Addressing health disparities by providing evidence-based treatment in the Black Church

摘要 黑人/非裔美国人使用酒精和非法药物的比率与白人相同，但 更有可能遭受与物质相关的负面后果。此外，他们不太可能发起 与其他种族群体相比；当他们这样做时，完成治疗的可能性明显较低 治疗或提供循证治疗。耻辱，对医疗系统的不信任，缺乏健康 护理覆盖面、复杂的护理途径、较低的社会经济地位以及缺乏了解文化的人 治疗可能都是导致低治疗开始和参与度的因素。因此，在中国提供治疗 另类背景，如黑人社区中高度信任的实体黑人教会，是一部小说，而且 改善获得循证治疗和饮酒机会的潜在高度可传播性战略 这一重要人群的治疗结果。以技术为基础的治疗是一种新兴的治疗策略 覆盖服务不足的人群，并可解决在新环境中提供干预措施的障碍。一 这样的策略，认知行为治疗的基于计算机的培训(CBT4CBT)已经被证明 在多个随机临床试验中，在减少酒精和其他物质使用方面是安全和有效的，两者 作为治疗的补充，以及作为相对于标准护理的独立治疗。 我们最近证明了进行严格的临床试验以及提供 CBT4CBT在黑人教会，表现出压倒性的兴趣和热情，来自 患有澳门氏症的黑人成年人，以及非常有希望的参与度和治疗完成率。我们现在 建议进行一项为期8周的随机临床试验，200名患有AUD的黑人成年人将被随机分配到 要么是黑人教堂的CBT4CBT，要么是转诊到特殊成瘾环境中的标准治疗，有9- 随访1个月，评价治疗效果的持久性。主要结果包括保留(开始 治疗，参与至少4周)和戒酒天数(PDA)。已选择 参与者特征(例如，性别、种族认同、宗教信仰、AUD的严重性、精神健康诊断、 健康的社会决定因素中的脆弱性)将被评估为可能影响结果的因素。 次要结果包括对护理的满意度、社会支持网络的扩大、沉重负担的减少 饮酒天数和世卫组织饮酒水平、对共病药物使用的影响以及总体生活质量。 此外，在这种情况下，如果CBT4CBT被证明对患有AUD的黑人成年人有效，这将 代表了一种解决健康差距的廉价战略，可以相对容易地传播 在美国为黑人个人服务的大型宗派网络中。

ABSTRACT Black/African-Americans use alcohol and illicit drugs at the same rates as their White counterparts but are much more likely to suffer negative substance related consequences. Moreover, they are less likely to initiate treatment when compared with other racial groups; and when they do, are significantly less likely to complete treatment or to be offered evidence-based treatments. Stigma, mistrust of the medical system, lack of health care coverage, complex pathways to care, lower socioeconomic status, and the scarcity of culturally-informed treatment may all be factors underlying low treatment initiation and engagement. Thus, offering treatment in alternative settings, such as the Black Church, a highly trusted entity in Black communities, is a novel, and potentially highly disseminable strategy for improving both access to evidence-based treatments and alcohol treatment outcomes for this important population. Technology-based treatments are an emerging strategy for reaching underserved populations and can address barriers to delivering interventions in novel settings. One such strategy, computer-based training for Cognitive Behavioral Therapy (CBT4CBT), has been demonstrated in multiple randomized clinical trials to be safe and effective in reducing alcohol and other substance use, both as an add on to treatment, and as a stand-alone treatment, relative to standard care. We recently demonstrated the feasibility of both conducting a rigorous clinical trial as well as delivering CBT4CBT in the Black Church, which demonstrated overwhelming levels of interest and enthusiasm from Black adults with AUD, as well as highly promising levels of engagement and treatment completion. We now propose an 8-week randomized clinical trial in which 200 Black adults with primary AUD will be randomized to either CBT4CBT in the Black church or referral to standard treatment in a specialty addiction setting, with a 9- month follow-up to evaluate durability of treatment effects. Primary outcomes include retention (initiation of treatment, engagement for at least 4 weeks) and percent days abstinent from alcohol (PDA). Selected participant characteristics (e.g., gender, ethnic identity, religiosity, severity of AUD, mental health diagnoses, and vulnerabilities in the social determinants of health) will be evaluated as potential moderators of outcome. Secondary outcomes include satisfaction with care, expansion of social support networks, reduction in heavy drinking days and in WHO drinking levels, effects on comorbid substance use, and overall quality of life. Moreover, if CBT4CBT is demonstrated to be effective with Black adults with AUD in this setting, this would represent an inexpensive strategy to address health disparities that could be disseminated with relative ease among the large network of denominations serving Black individuals in the US.