Understanding Race-Related Stress as a Mechanism Associated with Alcohol Craving to Inform Culturally-Adapting Alcohol Treatment for Black Adults

摘要 使用酒精的黑人(BP)是与酒精相关后果发生率最高的人群之一，但只有 一小部分患有酒精使用障碍(AUD)的BP接受治疗。这种待遇上的差距尚未得到满足 BP的需求突显了对这一群体进行有效酒精治疗的必要性。在BP中收到 对于酒精治疗，他们往往报告对治疗的满意度较低，辍学率较高。从文化上讲 量身定制的治疗被认为是一种可能提高治疗满意度和保留率的方法。 在BP中。鉴于广泛的研究将压力与酗酒和复发联系起来，以及少数民族压力模型 表明BP经历了特定于黑人的压力源，结合种族相关压力(RRS)是一种 为这一群体调整酒精治疗的合理目标。尽管先前的研究表明，RRS例如 歧视预测BP中的酒精滥用，之前的研究还没有调查酒精渴望作为一种 将RRS与BP之间的酒精滥用联系起来的潜在机制。此外，有关线索的知识 饮酒可能是重要的，以告知酒精治疗适应BP。此外，了解 中性/放松的事件可以为应对策略提供参考，将酒精治疗包括在BP的治疗中。建议数 研究将：[1]明确哪些压力源和类型的酒精暗示会引发酒精渴望和 BP应对策略；2)深入了解种族相关压力(RR)的影响 关于酒精渴望；3)确定与黑人经历有关的其他因素，这些因素有助于AUD和 应包括在这一群体的AUD治疗中；以及4)提供可行性和可接受性的证据 文化--根据这些因素调整早期的CBT课程。]完成这项研究将支持我的 发展为独立的酒精治疗研究人员，专注于优先人群(例如黑人 人员)和我的职业目标是[1)对难以接触到的人群进行有意义的研究；2)调查 在BP中维持AUD的应对策略和机制，以及3)领导严格的临床试验研究 为患有AUD的黑人成年人开发和测试了解文化知识的治疗方法。]我会完成我的研究和事业 通过以下领域的专家的培训和指导实现目标：酒精治疗研究(斯蒂芬妮·奥马利博士)， 个性化成像程序、压力和渴求研究(Rajita Sinha博士)、RRS和治疗 对BP的适应(Monnica Williams博士)，治疗发展和适应(凯瑟琳·卡罗尔博士)，以及 基于社区的参与性和定性研究方法(拉里·戴维森博士)，并与 在临床试验研究方面有专长的生物统计学家(Ralitza Guorguieva博士)。我的研究和培训将是 在耶鲁医学院完成，该学院拥有丰富的体力和智力资源。接收 这次培训和完成这项研究将支持我消除治疗健康的长期职业目标 英国石油与澳元之间的差距。

Abstract Black people (BP) who use alcohol experience among the highest rate of alcohol-related consequences, yet only a small percentage of BP with alcohol use disorder (AUD) receive treatment. This disparity in treatment unmet need among BP highlights the necessity of efficacious alcohol treatments for this group. Among BP who receive alcohol treatment, they tend report lower satisfaction with treatment and have higher dropout rates. Culturally tailoring treatment has been proposed as one approach that might increase treatment satisfaction and retention among BP. Given that extensive research links stress to alcohol craving and relapse, and Minority Stress Models indicate that BP experiences stressors specific to being Black, incorporating race-related stress (RRS) is a reasonable target for adapted alcohol treatments for this group. Although prior research shows RRS such as discrimination predict alcohol misuse among BP, prior research has not investigated alcohol craving as a potential mechanism that links RRS to alcohol misuse among BP. In addition, knowledge of cues associated with drinking may be important for informing alcohol treatment adaptations for BP. Further, knowledge of neutral/relaxing events could inform coping strategies to include in alcohol treatment for BP. The proposed research will: [1) identify specifically which stressors and types of alcohol cues trigger alcohol craving and strategies for coping among BP; 2) provide an in-depth understanding of the impact of race-related stress (RRS) on alcohol craving; 3) identify other factors associated with the Black experience that contribute to AUD and should be included in AUD treatment for this group; and 4) provide evidence of the feasibility and acceptability of culturally-adapting an early CBT session based on these factors.] Completing this research will support my development as an independent alcohol treatment researcher with a focus on priority populations (e.g., Black people) and my career goals to [1) conduct meaningful research with hard to reach populations; 2) investigate coping strategies and mechanisms that maintain AUD among BP, and 3) lead rigorous clinical trials research to develop and test culturally-informed treatments for Black adults with AUD.] I will achieve my research and career goals through training and mentorship by experts in: alcohol treatment research (Dr. Stephanie O’Malley), personalized imagery procedures and stress and craving research (Dr. Rajita Sinha), RRS and treatment adaptations for BP (Dr. Monnica Williams), treatment development and adaptations (Dr. Kathleen Carroll), and community-based participatory and qualitative research methods (Dr. Larry Davidson), and collaboration with a biostatistician with expertise in clinical trials research (Dr. Ralitza Gueorguieva). My research and training will be completed at Yale School of Medicine, which has an abundance of physical and intellectual resources. Receiving this training and completing this research will support my long-term career goal to eliminate treatment health disparities among BP with AUD.