Rates of alcohol and illicit drug use (AIDU) among residents of distressed communities with concentrations of African Americans (DCAA- i.e., localities with high rates of poverty and crime) are similar to the general population. Yet AIDU has significantly higher consequences for residents in DCAAs (e.g., higher incarceration and HIV/HCV infection rates), who also have considerably less access to effective treatment of substance use disorders. This project will continue to develop and test Community Wise, an innovative multi-level intervention created in partnership with service providers, residents of DCAAs and individuals with histories of substance use disorders and incarceration, to reduce health inequalities related to AIDU. We used community-based participatory research (CBPR) to develop and pilot test Community Wise, achieving 75% intervention completion rates, despite great participant challenges (such as homelessness, AIDU, and poverty). Note that substance use disorder intervention completion rates in the literature are much lower among populations with fewer challenges (often 30 to 40%). We believe that this success is due to the CBPR model used to develop an intervention that is relevant to participants' needs. Community Wise addresses social determinants of health (e.g., stigma, poverty, lack of treatment access, housing, and meaningful employment) and inequalities related to AIDU at the micro level (e.g., cognitive and behavioral processes), meso level (e.g., relationships with individuals and organizations) and macro level (e.g., political and cultural processes). Community Wise builds on critical consciousness theory, which empowers individuals, organizations, and communities to address social determinants of health while changing individual behaviors (e.g., reducing AIDU). We propose to apply the Multiphase Optimization Strategy (MOST) - an innovative and rigorous framework that employs factorial designs - to optimize Community Wise. Specifically, using MOST we will identify the most efficient, scalable, and sustainable components of Community Wise so that we can refine the intervention protocol by including only components that significantly reduce AIDU. The long-term goal of Community Wise is to reduce health inequalities related to AIDU between men with substance use disorders and a history of incarceration residing in DCAAs and the general population through an intervention that is congruent with DCAA world views and grounded in scientific and indigenous knowledge. Data from this study will culminate in an optimized Community Wise manual; enhanced methodological strategies to develop multi-component scalable interventions using MOST and CBPR; and a better understanding of the application of critical consciousness theory to the field of health inequalities related to AIDU.
Community Wise is a manualized, multilevel intervention to reduce health inequalities related to alcohol and illicit drug use that was developed and pilot-tested in a distressed community with concentrations of African American residents (DCAA) using community-based participatory research (CBPR) methods. We seek to apply the Multiphase Optimization Strategy (MOST) - an innovative and rigorous framework that employs factorial designs - to identify the most efficient, scalable, and sustainable components of Community Wise. Our innovative and rigorous combination of CBPR and MOST will produce an optimized intervention that is more acceptable to communities, reduces participant burden, and can be adapted and tested to reduce other health inequalities.