A New System of Care for Native Hawaiians and Substance Use

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Photo: Lilinoe Kauahikaua

By Lilinoe Kauahikaua

In Spring 2020, the Hawaiʻi State Department of Health Alcohol and Drug Abuse Division (ADAD) reached out to subject matter experts across Hawaiʻi to provide meaningful and intentional input surrounding the planning for their upcoming state strategic plan.

Papa Ola Lōkahi, the Native Hawaiian Health Board, was asked to participate in this endeavor, offering a chapter entitled “Conceptualizing a New System of Care in Hawaiʻi for Native Hawaiians and Substance Use.”

Native Hawaiians of all age groups experience a higher prevalence of substance use than other ethnic groups in Hawaiʻi. Research shows that this inequitable health status results from several complex and interconnected social determinants of health, including historical trauma, discrimination, and lifestyle changes.

Current western prevention, treatment, recovery, and harm reduction services are siloed and often ineffective for Native Hawaiians. Due to their individualistic approach to healing, these siloed methods often fail to resonate with Indigenous peoples and Indigenous healing.

Before European contact, Native Hawaiians understood that balanced nutrition, physical activity, social relationships, and spirituality were fundamental to maintaining optimal health. Western influences triggered an imbalance in Native Hawaiian society, shifting the paradigm of Native Hawaiian family systems. Historical and cultural trauma affects multiple generations and is linked to Native Hawaiian health disparities.

Cultural trauma is defined as “the loss of identity and meaning that negatively affects group consciousness. It marks and changes them in fundamental and irreversible ways, often resulting in the loss of language, lifestyles, and values.” The remedy for cultural trauma, as identified by loea (expert) Lynette Paglinawan, is cultural reclamation.

Historical trauma is defined as psychosocial trauma experienced by Indigenous groups as a result of colonization, war, genocide, or cultural, social, and political subjugation. The outcomes of these traumas have reached across generations and are reflected in higher rates of health disparities, including mental health, addiction, and incarceration, all of which have affected the social determinants of health and have a significant impact on individual, ʻohana, keiki, and community health.

Research indicates that re-centering healing for the native population, utilizing cultural connections and methodologies that speak to native perspectives, is more influential in creating positive health outcomes for native peoples. Papa Ola Lōkahi’s chapter provides recommendations that would reduce silos and incorporate cultural aspects to improve outcomes for Native Hawaiians receiving services.

We must begin to re-envision the existing continuum of care, embrace culturally grounded approaches, and begin to see the entire continuum as cyclical rather than linear, with each area of focus informing the next.

We hope that this chapter is a first step toward working together with Hawaiʻi’s ADAD in building a system of care that reduces silos and incorporates cultural aspects to improve outcomes for Native Hawaiians receiving services.


A webinar describing our findings and recommendations from the special chapter will be presented September 7 at 12:00 p.m. Please check Papa Ola Lōkahiʻs social media for the zoom link.

Lilinoe Kauahikaua, MSW, is a population health specialist – addictions, mental health, social justice with Papa Ola Lōkahi.