Centering culture in the treatment of opioid use disorder with American Indian and Alaska Native Communities: Contributions from a National Collaborative Board

American Indian/Alaska Native (AI/AN) communities are disproportionally impacted by the opioid overdose epidemic. There remains a dearth of research evaluating methods for effectively implementing treatments for opioid use disorder (OUD) within these communities. We describe proceedings from a 2-day Collaborative Board (CB) meeting tasked with developing an implementation intervention for AI/AN clinical programs to improve the delivery of medications to treat OUD (MOUD). The CB was comprised of Elders, cultural leaders, providers, individuals with lived experience with OUD, and researchers from over 25 communities, organizations, and academic institutions. Conversations were audio-recorded, transcribed, and coded by two academic researchers with interpretation oversight provided by the CB. These proceedings provided a foundation for ongoing CB work and a frame for developing the program-level implementation intervention using a strength-based and holistic model of OUD recovery and wellbeing. Topics of discussion posed to the CB included engagement and recovery strategies, integration of extended family traditions, and addressing stigma and building trust with providers and clients. Integration of traditional healing practices, ceremonies, and other cultural practices was recommended. The importance of centering AI/AN culture and involving family were highlighted as priorities for the intervention.     

Two models of unawareness: comparing the object-based and the subjective-state-space approaches

Over the past 20 years or so, a small but growing literature has emerged with the aim of modeling agents who are unaware of certain things. In this paper we compare two different approaches to modeling unawareness: the object-based approach of Board and Chung (Object-based unawareness: theory and applications. University of Minnesota, Mimeo, 2008) and the subjective-state-space approach of Heifetz et al. (J Econ Theory 130:78–94, 2006). In particular, we show that subjective-state-space models (henceforth HMS structures) can be embedded within object-based models (henceforth OBU structures), demonstrating that the latter are at least as expressive. As long as certain restrictions are imposed on the form of the OBU structure, the embedding can also go the other way. A generalization of HMS structures (relaxing the partitional properties of knowledge) gives us a full converse.