Randomized Controlled Trial of CRAFT with American Indians

项目摘要 尽管有充分的记录表明，美国印第安人/阿拉斯加原住民(AI/AN)面临着大量的酒精和毒品- 与健康相关的差异，人工智能/ANS的治疗研究还处于初级阶段(Greenfield&Venner，2013)。一 解决这些健康差距的途径是采用循证治疗(EBTS)。EBTS很少 在足够大的种族群体样本中进行了测试，因此结果往往是未知的(伯纳尔和 沙龙·德尔里奥，2001年)。而且，不幸的是，有一些EBTS的例子对 少数族裔群体，而不是最初的多数群体(Calsyn等人，2012年)。 最近，一个R01(DA021672)改编了两个EBTS来治疗物质使用障碍(SODS)(动机 访谈和社区强化方法(MICRA)，并进行了一项随机对照试验，将MICRA与 与本提案所涉及的相同人工智能社区进行照常治疗。本研究旨在寻求 为了扩展R01，它以文化为患有肥皂泡的人量身定做CRA，通过关注家庭和 关心重要的其他人(CSO)，他们希望帮助他们所爱的人与SUD(确定的患者； IP)进入治疗阶段。干预，社区加强和家庭培训(工艺)，是建立在 加固原则。手艺教会公民社会组织更好地照顾自己，停止任何 没有致力于解决IP的物质使用问题，并一致奖励IP任何戒酒和治疗 交战行为。重要的是，工艺已经被证明可以增加IP进入治疗，这将 解决办法：(1)人工智能/人工智能中的高自杀率及相关问题，(2)人工智能/人工智能自我转介率低 (3)由于法院的授权，进入治疗的人工智能比率更高(SAMHSA，2012年)。现在 研究的目的是开发人工智能文化适应版本的Craft(Craft-AI)；并进行RCT以 将其(n=20)与NaR/Al-Anon促进(n=20)进行比较，以检查文化定制的EBT和 估计干预前后IP治疗条目和CSO功能的影响大小。独一无二的是， 治疗进入的概念将扩大到包括接受人工智能传统治疗。拟议的研究将 第一个检查人工智能的潜在调解人和主持人，例如：人口统计变量， 自闭症的严重程度、自我效能感、文化风险和保护因素。这笔赠款的方法，即 利用学术和部落研究人员之间的合作伙伴关系，做好准备为新生的AI/AN做出贡献 影响AI/ANS和其他土著人口健康差距的SUD治疗研究 忍耐一下。积极的研究成果将促进未来的文化适应研究和传播与扩散 向感兴趣的AI/AN部落和其他不同文化群体推广EBTS。

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.