Addressing Alcohol Use Related Health Disparities: A Hybrid Effectiveness Implementation Study of a Culturally Adapted MI for Latinx Alcohol and Drug Users

摘要 酒精使用是拉丁美洲人的一个重要问题，因为身体伤害的负担不成比例 以及与其他种族/族裔群体有关的物质使用的负面后果。因素 与移民相关的压力增加了使用药物的风险。一个基于理论的 动机访谈的文化适应（CAMI），特别是整合了压力源的讨论 与移民有关的（例如，歧视、耻辱、社会孤立）导致伤害显著减少 与标准MI相比，具有高辨别力的拉丁裔重度饮酒者与酒精相关，以及 与MI相比，一年后焦虑和抑郁症状减少。严格的测试， 对成瘾的有效干预措施进行理论上知情的调整并不常见，但需要 推进实施科学，因为它们解决的问题是成功的基础， 实施.拟议的混合1型容错性-实施研究是 这条研究路线，这是调查在现实世界中实施CAMI干预的可行性 临床设置。关键问题是：CAMI是否会对同时使用这两种方法的人产生积极影响 毒品和酒精吗供应商如何看待这种干预？我们将与初级保健中心合作， 为主要的拉丁裔客户提供服务，以培训他们的社区健康倡导者（CWA）， 对于酗酒的患者来说。我们将同时调查 在初级保健中实施CAMI-一项双臂随机临床有效性试验将招募Latinx 重度饮酒者（18岁或以上）在初级保健谁使用酒精（并可能使用其他药物）-并遵循 干预后12个月。具体目标是：（1）研究非洲工业部长会议的影响， 人助推器会议（仅与评估）的结果：%酗酒天，酒精的频率- 相关后果、抑郁/焦虑症状和非法药物使用天数，使用混合类型 （2）从多个方面收集执行结果的指标 使用混合方法的利益攸关方。我们将遵循Curran的框架来评估 执行和普罗克特衡量执行成果框架：可接受性、采用 干预的适当性、可行性、总成本（即，CAMI vs.仅评估）和治疗保真度。 我们的研究，第一次检查在初级保健中适应文化的成瘾治疗的可接受性 设置，将回答关于实施拉丁美洲人的循证护理的基本问题， 与药物使用有关的健康差距。长期目标是将我们的经验教训从拟议的 将混合研究扩展到更广泛的社区，重点关注所有初级保健患者的人群健康。

Abstract Alcohol use is a significant problem among Latinxs because of the disproportionate burden of physical harms and negative consequences associated with substance use relative to other racial/ethnic groups. Factors associated with the stress related to being an immigrant increase risk for substance use. A theoretically-based cultural adaptation of motivational interviewing (CAMI) that specifically integrated discussion of stressors related to immigration (e.g., discrimination, stigma, social isolation) resulted in significant reductions in harms related to alcohol for those Latinx heavy drinkers with high discrimination compared to standard MI, and reduced anxiety and depressive symptoms one year later compared to MI. Rigorous tests that examine theoretically-informed adaptation of efficacious interventions for addictions are not common, yet are needed to advance implementation science because they address questions that are the basis for successful implementation. The proposed Hybrid Type 1 Effectiveness-Implementation study is an important next step in this line of research, which is to investigate the feasibility of implementing the CAMI intervention in a real-world clinical setting. The key questions are: Would CAMI have positive effects among individuals who use both drugs and alcohol? How do providers view this intervention? We will collaborate with a primary care center that serves a mainly Latinx client population to train their Community Wellness Advocates (CWAs) to deliver the CAMI to patients who are heavy drinkers. We will conduct a concurrent investigation on the process of implementing the CAMI in primary care - a two-arm randomized clinical effectiveness trial will enroll Latinx heavy drinkers (18 years or older) in primary care who use alcohol (and may use other drugs) - and follow them for 12 months after the intervention. Specific Aims are: (1) To examine the impact of CAMI plus an in- person booster session (vs. assessment only) on outcomes: % heavy drinking days, frequency of alcohol- related consequences, depressive/anxiety symptoms, and number of illicit drug use days, using a Hybrid Type 1 Effectiveness-Implementation design and (2) To gather indicators of implementation outcome from multiple stakeholders using a mixed-methods approach. We will follow Curran's framework to evaluate the process of implementation and Proctor's framework to measure implementation outcomes: acceptability, adoption, intervention appropriateness, feasibility, overall cost (i.e., CAMI vs. assessment only), and treatment fidelity. Our study, a first to examine the acceptability of culturally-adapted addiction treatments in primary care settings, will answer essential questions on implementing evidence-based care for Latinxs that can improve health disparities related to substance use. Long term goals are to translate our lessons from the proposed Hybrid study to the broader community to focus on population health for all primary care patients.