Pilot Outcome Results of Culturally Adapted Evidence-Based Substance Use Disorder Treatment with a Southwest Tribe

INTRODUCTION:

Although American Indians/Alaska Natives (AI/ANs) have exhibited high rates of alcohol and drug use disorders, there is a paucity of substance use disorder treatment outcome research. In addition, there exists controversy about whether evidence-based treatments (EBTs) are culturally appropriate given they were derived mainly by and for non-Hispanic White populations and do not explicitly include aspects of AI/AN culture and worldview.

METHODS:

In this pilot study, we collaboratively culturally adapted two EBTs, Motivational Interviewing and Community Reinforcement Approach (MICRA), and evaluated substance use and psychological outcomes at 4- and 8-months post baseline assessment. In preparation for a larger randomized clinical trial (RCT), eight tribal members (75% male) participated in this pilot treatment study. Measures included substance use, urine screens, self-efficacy, psychological distress, and hopelessness. All participants completed follow-up assessments at 4- and 8-months. Due to small sample size, effect sizes were calculated to evaluate outcomes pre- and post-treatment.

RESULTS:

Despite high rates of abstinence at baseline, percent days abstinent (PDA) increased at the 8-month time point for the most commonly used substances (alcohol, Hedges's g = 0.59, and marijuana, g = 0.60) and for all substances combined (excluding tobacco, g = 0.56). Improvements in psychological distress (g = -0.66) and 5 of the 7 Addiction Severity Index domains (range of g = -0.42 to -0.98) also emerged.

CONCLUSIONS:

Results suggest that culturally adapted EBTs yield significant improvements in alcohol use, psychological distress, and legal problems among AI/ANs. Future research using RCT methodology is needed to examine efficacy and effectiveness.

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By:  Venner KL1, Greenfield BL2, Hagler KJ1, Simmons J3, Lupee D4, Homer E4, Yamutewa Y4, Smith JE3.

• 1University of New Mexico, Department of Psychology, 1 University of New Mexico, MSC 03 2220, Albuquerque, NM 87131; Center on Alcoholism, Substance Abuse, and Addictions, 2650 Yale Blvd. SE, Albuquerque, NM 87106.
• 2University of Minnesota, Duluth, 1049 University Dr, Duluth, MN 55812.
• 3University of New Mexico, Department of Psychology, 1 University of New Mexico, MSC 03 2220, Albuquerque, NM 87131.
• 4Anonymous Tribal Agency. 
• Addict Behav Rep. 2016 Jun 1;3:21-27.

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