Experiences with recovery from substance use in a Northern Midwest Indigenous Reservation setting

• Family, Elders, peers in recovery, and friends were important sources of support for people in recovery in this reservation setting. • Engaging with spiritual practices and connection to culture facilitated social support. • Transportation barriers and lacking supportive social networks contributed to feelings of isolation and challenges to recovery in this rural setting. Participants highlighted the need for better access to substance use-free events and assistance with transportation. People in recovery from substance use face unique challenges that can threaten the sustainability of their progress. These issues are often compounded in rural areas, where economic and geographic barriers limit access to recovery services. Indigenous Peoples face ongoing structural inequities that further challenge sustained recovery. More information about experiences in recovery in rural Indigenous settings is needed in order to design effective programs. We conducted a qualitative Community-Based Participatory Research study with semi-structured interviews from n=24 adults in recovery from illicit substance use who self-identified as Indigenous in a rural reservation setting in the Northern Midwest United States. We asked about factors that supported their recovery, challenges faced, and what support they would like to see in their community. The interviews were thematically analyzed informed by the Indigenous Connectedness Framework (ICF). People in recovery in this rural reservation setting drew strength from each of the ICF domains of connectedness: peer support networks, family, elders, and friends, facilitated by connection and reconnection with spiritual practices. Many described feeling isolated, especially if they experienced transportation barriers or their social networks used drugs. Participants identified the need for improved access to substance use-free cultural events and assistance with transportation. Our findings highlight the importance of social connectedness to recovery in this reservation setting, tying in with Indigenous conceptualizations of individual wellbeing as interrelated with intergenerational, family, community, spiritual, and environmental connectedness. These findings support the potential for peer-recovery support programs and expanded access to cultural practices and events.