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Campbell ANC, Rieckmann T, Pavlicova M, Choo TH, Molina K, McDonell M, West AE, Daw R, Marsch LA, Venner KL. Culturally tailored digital therapeutic for substance use disorders with urban Indigenous people in the United States: A randomized controlled study. JOURNAL OF SUBSTANCE USE AND ADDICTION TREATMENT 2023; 155:209159. [PMID: 37690525 PMCID: PMC10872747 DOI: 10.1016/j.josat.2023.209159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 06/15/2023] [Accepted: 09/07/2023] [Indexed: 09/12/2023]
Abstract
INTRODUCTION Indigenous people experience health disparities, including higher rates of substance use disorders (SUDs). Digital therapeutics are a growing platform for treatment services and have the potential to expand access to culturally responsive interventions for Indigenous people. As one of the first randomized controlled trials for SUDs for American Indian and Alaska Native (AI/AN) adults, the aim of this study was to pilot test the efficacy of a culturally tailored intervention among urban Indigenous adults. METHODS The study used a randomized controlled parallel design of 12 weeks of treatment-as-usual (TAU) (n = 26) versus TAU + Therapeutic Education System-Native Version (TES-NAV) (n = 27) with follow-up assessments at end of treatment and week 24 in an urban outpatient addiction treatment program for Native American adults. TAU consisted of individual/group counseling and cultural activities. The TES-NAV arm comprised TAU + 26 self-directed culturally tailored digital skills-based modules grounded in the community reinforcement approach with contingency management for abstinence and module completion. Primary outcome was longest consecutive weeks of abstinence from drugs and heavy drinking measured using self-report (Timeline Followback) and urine alcohol and drug toxicology screen during 12 weeks of treatment. Secondary outcomes were percent days abstinence during and posttreatment, coping strategies, social connectedness, and substance use and sexual risk behaviors. RESULTS The study enrolled fifty-three (52.8 % male) AI/AN adults seeking treatment for a SUD. Although the study did not detect a benefit of TAU+TES-NAV over TAU on the primary outcome (Median = 2 consecutive weeks of abstinence for both arms) at end of treatment (treatment effect: Z = -0.78, p = 0.437), TAU+TES-NAV participants did demonstrate significantly greater percent days of abstinence at the week 24 follow-up (69.3 % versus 49.0 % for TAU; t = 2.08, p = 0.045) and significantly greater change in social connectedness mean score, baseline to week 12 (Z = -2.66, p = 0.011), compared to TAU. The study detected no differences between treatment arms for coping strategies or risk behaviors. CONCLUSION The addition of TES-NAV to TAU did not significantly improve consecutive weeks of abstinence from drugs or heavy drinking; however, several secondary findings suggest promise for a culturally tailored digital therapeutic SUD intervention among urban Indigenous people. CLINICAL TRIALS GOV REGISTRATION: #NCT03363256.
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Affiliation(s)
- Aimee N C Campbell
- Department of Psychiatry, Columbia University Irving Medical Center and New York State Psychiatric Institute, 1051 Riverside Drive Box 120, New York, NY 10032, USA.
| | - Traci Rieckmann
- School of Medicine, Oregon Health & Science University, 3015 NE 44th Ave, Portland, OR 97213, USA
| | - Martina Pavlicova
- Department of Biostatistics, Columbia University Mailman School of Public Health, 722 W. 168th St, 6th floor, Room 635, New York, NY 10032, USA
| | - Tse-Hwei Choo
- Department of Psychiatry, Columbia University Irving Medical Center and New York State Psychiatric Institute, 1051 Riverside Drive Box 120, New York, NY 10032, USA
| | - Kelly Molina
- Native American Rehabilitation Association of the Northwest, Inc., 1631 SW Columbia St, Portland, OR 97201, USA
| | - Michael McDonell
- Elson S. Floyd College of Medicine, Washington State University, 412 E. Spokane Falls Blvd, Spokane, WA 99202, USA
| | - Amy E West
- Children's Hospital Los Angeles, Keck School of Medicine, University of Southern California, 4640 W. Sunset Blvd, Los Angeles, CA 90027, USA
| | | | - Lisa A Marsch
- Center for Technology and Behavioral Health, Geisel School of Medicine, Dartmouth College, 1 Rope Ferry Rd, Hanover, NH 03755, USA
| | - Kamilla L Venner
- Department of Psychology and Center on Alcohol Substance use & Addiction (CASAA), University of New Mexico, 1 University of New Mexico, MSC03 2220, Albuquerque, NM 87131, USA
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Crouch MC, Venner KL, Wendt DC, Burlew AK, Baukol P, Funaro MC, Sorrell T, Haeny AM. Lessons learned and future directions: A scoping review of American Indian and Alaska Native participants in the National Drug Abuse Treatment Clinical Trials Network. JOURNAL OF SUBSTANCE USE AND ADDICTION TREATMENT 2023; 153:209081. [PMID: 37230391 PMCID: PMC10529616 DOI: 10.1016/j.josat.2023.209081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 02/09/2023] [Accepted: 05/18/2023] [Indexed: 05/27/2023]
Abstract
INTRODUCTION American Indian and Alaska Native (AI/AN) populations are disproportionately affected by substance use disorders (SUDs) and related health disparities in contrast to other ethnoracial groups in the United States. Over the past 20 years, substantial resources have been allocated to the National Institute on Drug Abuse Clinical Trials Network (CTN) to disseminate and implement effective SUD treatments in communities. However, we know little about how these resources have benefitted AI/AN peoples with SUD who arguably experience the greatest burden of SUDs. This review aims to determine lessons learned about AI/AN substance use and treatment outcomes in the CTN and the role of racism and Tribal identity. METHOD We conducted a scoping review informed by the Joanna Briggs framework and PRISMA Extension for Scoping Reviews checklist and explanation. The study team conducted the search strategy within the CTN Dissemination Library and nine additional databases for articles published between 2000 and 2021. The review included studies if they reported results for AI/AN participants. Two reviewers determined study eligibility. RESULTS A systematic search yielded 13 empirical articles and six conceptual articles. Themes from the 13 empirical articles included: (1) Tribal Identity: Race, Culture, and Discrimination; (2) Treatment Engagement: Access and Retention; (3) Comorbid Conditions; (4) HIV/Risky Sexual Behaviors; and (5) Dissemination. The most salient theme was Tribal Identity: Race, Culture, and Discrimination, which was present in all articles that included a primary AI/AN sample (k = 8). Themes assessed but not identified for AI/AN peoples were Harm Reduction, Measurement Equivalence, Pharmacotherapy, and Substance Use Outcomes. The conceptual contributions used AI/AN CTN studies as exemplars of community-based and Tribal participatory research (CBPR/TPR). CONCLUSION CTN studies conducted with AI/AN communities demonstrate culturally congruent methods, including CBPR/TPR strategies; consideration/assessment of cultural identity, racism, and discrimination; and CBPR/TPR informed dissemination plans. Although important efforts are underway to increase AI/AN participation in the CTN, future research would benefit from strategies to increase participation of this population. Such strategies include reporting AI/AN subgroup data; addressing issues of cultural identity and experiences of racism; and adopting an overall effort for research aimed at understanding barriers to treatment access, engagement, utilization, retention, and outcomes for both treatment and research disparities for AI/AN populations.
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Affiliation(s)
- Maria C Crouch
- Yale University School of Medicine, 333 Cedar St, New Haven, CT 06510, United States.
| | - Kamilla L Venner
- University of New Mexico, 1 University of New Mexico, MSC03 2220, Albuquerque, NM 87131-0001, United States
| | - Dennis C Wendt
- McGill University, 3700 McTavish St., Room 614, Montreal, QC H3A 1Y2, Canada
| | - Ann Kathleen Burlew
- University of Cincinnati, 2600 Clifton Ave., Cincinnati, OH 45220, United States
| | - Paulette Baukol
- Berman Center for Outcomes & Clinical Research, 701 Park Ave., Suite PP7.700, Minneapolis, MN 55415, United States
| | - Melissa C Funaro
- Harvey Cushing/John Hay Whitney Medical Library, Yale University, 333 Cedar St, New Haven, CT 06510, United States
| | - Tanya Sorrell
- Rush University Medical Center, 1645 W Jackson Blvd, Westgate Building, Suite 600, Chicago, IL 60612, United States
| | - Angela M Haeny
- Yale University School of Medicine, 333 Cedar St, New Haven, CT 06510, United States
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P Hong PY, Kim SH, Marley J, Park JH. Transforming Impossible into Possible (TIP) for SUD recovery: A promising practice innovation to combat the opioid crisis. SOCIAL WORK IN HEALTH CARE 2021; 60:509-528. [PMID: 34414853 DOI: 10.1080/00981389.2021.1958127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Accepted: 07/15/2021] [Indexed: 06/13/2023]
Abstract
The purpose of this study is to examine the psychological self-sufficiency (PSS) process among low-income individuals participating in the Transforming Impossible into Possible (TIP) program and explore the implications of TIP as a SUD recovery intervention. A sample of 622 individuals from 9 local job training programs in a large Midwestern city was used to examine the group differences in substance abuse barrier and employment hope as they relates to economic self-sufficiency (ESS). Individuals in the TIP program (n = 315) had statistically significant path coefficients between substance abuse barriers, employment hope and ESS while the non-TIP counterpart (n = 307) showed a significant path only between employment hope and ESS. Also, the time difference score in substance abuse barrier and ESS was greater for the TIP group compared to the non-TIP comparison group. Results provide implications for social work practice among persons with SUDs. While the traditional employment programs focused only on the interview and job skills, TIP allowed participants to discover their resources to address the inner obstacles that have been holding them back. TIP could serve as a promising model to treat SUDs and support the recovery process.
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Affiliation(s)
| | - Suk-Hee Kim
- School of Social Work, Northern Kentucky University, Highland Heights, KY, USA
| | - James Marley
- School of Social Work, Loyola University Chicago, Chicago, IL, USA
| | - Jang Ho Park
- School of Social Work, Loyola University Chicago, Chicago, IL, USA
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McDonell MG, Hirchak KA, Herron J, Lyons AJ, Alcover KC, Shaw J, Kordas G, Dirks LG, Jansen K, Avey J, Lillie K, Donovan D, McPherson SM, Dillard D, Ries R, Roll J, Buchwald D. Effect of Incentives for Alcohol Abstinence in Partnership With 3 American Indian and Alaska Native Communities: A Randomized Clinical Trial. JAMA Psychiatry 2021; 78:599-606. [PMID: 33656561 PMCID: PMC7931140 DOI: 10.1001/jamapsychiatry.2020.4768] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Accepted: 12/18/2020] [Indexed: 12/28/2022]
Abstract
Importance Many American Indian and Alaska Native communities are disproportionately affected by problems with alcohol use and seek culturally appropriate and effective interventions for individuals with alcohol use disorders. Objective To determine whether a culturally tailored contingency management intervention, in which incentives were offered for biologically verified alcohol abstinence, resulted in increased abstinence among American Indian and Alaska Native adults. This study hypothesized that adults assigned to receive a contingency management intervention would have higher levels of alcohol abstinence than those assigned to the control condition. Design, Setting, and Participants This multisite randomized clinical trial, the Helping Our Native Ongoing Recovery (HONOR) study, included a 1-month observation period before randomization and a 3-month intervention period. The study was conducted at 3 American Indian and Alaska Native health care organizations located in Alaska, the Pacific Northwest, and the Northern Plains from October 10, 2014, to September 2, 2019. Recruitment occurred between October 10, 2014, and February 20, 2019. Eligible participants were American Indian or Alaska Native adults who had 1 or more days of high alcohol-use episodes within the last 30 days and a current diagnosis of alcohol dependence. Data were analyzed from February 1 to April 29, 2020. Interventions Participants received treatment as usual and were randomized to either the contingency management group, in which individuals received 12 weeks of incentives for submitting a urine sample indicating alcohol abstinence, or the control group, in which individuals received 12 weeks of incentives for submitting a urine sample without the requirement of alcohol abstinence. Regression models fit with generalized estimating equations were used to assess differences in abstinence during the intervention period. Main Outcomes and Measures Alcohol-negative ethyl glucuronide (EtG) urine test result (defined as EtG<150 ng/mL). Results Among 1003 adults screened for eligibility, 400 individuals met the initial criteria. Of those, 158 individuals (39.5%; mean [SD] age, 42.1 [11.4] years; 83 men [52.5%]) met the criteria for randomization, which required submission of 4 or more urine samples and 1 alcohol-positive urine test result during the observation period before randomization. A total of 75 participants (47.5%) were randomized to the contingency management group, and 83 participants (52.5%) were randomized to the control group. At 16 weeks, the number who submitted an alcohol-negative urine sample was 19 (59.4%) in the intervention group vs 18 (38.3%) in the control group. Participants randomized to the contingency management group had a higher likelihood of submitting an alcohol-negative urine sample (averaged over time) compared with those randomized to the control group (odds ratio, 1.70; 95% CI, 1.05-2.76; P = .03). Conclusions and Relevance The study's findings indicate that contingency management may be an effective strategy for increasing alcohol abstinence and a tool that can be used by American Indian and Alaska Native communities for the treatment of individuals with alcohol use disorders. Trial Registration ClinicalTrials.gov Identifier: NCT02174315.
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Affiliation(s)
- Michael G. McDonell
- Department of Medical Education and Clinical Sciences, Elson S. Floyd College of Medicine, Washington State University, Spokane
- Program of Excellence in Addictions Research, Washington State University, Spokane
- Institute for Research and Education to Advance Community Health, Washington State University, Spokane
| | - Katherine A. Hirchak
- Department of Medical Education and Clinical Sciences, Elson S. Floyd College of Medicine, Washington State University, Spokane
- Program of Excellence in Addictions Research, Washington State University, Spokane
| | - Jalene Herron
- Center on Alcoholism, Substance Abuse and Addictions, University of New Mexico, Albuquerque
- Department of Psychology, University of New Mexico, Albuquerque
| | - Abram J. Lyons
- Department of Medical Education and Clinical Sciences, Elson S. Floyd College of Medicine, Washington State University, Spokane
- Program of Excellence in Addictions Research, Washington State University, Spokane
| | - Karl C. Alcover
- Department of Medical Education and Clinical Sciences, Elson S. Floyd College of Medicine, Washington State University, Spokane
- Program of Excellence in Addictions Research, Washington State University, Spokane
| | | | - Gordon Kordas
- Department of Medical Education and Clinical Sciences, Elson S. Floyd College of Medicine, Washington State University, Spokane
- Program of Excellence in Addictions Research, Washington State University, Spokane
| | | | | | | | | | - Dennis Donovan
- Alcohol and Drug Abuse Institute, University of Washington, Seattle
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle
| | - Sterling M. McPherson
- Department of Medical Education and Clinical Sciences, Elson S. Floyd College of Medicine, Washington State University, Spokane
- Program of Excellence in Addictions Research, Washington State University, Spokane
- Institute for Research and Education to Advance Community Health, Washington State University, Spokane
| | | | - Richard Ries
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle
| | - John Roll
- Department of Medical Education and Clinical Sciences, Elson S. Floyd College of Medicine, Washington State University, Spokane
- Program of Excellence in Addictions Research, Washington State University, Spokane
| | - Dedra Buchwald
- Department of Medical Education and Clinical Sciences, Elson S. Floyd College of Medicine, Washington State University, Spokane
- Institute for Research and Education to Advance Community Health, Washington State University, Spokane
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Venner KL, Serier K, Sarafin R, Greenfield BL, Hirchak K, Smith JE, Witkiewitz K. Culturally tailored evidence-based substance use disorder treatments are efficacious with an American Indian Southwest tribe: an open-label pilot-feasibility randomized controlled trial. Addiction 2021; 116:949-960. [PMID: 32667105 DOI: 10.1111/add.15191] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Revised: 02/04/2020] [Accepted: 07/07/2020] [Indexed: 12/21/2022]
Abstract
BACKGROUND AND AIMS Many evidence-based treatments (EBTs) for substance use disorder (SUD) exist, yet few are tailored to Indigenous patients. This trial tested the efficacy of a culturally tailored EBT that combined Motivational Interviewing and the Community Reinforcement Approach (MICRA) versus treatment as usual (TAU). DESIGN A mixed efficacy/effectiveness randomized controlled trial of MICRA (n = 38) and TAU (n = 41) using a parallel design with follow-up assessments at 4-, 8-, and 12- months post baseline. SETTING United States, reservation-based outpatient, addiction specialty care treatment program. PARTICIPANTS 79 (68% male) American Indian and Alaska Native (AI/AN) Tribal members meeting criteria for SUD and seeking SUD treatment. INTERVENTIONS MICRA (individual therapy sessions beginning with MI for 2-3 sessions) compared with TAU (individual and group counseling sessions in a didactic style with Twelve-Step philosophy and elements of relapse prevention). MEASURES Demographics, percent days abstinent (PDA; the primary outcome at 12months assessed by Form 90D), Inventory of Drug Use Consequences, Alcohol and Drug Use Self-Efficacy Scale, Native American Spirituality Scale, and SCID-DSM-IV-TR. FINDINGS There was no evidence for the benefit of MICRA over TAU (MICRA PDA = 72.63%, TAU = 73.62%, treatment effect: B = -4.04 (SE = 5.47); 95% CI = -14.941, 6.866; BF = 3.44) in the primary outcome. Both groups showed improvements in PDA, SUD severity, and negative consequences from baseline to the 12-month follow-up. Neither self-efficacy nor spirituality were significant mediators of MICRA. CONCLUSIONS There were no treatment group differences between culturally tailored evidence-based treatments for substance use disorder and treatment as usual in this randomized controlled trial with American Indian and Alaska Native participants. Nonetheless, participants improved over time on several substance-related outcomes.
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Affiliation(s)
- Kamilla L Venner
- Department of Psychology, University of New Mexico, Albuquerque, New Mexico, USA
- Center on Alcoholism, Substance Abuse, and Addiction, Albuquerque, New Mexico, USA
| | - Kelsey Serier
- Department of Psychology, University of New Mexico, Albuquerque, New Mexico, USA
| | - Ruth Sarafin
- Department of Psychology, University of New Mexico, Albuquerque, New Mexico, USA
| | | | - Katherine Hirchak
- Center on Alcoholism, Substance Abuse, and Addiction, Albuquerque, New Mexico, USA
| | - Jane Ellen Smith
- Department of Psychology, University of New Mexico, Albuquerque, New Mexico, USA
| | - Katie Witkiewitz
- Department of Psychology, University of New Mexico, Albuquerque, New Mexico, USA
- Center on Alcoholism, Substance Abuse, and Addiction, Albuquerque, New Mexico, USA
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Hirchak KA, Hernandez-Vallant A, Herron J, Cloud V, Tonigan JS, McCrady B, Venner K. Aligning three substance use disorder interventions among a tribe in the Southwest United States: Pilot feasibility for cultural re-centering, dissemination, and implementation. J Ethn Subst Abuse 2020; 21:1-17. [PMID: 33135985 PMCID: PMC8095342 DOI: 10.1080/15332640.2020.1836701] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
In this article we describe cultural re-centering, dissemination, and implementation activities in partnership between an American Indian reservation community and a university in the Southwest United States. We offer examples of cultural adaptation and implementation of evidence-based treatments (e.g., Motivational Interviewing, Community Reinforcement Approach and the Community Reinforcement and Family Training) using the Interactive Systems Framework. Facilitators and barriers are described within each study including recruitment strategies, training, and sustainability of counselors in the community. Through this Tribal-university partnership, we offer insight on the cultural adaptation and implementation process that will be translatable and clinically meaningful to other rural and reservation communities.
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Affiliation(s)
- Katherine A. Hirchak
- Center on Alcoholism, Substance Abuse and Addictions, University of New Mexico, Albuquerque, New Mexico, USA
- Revitalzing Indigenous Values in Empirical Research (RIVER) Lab, Albuquerque, NM, USA
| | - Alexandra Hernandez-Vallant
- Department of Psychology, University of New Mexico, Albuquerque, NM, USA
- Revitalzing Indigenous Values in Empirical Research (RIVER) Lab, Albuquerque, NM, USA
| | - Jalene Herron
- Department of Psychology, University of New Mexico, Albuquerque, NM, USA
- Revitalzing Indigenous Values in Empirical Research (RIVER) Lab, Albuquerque, NM, USA
| | - Violette Cloud
- Department of Psychology, University of New Mexico, Albuquerque, NM, USA
- Revitalzing Indigenous Values in Empirical Research (RIVER) Lab, Albuquerque, NM, USA
| | - J. Scott Tonigan
- Center on Alcoholism, Substance Abuse and Addictions, University of New Mexico, Albuquerque, New Mexico, USA
- Department of Psychology, University of New Mexico, Albuquerque, NM, USA
| | - Barbara McCrady
- Center on Alcoholism, Substance Abuse and Addictions, University of New Mexico, Albuquerque, New Mexico, USA
- Department of Psychology, University of New Mexico, Albuquerque, NM, USA
| | - Kamilla Venner
- Center on Alcoholism, Substance Abuse and Addictions, University of New Mexico, Albuquerque, New Mexico, USA
- Department of Psychology, University of New Mexico, Albuquerque, NM, USA
- Revitalzing Indigenous Values in Empirical Research (RIVER) Lab, Albuquerque, NM, USA
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Venner KL, Greenfield BL, Hagler KJ, Simmons J, Lupee D, Homer E, Yamutewa Y, Smith JE. Pilot Outcome Results of Culturally Adapted Evidence-Based Substance Use Disorder Treatment with a Southwest Tribe. Addict Behav Rep 2016; 3:21-27. [PMID: 26951788 PMCID: PMC4778727 DOI: 10.1016/j.abrep.2015.11.002] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Introduction Although American Indians/Alaska Natives (AI/ANs) have exhibited high rates of alcohol and drug use disorders, there is a paucity of substance use disorder treatment outcome research. In addition, there exists controversy about whether evidence-based treatments (EBTs) are culturally appropriate given that they were derived mainly by and for non-Hispanic White populations and do not explicitly include aspects of AI/AN culture and worldview. Methods In this pilot study, we collaboratively culturally adapted two EBTs, Motivational Interviewing and Community Reinforcement Approach (MICRA), and evaluated substance use and psychological outcomes at 4- and 8-months post-baseline assessment. In preparation for a larger randomized clinical trial (RCT), eight tribal members (75% male) participated in this pilot treatment study. Measures included substance use, urine screens, self-efficacy, psychological distress, and hopelessness. All participants completed follow-up assessments at 4- and 8-months. Due to small sample size, effect sizes were calculated to evaluate outcomes pre- and post-treatment. Results Despite high rates of abstinence at baseline, percent days abstinent (PDA) increased at the 8-month time point for the most commonly used substances (alcohol, Hedges's g = 0.59, and marijuana, g = 0.60) and for all substances combined (excluding tobacco, g = 0.56). Improvements in psychological distress (g = − 0.66) and 5 of the 7 Addiction Severity Index domains (range of g = − 0.42 to − 0.98) also emerged. Conclusions Results suggest that culturally adapted EBTs yield significant improvements in alcohol use, psychological distress, and legal problems among AI/ANs. Future research using RCT methodology is needed to examine efficacy and effectiveness. A pilot study of evidence-based treatment outcomes with American Indians with 8-month follow-ups Medium to large effect sizes for increased percent days abstinent at 4- and 8-month follow-ups Medium to large effect sizes for improvements in psychological distress and 5 of 7 ASI domains. Small effect size for improvement in self-efficacy
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Affiliation(s)
- Kamilla L. Venner
- University of New Mexico, Department of Psychology, 1 University of New Mexico, MSC 03 2220, Albuquerque, NM 87131, United States
- Center on Alcoholism, Substance Abuse, and Addictions, 2650 Yale Blvd. SE, Albuquerque, NM 87106, United States
- Corresponding author at: 1 University of New Mexico, MSC03 2220, Albuquerque, NM 87131, United States.1 University of New Mexico, MSC03 2220AlbuquerqueNM87131United States
| | - Brenna L. Greenfield
- University of Minnesota, Duluth, 1049 University Dr, Duluth, MN 55812, United States
| | - Kylee J. Hagler
- University of New Mexico, Department of Psychology, 1 University of New Mexico, MSC 03 2220, Albuquerque, NM 87131, United States
- Center on Alcoholism, Substance Abuse, and Addictions, 2650 Yale Blvd. SE, Albuquerque, NM 87106, United States
| | - Jeremiah Simmons
- University of New Mexico, Department of Psychology, 1 University of New Mexico, MSC 03 2220, Albuquerque, NM 87131, United States
| | | | | | | | - Jane Ellen Smith
- University of New Mexico, Department of Psychology, 1 University of New Mexico, MSC 03 2220, Albuquerque, NM 87131, United States
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Rosen MI, Ablondi K, Black AC, Mueller L, Serowik KL, Martino S, Mobo BH, Rosenheck RA. Work outcomes after benefits counseling among veterans applying for service connection for a psychiatric condition. Psychiatr Serv 2014; 65:1426-32. [PMID: 25082304 PMCID: PMC4713007 DOI: 10.1176/appi.ps.201300478] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE This study's objective was to determine the efficacy of benefits counseling in a clinical trial. There has been concern that disability payments for psychiatric disorders reduce incentives for employment and rehabilitation. Benefits counseling, with education about opportunities to work and the financial implications of work on receipt of disability benefits, may counter these disincentives. METHODS This single-blind, six-month randomized clinical trial enrolled 84 veterans who had applied for service-connected compensation for a psychiatric condition. Veterans were randomly assigned to either four sessions of benefits counseling or of a control condition involving orientation to the U.S Department of Veterans Affairs health care system and services. Days of paid work and work-related activities were assessed at follow-up visits by using a timeline follow-back calendar. RESULTS Veterans assigned to benefits counseling worked for pay for significantly more days than did veterans in the control group (effect size=.69, p<.05), reflecting an average of three more days of paid employment during the 28 days preceding the six-month follow-up. Benefits counseling was associated with increased use of mental health services, but this correlation did not mediate the effect of benefits counseling on working. CONCLUSIONS Barriers to employment associated with disability payments are remediable with basic counseling. More research is needed to understand the active ingredient of this counseling and to strengthen the intervention.
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Affiliation(s)
- Marc I Rosen
- Dr. Rosen, Ms. Ablondi, Dr. Black, Ms. Serowik, and Dr. Martino are with the Department of Psychiatry, Yale University School of Medicine, New Haven, and with the Department of Psychiatry, U.S. Department of Veterans Affairs (VA) Connecticut Healthcare System, West Haven (e-mail: ). Dr. Rosenheck is with the Department of Psychiatry, Yale University School of Medicine, and with the Mental Illness Research, Education and Clinical Center, VA New England Healthcare System, where Dr. Mueller is affiliated. Dr. Mueller is also with the Edith Nourse Rogers Memorial Veterans Hospital, Bedford, Massachusetts. Dr. Mobo is with the Christiana Care Health System, Newark, Delaware
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Glover M, Kira A, Johnston V, Walker N, Thomas D, Chang AB, Bullen C, Segan CJ, Brown N. A systematic review of barriers and facilitators to participation in randomized controlled trials by Indigenous people from New Zealand, Australia, Canada and the United States. Glob Health Promot 2014; 22:21-31. [PMID: 24842989 DOI: 10.1177/1757975914528961] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
ISSUE Many randomized controlled trials (RCTs) are conducted each year but only a small proportion is specifically designed for Indigenous people. In this review we consider the challenges of participation in RCTs for Indigenous peoples from New Zealand, Australia, Canada and the United States and the opportunities for increasing participation. APPROACH The literature was systematically searched for published articles including information on the barriers and facilitators for Indigenous people's participation in health-related RCTs. Articles were identified using a key word search of electronic databases (Scopus, Medline and EMBASE). To be included, papers had to include in their published work at least one aspect of their RCT that was either a barrier and/or facilitator for participation identified from, for example, design of intervention, or discussion sections of articles. Articles that were reviews, discussions, opinion pieces or rationale/methodology were excluded. Results were analysed inductively, allowing themes to emerge from the data. KEY FINDINGS Facilitators enabling Indigenous people's participation in RCTs included relationship and partnership building, employing Indigenous staff, drawing on Indigenous knowledge models, targeted recruitment techniques and adapting study material. Challenges for participation included both participant-level factors (such as a distrust of research) and RCT-level factors (including inadequately addressing likely participant barriers (phone availability, travel costs), and a lack of recognition or incorporation of Indigenous knowledge systems. IMPLICATION The findings from our review add to the body of knowledge on elimination of health disparities, by identifying effective and practical strategies for conducting and engaging Indigenous peoples with RCTs. Future trials that seek to benefit Indigenous peoples should actively involve Indigenous research partners, and respect and draw on pertinent Indigenous knowledge and values. This review has the potential to assist in the design of such studies.
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Affiliation(s)
- Marewa Glover
- Centre for Tobacco Control Research, University of Auckland, New Zealand
| | - Anette Kira
- Centre for Tobacco Control Research, University of Auckland, New Zealand
| | - Vanessa Johnston
- Menzies School of Health Research, Charles Darwin University, Darwin, Australia
| | - Natalie Walker
- National Institute for Health Innovation, University of Auckland, New Zealand
| | - David Thomas
- Menzies School of Health Research, Charles Darwin University and the Lowitja Institute, Darwin, Australia
| | - Anne B Chang
- Menzies School of Health Research, Charles Darwin University, Darwin, Australia
| | - Chris Bullen
- National Institute for Health Innovation, University of Auckland, New Zealand
| | - C J Segan
- Centre for Health Policy, Programs and Economics, University of Melbourne, Australia
| | - Ngiare Brown
- Menzies School of Health Research, Charles Darwin University and the Lowitja Institute, Darwin, Australia
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10
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Kropp F, Lilleskov M, Richards J, Somoza E. Client and provider views on access to care for substance-using American Indians: perspectives from a Northern Plains urban clinic. AMERICAN INDIAN AND ALASKA NATIVE MENTAL HEALTH RESEARCH 2014; 21:43-65. [PMID: 25111843 PMCID: PMC4144438 DOI: 10.5820/aian.2101.2014.43] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
In addition to disparities in rates of substance use problems, American Indians (AIs) report multiple barriers to receiving treatment services. The present study utilized intake questionnaire data and focus groups to gain perspectives from 152 clients (65% male, 35% female; mean age 30 years) and 6 female providers on access to treatment for Northern Plains AIs in an urban, non-Native program. AI clients acknowledged the need for treatment more often than did substance users in general, but faced greater resource barriers. Both clients and providers offered specific recommendations for improving access to substance use treatment for AI populations in the Northern Plains.
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11
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Greenfield BL, Venner KL. Review of Substance Use Disorder Treatment Research in Indian Country: Future Directions to Strive toward Health Equity. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2012; 38:483-92. [DOI: 10.3109/00952990.2012.702170] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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12
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Forcehimes AA, Venner KL, Bogenschutz MP, Foley K, Davis MP, Houck JM, Willie EL, Begaye P. American Indian methamphetamine and other drug use in the Southwestern United States. CULTURAL DIVERSITY & ETHNIC MINORITY PSYCHOLOGY 2011; 17:366-376. [PMID: 21988577 PMCID: PMC3415471 DOI: 10.1037/a0025431] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
To investigate the extent of methamphetamine and other drug use among American Indians (AIs) in the Four Corners region, we developed collaborations with Southwestern tribal entities and treatment programs in and around New Mexico. We held nine focus groups, mostly with Southwestern AI participants (N = 81) from three diverse New Mexico communities to understand community members, treatment providers, and clients/relatives views on methamphetamine. We conducted a telephone survey of staff (N = 100) from agencies across New Mexico to assess perceptions of methamphetamine use among people working with AI populations. We collected and analyzed self-reported drug use data from 300 AI clients/relatives who completed the Addiction Severity Index (ASI) in the context of treatment at three diverse addiction treatment programs. Each focus group offered a unique perspective about the effect of drugs and alcohol on each respective community. Though data from the phone surveys and ASIs suggested concerning rates of methamphetamine use, with women more adversely affected by substance use in general, alcohol was identified as the biggest substance use problem for AI populations in the Southwest. There appears to be agreement that methamphetamine use is a significant problem in these communities, but that alcohol is much more prevalent and problematic. There was less agreement about what should be done to prevent and treat methamphetamine use. Future research should attend to regional and tribal differences due to variability in drug use patterns, and should focus on identifying and improving dissemination of effective substance use interventions.
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Affiliation(s)
- Alyssa A Forcehimes
- University of New Mexico Center on Alcoholism, Substance Abuse, and Addictions, Alberquerque, USA.
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13
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Burlew AK, Weekes JC, Montgomery L, Feaster DJ, Robbins MS, Rosa CL, Ruglass LM, Venner KL, Wu LT. Conducting research with racial/ethnic minorities: methodological lessons from the NIDA Clinical Trials Network. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2011; 37:324-32. [PMID: 21854274 PMCID: PMC3445256 DOI: 10.3109/00952990.2011.596973] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Multiple studies in the National Institute on Drug Abuse Clinical Trials Network (CTN) demonstrate strategies for conducting effective substance abuse treatment research with racial/ethnic minorities (REMs). OBJECTIVES The objectives of this article are to describe lessons learned within the CTN to (1) enhance recruitment, retention, and other outcomes; (2) assess measurement equivalence; and (3) use data analytic plans that yield more information. METHOD This article includes background information and examples from multiple CTN studies on inclusion, measurement, and data analysis. RESULTS AND CONCLUSIONS Seven recommendations are included for conducting more effective research on REMs.
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Affiliation(s)
- A Kathleen Burlew
- Department of Psychology, University of Cincinnati, OH 45221-0376, USA.
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