Laudet AB, Stanick V, Sands B: What could the program have done differently? Despite promising advances in biopsychosocial treatments, substance use disorders continue to significantly impact the health of people worldwide, due in part to the treatment gap between optimal care and currently available services [1]. Pating DR, Miller MM, Goplerud E, Martin J, Ziedonis DM: New systems of care for substance use disorders: treatment, finance, and technology under health care reform. Substance use can cause acute medical complications (Table 1). We identified three sets of challenges for bringing effective substance abuse treatment to AI/AN communities: challenges associated with providing clinical support, challenges associated with the infrastructure of the treatment settings, and challenges associated with the service/treatment system. 10.3109/00952990.2012.694529. Several of the challenges we identified have been identified by others as ones that are likely unique to AI/AN communities. We first present these three sets of challenges separately for clarity and organization and then discuss their interrelatedness. The Centre for Addiction and Mental Health has conducted the Ontario Student Drug Use Survey2 biannually for 3 decades, using an anonymous self-reporting method. Am J Public Health. Am J Drug Alcohol Abuse. and that’s not something that you can necessarily measure by a survey” (Region F, Key Informant 3). The principal investigator, a psychiatrist who has worked with AI/AN communities for over fifteen years, conducted all interviews, which were recorded. NOTE: We only request your email address so that the person you are recommending the page to knows that you wanted them to see it, and that it is not junk mail. Our three categories of challenges provide a useful framework for eliciting challenges to providing quality substance abuse treatment in other substance abuse treatment settings. Unlike the majority of medical care in the United States, substance abuse treatment relies primarily on public rather than private sources, resulting in chronic underfunding. Accordingly, for the focus group and key informant interviews, we did not collect individual participants’ demographic information, and instead focused on the key topics of interest for this study. 10.1016/j.jsat.2008.10.009. . CAS  (Region A, Focus Group 1). Schmidt LA, Ye Y, Greenfield TK, Bond J: Ethnic disparities in clinical severity and services for alcohol problems: results from the national alcohol survey. Shore JH, Brooks E, Savin D, Orton H, Grigsby J, Manson SM: Acceptability of telepsychiatry in American Indians. Funding requirements to use EBTs combined with concerns about their applicability lead providers to feel “pushed into a corner” (Region F, Focus Group 3) and additionally burdened by treatment requirements that do not fit clients’ needs. Vienna: The Network; 2001. They are also at risk of their education being interrupted or negatively affected.10,11 The complex interaction of physical, mental, legal, educational and social issues among youth with substance abuse problems creates the potential for poor short-and long-term outcomes. PubMed  2011, Chichester, UK: John Wiley & Sons, Ltd, Qualitative Solutions & Research: NUDIST Vivo (NVivo). 10.1023/A:1013129131627. . 2011, 34: 375-381. Funding sources frequently require using evidence-based treatments (EBTs), but numerous programs expressed concern about their applicability to AI/AN programs and their lack of flexibility, considered critical for working with AI/AN communities’ diverse needs. However, the majority of the challenges identified likely apply to the general substance abuse patient population in the United States. Am J Community Psychol. Jason LA, Olson BD, Ferrari JR, Lo Sasso AT: Communal housing settings enhance substance abuse recovery. . World situation with regard to drug abuse, with particular reference to children and youth. Psychiatr Clin North Am. McLellan AT, Meyers K: Contemporary addiction treatment: a review of systems problems for adults and adolescents. 2004, 56: 764-770. He visits the emergency department for the fifth time in the past month reporting chest pain: “My heart's jumping out of my chest.