‘You Can’t Gangster a Horse’

Native Youth Connect with Culture to Break Cycles of Addiction

Native Americans now have the highest rate of drug-overdose deaths among teenagers and young adults of any ethnic group. At a Portland-based Native American health-care nonprofit, prevention specialists and tribal elders are blending traditional horsemanship and other Native culture with clinical approaches to prevent addiction before it starts.

Story and photography by Elyse Wild

This story is the first of a 3-part series produced in partnership with the Pulitzer Center on Crisis Reporting.

BEAVERTON, Ore. — On a hot July morning in Beaverton, Oregon, Dr. John Spence stands outside of an equestrian training arena, watching a 15-year-old boy lead a caramel-colored horse around an obstacle course marked by bright orange cones.

Spence, a citizen of the Gros Ventre tribe and tribal consultant for the Native American Rehabilitation Association of the Northwest (NARA NW), is lean and strong at 83 years old. He wears sunglasses, a cowboy hat, cowboy boots, and a black T-shirt that reads, “I am worthy.”

The horse swishes its coarse black tail as it walks gently behind the teenager, who is wearing an oversized white hoodie despite the triple-digit heat. Half a dozen other teenage boys stand in the arena, waiting their turn. Some shuffle their feet, their hands shoved in their pockets. A 16-year-old wearing long basketball shorts, a wide-brimmed baseball hat over his dark curls, and tattoos on his forearms calls out, “Nice job, man.”

Spence leans forward, his smile widening.

“Look at that,” Spence says quietly. “The horse won’t willingly go with you if they don’t want to. A lot of these kids have been in gangs, but you can’t gangster a horse.”

The boys, who range in age from 12 to 17, are part of a 90-day youth residential treatment program with NARA NW, a Portland-based nonprofit founded in 1970 to provide culturally competent addiction care to Native people. All but two of them are Native American. Most have been ordered by courts to participate in the program, which aims to rebuild their young lives that have been derailed by drug or alcohol abuse or criminal activity. Others are there voluntarily.

The teens represent one of the most at-risk groups in the opioid epidemic — according to a 2022 data analysis by the National Institute on Drug Abuse, Native Americans aged 15-34 consistently had the highest rate of drug-overdose deaths in 2020 and 2021.

Research points to culture as a solution. A 2022 study of 288 teenagers and young adults on a reservation in eastern Montana showed that Native youth who are connected to their tribal identity and engage in traditional practices are less likely to abuse alcohol or drugs. Across Indian Country, tribal communities and organizations like NARA NW are implementing culture-focused therapies to reduce overdose deaths among their youth.

Every other week, the boys visit the Beaverton ranch to work with accredited equine therapists on basic horse skills — groundwork, grooming, and riding — while Spence teaches traditional horsemanship. For Plains tribes, known as Horse Nations, the arrival of horses in the 16th century transformed their cultures, enabling more efficient hunting and new ways of life that became central to tribal identity. That deep connection was severed in the Indian Removal Act era through forced relocation and land loss.

“We lost land; therefore, we lost horses,” he said. “We talk about horses as our spirits and our relatives. This is one of the cultural ways that fits into the idea that culture is prevention and treatment.”

‘A dark spirit’

Native Americans have the highest rate of drug-overdose deaths of any ethnic group. It reached 65.2 per 100,000 people in 2022, 15% more than in 2021, according to CDC data. While opioid-overdose deaths decreased in the second half of 2023, they increased by 2% among Natives communities — and by 36% in Oregon, according to the KFF health-policy group. Limited health-care access and underfunded law enforcement leave tribes struggling to protect their citizens. Each overdose death ripples through close-knit communities where cultural bonds define health and wellness.

For Native youth, the risks run deeper. Depression, anxiety, and family alcohol and drug abuse — common pathways to addiction — affect them at higher rates. They carry the weight of their ancestors’ trauma: forced removal from tribal lands, boarding school abuse, and broken treaties.

“The majority of us Natives have intergenerational or historical trauma,” said Shirley Cain, a citizen of the Red Lake Nation and former tribal judge who sits on the Johns Hopkins Center for Indigenous Health Indigenous Advisory Committee on opioids. “Loss of land, loss of language, loss of culture, our cultural practices, loss of traditional child-rearing practices, loss of healthy family systems.” She knows this personally; her parents endured corporal punishment by administrators at Indian boarding schools.

“We need systems that can help them to heal and feel safe and supported in healthy ways,” she added.

As a tribal judge, Cain has witnessed waves of drug use and addiction on tribal lands. But the current opioid crisis stands apart, she said.

“It’s different. It’s a different kind of spirit. In Indian Country, we call it a dark spirit — it’s a stronger, darker spirit,” she said.

Healing through culture

There are 160 treatment centers across the country for young people. According to the Indian Health Service website, 13 of those are Native-led and geared toward Indigenous youth, including NARA NW.

While the 575 federally recognized tribes across the U.S. have distinct practices and beliefs, NARA’s programming centers on the cultural pieces that are shared across many tribal nations: the medicine wheel, talking circles, sweat lodges, and reverence for elders.

NARA NW has grown from a single outpatient treatment center in 1970 to ten locations in the greater Portland area. Its youth residential-treatment program, launched in 2017, represents the nonprofit’s commitment to prevention as a first line of defense against alcohol and drug abuse.

Three NARA NW departments — prevention, youth inpatient treatment, and child and family services — share this space. While treatment addresses active addiction, the prevention team uses COIPP funding to strengthen cultural connections before alcohol and drug problems begin. The departments receive funding for programs on suicide prevention, drug and alcohol abuse, and opioid response.

The first floor welcomes families for weekly cultural nights, where they share a meal — an act of community in many Native cultures — play games and engage in cultural activities.

NARA NW utilized part of the COIPP funds for a spring-break camp that included demonstrations by the Push Movement, a nonprofit that promotes recovery through skateboarding and traditional canoe-building. The two activities are emblematic of the program's approach.

“We try to do as much as we can to connect with culture while blending contemporary and traditional teachings,” Casey Shaneman, NARA NW’s director of prevention, said, noting that on the surface prevention work might look like fun activities, “there’s more to it than that.”

Shaneman points to the Strategic Prevention Framework, which is recognized by the Substance Abuse and Mental Health Services Administration (SAMHSA), a federal organization tasked with improving access to mental health and substance abuse care. The framework is designed to break down the complexities of substance use and help develop sustainable practices for specific communities with a data-informed approach.

On the second floor of the building, boys and girls from ages 12-17 in the youth residential treatment program spend a minimum of three months and up to six moving through tiers of addiction treatment. The tiers are named for animals that hold significance to many Native cultures — salmon, bear, buffalo, and, finally, eagle, to symbolize their graduation from the program.

The youths maintain a schedule that includes time for self-care, meals, group therapy and activities, and outings. They attend three culture-based groups a week: “wellbriety” — a curriculum similar to 12-step programs, with Indigenous values interwoven — traditions, and a purpose of life and culture group. They do beadwork, make regalia, attend powwows, hold drum circles, and smudge — a ceremonial practice in which a bundle of a sacred herb is burned, the smoke curling through the air to cleanse negative elements.

“We try to keep them as culturally involved as possible,” said clinical director Nathan Perry. “It’s about reintroducing them to it. A lot of them see it growing up, but then a lot of things interfere with their ability to access that culture.”

Across the street from the building is a healing garden. It once was a parking lot, but now, indigenous plants are growing in clusters alongside a winding pebble path, with a curved frame at the center — the frame for a future sweat lodge.

The transformation of space mirrors NARA NW’s prevention mission: creating environments where Native youth can connect with their culture, aiming to break cycles of addiction that often begin in adolescence. Once a week, the kids meet in the garden with Spence and gather in a talking circle. Every other week, they load into a van and drive out to Forward Strides Ranch to meet him and commune with the horses.

Success is hard to measure in the short term. Shaneman says participation in the program and the quality of relationships between the staff and participants are two ways to tell if they are moving in the right direction.

“It's hard to quantify that,” Shaneman said. “We look at engagement, how many people are showing up, retention, people that return regularly.”

Sacred directions of the horse

On July 18, Spence led a Native Equine Therapy demonstration as part of the Sacred Tobacco and Traditional Medicines Gathering hosted by the Northwest Portland Area Indian Health Board. Held on the Grande Ronde Valley at the Uyxat Powwow Grounds, two dozen Native families gathered in the sloping valley tucked amid the Blue and Wallowa mountains.

Spence led the group in a talking circle and introduced the principles of Native horsemanship that are woven through NARA’s youth program.

“The Horse Nation Tribes, these two horses are seen as daughters,” he said, nodding to two horses standing near a trailer they’ve just emerged from. “You would be kind to them. You wouldn’t train them in the old cowboy way, by using fear. We have to lead, yes, but with kindness. These horses are more moral than us. They only do the right thing.”

After the talking circle, children flocked around one horse, eager but gently petting them, some picking up grooming brushes and stroking their hides. The other horse stands still and patient while Spence helps a teenage boy onto a saddle to take his turn walking the horse in a small clearing.

These outreach events are a part of NARA efforts to spread wellness through culture outside of its direct programming.

In Native culture, elders like Spence are revered for their knowledge and connection to generations of knowledge-keepers who have sustained cultural practices through genocide and forced assimilation.

Chris (not his real name) is 14 years old and a citizen of the Confederated Tribes of Warm Springs, one of Oregon’s nine federally recognized tribes. He’s been at NARA NW for 88 days and is two days away from graduating. For many of his peers in the program, the biweekly equine therapy has been their first experience with horses. Chris, however, grew up with the powerful animals.

“My grandpa used to own horses, but he let them go because we couldn’t feed them,” he said. “Then I forgot how to work with horses.”

Sitting on a folding chair at the edge of the arena at Forward Strides Ranch, Spence leans forward with his elbows on his knees, watching as the boys work with the horses one by one, saddling them, mounting them. and finally riding. He nods and smiles to himself when he sees something he likes — a horse responding to a boy’s subtle movement, the curly-haired 16-year-old with the wide-brimmed hat deftly cleaning the bottom of a hoof — and whispers, “Look at that.” His affection for the kids, and the horses, is apparent.

“They are from foster homes, broken homes, poverty,” Spence said. “A lot of them know they are Indian, but don’t know their tribe. They aren’t enrolled or haven’t been to a lot of cultural activities, or they might not have an Indian name or know their language. Being at NARA for 90 days is sort of a cultural immersion.

He teaches the kids the Seven Sacred Directions of the Horse: The four feet of a horse represent the four cardinal directions, north, south, east and west; the ears point upward to the heavens, the Great Mystery; the tail points downward to Mother Earth; and finally the center, when a human and horse join.

“You’re getting in tune with another spirit,” Spence said. “They don’t have to do what we want them to do. We are respectful to them, they are going to be respectful to us. Maybe they appreciate how they are being cared for. We ask them to do things that aren’t natural for them to do. They gift that to us.”

A Canadian study published in 2016 showed that Indigenous youth in treatment for sniffing toxic volatile inhalants such as glue who engaged in equine therapy with a cultural component experienced increased feelings of well-being, and expressed feeling more connected to their culture.

Under Spence’s guidance, the boys at NARA NW speak softly and use their eyes and energy to connect with the horses.

For Chris, who came to NARA NW to recover from alcoholism, the horses bring him a sense of calm, and a sense of self he felt he lost in his addiction.

“They are spiritual animals, you can’t cuss around them or mess around by them,” he said. “The horses have taught me that I’m not the bad person I thought I was. I’m not just an alcoholic. I am someone else who is better than that.”

At the end of the session, the boys and Spence clasp hands in a talking circle, a traditional gathering method common across Native cultures that allows everyone an opportunity to speak with the full attention of others in the group. Their faces are flush in the heat, some with smudges of dirt on their cheeks and dust clinging to their pants.

One of the boys opens the circle with a prayer to the Creator, expressing gratitude for their time working with the horses, and asking the Creator to watch over Spence. They take turns saying how they are feeling on a scale of 1-10.

Spence goes first. “Easy 10. I’ve been out here a long time, and it’s good to see you guys. When you guys come out here, I see that you have respect, and that is why you are able to ride these beautiful horses.”

Chris closes the talking circle with a prayer. His peers pat him on the shoulder and smile at him, congratulating him on his graduation from NARA in two days' time. He knows he wants to keep working with horses when he leaves.

As for what else lies ahead, he says: “I don’t know. I’ll see when I get there.”

Elyse Wild is senior health editor for Native News Online, where she leads coverage of health equity issues including mental health, environmental health, maternal mortality, and the overdose crisis in Indian Country. Her award-winning journalism has appeared in The Guardian, McClatchy newspapers, and NPR affiliates. In 2024, she received the inaugural Excellence in Recovery Journalism Award for her solutions-focused reporting on addiction and recovery in Native communities.

Tribal Clinics Blend Native Culture, Western Science in Federal Prevention Pilot

Like NARA NW, tribal health centers across Indian Country are using federal funding to combat the opioid crisis through culturally-rooted prevention. The Indian Health Service's Community Opioid Intervention Pilot Projects (COIPP) distributed $16 million across 35 tribal organizations. Here are two other innovative approaches:

California's Mathiesen Memorial Health Clinic serves the Me-Wuk tribe in the Sierra Nevada mountains. Their $500,000 program takes a three-pronged approach: educating students about fentanyl risks, distributing the overdose-reversal drug naloxone, and offering traditional healing practices alongside Western pain management.

In Alaska's remote Copper River valley, six Ahtna villages united under the "Stand for Our Children" campaign. The initiative mobilizes tribal members to protect youth from drug dealers while reviving traditional community support systems.

Early results from COIPP-funded programs show increased engagement in prevention services across participating communities, reinforcing how Indigenous approaches can strengthen modern addiction medicine. Reported by Elyse Wild