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The purpose of this article is two-fold. First, it aims to understand some of the earliest documented perspectives voiced by Native Hawaiian communities and their appeals for the concept of culturally based treatment. Second, it presents research, practice, and policy considerations with the goal of evolving the base of evidence supporting cultural treatment. Within the context of Hawai'i and Native Hawaiian history, this paper first contextualizes the emergence and conceptual orientation of culture-based addiction treatment. In discussing substance use disorder treatment in the Hawaiian context, insights and perspectives consider cultural-political trauma a key factor in developing a beneficial framework of practice. This historical background, however, reveals that contemporary culturally based design and service delivery is not aligned with the objective of specifically improving treatment for Native Hawaiians.

This article reviews multidisciplinary literature to propose a structurally traumatized communities theoretical framework relating to three major topics: (a) addiction as an equal opportunity disease, (b) the psychology of marijuana use, and (c) anger and rage. From an ecological and structural perspective, the socially defined themes of stigma and stereotypes interplay with sociopolitical, historical, and cultural forces that contribute to substance use and addiction among African Americans and the treatment success gap that they experience in drug treatment. Empathy serves as an underlying mediating construct in clinical training and accreditation standards, inducing a systematic improvement in programmatic service delivery.