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）的酒精相关后果发生率最高，但只有 一小部分患有酒精使用障碍（AUD）的BP接受治疗。这种待遇上的差异未得到满足 BP的需求突出了对这一群体进行有效酒精治疗的必要性。在接受英国石油公司 在接受酒精治疗的情况下，他们往往报告对治疗的满意度较低，辍学率较高。文化 定制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。鉴于广泛的研究将压力与酒精渴望和复发联系起来，少数民族压力模型 表明BP经历了黑人特有的压力源，结合种族相关压力（RRS）是一种 合理的目标，以适应酒精治疗这一组。尽管先前的研究表明RRS，如 歧视预测BP之间的酒精滥用，以前的研究没有调查酒精渴望作为一个 RRS与BP中酒精滥用之间的潜在机制。此外，相关线索的知识 饮酒可能是重要的告知酒精治疗适应BP。此外，知识 中性/放松事件可以告知应对策略，包括在BP的酒精治疗中。拟议 研究将：[1]具体确定哪些压力源和酒精暗示类型会引发酒精渴望， 应对BP的策略; 2）深入了解种族相关压力（RRS）的影响 3）确定与导致AUD的黑人经历相关的其他因素， 应包括在该组的AUD治疗中;以及4）提供可行性和可接受性的证据 根据这些因素对早期CBT会话进行文化适应。完成这项研究将有助于我 发展成为一个独立的酒精治疗研究人员，重点是优先人群（例如，黑色 人）和我的职业目标，以[1]进行有意义的研究，难以达到的人群; 2）调查 应对策略和机制，维持AUD之间的BP，和3）导致严格的临床试验研究， 为患有AUD的黑人成年人开发和测试文化知情的治疗方法。我会实现我的研究和事业 通过专家的培训和指导实现目标：酒精治疗研究（Stephanie O 'Malley博士）， 个性化的成像程序和压力和渴望研究（Rajita Sinha博士），RRS和治疗 BP适应（Monnica威廉姆斯博士），治疗开发和适应（Kathleen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），并与一个 具有临床试验研究专业知识的生物统计学家（Ralitza Gueorguieva博士）。我的研究和训练 在耶鲁医学院完成，那里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的长期职业目标，消除治疗健康 BP与AUD之间的差异。

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.