Assessing American Indian Traditional Ceremonial Practices and Substance Use Behaviors in an Urban, Multi-Tribal Setting: Results from a Community Survey

American Indian and Alaska Native (AI/AN) communities have relied on traditional ceremonial practices (TCPs) for survival and resilience for generations. Research examining the role of TCPs on wellness in urban, multi-tribal communities, however, has only recently emerged over the last several decades. This study explored the association between TCP-related variables and substance use in an urban AI/AN community in Montana. Specifically, participant knowledge, attitudes, and beliefs (KAB) regarding TCPs, their level of intent to participate in TCPs, and past year substance use were measured. This cross-sectional study used survey data from 194 AI/AN adults (66% female, 5% nonbinary; M age = 44). Positive KAB toward TCPs was found in 56.4% of respondents. Greater level of intent to participate in TCPs was found in 36.7% of respondents. Multivariate logistic regression showed individuals with positive KAB were less likely to report past year alcohol [adjusted odds ratio (AOR): 0.49; 95% confidence interval (95% CI): 0.26, 0.93] or other drug use (AOR: 0.30; 95% CI: 0.11, 0.76). Individuals who reported a greater level of intent to participate in TCPs were also less likely to report past year alcohol (AOR: 0.51; 95% CI: 0.26, 0.98) or other drug use (AOR: 0.31; 95% CI: 0.08, 0.91). The findings highlight a need for further examination of the potential effectiveness of substance use interventions for urban AI/AN adults that incorporate TCP-related factors.