Social work professor's family-centered program reduces alcohol use

For the past 10 years, Catherine O'Connor, a professor in the Tulane University School of Social Work, has spent countless evenings with members of the Mississippi Band of Choctaw Indians.

The evenings always began with meals consisting of traditional foods like hominy, fry bread and beans. But the gatherings were more than dinner. They were part of a research effort aimed at reducing alcohol misuse in the Choctaw community.

The meals were designed to encourage conversation among tribal families, to talk about their day and anything else on their minds, good or bad. Meals were followed by break-out sessions for parents, teens and children, creating a space in a more intimate setting for discussions, about stressors that might trigger alcohol or drug abuse. Topics of conversation included healthy living, parenting practices, relationships and problem solving.

The families were taking part in a Tulane research project called Weaving Healthy Families (WHF), a culturally grounded program created with and for Indigenous communities to reduce harmful alcohol and drug use and strengthen wellness from the inside out.

Adults who took part in the initiative reported declines in hazardous drinking, alcohol use disorder symptoms and marijuana use, while youth also showed measurable decreases in alcohol and drug involvement. The results were published earlier this year in the journal Substance Use & Misuse.

"In addition to reducing substance misuse, we saw changes in physical health," O'Connor said. "People were eating more fruits and vegetables and thinking differently about nutrition."

The program is rooted in history. Many Indigenous communities continue to experience the effects of settler colonialism, including forced relocation, cultural disruption and intergenerational trauma, alongside present-day economic and health inequities, O'Connor said. Rather than focusing on individual behavior alone, WHF considered family relationships, cultural practices and community strengths. This approach was intentional from the start.

"We had the support of the community every step of the way," O'Connor said.

Local health representatives were trained to lead sessions, and funding from a National Institutes of Health grant supported community participation, including paying tribal members to prepare meals.

The Mississippi Band of Choctaw Indians is a federally recognized tribe with a population of just over 10,000. The tribe was selected for the study in part for its reservation-based setting and strong service infrastructure, even as it faces ongoing health and mental health challenges, O'Connor said.

To evaluate the program, researchers conducted a clinical trial with 218 adults and 354 youth using a design that allowed all participants to receive the intervention program over time. Outcomes were tracked before, immediately after and up to 12 months later.

Researchers say the program works by strengthening "protective layers" such as family cohesion, communication, cultural identity and social support that make healthier choices more sustainable.

Although the study is over, O'Connor hopes to expand the work and explore new ways to support healing from trauma. She is also working with the Mississippi Band of Choctaw Indians on ways to incorporate the Weaving Healthy Families initiative into the tribe's own programming.

"The next step is really about healing," she said. "Understanding how communities can recover from trauma in ways that are culturally meaningful and sustainable."

O'Connor was joined in the research by Associate Professor Jian Li and Professor Katherine Theall of the Celia Scott Weatherhead School of Public Health and Tropical Medicine, Kristi Ka'apu, program director of Weaving Healthy Families and researchers from the University of Washington and Washington State University.