Development of a Culturally Grounded, Trauma-Informed Alcohol Intervention with a Reserve-Dwelling First Nation Group

项目概要/摘要 酒精是当今土著人口健康差距的主要决定因素之一。 土著居民表现出最高的狂欢和酗酒率，终身（43.4%）和12- 19.2%的酒精使用障碍率大大高于其他种族/族裔群体。 此外，土著居民完成酒精治疗的可能性要小得多; 治疗后复发更快，并显示出更严重的酒精使用模式。很少有 由土著社区设计并为土著社区设计的基于经验的干预措施， 研究合作伙伴依赖于现有的经验为基础的干预措施，最初设计的非 土著居民。土著居民越来越多地主张保健干预措施， 有文化背景的立足文化的方法涉及社区之间的密切合作， 研究人员在干预工作的设计植根于土著知识，协议和实践。这 借鉴文化优势，利用土著历史，语言，价值观和治疗传统作为一种方式， 土著人民恢复其文化信仰和习俗。研究应用一种文化 解决酒精干预中的历史创伤的基础框架是改善 土著居民的健康和福祉。土著居民曾面临种族灭绝的历史， 殖民化、强迫同化和排斥，损害健康和福祉。历史创伤 导致了酒精使用的文化转变。殖民化造成的压迫行为，如禁止 传统的治疗方法使土著人民没有应对情绪困扰的机制。这 再加上历史创伤的情感后遗症，使土著人民容易受到发展的影响， 不适应的应对方式土著居民开始使用酒精作为一种自我治疗的方式， 逃避或避免与历史创伤相关的创伤性记忆和情感痛苦。 该项目的目标是开发和获得关于基于文化的创伤的初步数据， 知情的酒精干预。具体目标是：（1）使用基于社区的前瞻性研究 通过能力建设和知识共享加深与金斯凯尔第一民族伙伴关系的方法; (2)收集和应用定性数据，以制定基于文化的、了解创伤的酒精干预措施 这是集中在历史创伤与第一民族样本使用;（3）进行试点随机对照试验研究， 检查可接受性，可持续性，和初步疗效数据的干预相比，等待名单控制。 研究团队（PI：Spillane和韦斯; Co-I：Yang;顾问：戈尔和摩尔）具有专业知识 在研究内容中（例如，酒精使用和土著居民的历史创伤）和方法（例如， 干预开发、临床试验）。这项工作是重要的，及时的和创新的。解决酗酒问题 对土著居民的健康有重要影响。

PROJECT SUMMARY/ABSTRACT Alcohol is one of the primary determinants of health disparity facing Indigenous populations today. Indigenous populations exhibit the highest rates of binge and heavy drinking, and lifetime (43.4%) and 12- month (19.2%) rates of alcohol use disorder are substantially higher than among other racial/ethnic groups. Further, Indigenous populations are significantly less likely to complete alcohol treatment; those that complete treatment are quicker to relapse and display more severe patterns of alcohol use. There is a paucity of empirically based interventions designed by and for Indigenous communities, which has led communities and research partners to rely on adaptations of existing empirically based interventions originally designed for non- Indigenous populations. Indigenous populations have increasingly advocated for health interventions to be culturally grounded. A culturally grounded approach involves close collaboration among communities and researchers in the design of intervention efforts rooted in Indigenous knowledge, protocols, and practices. This draws from cultural strengths, using Indigenous history, language, values, and healing traditions as a way for Indigenous populations to reclaim their cultural beliefs and practices. Research that applies a culturally grounded framework to address historical trauma in alcohol interventions is a critical next step to improving the health and well-being of Indigenous populations. Indigenous populations have faced histories of genocide, colonization, forced assimilation, and exclusion that undermine health and well-being. Historical trauma resulted in cultural shifts in alcohol use. Acts of oppression stemming from colonization such as the banning of traditional ways of healing left Indigenous people without mechanisms for coping with emotional distress. This coupled with the emotional aftereffects of historical trauma made Indigenous people vulnerable to developing maladaptive ways of coping. Indigenous populations began using alcohol as a way of self-medicating to escape or avoid traumatic memories and emotional pain associated with historical trauma. The objective of this project is to develop and obtain preliminary data on a culturally grounded, trauma- informed alcohol intervention. The specific aims are to (1) use Community-Based Participatory Research methods to deepen partnerships with Kingsclear First Nation through capacity-building and knowledge sharing; (2) collect and apply qualitative data to develop a culturally grounded, trauma-informed alcohol intervention that is focused on historical trauma for use with a First Nation sample; and (3) conduct a pilot RCT study to examine acceptability, sustainability, and initial efficacy data of the intervention compared to waitlist control. The research team (PIs: Spillane and Weiss; Co-I: Yang; Consultants: Gore and Moore) has expertise in the study content (e.g., alcohol use and historical trauma among Indigenous populations) and methods (e.g., intervention development, clinical trials). This work is important, timely, and innovative. Addressing alcohol use has important implications for the health of Indigenous populations.