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

摘要

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.