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

1虽然阿片类药物的使用一直是最近国家关注的一个必要焦点，但美国的总体使用率 2酒精使用、酗酒和与酒精有关的死亡正在上升，包括青少年， 3与一些最高的差距为美洲原住民。长期以来，酒精一直是一种 4殖民者压迫原住民，故意造成伤害。物质使用正在进一步 5受COVID-19疫情影响，弱势社群的感受更为强烈。而 6.有一些有希望的循证干预措施来解决药物使用问题， 7.缺乏对土著社区这些干预措施的严格研究。认识到 8在他们的社区内滥用物质的流行率， 9主权，白色山阿帕奇部落授权报告酗酒使用他们的 10自杀和自我伤害监测系统，并进行了一系列的研究。明亮 11 Horizons是一种很有前途的、适应文化的干预措施，随后在1999年开发。 12基于一些初步研究的前一个Numbers赠款的最后阶段，但尚未 13评价Bright Horizons是一种包括认知行为疗法在内的简短干预 14（CBT）和动机访谈（MI），以减少酒精和其他物质的使用，并连接 15人接受治疗我们的研究目的是：1）使用一个定性的积极偏差 16确定不使用药物的高危青少年（12-17岁：N=30）的优势和技能的方法 17种物质，以了解可能与物质使用预防相关的独特因素 18项干预措施; 2）根据目标1的发现、现有文献， 19 CAB输入，用于Apache社区心理健康专家（CMHS）的试点，N=10 20名最近严重酗酒的阿帕奇青年; 3）测试Bright的有效性 21 Horizons使用最近患有Apache青少年（N=100）的随机对照试验 22、严重酗酒。这项研究是创新的，将增加文献：a）设计 23一种基于我们自己的理论模型的干预，该模型由当地数据和其他数据提供信息。 24个土著框架; B）实施一项简短的干预措施，在重点关注酒精问题的同时， 25认识到青少年正在使用多种物质， 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COVID-19危机期间，其必要性变得更加明显和明显。 28这项补助金由两名拥有硕士学位的阿帕奇共同研究员在当地领导， 29个心理健康兼职博士课程，并支持另外4个Apache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.