Despite decades of research as well as concerted efforts to improve prevention and treatment, available information suggests that the prevalence of problematic alcohol and drug use (referred to hereafter as substance use) has not appreciably changed in most American Indian and Alaska Native (AI/AN) communities. Research and health surveillance activities further document the substantial impacts of problematic substance use on the health of AI/AN people at rates that continue to far exceed those of non-AI/ANs. Fortunately, a number of Evidence-Based Practices (EBPs) have now been developed that hold substantial promise for improving treatment for AI/ANs with substance use problems, as they do for non-AIs. Anecdotal reports suggest, however, that the use of EBPs in programs that serve AI/ANs is limited. Furthermore, the unique funding mechanisms for programs serving AI/ANs, as well as the sovereign status of AI/AN tribes, mean that we cannot assume that the factors influencing the implementation of EBPs in programs more generally, such as mandates for the use of EBPs in federally-sponsored programs, impact programs serving this special population in the manner in which they were intended. Organizational factors may also operate differently given the severe fiscal and human resource limitations under which these programs operate. In addition, concerns about the cultural appropriateness of some EBPs may discourage their use.
The specific aims of this project are as follows: 1) to describe the use of specific EBPs in substance abuse treatment programs serving AI/AN communities;2) to describe the factors associated with the decision to implement EBPs in these programs;and 3) to identify methods for more effective dissemination of EBPs to substance abuse treatment programs serving AI/AN communities. We will utilize a three-stage study design. First, we will conduct a focused set of 2 case studies of model substance abuse treatment systems serving AI/AN communities. Second, we will conduct a telephone survey of the directors of all 480 substance abuse treatment programs serving AI/AN communities. Finally, we will conduct in-depth case studies of 12 of these programs. We will collect and analyze both quantitative and qualitative data. The results of this project will provide the first description of the use of EBPs in substance abuse treatment programs serving AI/AN communities, much- needed insights regarding the dynamics around the decision to implement such practices, and carefully formulated methods for more effective dissemination.
The results of this project will provide the first description of the use of Evidence-Based Practices in substance abuse treatment programs serving American Indian and Alaska Native communities. Along with these descriptions, we will also develop a detailed understanding of how these substance abuse treatment programs decide to implement Evidence-Based Practices, and how we could improve our methods for encouraging their use in these programs
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