Culture is vital for recovery. That's a lesson Juli Skinner, a citizen of the Ponca Tribe of Oklahoma, learned during her time in foster care, years later working in child welfare and now, as the senior director of the Cherokee Nation's behavioral health center.
Tribal traditions have given her a healthy way to self-regulate and strengthen her connection with Spirit.
"Culture is such a protective factor," Skinner said. "Historical trauma has hit a lot of people – Native Americans, tribes – hard. Lost language, lost traditional ways, and we'll never get all of that back."
Despite seeing the benefits, culture has never been baked into the inpatient treatment options available to citizens of the Cherokee Nation of Oklahoma, a tribe Skinner has worked with for more than a decade. That is changing next year.
Cherokee Nation plans to open a residential and intensive outpatient treatment center in Tahlequah, where the tribe is headquartered. It will incorporate centuries-old traditions into recovery, including the game of stickball and an on-campus garden to grow selu, or corn.
Money for the facility comes from the roughly $150 million the tribe recovered through settlements with opioid manufacturers. The 45,000-square-foot campus will have 100 inpatient beds and an outpatient hub with follow-up support.
Suing opioid manufacturers
Tribes – like thousands of state and local governments – sued drugmakers, wholesalers, pharmacies and other businesses starting in the last decade over the toll of an opioid crisis that has now been linked to more than 900,000 deaths in the U.S. since 1999.
The companies have so far reached settlements worth nearly $58 billion, according to a tally kept by Christine Minhee, who runs Opioid Settlement Tracker. Most of the money must be used to address the crisis. For some communities, it's been a struggle to figure out how to use the funds.
About $1.3 billion of the total is going to hundreds of tribes and Alaska Native corporations over time.
The largest of 575 federally recognized tribes, Cherokee Nation was the first to sue opioid manufacturers in 2017. The tribe now has more than 450,000 citizens, many of whom reside in Oklahoma due to federal policies that forced Cherokee people to leave the southeastern United States.
Principal Chief Chuck Hoskin Jr. said Cherokee leaders wanted to take an active role in opioid litigation after missing the chance to do so during a similar series of lawsuits against tobacco companies in the late 1990s.
"There will never be another era in which there's some industry that does damage to the Cherokee Nation, damage to the Cherokee people, where we will be bystanders looking for state legislatures, state attorney[s] general to get us justice," he said.
'Existential effort': Continuing Cherokee culture
The opioid crisis has had three waves: First, prescription pain pills that were the biggest killer, then heroin and for the last decade or so, fentanyl and other synthetic opioids. The opioid-related death rate for Native Americans was similar to that for white Americans until fentanyl took hold; since then, and especially through the coronavirus pandemic, Native Americans have had a higher rate of opioid-related deaths.
It's something Ashley Caudle, a citizen of the Cherokee Nation, saw firsthand while running her small business last year. She would regularly put free Narcan outside her storefront in Stilwell, a small city 20 miles east of Tahlequah.
"I had to restock that thing every week, almost daily," Caudle said.
In the 14 counties that make up Cherokee Nation, more than 1,000 people died between 2020 and 2024. Hoskin Jr. said many of the deaths were in rural areas, where language and culture are often strongest. Investing in behavioral health preserves the lifeblood of the tribe, he said.
"In many ways, our success here is part of an existential effort," Hoskin Jr. said. "Whether what it means to be Cherokee is going to continue on; that's only true if we have people that continue our lifeways and continue to speak our language and pass that down."
![Rolling hills and grazing cattle surround the Cherokee Nation of Oklahoma's new residential and intensive outpatient addiction treatment center. "Even though it's not completed yet, [the facility] is a very tranquil place where you can just anticipate there'll be a lot of healing going on here," Cherokee Nation Principal Chief Chuck Hoskin Jr. said.](https://npr.brightspotcdn.com/dims4/default/97c9ff1/2147483647/strip/true/crop/5146x3169+0+131/resize/880x542!/quality/90/?url=http%3A%2F%2Fnpr-brightspot.s3.amazonaws.com%2Fd5%2Fdd%2F11c07693415aba04d4dd69d25aa3%2F260326cnopioidsettlement12.jpg)
A safe place to recover
Culture is integrated into every part of the new treatment center's design. While choosing the layout, the tribe hosted listening sessions with community members and elders. Cherokee language experts are finalizing a name for the center.
The facility has large windows that offer a view of rolling hills and grazing cattle. It faces the east to greet the rising sun and is a short drive from a sweat lodge. Residential patients will also have access to a stickball court, garden space for traditional foods, a gym and room for meditation.
Skinner said there are typically 50 to 70 tribal citizens who need to be connected to residential treatment each month. Right now, if someone goes to an emergency room, primary care doctor or local clinic and asks for help with substance abuse, the tribe will refer them to a contracted facility, not owned by the tribe.
The new center will be the first of its kind, completely operated by Cherokee Nation, and comes at no cost for tribal citizens.
"I can hardly wait until we have our own," Skinner said.
The new treatment center in Tahlequah will also be one of three locations on the reservation offering intensive outpatient care to Cherokee Nation citizens.
Skinner said the tribe is building a continuum of care, which will include a variety of treatment options, not just inpatient care. When someone returns home to where they were living in active addiction, it can be difficult to stay sober.
"No matter where you're at in your journey to recovery, there's going to be a door, a pathway for you," Skinner said.
Caudle, the Cherokee Nation citizen in Stilwell, also knows people who could have benefited from the resources the tribe is building. Both her mother and brother struggled with substance abuse, which eventually led to their deaths.
When thinking about how the new facility in Tahlequah could have impacted their lives, Caudle said, "I guess there's a lot of 'what ifs' and 'woulda, coulda, shouldas,' and that will never change. But the opportunities that people will have with this facility and the potential is huge."
Caudle continues to find her own ways of healing and is passing this knowledge down to her son, Elliot.
"If he messes up, it's not 'get out of my house. I never want to see you again,'" Caudle said. "[It's] let's pick yourself back up and let's try again. Same concept I want people to embrace as a community."
As the tribe continues to heal from the height of the epidemic, Hoskin Jr. said more culturally competent resources will help tackle the latest challenges Cherokee people face.
"All of it is in service of restoring and repairing injury done by the opioid industry," Hoskin Jr. said.
Associated Press writer Geoff Mulvihill in Haddonfield, New Jersey, contributed to this story.
This article was produced as part of The Associated Press' Global Indigenous Reporting Network, a collaboration of news networks with dedicated Indigenous affairs coverage. KOSU, a public radio station in Oklahoma, is a network partner.
This report was produced by the Oklahoma Public Media Exchange, a collaboration of public media organizations. Help support collaborative journalism by donating at the link at the top of this webpage.
