Randomized Controlled Trial of CRAFT with American Indians

项目摘要 虽然有充分的证据表明，美国印第安人/阿拉斯加原住民（AI/AN）面临大量的酒精和毒品- 由于与健康相关的差异，AI/AN的治疗研究尚处于起步阶段（格林菲尔德& Venner，2013）。一 解决这些健康差距的途径是采用循证治疗（EBT）。EBT很少 用足够大的种族群体样本进行测试，因此结果往往是未知的（Bernal & Scharrón德尔里奥，2001年）。而且，不幸的是，有一些EBT的例子， 少数民族群体而不是其发展的原始多数群体（Calsyn等人，2012年）。 最近，R01（DA021672）采用了两种EBT用于物质使用障碍（SUD）（动机 访谈和社区强化方法（MICRA），并进行了一项RCT，将MICRA与 与本提案所涉及的相同AI社区一样对待。本研究旨在 通过以家庭为重点，扩大R 01的范围，该R 01在文化上为SUD患者量身定制了CRA， 关心的重要他人（CSO），他们希望帮助他们所爱的人与SUD（已确定的患者; IP）进行治疗。社区强化和家庭培训（CRAFT）的干预措施建立在 强化原则。CRAFT教导公民社会组织更好地照顾自己，停止任何行为， 不致力于解决知识产权的物质使用，并一贯奖励知识产权的任何清醒和治疗 参与行为重要的是，CRAFT已被证明可增加IP进入治疗， 解决：（1）AI/AN中SUD和相关问题的高比率，（2）AI/AN自我转诊的低比率， 治疗，以及（3）由于法院授权，AI进入治疗的比率较高（SAMHSA，2012）。本 该研究旨在开发一种适应人工智能文化的CRAFT版本（CRAFT-AI）;并进行RCT， 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的可接受性， 估计干预前后IP治疗入组和CSO功能的效应量。独特的是， 治疗进入的概念将扩大到包括接受人工智能传统治疗。拟定的研究将 成为第一个检查CRAFT-AI的潜在中介者和主持人的人，例如：人口统计变量， SUD的严重程度、自我效能、文化风险和保护因素。这项赠款的方法， 使用学术和部落研究人员之间的合作关系，准备为新生的AI/AN做出贡献 SUD治疗研究，以影响AI/AN和其他土著人口的重大健康差距 忍耐积极的研究成果将有助于未来的文化适应研究和传播和扩散 向感兴趣的AI/AN部落和其他文化多样性人口提供EBT。

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.