Zuni MI/CRA Project

描述(由申请人提供)： 美洲原住民的药物使用障碍的流行率至少是美国总人口的两倍，相应地，死亡率、健康和社会问题的比率也很高。然而，几乎没有临床研究，也没有随机试验来发现和记录对美洲印第安人有效的治疗方法。在为特殊人群寻求有效的治疗方法时，合理的做法是从具有更广泛疗效证据的方法开始并采用这些方法。我们的初步研究表明，在循证治疗方法中，动机访谈(ML)和社区强化方法(CRA)在与保留地居住的部落人口合作方面显示出特别的前景，是文化上一致的方法。与更具指导性或对抗性的风格相比，ML反映了部落交流的规范，而CRA特别适合利用保留生活的大家庭和独特的氏族结构。这是第一阶段行为疗法开发提案，旨在调整和测试这两种循证方法(MICRA)与Zuni Pueblo的组合，为随后的正式临床试验做准备。与Zuni社区的团队成员合作，我们建议开发更大规模随机试验所需的研究材料：MICRA顾问手册、适应美洲原住民背景的评估工具，以及一份详细的研究操作手册。至少三名Zuni行为健康专业人员将接受MICRA的培训和认证，并将完成一项小型随机试验(N=60)，以估计MICRA相对于通常基于保留的治疗的效果大小，并在随机化后一年进行后续访谈。在开发和测试MICRA之后，将进行进一步的磋商，评估MICRA在其他部落中使用的普适性。

DESCRIPTION (provided by applicant): The prevalence of substance use disorders among Native Americans is at least twice that in the general U.S. population, with correspondingly high rates of mortality, health and social problems. Yet there have been very few clinical studies, and no randomized trials, to discover and document effective treatment methods for American Indians. In seeking effective treatment methods for a special population, it is reasonable to begin with and adapt approaches with more general evidence of efficacy. Our preliminary research indicates that among evidence-based treatment methods, motivational interviewing (Ml) and the community reinforcement approach (CRA) show particular promise as culturally congruent methods in working with reservation-dwelling tribal populations. In contrast to more directive or confrontational styles, Ml mirrors tribal communication norms, and CRA is particularly well suited to make use of the extended family and unique clan structure of reservation life. This is a Stage 1 Behavior Therapy Development proposal to adapt and test a combination of these two evidence-based methods (MICRA) with the Zuni pueblo, in preparation for a subsequent formal clinical trial. Working collaboratively with team members from the Zuni community, we propose to develop research materials needed for a larger randomized trial: a MICRA counselor manual, assessment instruments adapted to a Native American context, and a detailed manual of research operations. At least three Zuni behavioral health professionals will be trained and certified in MICRA, and a small randomized trial (N=60) will be completed to estimate the effect size for MICRA relative to reservation-based treatment as usual, with follow-up interviews through one year post-randomization. After development and testing of MICRA, further consultation will assess the generalizability of MICRA for use with other tribes.