Understanding Race-Related Stress as a Mechanism Associated with Alcohol Craving to Inform Culturally-Adapting Alcohol Treatment for Black Adults

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Abstract Black people (BP) who use alcohol experience among the highest rate of alcohol-related consequences, yet only a small percentage of BP with alcohol use disorder (AUD) receive treatment. This disparity in treatment unmet need among BP highlights the necessity of efficacious alcohol treatments for this group. Among BP who receive alcohol treatment, they tend report lower satisfaction with treatment and have higher dropout rates. Culturally tailoring treatment has been proposed as one approach that might increase treatment satisfaction and retention among BP. Given that extensive research links stress to alcohol craving and relapse, and Minority Stress Models indicate that BP experiences stressors specific to being Black, incorporating race-related stress (RRS) is a reasonable target for adapted alcohol treatments for this group. Although prior research shows RRS such as discrimination predict alcohol misuse among BP, prior research has not investigated alcohol craving as a potential mechanism that links RRS to alcohol misuse among BP. In addition, knowledge of cues associated with drinking may be important for informing alcohol treatment adaptations for BP. Further, knowledge of neutral/relaxing events could inform coping strategies to include in alcohol treatment for BP. The proposed research will: [1) identify specifically which stressors and types of alcohol cues trigger alcohol craving and strategies for coping among BP; 2) provide an in-depth understanding of the impact of race-related stress (RRS) on alcohol craving; 3) identify other factors associated with the Black experience that contribute to AUD and should be included in AUD treatment for this group; and 4) provide evidence of the feasibility and acceptability of culturally-adapting an early CBT session based on these factors.] Completing this research will support my development as an independent alcohol treatment researcher with a focus on priority populations (e.g., Black people) and my career goals to [1) conduct meaningful research with hard to reach populations; 2) investigate coping strategies and mechanisms that maintain AUD among BP, and 3) lead rigorous clinical trials research to develop and test culturally-informed treatments for Black adults with AUD.] I will achieve my research and career goals through training and mentorship by experts in: alcohol treatment research (Dr. Stephanie O’Malley), personalized imagery procedures and stress and craving research (Dr. Rajita Sinha), RRS and treatment adaptations for BP (Dr. Monnica Williams), treatment development and adaptations (Dr. Kathleen Carroll), and community-based participatory and qualitative research methods (Dr. Larry Davidson), and collaboration with a biostatistician with expertise in clinical trials research (Dr. Ralitza Gueorguieva). My research and training will be completed at Yale School of Medicine, which has an abundance of physical and intellectual resources. Receiving this training and completing this research will support my long-term career goal to eliminate treatment health disparities among BP with AUD.