Alcohol treatment & health disparity in American Indians

描述（申请人提供）：本提案是第三次提交申请号为R 01 AA 013806 -01的申请，最初提交申请号为AA02.002（“酒精健康差异研究”），最近于2003年2月13日由国家酒精滥用和酒精中毒健康服务研究审查小组委员会（AA-2）审查。根据审查人员的意见，再次对申请进行了广泛修订。 尽管如此，这项卫生服务研究的动机仍然是健康方面的差异，如美洲印第安人与饮酒有关的高发病率和死亡率。 考虑到这些健康差异，令人担忧的是，很少有研究探讨当地人酒精问题的治疗和结果之间的关系。特别是，很少或根本没有关于为酗酒或依赖酒精的城市美洲原住民提供服务的研究。这种信息的缺乏是不幸的，因为大多数美国印第安人现在住在城市里。 拟议的项目将审查在华盛顿的西雅图和俄勒冈州的波特兰的美洲印第安人方案的客户中的治疗过程和结果。西雅图印第安人健康委员会和俄勒冈州波特兰的美洲原住民康复协会主要为城市美洲印第安人提供服务，与一般医疗服务密切相关，提供家庭治疗等辅助护理，为有酒精问题的个人提供多种治疗方式，并支持正在进行的研究项目。这两家机构都为几个部落的成员提供服务，两家机构都有客户，他们一年中有一部分时间在城里，一部分时间在保留地。这两个机构都为土著人进行了调整，并将包括动机增强和认知行为治疗在内的标准化疗法纳入其治疗方案。 该项目将使用初始队列设计。在研究项目中治疗酒精问题的客户将被告知该项目。获得知情同意后，将使用成瘾严重程度指数和项目匹配表90等工具对受试者进行访谈。受试者将在基线后6个月、12个月和18个月再次接受访谈。感兴趣的结果将包括戒酒，饮酒天数，酒精相关问题，精神问题，一般医疗问题和服务满意度。与客户和供应商的访谈，治疗会议的意见，并审查录音治疗遇到将被雇用，以了解所收到的治疗服务的细节。 将使用分层线性模型和结构方程模型将治疗与结局联系起来。预测因素将包括变量描述提供给本地客户的文化特定的治疗，以及临床医生的文化能力的措施。行政数据将用于比较美国印第安人与一般人口客户的结果。该项目产生的信息将有助于为居住在城市地区的土著人民设计最佳治疗方法和规划随机临床试验。该研究小组（由一名切罗基精神病学家领导，成员包括几个部落的成员）将与新资助的美国印第安人和阿拉斯加原住民药物滥用预防和治疗国家资源中心合作传播研究结果。

DESCRIPTION (provided by applicant): This proposal is the third submission of application number R01 AA013806-01 which was originally submitted in response to Request for Application Number AA02.002 ("Research on Alcohol Health Disparities") and most recently reviewed February 13, 2003 by the National Institute on Alcohol Abuse and Alcoholism Health Services Research Review sub-committee (AA-2). The application has again been extensively revised in response to reviewer comments. Nonetheless, this health services research study continues to be motivated by health disparities such as the high rates of morbidity and mortality related to alcohol use among American Indians. Given these health disparities, it is worrisome that there have been few studies examining relationships between treatments and outcomes for natives with alcohol problems. In particular, there is little or no research on services for urban Native Americans with alcohol abuse or dependence. This lack of information is unfortunate since most American Indians now live in cities. The proposed project will examine processes of treatment and outcomes among clients of programs focusing on American Indians in Seattle, Washington and Portland, Oregon. The Seattle Indian Health Board and the Native American Rehabilitation Association in Portland, Oregon primarily serve urban American Indians, are closely connected with general medical services, offer ancillary care such as family therapy, provide numerous treatment modalities for individuals with alcohol problems, and support ongoing research projects. Both agencies serve members of several tribes and both have clients who spend part of the year in the city and part on reservations. Both agencies have adapted for Native people and incorporated into their treatment programs standardized therapies including Motivational Enhancement and Cognitive-Behavioral Treatment. The project will use an inception cohort design. Clients presenting for treatment of alcohol problems at the study programs will be informed about the project. After informed consent is obtained, subjects will be interviewed using instruments such as the Addiction Severity Index and the Project Match Form 90. Subjects will be interviewed again six months, 12, and 18 months after baseline. Outcomes of interest will include abstinence, number of drinking days, alcohol-related problems, psychiatric problems, general medical problems, and satisfaction with services. Interviews with clients and providers, observations of treatment sessions, and reviews of taped treatment encounters will be employed to elicit details of treatment services received. Hierarchical linear models and structural equations models will be used to relate treatments to outcomes. Predictors will include variables describing culturally specific treatments provided to the Native clients as well as measures of clinician cultural competence. Administrative data will be used to compare outcomes for American Indians versus general population clients. Information generated from the project will be useful in devising optimal treatment for indigenous people living in urban areas and in planning randomized clinical trials. The research team (headed by a Cherokee psychiatrist and including members of several tribes) will disseminate results in collaboration with the newly funded American Indian and Alaska Native National Resource Center on Substance Abuse Prevention and Treatment.