Inside the TACUNA Trial and What It Found

A randomized clinical trial funded by the National Institutes of Health has found that a virtual prevention program called Traditions and Connections for Urban Native Americans, or TACUNA, reduced cannabis and alcohol use among American Indian and Alaska Native emerging adults. The program blends evidence-based motivational interviewing with traditional practices such as cooking, storytelling and prayer.

The study recruited 541 American Indian and Alaska Native adults aged 18 to 25 and randomly assigned them to either TACUNA or a standard care condition. TACUNA included three workshops and a wellness gathering; standard care consisted of a single opioid and pain cultural health and wellness workshop. Both interventions were led by American Indian and Alaska Native facilitators.

At three, six and 12 months after the intervention, both groups reported using cannabis less often and experienced fewer negative consequences tied to alcohol and cannabis. However, only the TACUNA group reported meaningful decreases in how often and how much they drank and in the amount of cannabis they used. TACUNA participants also showed greater reductions in anxiety symptoms and spent less time around peers who used cannabis or heroin.

The study was led by researchers from RAND, UCLA and the Sacred Path Indigenous Wellness Center, with support from NIDA and the NIH HEAL Initiative. First author Elizabeth D'Amico said the program was originally designed for in-person sessions but moved online during the COVID-19 pandemic, and the virtual format still produced strong results.

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Why Culturally Grounded Virtual Delivery Changed Outcomes

What Separated TACUNA From Standard Care

Both groups improved on some measures, but only TACUNA reduced the frequency and quantity of alcohol use and the amount of cannabis used. The key difference appears to be the combination of motivational interviewing with traditional practices, delivered through multiple sessions rather than a single workshop. This suggests that the structure and cultural specificity of TACUNA, not simply receiving any intervention, drove the stronger outcomes.

The Cultural Connection Factor

NIDA Director Nora Volkow emphasized that supportive social environments and community engagement are important components of substance use prevention. The trial builds on earlier findings that traditional practices and feelings of cultural connectedness are linked to lower drug use and better mental health. Notably, both the TACUNA and standard care groups maintained their sense of cultural connection over the following year, so cultural contact alone may not explain the difference. The integration of cultural activities into structured motivational interviewing appears to be the operative mechanism.

Why Virtual Delivery Matters

The pandemic forced TACUNA online, a shift the researchers initially saw as a constraint. Instead, it became an accessibility advantage. Urban American Indian and Alaska Native populations are often geographically dispersed and may feel disconnected from tribal communities; a virtual format reduces travel and scheduling barriers. The strong outcomes in remote sessions support further rollout beyond a single location, although the release does not provide detailed cost data to substantiate the description of TACUNA as cost-effective.

What the TACUNA Results Mean for Tribal Health Programs and Funders

For tribal health providers and urban Indian organizations

  • The trial offers a tested program model: three culturally grounded workshops plus a wellness gathering, led by American Indian and Alaska Native facilitators, can be delivered virtually without losing effect.
  • Programs serving dispersed urban Native young adults can use TACUNA's structure—motivational interviewing paired with cooking, storytelling and prayer—rather than treating cultural activities as a one-off addition.
  • Funders and public health agencies should note that TACUNA was supported by NIDA grant UH3DA050235 under the NIH HEAL Initiative; similar culturally grounded prevention research is eligible for NIH funding.
  • Because the data extend to 12 months, organizations considering adoption should track substance use, anxiety and peer exposure at similar intervals to compare local results with the trial's findings.