Addressing substance use and mental illness among Quinault Indian Nation adolescents and young adults: community perspectives on community and cultural connection

American Indian/Alaska Native (AI/AN) communities persist and thrive through intergenerational strength and resilience; they also continue to face disproportionate impacts from harms related to substance use and mental illness. There is an urgent need for evidence-based, culturally responsive approaches to increase protective factors against substance use and mental illness in AI/AN communities. Positive reinforcement of community and cultural connection may be protective against substance use and mental illness in adolescents and young adults (AYA). We partnered with the Quinault Indian Nation (QIN) to explore perspectives on community and cultural connection and how best to provide positive reinforcement that rewards engagement in cultural activities in order to build resilience, decrease substance use, and improve overall mental health. This study was guided by community-based participatory principles, approved by the QIN business council, and supported by a community advisory board of QIN members. We conducted semi-structured, 30–60-minute interviews with 15 QIN community members (both AYA and adults/elders). Interviews asked about community connection as well as community needs and preferences to address substance use and mental illness among QIN AYA. Interview transcripts were double-coded by three qualitative researchers and analyzed using a combination of Rapid Assessment Process and thematic analysis. Our sample included 6 AYA and 9 adults/elders from the QIN community. Five themes emerged: (1) community connection involves reflecting community values in daily life, (2) QIN AYA have few formal and informal pathways to learn cultural practices and traditions, (3) QIN AYA frequently face logistical and/or structural barriers when trying to access cultural activities, (4) shyness, low confidence, isolation, and competing interests may also hinder QIN AYA engagement in cultural activities, and (5) new approaches to fostering cultural connection are needed to promote wellbeing and prevent harms related to substance use and mental illness. Both AYA and adult QIN community members described substantial barriers that hinder AYA engagement in cultural activities which build cultural connection and may support substance use and mental illness prevention. Community members emphasized focusing on upstream factors to encourage community and cultural connection and prevent substance use and mental health problems in the future rather than focusing on providing positive reinforcement for engagement in specific activities.