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Table 2 Themes, subthemes, and examples: challenges to providing quality substance abuse treatment to AI/AN communities

From: Challenges to providing quality substance abuse treatment services for American Indian and Alaska native communities: perspectives of staff from 18 treatment centers

Themes Subthemes Examples
Challenges associated with providing clinical support Barriers to treatment seeking and engagement: sociodemographic Homelessness
Lack of transportation
Legal issues
High relapse
Barriers to treatment engagement and process Complex trauma histories
Diversity of patients
Integrating culture into services
Lack of motivation
Stigma of treatment
Challenges associated with the infrastructure of treatment settings Frontline worker challenges: fatigue and burnout Emotional and personal investment
High caseloads
Paperwork and administrative responsibilities
Professional boundaries
Shortage of staff
Lack of program and treatment resources Inadequate length of treatment
Lack of office supplies and space
Challenges associated with the service/treatment system Barriers associated with providing Limited housing options
Adequate aftercare Limited transportation resources
Limited treatment options
Appropriateness of treatments Pressure to use Evidence-Based Treatments (EBTs)
Excessive and unconstructive paperwork Interference with clinical care
Not pragmatic or useful