Although it is well documented that American Indian/Alaska Natives (AI/AN) face substantial alcohol- and drug- related health disparities, treatment research with AI/ANs is in its infancy (Greenfield & Venner, 2013). One route to address these health disparities is to employ evidence-based treatments (EBTs). EBTs are rarely tested with sufficiently large samples of racial ethnic groups, so outcomes are often unknown (Bernal & Scharrn Del Rio, 2001). And, unfortunately, there are examples of EBTs that have been less effective with an ethnic minority group than the original majority group on which it was developed (Calsyn et al., 2012). Recently, an R01 (DA021672) adapted two EBTs for substance use disorders (SUDs) (motivational interviewing and community reinforcement approach - MICRA) and conducted an RCT comparing MICRA to treatment as usual with the same AI community as involved in the present proposal. The present study seeks to expand on that R01, which culturally tailored CRA for people with SUDs, by focusing on families and concerned significant others (CSOs) who want to help engage their loved one with an SUD (identified patient; IP) into treatment. The intervention, Community Reinforcement and Family Training (CRAFT), is built on reinforcement principles. CRAFT teaches CSOs to take better care of themselves, cease any behaviors that are not working to address the IP's substance use, and consistently reward the IP for any sober and treatment engagement behavior. Importantly, CRAFT has been shown to increase IP entry into treatment, which would address: (1) the high rates of SUDs and related problems among AI/AN, (2) low rates of AI/AN self-referrals to treatment, and (3) higher rates of AI entering treatment due to court mandates (SAMHSA, 2012). The present study aims to develop an AI culturally adapted version of CRAFT (CRAFT-AI); and conduct an RCT to compare it (n=20) to Nar/Al-Anon facilitation (n=20) to examine acceptability of a culturally tailored EBT and estimate effect sizes for IP treatment entry and for CSO functioning pre to post intervention. Uniquely, the concept of treatment entry will be broadened to include receiving AI traditional healing. The proposed study will be the first to examine potential mediators and moderators of CRAFT-AI such as: demographic variables, severity of SUD, self-efficacy, and cultural risk and protective factors. The methodology of this grant, which uses a partnership between academic and tribal researchers, is well-poised to contribute to nascent AI/AN SUD treatment research to impact the substantial health disparities AI/ANs and other indigenous populations endure. Positive study results will facilitate future cultural adaptation research and dissemination and diffusion of EBTs to interested AI/AN tribes and other culturally diverse populations.

Public Health Relevance

It is important to address the substantial substance-related health disparities of American Indians (AI). This project aims to examine the effectiveness of a culturally adapted Community Reinforcement and Family Training approach and Nar/Al-Anon Facilitation with AIs to increase engagement of treatment refusing individuals into treatment/healing and to reduce distress of their loved ones. This knowledge may impact dissemination and diffusion efforts for CRAFT-AI and other evidence-based treatments among AIs and other culturally diverse groups.

Agency
National Institute of Health (NIH)
Institute
National Institute on Drug Abuse (NIDA)
Type
Planning Grant (R34)
Project #
5R34DA040064-03
Application #
9538683
Study Section
Interventions to Prevent and Treat Addictions Study Section (IPTA)
Program Officer
Aklin, Will
Project Start
2016-09-15
Project End
2019-07-31
Budget Start
2018-08-01
Budget End
2019-07-31
Support Year
3
Fiscal Year
2018
Total Cost
Indirect Cost
Name
University of New Mexico
Department
Type
Organized Research Units
DUNS #
868853094
City
Albuquerque
State
NM
Country
United States
Zip Code
87106
Venner, Kamilla L; Donovan, Dennis M; Campbell, Aimee N C et al. (2018) Future directions for medication assisted treatment for opioid use disorder with American Indian/Alaska Natives. Addict Behav 86:111-117
Venner, Kamilla L; Sánchez, Victoria; Garcia, Jacqueline et al. (2018) Moving Away from the Tip of the Pyramid: Screening and Brief Intervention for Risky Alcohol and Opioid Use in Underserved Patients. J Am Board Fam Med 31:243-251
Greenfield, Brenna L; Venner, Kamilla L; Tonigan, J Scott et al. (2018) Low rates of alcohol and tobacco use, strong cultural ties for Native American college students in the Southwest. Addict Behav 82:122-128
Hagler, Kylee J; Pearson, Matthew R; Venner, Kamilla L et al. (2017) Descriptive drinking norms in Native American and non-Hispanic White college students. Addict Behav 72:45-50
Dickerson, Daniel L; Venner, Kamilla L; Duran, Bonnie et al. (2014) Drum-Assisted Recovery Therapy for Native Americans (DARTNA): results from a pretest and focus groups. Am Indian Alsk Native Ment Health Res 21:35-58