Web-based Addiction Treatment: Cultural Adaptation with American Indians

项目摘要 美国印第安人/阿拉斯加原住民（AI/AN）人口在许多健康问题上面临长期的差距。 指标，包括药物滥用率过高，这是一个特别有害的问题， 不仅影响身心健康，而且影响社区能力和文化联系。到 从文化上解决这些差异和目前获得适当治疗服务的问题， 必须制定并成功传播相关的循证干预措施。城市AI/AN（即， 那些生活在城市中心部落土地上的人）有更严重的物质使用问题， 独特的治疗障碍。例如，印度管理的大多数药物滥用治疗设施 60%的人口居住在农村地区，而78%的印第安人/土著人居住在城市地区。鉴于疾病方面的这些差异 和治疗机会，网络提供的文化一致的干预措施可能是改善 城市AI/AN的治疗结果。基于网络的干预措施可以解决采用和 执行，提高治疗的可及性和强度，并改善结果。调查 一个小组完成了一个有效的基于网络的社区版本的混合方法的可接受性研究 强化方法（CRA）（加上应急管理[CM]）称为治疗教育 系统（TES）（Bickel等人，2008;坎贝尔等人，2014年）与城市AI/AN从计划在NIDA的临床 Trials Network（CTN）.结果表明，通过计算机提供的核心TES内容具有很高的可接受性， 文化适应也是非常可取的。研究支持文化知情干预， AI/AN。虽然城市AI/AN在部落归属方面是异质的（即，语言、历史、文化 活动），在文化、价值观和传统方面存在许多相似之处和相似之处。文化适应 最近在CTN的补充支持下完成了城市AI/AN（TES-NAV）的TES。在此基础上 开发工作，目前的建议的目标是评估TES-NAV的初步疗效， 确定未来是否需要进行大规模的有效性试验。具体而言，IB期随机化 将在接受门诊成瘾治疗服务的城市AI/AN（N=80）中进行对照试验 （1）估计12周TES-NAV的初步效应量;（2）探索TES-NAV的相关调节因子 结果和潜在的作用机制;（3）评估可能与变化相对应的文化因素 结果。治疗后3个月的随访将有助于识别和解释结果。 这项工作遵循基于社区的探索性研究方法的原则，并以 长期合作的董事会。在项目的最后几个月，董事会和其他利益攸关方将努力 与调查小组一起解释调查结果，并就下一步工作达成共识。拟定研究 这是改善长期存在的健康差距的重要承诺，据我们所知， 第一个随机对照试验的文化适应性网络成瘾治疗AI/AN。

PROJECT SUMMARY American Indian/Alaska Native (AI/AN) populations face long-standing disparities across numerous health indicators including disproportionately high rates of substance abuse, a particularly damaging problem which impacts not only physical and mental health, but also community capacity and cultural connectedness. To address these disparities and the ongoing problem of access to appropriate treatment services, culturally relevant, evidence-based interventions must be developed and successfully disseminated. Urban AI/AN (i.e., those who live off Tribal land in urban centers) have more severe substance use problems and encounter unique barriers to treatment. For example, the majority of Indian-managed substance abuse treatment facilities are located in rural areas (60%), yet 78% of AI/AN reside in urban areas. Given these disparities in disease and treatment access, a web-delivered culturally congruent intervention could be a means of improving treatment outcomes among urban AI/AN. Web-based interventions can address challenges to adoption and implementation, enhance accessibility to and intensity of treatment, and improve outcomes. The investigative team completed a mixed methods acceptability study of an efficacious web-based version of the Community Reinforcement Approach (CRA) (plus contingency management [CM]) called the Therapeutic Education System (TES) (Bickel et al., 2008; Campbell et al., 2014) with urban AI/AN from programs in NIDA's Clinical Trials Network (CTN). Results demonstrated high acceptability for core TES content delivered via computer but also that cultural adaptation would be highly desirable. Research supports culturally-informed interventions for AI/AN. Although urban AI/AN are heterogeneous with regard to tribal affiliation (i.e., language, history cultural activities), many similarities and consistencies in culture, values, and traditions exist. A cultural adaptation of TES for urban AI/AN (TES-NAV) was recently completed with supplemental CTN support. Building upon this developmental work, the goal of the current proposal is to evaluate the preliminary efficacy of TES-NAV to determine whether a future large-scale effectiveness trial is warranted. Specifically, a Stage IB randomized controlled trial among urban AI/AN (N=80) attending outpatient addiction treatment services will be conducted to (1) estimate preliminary effect size of 12 weeks of TES-NAV; (2) explore relevant moderators of TES-NAV outcomes and potential mechanisms of action; and (3) assess cultural factors that may correspond to variation in outcome. A three-month post-treatment follow-up will facilitate identification and interpretation of outcomes. This work follows the tenets of the Community Based Participatory Research approach and is guided by a long-standing collaborative board. In the final months of the project, the Board and other stakeholders will work with the investigative team to interpret findings and build consensus for next steps. The proposed study represents an important commitment to improving longstanding health disparities and is, to our knowledge, the first randomized controlled trial of a culturally adapted web-based addiction treatment for AI/AN.