For anyone weighing whether remote care can do real clinical work, the trial offers a rare piece of evidence. The study tested a program called Traditions and Connections for Urban Native Americans, or TACUNA, among 541 American Indian and Alaska Native adults between 18 and 25 living in urban areas.
Researchers at RAND Corporation, the University of California, Los Angeles, and the Sacred Path Indigenous Wellness Center in Long Beach developed it. The National Institute on Drug Abuse funded the work through the Helping to End Addiction Long-term Initiative.
What the NIH Funded Trial Measured
Participants were randomly assigned to TACUNA or to standard care, which consisted of a single virtual workshop on opioids, pain, and cultural health and wellness.
TACUNA itself ran across three virtual workshops plus a wellness gathering, combining motivational interviewing with traditional practices including cooking, storytelling, and prayer. American Indian and Alaska Native facilitators led both conditions.
Investigators then surveyed participants about substance use, mental health, and peer influences at three, six, and twelve months after the intervention.
Where the Two Groups Diverged
Both groups reported using cannabis less frequently and reported fewer negative consequences tied to alcohol and cannabis. That is worth noting, because standard care here was itself an active intervention rather than a waitlist.
The differences showed up in the details. Only TACUNA participants reported decreases in the frequency and quantity of their drinking, and in the quantity of cannabis they used.
Reported effects were modest in size, with a coefficient of negative 0.51 for drinking frequency and negative 0.25 for quantity.
TACUNA participants also reported greater reductions in anxiety symptoms and less time spent around peers using cannabis or heroin. Both groups held onto their sense of cultural connection across the year.
Why an Addiction Prevention Program Reaches People Treatment Misses
Nora Volkow, who directs NIDA, said the approach “could be a powerful tool for reducing drug use and addiction within this population.” Her framing points at a gap the field knows well.
American Indian and Alaska Native people face higher risk of drug overdose death and report higher rates of cannabis use and psychological distress than other groups, yet few programs have been built for those living in cities and away from their tribal communities.
Lead author Elizabeth D’Amico, a senior behavioral scientist at RAND, noted that the program was originally designed for in-person sessions and moved online when the pandemic hit in 2020. She described the strength of the remote results as encouraging for accessibility.
What Virtual Delivery Means for Treatment Seekers
Remote delivery is often treated as a lesser substitute for showing up in person. This trial suggests a well-designed virtual group program can produce measurable change in drinking and cannabis use, which matters if distance, transportation, work schedules, or a lack of local providers stands between you and care.
It is also a reminder to ask whether a program was designed for people like you. Cultural fit is not a soft feature. In this trial, the arm that layered traditional practices onto evidence-based counseling was the arm that moved more outcomes.
Exploring Treatment Options
If you are researching next steps, compare programs by what they actually deliver. Ask whether telehealth or virtual group sessions are available, whether the program treats co-occurring anxiety and depression alongside substance use, and whether staff have experience with your community.
Verify licensing and accreditation before you commit, and confirm how your insurance applies. Rehab.com’s directory lets you compare verified treatment centers by location, level of care, insurance accepted, and specialty programming, including telehealth and culturally specific services. Call
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