Researchers recruited urban American Indian and Alaska Native emerging adults ages 18 to 25 from across the United States between December 2020 and October 2023, screening for eligibility online and excluding anyone with an existing opioid use disorder. Participants completed baseline surveys and were randomized to one of two virtual interventions.

The TACUNA arm received three culturally grounded workshops, Traditions and Connections for Urban Native Americans, plus a wellness circle. The comparison arm received an opioid-education Health and Wellness Cultural workshop, serving as the usual-care condition. Both arms completed follow-up surveys at 3, 6, and 12 months, with final follow-up data collected in January 2025.

The trial enrolled 541 participants with a mean age of 22.1 years; 83.2% identified as female. All lived in urban areas rather than on reservations or rancherias, a population that is both large, roughly seven in ten American Indian and Alaska Native people live in urban areas, and underrepresented in substance use research.

Virtual recruitment and delivery allowed the study team to reach this dispersed, often under-resourced population at a scale that in-person, geographically anchored programs typically cannot match.

Participants in both the TACUNA and HWC arms reported a decreased frequency of cannabis use over the follow-up period (TACUNA B=-0.44, SE=0.20; HWC B=-0.54, SE=0.21), along with decreased rates of positive screens for both alcohol use disorder and cannabis use disorder.

This pattern suggests that structured virtual engagement, whether or not it is culturally specific, was associated with less frequent substance use in this population over the year of follow-up.

The picture changed when the researchers looked at quantity rather than frequency of use. Only participants in the TACUNA arm reported decreases in frequency (B=-0.51, SE=0.20) and quantity (B=-0.25, SE=0.09) of alcohol use, and in quantity of cannabis use (B=-0.07, SE=0.03).

TACUNA participants also reported greater decreases in time spent around peers who use cannabis and heroin, and greater reductions in anxiety, compared with participants in the HWC comparison arm.

Beyond substance use itself, both groups reported improvements in time spent with peers who use alcohol and prescription opioids, clinical depression and anxiety symptoms, consequences of alcohol and drug use, and peer norms around alcohol, cannabis, prescription opioid, and heroin use.

The added anxiety reduction seen specifically in the TACUNA arm suggests the cultural and community-connection elements of the program, not just the substance use content, may have contributed to participants’ wellbeing.

The authors concluded that virtual recruitment and intervention successfully reached urban American Indian and Alaska Native emerging adults with decreased access to resources, and that both interventions were associated with reduced consequences and cannabis use.

They highlighted that only TACUNA participants showed decreases in quantity of alcohol and cannabis use, time spent around peers using cannabis and heroin, and anxiety, framing this as evidence for the value of bringing Native emerging adults together virtually to discuss substance use reduction while reconnecting with tribal community and culture.

This trial adds to a small but growing body of research on culturally grounded, virtually delivered interventions for underserved populations, an approach that gained urgency as telehealth expanded substance use and mental health care access during and after the COVID-19 pandemic. American Indian and Alaska Native communities have long been underrepresented in substance use and cannabis research relative to the scale of documented health disparities they face.

What this trial adds is a direct, randomized comparison showing that cultural grounding was associated with measurable additional benefit, not just cultural appropriateness or acceptability, when tested against a structured comparison intervention rather than no treatment. That distinction matters for clinicians and program designers deciding how to allocate limited resources for underserved populations.

In more than 20 years of practicing evidence-based cannabis medicine, I have seen how rarely clinical trial populations reflect the patients who actually walk into a clinic. This trial stands out because it was built, from recruitment through delivery, around a population, urban American Indian and Alaska Native emerging adults, that is too often absent from the evidence base clinicians are asked to apply to every patient.

The finding that matters most to me clinically is not simply that cannabis and alcohol use went down, both arms showed that, but that the culturally grounded TACUNA program showed an added benefit on quantity of use and on anxiety compared with a real, active comparison program. That tells me cultural relevance was not incidental here; it appears to have done clinical work. For a patient population with documented disparities in both substance use and access to culturally appropriate care, that is a meaningful, if still early, signal worth building on with further trials.

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