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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American Indian Substance Abuse Prevention Efforts: A Review of Programs, 2003-2013

The purpose of the review was to assess substance abuse prevention (SAP) efforts in American Indian and Alaska Native (AI/AN) communities from 2003-2013. In the past, many SAP programs were unable to meet the unique cultural needs of AI/AN communities adequately. It has been suggested that a disconnect may exist between the theories that are used to guide development of prevention programs in AI/AN communities and culturally appropriate theoretical constructs of AI/AN worldviews. 

To explore this possible disconnect further, Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were used to assess a total of 18 articles (N = 31 programs) on program location and method, participant characteristics, described program cultural elements, use of theory, program outcomes, program measures, and future recommendations. 

Results indicated that SAP programs in AI/AN communities vary widely in their use of theory, implementation strategies, view and definition of cultural constructs, overall evaluational rigor, and reporting methods. Future research is needed to integrate appropriate theory and cultural elements into SAP programs to tie them to measurable outcomes for AI/AN communities.

Full PDF article at: http://goo.gl/39h6MG

By: Walsh ML, Baldwin JA.

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Post-Traumatic Stress Disorder & HIV Risk Behaviors among Rural American Indian/Alaska Native Women

We assessed the relationship between post-traumatic stress disorder (PTSD), binge drinking, and HIV sexual risk behavior by examining number of unprotected sex acts and number of sexual partners in the past 6 months among 129 sexually active American Indian women. 

A total of 51 (39.5%) young women met PTSD criteria. Among women who met the PTSD criteria, binge drinking was associated with a 35% increased rate of unprotected sex (IRR 1.35, p < .05), and there was a stronger association between increased binge drinking and risk of more sexual partners (IRR 1.21, p < .001) than among women who did not meet PTSD criteria (IRR 1.08, p < .01) with a difference of 13% (p < .05). 

HIV intervention and prevention interventions in this population likely would benefit from the inclusion of efforts to reduce binge drinking and increase treatment of PTSD symptoms.

Via: http://goo.gl/dfJH2C  Full PDF article at: http://goo.gl/aNo1iN

By:  Pearson CR, Kaysen D, Belcourt A, Stappenbeck CA, Zhou C, Smartlowit-Briggs L, Whitefoot P.

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