A scoping review of cultural adaptations of substance use disorder treatments across Latinx communities: Guidance for future research and practice

ATICC: a mixed-methods study on addiction, trauma, and immigration among vulnerable young adults in the grand est youth network

BACKGROUND

This research protocol for the study ATICC (Addiction, Trauma and Immigration, prevention and Cross-Cultural support for care with the Grand Est youth network) aims to model the complex interrelations between trauma, substance use behaviors, migration and representations of mental health among vulnerable youth residing in Transitional Housing for Young Adults. This study focuses on a specific and underexplored population, many of whom have experienced traumatic events and/or complex migratory trajectories. The ultimate objective of this research is to develop transferable models of understanding that can inform the design of prevention and support programs tailored to this demographic.

METHODS/DESIGN

We adopt a tripartite methodology approach: (1) a cross-sectional study using standardized questionnaires to identify factors associated with substance use, trauma, and barriers to healthcare access; (2) an in-depth qualitative study based on semi-structured individual interviews with substance users, exploring their subjective experiences and perceptions related to substance use and mental health care; and (3) a longitudinal interventional study involving various configurations of focus groups open to residents of transitional housing structures, aiming to assess the impact of these group sessions on participants' psychological well-being and attitudes toward care. Quantitative analyses will include descriptive and multivariate statistical tests using R, while qualitative data will be analyzed through thematic analysis with NVivo. The effectiveness of the group intervention will be evaluated using pre/post-tests, mixed models, and appropriate statistical corrections.

DISCUSSION

Analyses are expected to identify key psychosocial factors influencing addictive behaviors and mental health, highlight cultural and structural barriers to care, and assess the psychological benefits of the group intervention. The ATICC study aims to contribute to the development of culturally adapted prevention and support models for young adults in precarious situations. The results should assist healthcare professionals and policymakers in designing evidence-based interventions that effectively address the specific needs of this population.

TRIAL REGISTRATION

This study is registered with the Biomedical Research Identification Number (n°ID-RCB) assigned in France by the National Agency for the Safety of Medicines and Health Products (ANSM): 2024-A01534-43, and have received the approval from the committee for the protection of persons (CPP) Ile-de-France on November 18, 2024. Cette étude a également été déposée sur clinicaltrials (NCT06922721, date assigned April 10, 2025).

Sociocultural context of SMART recovery in Singapore: A qualitative exploration of members and facilitators perspectives and experiences

INTRODUCTION

Various services and mutual-aid groups, such as SMART Recovery, provide support for substance use rehabilitation in Singapore. Despite this, substance use remains a growing public health concern with a large treatment gap. This suggests potential barriers to accessing substance use treatment unique to Singapore's sociocultural context. Culture can play a significant role in shaping members' experiences. Hence, this study sought to explore members' and facilitators' experiences and perspectives of SMART Recovery within Singapore's sociocultural context.

METHODS

A critical realist position guided the present study. Semi-structured, in-depth interviews were conducted with 18 participants (14 members and 4 facilitators) in 2023. Data were analysed using reflexive thematic analysis.

RESULTS

Five themes were generated from the data: (i) Non-disclosure from fear of negative social evaluation; (ii) Stigma and shame surrounding the use of substances; (iii) Linguistic challenges as a barrier to participation; (iv) A 'second family' fostered through continued engagement with SMART Recovery; and (v) Facilitation approach and quality affected by sociocultural factors (e.g., sensitivity to relational cues). Although there were initial sociocultural challenges, this improved through continued engagement, and the experience of SMART Recovery was largely positive. Facilitators also identified that their facilitation style is influenced by sociocultural factors, which in turn affects members' experience of SMART Recovery.

DISCUSSION AND CONCLUSIONS

Members and facilitators in Singapore face sociocultural challenges that influence their experience of SMART Recovery. This study highlights the need to optimise services to the needs of this population. Future research can identify processes of change that foster members' engagement in SMART Recovery.

The relationship between patient-centred care for substance use disorders and patient outcomes: A scoping review

BACKGROUND

Patient-centred care (PCC) is considered crucial for high-quality substance use disorder (SUD) treatment and care, but it is unclear whether PCC is associated with enhanced outcomes. This review aimed to map available evidence of the relationship between PCC and outcomes across the SUD treatment continuum.

METHODS

We conducted a scoping review of the literature on the relationship between PCC for SUD and service outcomes in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) guidelines. Six electronic databases were searched for peer-reviewed articles published in English between January 1994 and June 2024. After screening 5268 titles and abstracts and 186 full texts in duplicate, data were extracted from 135 articles and narratively synthesized according to six PCC dimensions (therapeutic alliance, shared decision-making, personalised supports, integrated care for co-occurring disorders, trauma-informed and culturally-informed care).

RESULTS

The findings from this review suggest largely positive associations between these PCC components and the outcomes of generalist and specialist SUD services. Few studies (<1 %) assessed more than one PCC dimension. The therapeutic alliance was the most frequently assessed dimension (35.6 %, 48/135 articles), followed by shared decision-making (16.3 %, 22/135 articles), trauma-informed care (14.8 %, 20/135 articles), integrated care (13.3 %, 18/135 articles), and personalised services (13.3 %, 18/135 articles). PCC in generalist services was associated with greater SUD treatment utilization and fewer adverse events. PCC in specialist SUD treatment was largely associated with better SUD outcomes.

CONCLUSIONS

This review highlighted evidence gaps on the relationship between PCC and SUD service outcomes, with literature scant for some PCC dimensions and studies typically examining a single dimension of PCC. More research is needed to understand the relative importance of each PCC dimension for predicting SUD service outcomes, how these dimensions interact to influence outcomes, and to develop and evaluate interventions for enhancing PCC.

Systematic Review of Cocaine-Treatment Interventions for Black Americans

Evidence-based drug treatment studies that have shaped best practice in the United States demonstrate racial differences in effectiveness, with Black participants reporting worse outcomes compared to White participants. There are disproportionate cocaine-related overdose deaths impacting Black Americans, with limited information about interventions that serve them best. Culturally tailored treatment approaches, which incorporate participants' salient identities and experiences, have shown effectiveness in meta-analyses. Thus, this qualitative systematic review used PRISMA guidelines to identify both culturally universal and culturally tailored treatment intervention studies that addressed cocaine outcomes among Black Americans. 402 articles met initial criteria, 330 were reviewed by independent coders, and k=30 treatment approaches are described in the paper. Results indicate 72% of culturally tailored interventions were effective at reducing cocaine use, compared to 47% of culturally universal interventions. Implications for provision and funding of effective cocaine treatment interventions for Black Americans are critical to researchers, practitioners, and policymakers alike.

Services Provided in Spanish in Substance Use Disorder Treatment Facilities: Limited Access in Communities with Fast-Growing Spanish-Speaking Populations

Substance use disorder (SUD) is increasing among primary Spanish-speaking populations, and treatment use is disproportionately low. Patient-provider Spanish language concordance is associated with SUD treatment initiation and better outcomes. Recent geographic shifts within primary Spanish-speaking populations are important considerations in identifying gaps in SUD service delivery in Spanish. This national epidemiologic study used the Mental Health and Addiction Treatment Tracking Repository (2022; N = 9336 facilities) and US census data to pinpoint the location of SUD treatment facilities that offer services in Spanish, and used multilevel models to determine whether access to Spanish services is keeping up with the influx of primary Spanish-speaking populations in new areas that have not historically had a large Spanish language presence. Twenty-two percent of SUD treatment facilities provided services in Spanish. For every 10% increase in the percentage of a census tract speaking Spanish, the odds of SUD treatment facilities offering services in Spanish increased by 30% (aOR = 1.03, 95% CI = 1.02-1.04, p < 0.0001), indicating that Spanish language services were more common in places where people who speak Spanish already live. In contrast, the study team identified no association between the availability of Spanish services and increases in community-level Spanish between 2010 and 2022 (aOR = 1.00, 95% CI = 0.99-1.01, p = 0.87), indicating that access to services is not keeping up with demand as populations move and the Spanish language grows in new areas. SUD treatment services are lagging behind as the location of where primary Spanish-speaking families choose to live changes. Local health policies and ambitious interventions are needed that target the unique needs of SUD treatment clients who speak Spanish.

A Scoping Study of Cultural Adaptation Frameworks

Translating evidence-based intervention in public health is important to improve health behaviors and other outcomes and reduce health disparities. Culturally adapting intervention is one approach to reaching different cultural groups. The goals of this paper were to compile definitions of program adaptations, identify processes and steps in cultural adaptations, and pose recommendations for future research related to cultural adaptations. We performed a scoping review of cultural adaptation frameworks or models for public health. Studies were coded for definitions of adaptation, cultural adaptation, other cultural concepts, process steps, community engagement, and public health topic. We found 15 frameworks that described cultural adaptation concepts and processes, and nine had varying definitions of cultural adaptations. All frameworks included tasks of information gathering about the community and developing a preliminary adapted program; over 50% had making refinements to the adapted program after some pilot testing. Only one framework mentioned the role of experts in the adaptation or enhancement process, and one mentioned dissemination. Thirteen articles (86.7%) reported the inclusion of community engagement in the adaptation process. These data present key definitions related to cultural adaptation and themes related to the process of cultural adaptation. We also report on key steps for conducting cultural adaptations. Findings can be utilized to guide future adaptations of evidence-based interventions to ensure culturally competent research and practice.

The role of sociocultural factors on alcohol self-efficacy and protective drinking behaviors among Hispanic/Latinx young adults

OBJECTIVES

Hispanic/Latinx drinkers have been found to experience more adverse alcohol-related consequences than any other racial/ethnic group. Due to this, researchers have looked at the connection between drinking and cultural factors, alongside discrimination, to further analyze what sociocultural factors lead to negative outcomes when drinking.

DESIGN

Researchers used a sample of Hispanic/Latinx young adult drinkers (n = 710) with an average age of 22.43 (SD = 6.69), recruited through social media and assessed on several factors, including protective behavioral strategies (PBS), alcohol use severity, bicultural self-efficacy, discrimination, acculturation, and enculturation.

RESULTS

Utilizing an observed variable path analysis, results showed perceived discrimination to have a significant effect on all variables in the model (bicultural self-efficacy, acculturation, enculturation, PBS self-efficacy, PBS use, and alcohol use severity). Acculturation was positively associated with PBS self-efficacy, while enculturation was positively associated with PBS use. PBS self-efficacy was positively correlated with PBS use and negatively associated with alcohol use severity. There was a significant total indirect effect from perceived discrimination to alcohol use severity through various paths (i.e. PBS self-efficacy, acculturation, and bicultural self-efficacy), with the strongest path to occur through PBS self-efficacy.

CONCLUSIONS

Findings showcase the risk and protective effects of various sociocultural factors on drinking behaviors among young adults. PBS self-efficacy was found to have robust protective effects against alcohol use severity. Future research should continue to investigate these sociocultural and behavioral factors in order to develop efforts to mitigate hazardous alcohol use among Hispanic/Latinx young adult drinkers.

Computer-based training for cognitive behavioral therapy for Spanish-speaking substance users: adaptation and satisfaction

There are few available culturally and linguistically adapted behavioral health interventions for substance use among Spanish-speaking adults. The authors describe the cultural adaptation of an innovative computer-based training for cognitive behavioral therapy program (CBT4CBT). Based in cognitive-behavioral skills training, CBT4CBT utilizes a telenovela to teach monolingual Spanish-speaking adults who have migrated to the United States to recognize triggers; avoid these situations; and cope more effectively with the consequences of substance use. Participants endorsed high levels of satisfaction with the program content and found the material to be easy to understand and relevant to their life experiences.

Designing and testing treatments for alcohol use disorder

This chapter provides a succinct overview of several recommendations for the design and analysis of treatments for AUD with a specific focus on increasing rigor and generalizability of treatment studies in order to increase the reach of AUD treatment. We recommend that researchers always register their trials in a clinical trial registry and make the protocol accessible so that the trial can be replicated in future work, follow CONSORT reporting guidelines when reporting the results of the trial, carefully describe all inclusion and exclusion criteria as well as the randomization scheme, and always use an intent to treat design with attention to analysis of missing data. In addition, we recommend that researchers pay closer attention to recruitment and engagement strategies that increase enrollment and retention of historically marginalized and understudied populations, and we end with a plea for more consideration of implementation science approaches to increase the dissemination and implementation of AUD treatment in real-world settings.

"Knowing I Had Someone to Turn to Was a Great Feeling": Mentoring Rural-Appalachian STEM Students

Post-secondary students benefit from mentorships, which provide both emotional and academic support tailored to the unique challenges they face. STEM students, and, in particular, those with historically marginalized identities, have unique strengths and face distinct barriers that can be ameliorated by careful, knowledgeable, and well-situated mentoring relationships. With that in mind, we conducted a narrative case study with 10 rural-Appalachian STEM majors enrolled in an NSF-funded mentoring program, intending to collect stories of their impactful experiences with their mentors. We utilized the narrative reconstruction process, and, in so doing, identified five major themes related to the importance of mentor assignment and the impact of mentors' characteristics and skills related to empathy, consistency, active listening, and teaching. We situate our findings within the existing literature and provide implications for scholars and practitioners who work with mentoring programs dedicated to working with Appalachian communities.

The relative contribution of ethnic identity and ethnic discrimination on alcohol, tobacco, and other drug use disorders among Hispanic/Latin American individuals

INTRODUCTION

Racial/ethnic discrimination and ethnic identity, the affiliation and connection to one's ethnic group, are important for understanding alcohol, tobacco, and drug use disorders (AUD, TUD, DUD, respectively) among Hispanic/Latin American individuals. Although discrimination is a well-recognized risk factor, the role of ethnic identity is less understood. Moreover, no study has examined which of these factors is more important for informing AUD, TUD, and DUD. This information is necessary for creating effective prevention and treatment programs tailored for Hispanic/Latin American people. Herein we examined the role and relative importance of racial/ethnic discrimination and Hispanic ethnic identity on past year AUD, TUD, and DUD.

METHODS

Hispanic/Latin American participants of the National Epidemiologic Survey on Alcohol and Related Conditions-III constituted the sample for this cross-sectional secondary data analysis. Participants (N = 7037) were 39.93 years old on average (SD = 15.32). More than half were female (56.1 %) and had family incomes below the median household income in the United States (58.7 %). Most had national origins in North America (79.3 %), including US dependent territories and Mexico. Confirmatory factor analysis (CFA) verified the psychometric properties of the discrimination and Hispanic ethnic identity measures. Logistic regressions, supplemented with dominance analysis, estimated the role and relative contribution of discrimination and Hispanic ethnic identity on the probability of past year AUD, TUD, and DUD.

RESULTS

The CFAs yielded adequate convergent validity and reliability for each construct. More racial/ethnic discrimination and a higher Hispanic ethnic identity related to a higher and lower probability of AUD, TUD, and DUD, respectively. The magnitude of the association between Hispanic ethnic identity and the probability of TUD exceeded that of racial/ethnic discrimination, but the converse was the case for AUD and DUD.

CONCLUSIONS

Prevention and treatment programs for TUD that highlight the value of having a strong sense of self as a member of a Hispanic ethnic group, and that encourage the individual to explore their Hispanic ancestry may prove effective among Hispanic/Latin American individuals, particularly those who have experienced racial/ethnic discrimination. Programs for AUD and DUD tailored for Hispanic Latin/American adults should also incorporate coping strategies to address experiences with racial/ethnic discrimination.

Substance Use Disorders in Women

Substance use disorder (SUD) is among the leading causes of premature morbidity and mortality and imposes significant health, economic, and social burdens. Gender differences have been found in the development, course, and treatment of SUD, with women at increased risk for physiologic and psychosocial consequences compared with men. Reasons for these differences are multifold and include biological, genetic, environmental, and behavioral factors. This article discusses SUD among women, emphasizing clinical considerations for care. Specific topics include epidemiology, sex and gender differences, common comorbidities, screening, diagnosis, treatment, pregnancy, and sociocultural factors.

Stability and change in acculturation-related characteristics in older Latinos: Implications for culturally compatible ADRD research

Introduction

Acculturation-related characteristics, that is, factors directly connected to culture and familial relationships, are associated with engaged research participation within Latino communities. Despite this, little empirical data exists on whether acculturation changes over time in older Latinos, which has potential implications for Alzheimer's disease and related dementias (ADRD) research study design including longer duration clinical trial implementation.

Methods

Self-identified Latinos (n = 222; mean age = 71, 76% female) participating in one of three ongoing longitudinal community-based cohort studies of aging who reported their nativity outside of the United States/District of Columbia (US/DC) contributed, on average, 4.0 ± 1.2 years of annually collected data. This included acculturation-related characteristics of total, language-, and social-based scores from the Short Acculturation Scale for Hispanics (SASH) and total and domain-specific scores from an abbreviated Sabogal Familism questionnaire. We used ordinal mixed effects models and linear mixed effects models (as appropriate) to assess change in acculturation metrics after adjusting for age, sex, education, income, and duration of time in the US/DC.

Results

Although none of the SASH metrics changed over time (P-values ≥ 0.25), all Familism metrics declined over time (P-values ≤ 0.044). Additionally, select participant-based characteristics including years of education were significantly (and differentially) associated with level of, but not change in, acculturation-related outcomes.

Discussion

Results suggest that specific acculturation-related factors (i.e., familism) change over time in older Latinos, and participant-based characteristics associated with baseline levels of (but not change in) acculturation more generally. Thus, acculturation-related characteristics are not all static, trait-like qualities but rather a multi-faceted, and at times evolving, construct. Considering this dynamic phenotyping is important when contextualizing older Latinos' lived experience, and when designing, adapting, and conducting ADRD clinical trials and other health-related interventions.

Centering culture in the treatment of opioid use disorder with American Indian and Alaska Native Communities: Contributions from a National Collaborative Board

American Indian/Alaska Native (AI/AN) communities are disproportionally impacted by the opioid overdose epidemic. There remains a dearth of research evaluating methods for effectively implementing treatments for opioid use disorder (OUD) within these communities. We describe proceedings from a 2-day Collaborative Board (CB) meeting tasked with developing an implementation intervention for AI/AN clinical programs to improve the delivery of medications to treat OUD (MOUD). The CB was comprised of Elders, cultural leaders, providers, individuals with lived experience with OUD, and researchers from over 25 communities, organizations, and academic institutions. Conversations were audio-recorded, transcribed, and coded by two academic researchers with interpretation oversight provided by the CB. These proceedings provided a foundation for ongoing CB work and a frame for developing the program-level implementation intervention using a strength-based and holistic model of OUD recovery and wellbeing. Topics of discussion posed to the CB included engagement and recovery strategies, integration of extended family traditions, and addressing stigma and building trust with providers and clients. Integration of traditional healing practices, ceremonies, and other cultural practices was recommended. The importance of centering AI/AN culture and involving family were highlighted as priorities for the intervention.