Randomized Controlled Trial of Indigenous Recovery Planning for American Indians

尽管在美洲印第安人(Ais)中有很高的禁酒率，但也有证据表明存在酒精。 毒品使用障碍对土著社区的影响不成比例。由于几代人的系统性 种族主义和历史创伤，人工智能经历了与药物使用相关的严重健康差距 精神障碍(肥皂泡)。有效的SUD治疗是改善人工智能健康公平的关键 但很少有以文化为基础的循证干预措施在人工智能机构中开发或测试。 通过这项研究，美洲印第安人土著恢复计划的随机对照试验，我们的目标是 帮助填补这一空白。我们的研究使用基于社区的参与性研究(CBPR)框架来测试 社区合作伙伴合作设计的文化适应的复吸预防干预的有效性 来自蒙大拿州东北部的佩克堡印第安人保留地和来自蒙大拿州的研究伙伴 大学。土著恢复计划(IRP)雇用训练有素的佩克堡社区成员来提供 从文化上改编自复发预防(RP)的人工干预内容，是研究最多的和 对SUD的有效治疗。使用4个混合方法初步研究的数据，我们密切合作 通过社区咨询委员会(CAB)修改RP以专注于优势，提高保护级别 解决文化上特定的风险因素，并克服参与治疗的障碍。我们现在会 在一项前瞻性随机对照试验中测试IRP的疗效，试验对象为150名患有SUD的部落成员 等待名单控制组，一个社区合作伙伴渴望的设计。对IRP使用随机赋值 (立即干预；n=75)或等待名单对照组(延迟干预；n=75)，我们将测试 IRP对初次结果(戒断天数百分比)和次要结果(与物质相关)的影响 结果、生活质量)对干预后进行评估。我们还将研究如何维护 干预后12周随访的治疗结果，并检验假设的文化特异性 治疗效果的中介者(人工智能身份、灵性、集体掌握、悲伤和损失、来自 历史创伤、横向暴力和种族主义)在我们的初步研究中发现。最后，我们将进行一次 过程评价，以检查干预措施的可接受性和可持续性，以确保IRP 按设计解决循证SUD干预的障碍。这项研究将填补一个重要的空白 关于适应文化的循证治疗的有效性和可接受性的科学知识 在人工智能人群中进行了测试。这些知识可能会被转移到具有类似文化价值的其他社区。 以及治疗的障碍。通过增加获得有效治疗的机会，这项研究有可能 改善当地未得到充分服务的人工智能社区的健康结果并减少与SUD相关的健康差距 以及全国范围内。

Although there are high rates of abstinence among American Indians (AIs), there also is evidence of alcohol and drug use disorders disproportionately affecting Native communities. As a result of generations of systemic racism and historical trauma, AIs experience serious health disparities associated with substance use disorders (SUDs). Effective treatments for SUD are critically needed for improving health equity in AI communities, but there are few culturally grounded evidence-based interventions developed or tested with AIs. With this study, Randomized Controlled Trial of Indigenous Recovery Planning for American Indians, we aim to help fill this gap. Our research uses a Community-Based Participatory Research (CBPR) framework to test the efficacy of a culturally adapted relapse prevention intervention designed collaboratively by community partners from the Fort Peck Indian Reservation in northeastern Montana and research partners from Montana State University. Indigenous Recovery Planning (IRP) employs trained Fort Peck community members to deliver manualized intervention content culturally adapted from Relapse Prevention (RP), one of the most studied and efficacious treatments for SUD. Using data from 4 mixed-methods preliminary studies, we have worked closely with a Community Advisory Board (CAB) to modify RP to focus on strengths, increase levels of protective factors, address culturally specific risk factors, and overcome barriers to engagement in treatment. We now will test the efficacy of IRP in a prospective randomized controlled trial with 150 tribal members with SUD using a waitlist control group, a design desired by the community partners. Using random assignment to IRP (immediate intervention; n = 75) or to a waitlist control group (delayed intervention; n = 75), we will test the effects of IRP on primary outcomes (percent days abstinent) and secondary outcomes (substance-related consequences, quality of life) assessed post-intervention. We also will examine maintenance of changes in treatment outcomes at 12-week post-intervention follow-up, and examine hypothesized culturally specific mediators of treatment effects (AI identity, spirituality, communal mastery, grief and loss, distress from historical trauma, lateral violence, and racism) identified in our preliminary studies. Finally, we will conduct a process evaluation to examine the acceptability and sustainability of the intervention to ensure that IRP addresses barriers to evidence-based SUD interventions as designed. This research will fill an important gap in scientific knowledge regarding the efficacy and acceptability of culturally adapted evidence-based treatments tested in AI populations. This knowledge may be transferable to other communities with similar cultural values and barriers to treatment. By increasing access to efficacious treatment, this research has the potential to improve health outcomes and decrease SUD-related health disparities for underserved AI communities locally and nationally.