Randomized Controlled Trial of CRAFT with American Indians

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Project Summary Although it is well documented that American Indian/Alaska Natives (AI/AN) face substantial alcohol- and drug- related health disparities, treatment research with AI/ANs is in its infancy (Greenfield & Venner, 2013). One route to address these health disparities is to employ evidence-based treatments (EBTs). EBTs are rarely tested with sufficiently large samples of racial ethnic groups, so outcomes are often unknown (Bernal & Scharrón Del Rio, 2001). And, unfortunately, there are examples of EBTs that have been less effective with an ethnic minority group than the original majority group on which it was developed (Calsyn et al., 2012). Recently, an R01 (DA021672) adapted two EBTs for substance use disorders (SUDs) (motivational interviewing and community reinforcement approach - MICRA) and conducted an RCT comparing MICRA to treatment as usual with the same AI community as involved in the present proposal. The present study seeks to expand on that R01, which culturally tailored CRA for people with SUDs, by focusing on families and concerned significant others (CSOs) who want to help engage their loved one with an SUD (identified patient; IP) into treatment. The intervention, Community Reinforcement and Family Training (CRAFT), is built on reinforcement principles. CRAFT teaches CSOs to take better care of themselves, cease any behaviors that are not working to address the IP's substance use, and consistently reward the IP for any sober and treatment engagement behavior. Importantly, CRAFT has been shown to increase IP entry into treatment, which would address: (1) the high rates of SUDs and related problems among AI/AN, (2) low rates of AI/AN self-referrals to treatment, and (3) higher rates of AI entering treatment due to court mandates (SAMHSA, 2012). The present study aims to develop an AI culturally adapted version of CRAFT (CRAFT-AI); and conduct an RCT to compare it (n=20) to Nar/Al-Anon facilitation (n=20) to examine acceptability of a culturally tailored EBT and estimate effect sizes for IP treatment entry and for CSO functioning pre to post intervention. Uniquely, the concept of treatment entry will be broadened to include receiving AI traditional healing. The proposed study will be the first to examine potential mediators and moderators of CRAFT-AI such as: demographic variables, severity of SUD, self-efficacy, and cultural risk and protective factors. The methodology of this grant, which uses a partnership between academic and tribal researchers, is well-poised to contribute to nascent AI/AN SUD treatment research to impact the substantial health disparities AI/ANs and other indigenous populations endure. Positive study results will facilitate future cultural adaptation research and dissemination and diffusion of EBTs to interested AI/AN tribes and other culturally diverse populations.