We are currently in the process of conducting some research around the impacts of culture-based interventions to address substance use issues. We're looking forward to gathering evidence over time about the impacts of culture-based interventions.
We have some good preliminary data on the outcome of residential treatment programs for first nations. Where those programs offer culturally based services there's a good indication that at least 65% of people leaving treatment going back into first nation communities are able to maintain a good level of wellness—meaning they're not using their primary choice of substance, and they're at least reducing another substance because first nations people are polysubstance users.
In terms of community-based programs there has not been enough investment in community-based services to get a good sense about the most effective programs. They're going based on what happens in residential treatment and the conversations that we've had over the development of the HOS renewal framework, and the recent first nations mental wellness continuum framework. First nations people are saying that culture has to be central—that's the HOS renewal framework—and in the first nations mental wellness continuum framework it says culture has to be the foundation. It can't be an add-on. It can't be the adaptation of western-based approaches. It has to be the foundation.
If we're going to make any significant long-term gains then that requires culture that is not marginalized in the workforce. So for example, cultural practitioners and elders have to be central. There has to be good collaboration across health care providers.