Culturally tailored evidence-based substance use disorder treatments are efficacious with an American Indian Southwest tribe: an open-label pilot-feasibility randomized controlled trial.
Culturally tailored evidence-based substance use disorder treatments are efficacious with an American Indian Southwest tribe: an open-label pilot-feasibility randomized controlled trial.
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根据文化量身定制的循证物质使用障碍治疗方法对美洲印第安人西南部落有效：一项开放标签试点可行性随机对照试验。
DOI：
10.1111/add.15191
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发表时间：
2021
期刊：
影响因子：
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通讯作者：
Witkiewitz,Katie
中科院分区：
文献类型：
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作者：
Venner,KamillaL;Serier,Kelsey;Sarafin,Ruth;Greenfield,BrennaL;Hirchak,Katherine;Smith,JaneEllen;Witkiewitz,Katie
背景与目的目前已有许多针对物质使用障碍(SUD)的循证治疗(EBT)，但很少有针对土著患者的。这项试验测试了一种文化定制的EBT的有效性，该方法结合了激励性访谈和社区强化方法(MICRA)与常规治疗(TAU)。设计了一项混合疗效/有效性的随机对照试验，MICRA(n=38)和TAU(n=441)采用平行设计，在基线后4、8和12个月进行随访评估。设置美国，基于预约的门诊患者，成瘾特殊护理治疗计划。参与者79名(68%男性)美国印第安人和阿拉斯加原住民(AI/AN)部落成员符合SUD标准并寻求SUD治疗。干预MICRA(从MI开始的个人治疗2-3次)与TAU(具有十二步哲学和预防复发要素的个人和团体咨询会议)比较。测量人口统计学，戒除天数百分比(PDA；12个月时的主要结果采用《药物使用后果调查表》、《酒精和药物使用自我效能量表》、《美国原住民精神性量表》和《SCID-DSM-IV-TR.》进行评估。结果在主要结果中，没有证据表明MICRA优于TAU(MICRA PDA=0.72.63%，TAU=0.73.62%，治疗效果：B=−4.04(SE=5.47)；95%CI=−14.941，6.866；BF=3.44)。从基线到12个月的随访，两组患者的PDA、SUD严重程度和负面后果均有改善。自我效能感和灵性都不是MICRA的显著中介因素。结论在这项以美洲印第安人和阿拉斯加原住民为参与者的随机对照试验中，药物使用障碍的文化定制循证治疗与常规治疗之间没有治疗组差异。尽管如此，随着时间的推移，参与者在几个与物质相关的结果上有所改善。
Background and AimsMany evidence‐based treatments (EBTs) for substance use disorder (SUD) exist, yet few are tailored to Indigenous patients. This trial tested the efficacy of a culturally tailored EBT that combined Motivational Interviewing and the Community Reinforcement Approach (MICRA) versus treatment as usual (TAU).DesignA mixed efficacy/effectiveness randomized controlled trial of MICRA (n= 38) and TAU (n= 41) using a parallel design with follow‐up assessments at 4‐, 8‐, and 12‐ months post baseline.SettingUnited States, reservation‐based outpatient, addiction specialty care treatment program.Participants79 (68% male) American Indian and Alaska Native (AI/AN) Tribal members meeting criteria for SUD and seeking SUD treatment.InterventionsMICRA (individual therapy sessions beginning with MI for 2–3 sessions) compared with TAU (individual and group counseling sessions in a didactic style with Twelve‐Step philosophy and elements of relapse prevention).MeasuresDemographics, percent days abstinent (PDA; the primary outcome at 12months assessed by Form 90D), Inventory of Drug Use Consequences, Alcohol and Drug Use Self‐Efficacy Scale, Native American Spirituality Scale, and SCID‐DSM‐IV‐TR.FindingsThere was no evidence for the benefit of MICRA over TAU (MICRA PDA = 72.63%, TAU = 73.62%, treatment effect: B = −4.04 (SE = 5.47); 95% CI = −14.941, 6.866;BF= 3.44) in the primary outcome. Both groups showed improvements in PDA, SUD severity, and negative consequences from baseline to the 12‐month follow‐up. Neither self‐efficacy nor spirituality were significant mediators of MICRA.ConclusionsThere were no treatment group differences between culturally tailored evidence‐based treatments for substance use disorder and treatment as usual in this randomized controlled trial with American Indian and Alaska Native participants. Nonetheless, participants improved over time on several substance‐related outcomes.