The Role of Historical Trauma: Addiction in Native Communities

0:00:11 Andrew Williams
Welcome to Let's Talk Recovery Equity. A series of conversations about how we can reach and help more people find freedom from addiction. This series offers us a space to reflect on some of the complexities of substance use and mental health conditions. And to consider new pathways toward hope, recovery, and healing. I am Andrew Williams, Director of Diversity, Equity, and Inclusion at the Hazelden Betty Ford Foundation. And I am the host of our series. Today, for our series kickoff episode, I'm joined by two very special guests. My colleague, Cecelia Jayme, Director of Clinical Services for Hazelden Betty Ford in Center City, Minnesota. And Dr. Sarita McGowan, an Addiction Counselor at our Betty Ford Center in Rancho Mirage, California. Today, Cecelia, Sarita, and I will set the context for our series. By discussing the meaning and significance of our series focus on Native American communities and promising new approaches to substance use, mental health conditions, treatment, and recovery. Offering a preview of the conversations with future guests, we will move into some introductory conversations around health equity, culturally attentive care, intergenerational trauma, substance use, as well as spirituality and healing in diverse, American Indian communities.

0:01:28 Andrew Williams
[turns to laptop screen] Welcome, Sarita and Cecelia! I'm very grateful to have this opportunity to have today's important discussion with both of you.

0:01:37 Cecelia Jayme
Thank you, Andrew.

0:01:37 Dr. Sarita McGowan
Thank you.

0:01:38 Andrew Williams
As we move into our conversation today, I'd like to start by giving you each a chance starting with Sarita then Cecelia to introduce yourself. Please tell us a little bit about yourself. As well as some of what is the passion behind the work that you do for the Hazelden Betty Ford Foundation.

0:01:56 Dr. Sarita McGowan
Thank you, Andrew. [gives an Ioway greeting] I'm Sarita Little Eagle Woman of the Iowa tribe of Kansas and Nebraska, the Black Bear People. Grateful to be here today. Thank you, Andrew, for having us. The passion that drives me is giving back to my community. Giving back to those who are suffering from addiction. Myself I was a consumer of alcohol and drugs and I have been clean and sober for sixteen years. And in that way, I've been able to give back and to keep doing that and I love my position to do that. During that journey of sixteen years, I've gone to school and it's been a blessing. And now I just graduated with my Doctor's degree in Diversity, Equity, and Inclusion out of University of Illinois Urbana-Champaign.

0:02:54 Andrew Williams
All right well thank you, Sarita, and congratulations on earning your Doctorate. I'm really happy to recognize and celebrate that accomplishment.

0:03:02 Dr. Sarita McGowan
Thank you so much. [smiles]

0:03:04 Andrew Williams
Cecelia, please tell us a little bit about yourself. And what really does fuel your passion for this work in Native communities and beyond.

0:03:13 Cecelia Jayme
Thank you, Andrew. My name is Cecelia Jayme. I work at the Center City campus for Hazelden Betty Ford. I've been with this organization for 27 years. [speaks in Ojibwe language] I don't speak my language very well. My name in Ojibwe is Eagle Woman [translates]. And my Clan is the Bear [gives translation in Ojibwe]. I come from Manitoulin, Canada. I live in Sankria Falls, Wisconsin currently. I came to Hazelden Betty Ford as an intern for my tribal college and I've stayed on ever since. My passion lies in that I've been gifted with 40 years of recovery from substances. And it's important to me that others in our communities have the opportunity to find their path in recovery. And that as helpers, we assist them on their path by supporting their path. Through their spirituality, their culture, and their communities.

0:04:21 Andrew Williams
Oh, thank you so much, Cecelia. I really appreciate both you and Sarita sharing your own stories of recovery as well. And we certainly wanna recognize and celebrate that. As well as your long-standing service to the Hazelden Betty Ford Foundation.

0:04:34 Cecelia Jayme
Thank you.

0:04:36 Andrew Williams
One of the questions I have now for both of you, and I'll start, Cecelia, with you, and then move on to Sarita. Is you know why you believe this series and in our series focus on Native American communities and promising new pathways for hope and healing, why do you believe that this series is important? What do you think it might mean for Native communities that you're affiliated with? What do you think it might mean for our country? What do you think it might mean for our Foundation?

0:05:05 Cecelia Jayme
So for our Foundation, to support and lift up voices is very important. Hazelden Betty Ford is a well-known recovery organization. We're a national site. And we as an organization have made a commitment to lifting up people to find their paths. To really look at substance use and mental health disorder and make a difference where we can. What really resonates for myself is that the organization has values that are similar to my own. Which is the values of respect and integrity. And the respect for not trying to put everybody in the same mold. But to rather strengthen and support those resources already in place. And to lend a hand where it's wanted.

0:06:07 Andrew Williams
Thank you, Cecelia. Sarita, same question to you. What do you think is the importance and really deeper meaning of this series that we're kicking off today?

0:06:17 Dr. Sarita McGowan
You know, I just think it's an amazing opportunity. I think this is the first time that this is happening for Hazelden Betty Ford. And recognizing that there's over 574 tribes that are federally recognized. That's not saying that there's other tribes that are, you know, State-recognized in our nation. And bringing this to the nation is just I think it's amazing. I feel like on reservations, they need to know that we are this big organization, that we wanna help, we wanna bring that gap. And have people come in and give them what they need. As far as treatment and what they want. There's a lot of things that they want and need and they don't feel like there's access. And I think this series is really gonna open up that access and letting them know we're on your side. We really wanna help in that way. I think it's a beautiful opportunity.

0:07:22 Andrew Williams
All right. Well, thank you, Sarita. I really appreciate both your responses. Which really highlight our organization's amplified commitment. To both lifting up the voices of communities from historically underrepresented and marginalized backgrounds. But also importantly, right, expanding access, trying to expand the reach of our mission of offering hope and healing. You know as I think about a vision of potential impact of our series and our conversation today, one of the things I have in mind is that I hope our series will contribute to sort of the explosion, right? Of this sort of myth that there are no longer any Native Americans. As odd as it might sound, there are way too many in our country today who believe that there are no more real Indians left. But despite, right, a long history of settler Colonialism, genocide, and cultural oppression, Native American people are still here. As you say, we still have over 600 or 700 officially recognized tribes. Sarita, I'm wondering if you could share some of your reflections on the strength and resilience and cultural vibrancy of Native American communities that you're familiar with.

0:08:31 Dr. Sarita McGowan
Oh definitely. You know, I ground myself in the ceremonies and always, you know, with the patients, they want to know about what kind of healing technique will help them. And grounding myself in spirituality and the Native American ceremonies. Which in fact we did not have a Native freedom of religion until 1979. That was—that's not very long ago at all. And here we are this nation full of Native Americans and I really appreciate how you said this explosion. Because really people do not know that we're here. The passion they have for culture has helped in my position as Addiction Counselor. And sharing smudging with them, I just—they came this morning I said I'm gonna leave you a note and this is how you're gonna do it. You know, you have the power in yourself to heal yourself. So, they were quiet, they just completed smudging as they walked onto their task. And then we do drumming. And talk about eagle feathers and talk about the deer hide that's on the stick, for the talking stick. And talk about where the stick came from. Stick came from a ceremony ten years ago that I carried around and I've had it, you know, and talking about stones and sticks and the trees and everything has this—there's so much that we can share with each other. And you don't have to be Native American to enjoy it. And so we have a lot of patients that come up and want to smudge and want to learn. And I think that's a really good thing. That's really and how I stay grounded. Going to ceremonies and participating, fasting, and praying. That's a big, big thing for me. To give back. [smiles]

0:10:17 Andrew Williams
Oh Sarita, again, thank you for your response. And really, you know, you beautifully highlight the real centrality of culture and spiritual traditions, right, as the real sort of infrastructure of the resiliency, strength, right, of Native American communities. And I'm really looking forward to our future conversations with other leaders who I know will highlight the real centrality of cultural traditions in developing new pathways for hope and healing for Native communities. Cecelia, I'm gonna come to you with my next question. Partly, we both live here in Minnesota. Where our Department of Health says that African-Americans are almost twice as likely to die from overdose deaths than Whites. And American Indians have an even higher rate. And their overdose rate is almost seven times as high as that for Whites. And sadly, these troubling, unsettling disparities are only increasing. Knowing, Cecelia, this is a very complex issue, I'm wondering if you can begin to help us understand these really radical disparities in overdose deaths in Native American communities.

0:11:28 Cecelia Jayme
So, the overdose rates have risen across all cultures, that's true. But when you look at indigenous peoples, they've increased fivefold over the course of the last decade. So that's increasing overdose deaths in indigenous people in this country. A study completed in November of 2021 indicates that 107,000 people who all died of overdose deaths, right, 16.5—the rate of indigenous men who died in that study was 16.5. The rate of Caucasian men who died during that study was 1.5. That's a significant difference in those rates. Which is really very disturbing when you consider that the indigenous population makes up 2 percent of the United States population. So, people are dying. Why is overdose rate higher? I think there's many reasons why. I think some of it has to do with access to resources, access to treatment, access to prevention. We know that in indigenous adolescents that there's a higher rate of suicide and a higher rate of feelings of hopelessness. So, this is an important issue.

Another interesting thing is that when you look at studies, right, Native Americans overall have a lower rate of continuous alcohol use. Than any other culture. But they have a higher rate of binge drinking, right? And so, 70 percent of the Native, indigenous people who are incarcerated, were under the influence of alcohol or other substances when they were, you know, convicted of that reason for being incarcerated. The reality being that I think that the overdose rates, the suicide rates, really have to do with not having resources, access to resources, that other people have. And then we talk about historical trauma. And the history—historical trauma isn't just what happened 500 years ago. It's what continues to happen in this moment in time. And it's like any wound. As you keep picking at the wound, it continues to get sore. And it gets sore and it gets sore, it doesn't go away. And so this historical trauma has a big impact in that it continues. It's not just what happened before, but what keeps happening. Again and again and again.

0:14:45 Andrew Williams
I really appreciate your response, Cecelia. And the ways in which you help contextualize these really unsettling disparities in overdose deaths among American Indian communities. But again, what I especially appreciate in what you offer is this reminder that there are strengths within the culture—

0:15:01 Cecelia Jayme
[nods] Yes.

0:15:01 Andrew Williams
--And whether it be traditions, long-standing traditions of sobriety as well. That can kind of inform and provide a foundation, right, for addressing these sorts of disparities. And I also appreciate your point, Cecelia, that although we've—there's a lot of recent research that many of us are becoming more aware of of the link between intergenerational trauma and substance use disorder. That you remind us, right, that when we talk about intergenerational trauma, we're not just talking about historical trauma. But an ongoing trauma related to social, political, economic, cultural marginalization. Sarita, I'm wondering if you might share with us some of your reflections and help us begin to understand the possible linkages between intergenerational trauma and substance use disorder. There's some really interesting research that suggests that intergenerational trauma actually gets passed on through our DNA to the next generation. It really kind of is something that gets inherited.

0:16:01 Dr. Sarita McGowan
[nods] Yes.

0:16:01 Andrew Williams
Could you speak to your understanding of those linkages?

0:16:04 Dr. Sarita McGowan
Yeah. You know, like Cecelia was saying, 500 hundred years ago yes colonizers, settlers came and dispersed and you know made us or had the Trail of Tears for one and there's other movements, moving tribes off their land to Indian territory. That's a trauma. You know, those people died on that trip. The voices of people that try to imitate or initiate that they know what a Native person is saying. And that's traumatizing. ‘Cause we haven't had a voice for so long. And so things like that re-occurring. And not being seen. There's so much more, you know, the historical trauma, the violence. Boarding schools. There's boarding schools the residential schools in Canada and here in the United States, you know, acculturation and assimilation. We had to become White people. We had to just kill the Indian, they would say. And save the man. So, there's so much of that it's continuously. And there's a lot of sexual abuse in those boarding schools, a lot of kids died. They were pulled from their families. And it sounds really horrific to talk about it but it's there and it does get passed down in our DNA. And sometimes we don't know how to handle it. We don't know where that grief is coming from or where that sadness is coming from. And they go to using drugs and alcohol. The kids, you know.

And their suicide is such a big thing on the reservations. A couple years ago they had clusters of suicides. There'd be like children from ages ten to thirty-four. It could be six or seven of them take their lives in a cluster. And so, Indian Health Services and SAMSHA have some grounds set to help tribes. There's a lot of movement on the tribes, a lot of funding we're getting out there. To help them with these disparities. And help them, you know, know that mental health access is gonna be good. Also, for a Native myself, I need to bridge and also know what kind of evidence-based treatment is out there to help me. Which has. You know, I went through a lot of treatment as well. To get to where I'm at today. With sixteen years clean and sober. [nods, smiles]

0:19:09 Andrew Williams
Well, Sarita, again thank you for helping us deepen our understanding of again what you say is a very troubling, unsettling topic in reality but also appreciate the ways in which you challenge, you know, us as an organization to think about how we might address this intergenerational trauma in Native communities. And as we do so, I think what I also hear in response is that this is priority number one. In Native-serving organizations. And that we may have a lot to learn from them. On how to address this and in fact again, this intergenerational trauma is being addressed and is understood, along with grief, right? As one of the really key issues that we need to address in helping move more Native Americans toward recovery and healing.

0:19:54 Dr. Sarita McGowan
Yes. Yes. [nods]

0:19:57 Andrew Williams
Well as we begin to close out our interview today, I want to ask each of you, starting with you, Cecelia, then moving back to Sarita, to tell us some about the work you actually do for the Hazelden Betty Ford Foundation. Cecelia?

0:20:12 Cecelia Jayme
Thank you, Andrew. So as the Director of Clinical Services in Center City, I have the opportunity to make sure that operations are occurring, that we continue to be able to serve people who come through their doors. But additionally, Hazelden Betty Ford has provided a platform. In order that I am able to have conversation across multiple communities, across multiple tribes. To discuss ways to address addiction and suicide and substance use and all the things that we look at. So in Center City, we use the Wellbriety materials for those indigenous patients that identify. We also are putting a group together so that indigenous clients can gather together to practice ceremonial things. One of the things that, along with our historical trauma, we also have this deeply ingrained resilience, right? As Sarita said early on in this conversation, we're still here. You know? And we're not just struggling. We are here and we have a voice and we are standing up. So I think part of what I've been given the opportunity to do is work with our PCN, our Patient Care Network, and PCS, our Publication and Educational Division in order to work with multiple tribes who have come forward and said, ‘We need either literature or materials that are adjusted to fit our needs to develop treatment curriculum,' to utilize what they have and develop it in a way that they can continue forward. So we have multiple things happening at all times in support of multiple areas, multiple tribes, and I'm very excited in this particular series that you're lifting up some of the voices to those people that we've worked with, that have worked with us. And the education that we share back and forth. [smiles]

0:22:36 Andrew Williams
Well, thank you, Cecelia. And Sarita, how does your work at the Betty Ford Center in Rancho Mirage compare to the work of Cecelia here in Minnesota?

0:22:44 Dr. Sarita McGowan
Well, I don't know that there's any comparison, it's just that we are also being able to branch out and discover. We're working with several tribes as well, that we're rebuilding that connection, and bridging that gap. We're on Indian land, we have over seven I'm sorry nine recognized tribes around us. And so, the Cahuilla, and we are actually having our 40th anniversary having the Cahuilla Bird Singers come and Native American Pow Wow counselors coming. This is the first in 40 years since Betty Ford has been here. So this is a wonderful opportunity I get to help with.

Also as Addiction Counselor here in Rancho Mirage, I get to help with the Wellbriety books. While speaking to patients that identify as Native. And walking with them as once they get here, I get to go with them to MSU and go meet them and let them know I'm here for them. As an alliance, to work with them. And give them that Wellbriety book and also let them know we can use the sage and smudge. Talking stick, the drumming, and just give them some—and also I look Native, I think that's a big thing. You know, if you look on my campus, and I can point out a Native, I see a person walking out the dining hall [Andrew and Cecelia laugh] and I'm like, ‘Wait! She's Native! Let me go talk to her!' You know, and it's important. We notice each other. And like Cecelia said, we might have—we're all over the country. And to see somebody that looks like us, it really feels good. And so what a blessing I get to be here and I get to be in this—I get to do smudging every morning. And it's not just for Native patients, you know? Everybody comes. And I think that's so important. ‘Cause the Medicine Wheel is not just one human being, it's all the colors of the human beings. So that Medicine Wheel, we have to come together in that way. And that's something we can teach the nation, right? Eventually we start here and we're branching out, we're nationally known. For me, Hazelden Betty Ford is the best of the best. Crème de la crème without the alcohol. [laughs] You know? It's wonderful. What a blessing. So, yeah. [nods]

0:25:06 Andrew Williams
Well Cecelia and Sarita, thank you both for offering us such a rich window into the important work you're doing in California and here in Minnesota. And I think in the examples that you offer, you offer our listeners and viewers a sense for why so many of us within the Foundation are really excited about the possibilities that are out in front of us as a Foundation, right? To expand our mission of offering hope and healing to more Native American individuals, families, and communities. And let me thank you both again for joining us today. And sharing your wisdom, your experience, and tremendous insight. We are so grateful for your advocacy and the real life-saving, life-changing work that you do each day. So thank you both.

0:25:49 Cecilia and Sarita
[in unison] Thank you, Andrew.

0:25:51 Andrew Williams
In the upcoming episodes, we will be lifting up the voices and hearing about the life-saving work being done in Native communities across the country. From Hawaii to Alaska, from Colorado to Minnesota. And many other regions. You'll have the opportunity to learn more about the importance of culturally-based healing like we discussed today, peer recovery, more about Wellbriety, we'll talk about decolonization, and we'll also hear inspiring personal stories of strength, resiliency, and hope. To all of you listening or watching today, I wanna express my gratitude to you for taking the time to join us for this important conversation. Please let your friends and colleagues know about these conversations. And come back often to catch more episodes of Let's Talk Recovery Equity. Together, we can build a healthier, happier, and more equitable tomorrow.