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Despite being one of the smallest racial/ethnic groups in the State of Hawai‘i (~10–21%), Native Hawaiians have persistently and disparately comprised the largest racial/ethnic group in the state public treatment system (≥43%). One outcome of Hawaiʻi’s history as a colonial subject, is that social institutions of the State became characterized by the imposition of social control emphasizing the maintenance of punishment mediated through the dynamics of state-sanctioned coercion. At both the individual and community level, implications are drawn out to hypothesize that treatment avoidance or community-wide disengagement patterns of help-seeking, is a manifest expression of collective cultural resistance to what has long been regarded by Hawaiian communities as a “haole [foreign] system” of medicine. While cultural interventions imbued with cultural sensitivities remain relevant to improving treatment care, there is a false assumption embedded within the current treatment paradigm, projecting a doctrine of repeated and prolonged calls for cultural competence and cultural humility to correct the status quo of cultural deficiencies in the publicly funded treatment system. This article proposes an alternative theory, arguing that the source of the problem is the existence of a drug treatment superstructure itself, rooted in the historical reproduction of colonial persecution and continued subjugation of Native Hawaiian identity.

The Colonial Character of the Drug Treatment Superstructure: Theorizing Collective Cultural Resistance to Varying Manifestations of Coercive Control