Why Culturally Defined Evidence-Based Practices (CDEPs) are the Future of SUD Prevention, Treatment, and Care

The Kaiser Family Foundation reports that in 2021, there were over 106,600 deaths due to drug overdose in the U.S.– the highest on record. This marks a 51% increase in drug overdose deaths from before the pandemic.[1] According to recent data collected by the California Health Care Foundation, approximately 2.9 million Californians aged 12 and older reported a substance use disorder (SUD) in 2022[2]. More recent reports from other organizations have shown growing rates of SUD and overdose deaths in the years following the pandemic, both in the United States and in California specifically. The uptick in substance uses and overdose deaths disproportionately affects people of color. Given California’s diverse population and the high number of individuals with SUD, building out programs and services that specifically support the needs of diverse populations is paramount to better future health outcomes and effective prevention & treatment.

While Evidence-Based Practices (EBPs) provide a strong foundation for care, there is a growing opportunity to incorporate an innovation in SUD and overdose prevention, treatment, and care in the behavioral health delivery system: Culturally Defined Evidence-Based Practices (CDEPs).

CDEPs acknowledge that while the core mechanisms of addiction may be universal, the pathways to prevention, the road to recovery, the meaning of sobriety, and the very effectiveness of interventions are deeply shaped by an individual’s cultural background, language, racial/gender identities, lived experiences, and community context. What works effectively for one group may not be as impactful for another if cultural nuances aren’t integrated into the prevention or treatment approach.

Generally, it is more common to find CDEPs used in mental health treatment or substance use prevention programs in comparison to treatment programs. For instance, through the Gathering of Native Americans (GONA) Curriculum, some AI/AN communities have developed tribal specific curriculums for youth SUD prevention programs that focus on core themes of belonging, mastery, interdependence, and generosity. While we have seen examples of CDEPs to support substance use prevention approaches, CDEPs are largely absent in the treatment and care space.

At CIBHS, we believe CDEPs can be a very effective tool for helping to make SUD treatment much more effective with underserved populations. Here’s why:

• Dismantle Barriers to Access and Engagement: For many communities, particularly people of color and LGBTQ+ individuals, historical trauma, systemic discrimination, and deeply ingrained mistrust of healthcare systems can be formidable barriers to seeking and sustaining SUD treatment. CDEPs for SUD care can be co-created with these communities, ensuring that interventions are not only culturally relevant but also trust-building and inviting, addressing these historical and systemic challenges head-on.
• Enhance Relatability and Reduce Stigma: CDEPs integrate cultural wisdom, spiritual practices, family dynamics, and community values that resonate deeply with clients. For example, incorporating traditional healing ceremonies, peer support models rooted in community narratives, or addressing the specific stressors of discrimination within therapy sessions makes the treatment feel personally meaningful, thereby reducing stigma and increasing engagement.
• Improve Treatment Outcomes and Retention: When individuals feel truly seen, understood, and respected in their treatment journey, their adherence and retention rates significantly improve. Research consistently shows that culturally adapted interventions lead to better outcomes. This isn’t just about language translation; it’s about tailoring communication styles, adapting examples, and structuring sessions in ways that are congruent with an individual’s worldview.
• Address Unique Risk Factors and Protective Factors: Cultural contexts influence not only how addiction manifests but also the unique risk factors (e.g., racial discrimination, homophobia, acculturative stress) and protective factors (e.g., strong family bonds, spiritual beliefs, community resilience) within a particular group. CDEPs are designed to leverage these protective factors and specifically address culturally relevant risk factors, leading to more holistic and effective treatment plans.
• Build Community Capacity and Sustainability: CDEPs often involve engaging and training community members as cultural navigators or even co-developers of interventions. This approach empowers local leaders, builds sustainable community-led recovery pathways, and ensures that treatment remains relevant and responsive over time.

CIBHS Call to Action

As advocates of a more equitable behavioral healthcare system, we must work together to champion the development and implementation of CDEPs in SUD treatment.

This means:

• Investing in Community-Led Research: Supporting initiatives that center the voices and experiences of diverse communities in defining what works for them.
• Prioritizing Cultural Competency Training: Ensuring our workforce is not only culturally aware but also deeply competent in delivering adapted interventions.
• Investing in Programs to Scale Treatment and Care: We most promote partnerships at all levels of the behavioral health delivery system. Working directly with healthcare organizations, providers, community organizations and cultural leaders to co-create and disseminate CDEPs.

Let’s embrace CDEPs at all stages of SUD work and move toward more sustainable, effective, and equitable SUD prevention, care and treatment, ensuring that every individual, regardless of their background, has access to the most effective path to lasting recovery.

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