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（AUDs）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AUD水平和酒精问题是 城市非西班牙裔白人不幸的是，最广泛使用的治疗方案-禁欲为基础的 治疗-在吸引和成功治疗这一得不到充分服务的人群方面，通常是无效的。到 为了阐明这一问题的潜在解决方案，我们进行了试点定性研究，其中城市AI/AN与 AUD对整合低障碍、非禁欲基础的伤害减少的干预措施表示感兴趣 与当地文化习俗的结合。最常被要求的文化活动是谈话圈。 一个谈话圈是一个有共同关注的人的聚会，他们尊重地分享他们的观点， “用心倾听”，每个人都在说话。传统上，谈话圈被用来解决 社区问题，治愈个人的创伤，并带来社区和谐。最近的研究 与其他人群进行的研究表明，谈话圈可能是一种有效的临床干预措施。我们 建议使用一个基于社区的参与性研究框架，以指导 对具有AUD的城市AI/AN的伤害减少谈话圈（HaRTC）的评估。HaRTC将被设计为 社区咨询委员会由研究人员，传统的土著治疗师，城市AI/AN与生活 澳大利亚发展署的经验，以及来自西雅图印第安人健康委员会的代表， study.该项目将分三个阶段进行：在第一阶段，我们将通过访谈收集定性数据， 与西雅图印第安人健康委员会工作人员和重点人群的焦点小组。定性分析将阐明 优化HaRTC的方法。在第2阶段，我们将使用以下方法完善研究程序和HaRTC治疗手册： 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 一项HaRTC随机对照试验，纳入了来自西雅图印度卫生委员会初级保健的280例患者， 行为健康诊所受试者将被单独随机分配接受HaRTC或诊所的治疗 正常服务（对照），并将在基线、试验后（治疗结束后立即）、1- 、3个月和6个月随访。定量分析将测试HaRTC与治疗相比的疗效， 往常我们的具体目标是：1）定制HaRTC，以满足临床中具有AUD的城市AI/AN的需求 2）进行随机对照试验，以评估HaRTC与常规治疗的疗效; 3）从成本效益和成本效果两个方面对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改善 与对照组参与者相比，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AI/AN文化实践和社区活动， 其将被评估为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.