. controls.
• Results revealed natural killer cell activity was
boostered in subjects who drummed compared
to controls.
• Natural killer cell activity stimulated by cytokines
(orchestrators or modulators of immune
function) was boosted in subjects who drummed
compared to controls.
Women and drums
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In many tribes, drumming is not the “role traditionally prescribed for
women.”
Men usually are seated in a circle around a drum, while women stand
around the outside of the circle and sing.
Red Drum Women Society Singers, an all female American Indian drum
group was created after four years of prayer at Bear Butte near Sturgis,
S.D.
“Culture always changes. It’s controversial, and it’s something I think is
pretty interesting,” Amber Annis, president of UND’s Indian Studies
Association.
Greg Gagnon, an associate professor of Indian Studies at UND, said female
drum groups are comparable to women seeking positions as priests in the
Roman Catholic religion. It’s a break from long-held tradition and values.
“We don’t compete against our men; we are equals with our men,” she said.
“This drum is about women healing.” Jermaine Tremmel, Red Drum Women
Society Singers.
(Indian County News, 2008)
American Indians/Alaska Natives
and Drug/Alcohol Abuse
• American Indians/Alaska Natives (AI/ANs) have
the highest rates of using alcohol, marijuana,
cocaine, nicotine, and hallucinogens compared
to any other racial/ethnic group in the U.S.
• AI/ANs also have the second highest rates of
methamphetamine abuse, with another
indigenous group, Native Hawaiians, having the
highest rates (USDDH, 2005).
Questions relating to drumming
and AI/ANs
• Can the use of the drum be used in a culturallyappropriate manner for substance abuse treatment?
• How important culturally is it to accompany singing with
drumming?
• Roles of AI/AN females in drumming?
• Approaching diversity of AI/AN drumming
traditions (562 federally-recognized tribes)
Drum-Assisted Recovery Therapy
for Native Americans (DARTNA)
• Daniel Dickerson, D.O., M.P.H. and Anthony
Robichaud, CADC II, developed a preliminary
substance abuse treatment protocol utilizing
drumming for AI/AN with substance use
disorders.
• R-21 NIH/NCCAM grant awarded (Principal
Investigator: Daniel Dickerson, D.O., M.P.H.) to
complete the development and pilot-test a new
drum therapy treatment protocol for AI/ANs with
substance use disorders.
DARTNA Treatment Protocol
• Initially proposed to be 3 days/wk x 12/wks
(changed to 2 days/wk as recommended
through focus groups)
• Each day consists of a 3-hour treatment format.
• Each wk focusing sequentially on the12-steps of
AA/NA and concepts of the Northern Plains
Medicine Wheel
Daily treatment structure
(Monday and Friday)
• Hour 1: Education/Cultural Discussion:
drumming, teaching of songs, Medicine Wheel
concepts,12-steps, White Bison concepts
• Hour 2: Drumming Activities Corresponding to
Medicine Wheel Concepts
• Hour 3: Talking Circle/Processing Group
Figure 2. DARTNA Medicine Wheel
Step 10. Continued to take
personal inventory and when
we were wrong promptly
admitted it.
Weeks 10-12
Step 11. Sought through prayer and
meditation to improve our conscious
connection with God as we understood
Him, praying only for knowledge of His will
for us and the power to carry it out.
Step 12. Having had a spiritual
awakening as a result of these steps, we
tried to carry this message to alcoholics
and drug users, and to practice these
principles in all our affairs.
N
Mental1
(Intellect, Integration)2
Weeks 7-9
Step 9. Made direct amends to
such persons wherever
possible, except when to do so
would injure them or others.
Step 8. Made a list of all
persons we had harmed, and
became willing to make
amends to them all.
W
Weeks 1-3
Step 1. We admitted we were
powerless over alcohol and
drugs - that our lives had
become unmanageable.
4. Integrating the changes7
Let’s maintain and deepen the
healing
3. Trying new behaviors7
1. Breaking Denial
7
I’ve got a problem and there’s
hope
Let’s try doing it differently
Psychological1
(Emotions, Introspection)2
Step 2. Came to believe that
a Power greater than
ourselves could restore us to
sanity.
E
Spiritual1
(Vision, Perception)2
2. Getting
Involved in Recovery7
Step 7. Humbly asked Him to
remove our shortcomings.
Let’s look at the problem and
get help
Step 3. Made a decision to
turn our will and our lives
over to the care of God as
we understood Him.
S
Physical1
(Senses, Action)2
Step 6. Were entirely ready
to have God remove all these
defects of character.
Step 5. Admitted to God, to
ourselves, and to another human
being the exact nature of our wrongs.
Weeks 4-6
Step 4. Made a searching
and fearless moral inventory
of ourselves.
White Bison Philosophy
• White Bison, Inc., is an American Indian non
profit organization
• President Don Coyhis, Mohican Nation, has
offered healing resources to Native America
since 1988.
• White Bison offers sobriety, recovery, addictions
prevention, and wellness/Wellbriety learning
resources to the Native American community
nationwide.
• Utilizes AI/AN traditions as a primary focus in
substance abuse recovery
Primary Grant Activities
• Series of focus groups (treatment providers, AI/AN
substance abuse patients, and Community Advisory
Board (CAB) to discuss initial treatment format
• Pretest of DARTNA among 10 AI/ANs
• Follow-up focus group to finalize protocol.
• Randomized controlled trial DARTNA (n=30) vs.
Treatment-as-usual (TAU) (N=30) at United American
Indian Involvement, Inc. (UAII) in Los Angeles
Initial Focus Groups
• Focus groups conducted among
1) AI/AN substance abuse providers (n=9),
2) AI/ANs with substance abuse hx. (n=9)
3) Community Advisory Board (n=4)
• Purpose to obtain feedback with regard to
the preliminary DARTNA treatment
protocol.
• Feedback received to be used for a followup pretest of DARTNA
DARTNA focus group overarching
conceptual themes
• (1) drumming can be especially beneficial for
AI/ANs with substance abuse issues
• (2) assuring a culturally-based focus is
necessary as it relates to drumming for AI/ANs
with substance abuse issues
• (3) providing a treatment format which will
provide a foundation of cultural ideals which
cross the landscape of diverse tribes while
recognizing tribal diversity is necessary
• (4) addressing gender roles as it relates to
drumming activities must be addressed within
the treatment setting.
Focus group: Community Advisory
Board (CAB) member quote
“You want to teach definitely the
significance of drumming and Native
people feel the drumming is sacred. It’s
the heartbeat of the earth and mother
earth. The target is also educating and
hands on experience and to have your
own creativity to you making the drum and
on top of that teaching how to create the
drum.”
CAB member quote
“I think it’s important, to me, if you’re going
to integrate our culture and the drum into
this, that it needs to be done in a proper
way-in the way it was intended to be.
Because that healing power is there in the
drum and the songs if we use it in the right
way…”
CAB quote
“I think there are a lot of native people who
haven’t even been to very many traditional
ceremonies of their culture. So it’s really
important to keep that going. I know the
main thing has to do with sobriety and
recovery but again it goes hand in hand.
And this is the most excellent way to
facilitate that and to reintroduce the
blending of these things. Because it
works.”
CAB quote
“Even if clients have no knowledge of their
culture, our culture is part of our ‘cultural
DNA,’ Even though we haven’t been
exposed to it, once we start getting
exposed, it comes back to use. It enables
us. It’s spiritual memory. To me, our
spiritual memory is about the songs.
Because we carry the traditions through
song and that’s where our culture is going
to come from.”
CAB and cultural identity
“So we know there is a relationship with
someone’s cultural identity and their
substance use or other behavior problems.
So there is already that relationship. So by
being more connected to the culture is
really going to help them whether they’ve
drummed before or whether they’ve ever
had any knowledge about their tribal
culture. I think it’s their first step that will
really help.”
CAB quote
“It’s (drumming) going to lead them down
a new path you know a better path than
before. And even one’s who have lost
track with who they are or where they’re
from will realize where they’re at and how
they got away from it…When you start
getting that connection whole again with
who we are. It’s what makes us complete.”
CAB member quote
“That base has to be understood before
you even sit at the drum.” “There also has
to be that respect value.”
CAB: Drumming and singing
“You have no reason to beat a drum
unless you have a song. We just don’t
beat on a drum. There is a song for a
certain specific reason and you have to
sing that song for that reason and the
drum accompanies that song.”
Substance abuse provider
quote
“People understand that it (education) has
to be covered before they start making
those drums and singing. If there’s no
foundation, there’s no building. Whoever
facilitates your groups has to understand
when they’re teaching these songs to a
group, that all those people understand
the song they are teaching it and not take
their own interpretation into it.”
Substance Abuse Provider
quote:
“There are steps to putting the drum
together; history in it, there’s a lot of things
to learn about that drum and how it came
to be and the respect that you should have
for it and what it takes to put one together
and the responsibility involved.”
Substance abuse patient quote:
“The urban Indians are really Natives not
learned in their cultures and where they
are. This is important to know for their part
of the nation. Urban Indians need
teachings also as well as the people from
the reservation. The people from the
reservations are no different than urban
Indians because on the reservation, we
abused all the other drugs and that’s what
strays us away from our culture.”
Substance abuse provider quote:
Regarding women and drumming
“In our tribe, the women don’t touch the
drum, it’s bad luck for our drum.”
Substance abuse provider
quote
“If you’re going to teach them traditional
(gender) roles so to speak that level of
who’s facilitating your group is going to
come into play. I use the word support
because they (women) have always been
our strength. To support the women in
standing and singing behind the drum is
something that you want to be taught first.”
Substance abuse provider
quote:
“I kinda feel like I go against the norm,
which is that women should stand behind
the men.”
“I’m not opposed to either or and mixing
men and women but I’ve heard it’s not
suppose to be done. But I think it would be
grand.”
After treatment quote (CAB)
“The tools that they use in treatment
should be implemented in their lives. It’s
up to them to continue to go to Pow Wows
or to sweat…to cultivate it in their lives and
for drumming to be a part of their lives. It
will be the responsibility of the service
providers to create opportunities for the
clients after their participation in
treatment.”
Pretest of DARTNA
• 10 AI/ANs with current substance use
disorders (5 males, 5 females) will be
provided the preliminary treatment
protocol.
• Follow-up focus groups among
participants, providers and CAB will be
conducted to aid in the development of the
final treatment protocol.
• Completed 12/2011
DARTNA Pretest Assessments
• Brief Symptom Inventory (BSI)
• Functional Assessment of Chronic Illness TherapyFatigue (FACIT-F) (Physical well-being, Social /Family
well-being, emotional well-being, functional well-being)
• FACIT-Spiritual Questions
• Functional Assessment of Cancer Therapy (FACT)Cognitive Function
• General AA Tools of Recovery (GAATOR) 2.1- a12 step
questionnaire
• American Indian Alaska Native Cultural Identity Scale
• Addiction Severity Index (ASI), Native American version
Pilot study DARTNA
• A pilot study will be conducted comparing
the following 2 study groups:
DARTNA (n=30) vs.TAU at United
American Indian Involvement, Inc. (UAII)
(n=30)
• The current outpatient treatment protocol
at UAII is similar in time length to DARTNA
(6 hours/week over 12 weeks).
Conclusions
• Drumming may have a role in the
treatment of substance abuse for AI/ANs.
• Recognition and adherence to cultural
traditions is necessary when using
drumming as a treatment option for
AI/ANs.
• Further research investigating traditionalbased healing strategies are needed.
Complementary and Alternative Medicine
• Defining Complementary and Alternative
Medicine (CAM)
• Types of CAM:
-Natural Products
-Mind Body Medicine (Mindfulness)
-Manipulative and Body-Based Practices
-Other CAM Practices
Contact Info
• Daniel Dickerson, D.O., M.P.H.
• Phone: 562-277-0310
• E-mail: daniel.dickerson@ucla.edu