RESEARCH PROJECT 2 ABSTRACT: Alcohol-use disorders (AUDs) are a serious public health issue for urban American Indians and Alaska Natives (AI/ANs). They have twice the levels of AUDs and alcohol problems of urban non-Hispanic whites. Unfortunately, the most widely available treatment option ? abstinence-based treatment ? is generally ineffective in engaging and successfully treating this underserved population. To illuminate potential solutions to this problem, we conducted pilot qualitative studies, in which urban AI/ANs with AUDs expressed interest in interventions that integrate low-barrier, nonabstinence-based harm-reduction approaches with Native cultural practices. The most commonly requested cultural practice was the talking circle. A talking circle is a gathering of people with a common concern who respectfully share their perspectives and ?listen with their heart? while each individual speaks. Traditionally, talking circles have been used to address community problems, heal individuals from trauma, and bring about community harmony. Recent studies conducted with other populations have indicated talking circles may be an efficacious clinical intervention. We propose to use a community-based participatory research framework to guide the refinement and formal evaluation of Harm Reduction Talking Circles (HaRTC) for urban AI/ANs with AUDs. HaRTC will be designed with a community advisory board made up of researchers, traditional Native healers, urban AI/ANs with the lived experience of AUDs, and representatives from the Seattle Indian Health Board, the community partner for the study. This project will be conducted in 3 phases: In Phase 1, we will collect qualitative data via interviews and focus groups with Seattle Indian Health Board staff and the priority population. Qualitative analyses will elucidate ways to optimally tailor HaRTC. In Phase 2, we will refine study procedures and HaRTC treatment manual using qualitative data collected in Phase 1 and the guidance of the community advisory board. Phase 3 will comprise a randomized controlled trial of HaRTC with 280 patients from the Seattle Indian Health Board primary care and behavioral health clinics. Participants will be individually randomized to receive HaRTC or the clinic?s treatment as usual services (control), and will be assessed at baseline, posttest (immediately following treatment end), 1- , 3- and 6-month follow-ups. Quantitative analyses will test the efficacy of the HaRTC compared to treatment as usual.
Our Specific Aims are to 1) Tailor HaRTC to meet the needs of urban AI/ANs with AUDs in a clinical setting; 2) Conduct a randomized controlled trial to evaluate the efficacy of HaRTC versus treatment as usual; and 3) Perform a comprehensive economic evaluation of HaRTC with cost-benefit and cost-effectiveness analyses. We expect that HaRTC participants will show greater improvements on alcohol outcomes and quality of life compared to control participants and that the intervention will be cost-effective and sustainable. We also expect HaRTC participants will show increased engagement in AI/AN cultural practices and community events, which will be evaluated as a potential mediator of the HaRTC effect.