Bright Horizons: Designing and Evaluating a Brief Intervention to Address Alcohol, Opioid, and other Substance Use among At-Risk Apaches

虽然阿片类药物的使用一直是最近全国关注的一个必要的焦点，但美国总体上 酗酒、酗酒和与酒精相关的死亡人数正在上升，其中包括青少年。 3印第安人的差距最大。长期以来，酒精一直是一种 4殖民者压迫土著人民，故意造成伤害。物质使用正在进一步 5受新冠肺炎大流行的影响，对弱势社区的感受更强烈。而当 6有一些有希望的、循证的干预措施来解决物质使用问题， 7在土著社区中缺乏对这些干预措施的严格研究。认识到 8社区内滥用滥用药物和部落使用新方法的流行率 9主权，白山阿帕奇部落强制向他们的 并对自杀和自残监测系统进行了一系列研究。明亮 11 Horizons是一种很有前途的、适应文化的干预措施，后来在 12基于一些初步研究的上一次国家农业发展基金赠款的最后阶段，但尚未 13个被评估。Bright Horizons是一种短暂的干预，包括认知行为疗法 14(CBT)和动机访谈(MI)，以减少酒精和其他物质的使用并建立联系 15名接受治疗的人。我们的研究目的是：1)使用定性的正向偏离 16确定不使用药物的高危青年(12-17岁：n=30)的优势和技能 17种物质以了解可能与预防药物使用有关的独特因素 18干预；2)根据目标1的发现、当前的文献，改编Bright Horizons 19个驾驶室输入，由阿帕奇社区精神卫生专家(CMHS)进行试点，N=10 20名最近严重酗酒的阿帕奇青年；以及3)测试Bright的有效性 21 Horizons对阿帕奇青少年(N=100)进行的随机对照试验 22严重酗酒。这项研究是创新的，并将通过以下方式增加文献：a)设计 23以我们自己的理论模型为基础的干预，由当地数据和其他 24个土著框架；b)实施简短干预，虽然重点是酒精，但也 25认识到青少年正在使用多种物质，并有变化的物质使用 26种模式，以及c)使用CMHS作为转变精神卫生保健的模式， 27.在新冠肺炎危机期间，这一必要性变得更加明显。 28这笔赠款由两名阿帕奇联合调查员在当地领导，他们拥有硕士学位，并在 29个心理健康方面的兼职博士项目，并支持另外4个阿帕奇团队 30名成员将接受药物使用干预和研究方面的培训。

1 While opioid use has been a necessary focus of recent national attention, general US rates of 2 alcohol use, binge drinking, and alcohol-related deaths are rising including among adolescents, 3 with some of the highest disparities for Native Americans. Alcohol has long been a tool of 4 colonizers to oppress Native people and purposefully inflict harm. Substance use is being further 5 impacted by the COVID-19 pandemic, felt more acutely for disadvantaged communities. While 6 there are some promising, evidence-based interventions to address substance use problems, 7 rigorous research on these interventions in Native communities is lacking. Recognizing the 8 prevalence of binge substance use within their community and making novel use of tribal 9 sovereignty, the White Mountain Apache Tribe mandated reporting of binge alcohol use to their 10 suicide and self-harm surveillance system and conducted a series of research studies. Bright 11 Horizons is a promising, culturally adapted intervention that was subsequently developed in the 12 final phase of a previous NARCH grant based on some of this initial research but has not been 13 evaluated. Bright Horizons is a brief intervention that includes cognitive behavioral therapy 14 (CBT) and motivational interviewing (MI) to reduce alcohol and other substance use and connect 15 individuals with treatment. Our study aims are to: 1) to use a qualitative positive deviance 16 approach to identify strengths and skills of at-risk youth (12-17 years old: N=30) who do not use 17 substances to understand unique factors that may be relevant for a substance use prevention 18 intervention; 2) to adapt Bright Horizons, based on Aim 1 findings, the current literature, and 19 CAB input for piloting by Apache community mental health specialists (CMHS) with N=10 20 Apache youth with recent serious binge alcohol use; and 3) to test the effectiveness of Bright 21 Horizons using a randomized controlled trial with Apache adolescents (N=100) with recent 22 serious binge alcohol use. This study is innovative and will add to the literature by: a) designing 23 an intervention grounded in our own theoretical model informed by local data and other 24 Indigenous frameworks; b) implementing a brief intervention that while focused on alcohol, also 25 recognizes that adolescents, are engaged in polysubstance use and have changing substance use 26 patterns, and c) use of CMHS which serves as a model for transforming mental health care, the 27 necessity of which has become even more pronounced and evident during the COVID-19 crisis. 28 This grant is locally led by two Apache Co-Investigators with their Master's degrees, enrolled in 29 part-time doctoral programs in mental health, and supports an additional 4 Apache team 30 members who will receive training in substance use intervention and research.