Randomized Clinical Trial of Harm Reduction Talking Circles for Urban American Indians and Alaska Natives with Alcohol Use Disorders

研究项目2摘要：酒精使用障碍(AUD)是一个严重的城市公共卫生问题 美国印第安人和阿拉斯加原住民(AI/ANS)。他们的AUDS水平和酒精问题是 城市里的非西班牙裔白人。不幸的是，最广泛使用的治疗方案--基于禁欲 治疗--在参与和成功治疗这一服务不足的人群方面通常无效。至 为了阐明这个问题的潜在解决方案，我们进行了试点定性研究，在这些研究中，城市人工智能/ANS AUDS表示对整合低障碍、基于非禁欲的减少伤害的干预措施感兴趣 与土著文化习俗相结合的方法。最常被要求的文化实践是谈话圈。 谈话圈是有共同关切的人的聚会，他们恭敬地分享他们的观点和 “用心倾听”，每个人都在说话。传统上，谈话圈被用来表示 社区问题，治愈个人创伤，带来社区和谐。最新研究 在其他人群中进行的研究表明，谈话圈可能是一种有效的临床干预措施。我们 建议使用以社区为基础的参与式研究框架来指导细化和形式化 应用AUDS评价城市人工智能/ANS的减害讨论圈HaRTC将被设计为 社区咨询委员会由研究人员、传统土著治疗师、城市人工智能/ANS和活着的人组成 AUDS的经验，以及西雅图印第安人健康委员会的代表，西雅图印第安人健康委员会是 学习。该项目将分三个阶段进行：在第一阶段，我们将通过访谈和 与西雅图印第安人健康委员会工作人员和优先人群组成的焦点小组。定性分析将阐明 如何以最佳方式定制HaRTC。在第二阶段，我们将完善研究程序和HaRTC治疗手册，使用 在第一阶段收集的定性数据和社区咨询委员会的指导。第三阶段将包括 来自西雅图印第安人健康委员会初级保健和初级保健的280名患者参加了HaRTC的随机对照试验 行为健康诊所。参与者将被个别随机地接受HaRTC或诊所的治疗 照常服务(对照)，并将在基线、后测试(紧接治疗结束后)进行评估，1- 、3个月和6个月的随访。定量分析将测试与AS治疗相比，HaRTC的疗效 像往常一样。我们的具体目标是1)量身定做HaRTC，以满足临床上患有AUDS的城市AI/ANS的需求 背景：2)进行随机对照试验，评价HaRTC与常规治疗的疗效； 3)从成本效益和成本效益两个方面对HARTC进行综合经济评价 分析。我们预计HaRTC参与者将在酒精结果和质量方面表现出更大的进步 他说，与对照组参与者相比，他们的生活质量更高，而且干预措施将具有成本效益和可持续性。我们也 预计HaRTC参与者将更多地参与人工智能/AN文化实践和社区活动， 它将被评估为HaRTC效应的潜在介体。

RESEARCH PROJECT 2 ABSTRACT: Alcohol-use disorders (AUDs) are a serious public health issue for urban American Indians and Alaska Natives (AI/ANs). They have twice the levels of AUDs and alcohol problems of urban non-Hispanic whites. Unfortunately, the most widely available treatment option – abstinence-based treatment – is generally ineffective in engaging and successfully treating this underserved population. To illuminate potential solutions to this problem, we conducted pilot qualitative studies, in which urban AI/ANs with AUDs expressed interest in interventions that integrate low-barrier, nonabstinence-based harm-reduction approaches with Native cultural practices. The most commonly requested cultural practice was the talking circle. A talking circle is a gathering of people with a common concern who respectfully share their perspectives and “listen with their heart” while each individual speaks. Traditionally, talking circles have been used to address community problems, heal individuals from trauma, and bring about community harmony. Recent studies conducted with other populations have indicated talking circles may be an efficacious clinical intervention. We propose to use a community-based participatory research framework to guide the refinement and formal evaluation of Harm Reduction Talking Circles (HaRTC) for urban AI/ANs with AUDs. HaRTC will be designed with a community advisory board made up of researchers, traditional Native healers, urban AI/ANs with the lived experience of AUDs, and representatives from the Seattle Indian Health Board, the community partner for the study. This project will be conducted in 3 phases: In Phase 1, we will collect qualitative data via interviews and focus groups with Seattle Indian Health Board staff and the priority population. Qualitative analyses will elucidate ways to optimally tailor HaRTC. In Phase 2, we will refine study procedures and HaRTC treatment manual using qualitative data collected in Phase 1 and the guidance of the community advisory board. Phase 3 will comprise a randomized controlled trial of HaRTC with 280 patients from the Seattle Indian Health Board primary care and behavioral health clinics. Participants will be individually randomized to receive HaRTC or the clinic’s treatment as usual services (control), and will be assessed at baseline, posttest (immediately following treatment end), 1- , 3- and 6-month follow-ups. Quantitative analyses will test the efficacy of the HaRTC compared to treatment as usual. Our Specific Aims are to 1) Tailor HaRTC to meet the needs of urban AI/ANs with AUDs in a clinical setting; 2) Conduct a randomized controlled trial to evaluate the efficacy of HaRTC versus treatment as usual; and 3) Perform a comprehensive economic evaluation of HaRTC with cost-benefit and cost-effectiveness analyses. We expect that HaRTC participants will show greater improvements on alcohol outcomes and quality of life compared to control participants and that the intervention will be cost-effective and sustainable. We also expect HaRTC participants will show increased engagement in AI/AN cultural practices and community events, which will be evaluated as a potential mediator of the HaRTC effect.