? ? The prevalence of substance use disorders among Native Americans is at least twice that in the general U.S. population, with correspondingly high rates of mortality, health and social problems. Yet there have been very few clinical studies, and no randomized trials, to discover and document effective treatment methods for American Indians. In seeking effective treatment methods for a special population, it is reasonable to begin with and adapt approaches with more general evidence of efficacy. Our preliminary research indicates that among evidence-based treatment methods, motivational interviewing (Ml) and the community reinforcement approach (CRA) show particular promise as culturally congruent methods in working with reservation-dwelling tribal populations. In contrast to more directive or confrontational styles, Ml mirrors tribal communication norms, and CRA is particularly well suited to make use of the extended family and unique clan structure of reservation life. This is a Stage 1 Behavior Therapy Development proposal to adapt and test a combination of these two evidence-based methods (MICRA) with the Zuni pueblo, in preparation for a subsequent formal clinical trial. Working collaboratively with team members from the Zuni community, we propose to develop research materials needed for a larger randomized trial: a MICRA counselor manual, assessment instruments adapted to a Native American context, and a detailed manual of research operations. At least three Zuni behavioral health professionals will be trained and certified in MICRA, and a small randomized trial (N=60) will be completed to estimate the effect size for MICRA relative to reservation-based treatment as usual, with follow-up interviews through one year post-randomization. After development and testing of MICRA, further consultation will assess the generalizability of MICRA for use with other tribes. ? ? ?
