Bright Horizons: Designing and Evaluating a Brief Intervention to Address Alcohol, Opioid, and other Substance Use among At-Risk Apaches

虽然阿片类药物的使用一直是最近全国关注的一个必要焦点，但美国的总体酒精使用率、酗酒率和与酒精相关的死亡率正在上升，包括在青少年中，其中印第安人的差距最大。长期以来，酒精一直是殖民者压迫土著人民并故意造成伤害的工具。药物使用受到COVID-19大流行的进一步影响，弱势社区的感受更为强烈。虽然有一些有希望的、基于证据的干预措施来解决药物使用问题，但缺乏对土著社区这些干预措施的严格研究。白山阿帕奇部落认识到他们社区内暴饮暴食的普遍现象，并对部落主权进行了新的利用，他们要求向他们的自杀和自残监测系统报告暴饮暴食的情况，并进行了一系列的研究。“光明地平线”是一个很有前途的、适应文化的干预措施，后来在先前NARCH拨款的最后阶段根据一些初步研究开发出来，但尚未进行评估。Bright Horizons是一项简短的干预措施，包括认知行为疗法（CBT）和动机访谈（MI），以减少酒精和其他物质的使用，并将个人与治疗联系起来。我们的研究目的是：1)使用定性的积极偏差方法来识别不使用物质的高危青少年（12-17岁：N=30）的优势和技能，以了解可能与物质使用预防干预相关的独特因素；2)根据Aim 1的研究结果、现有文献和CAB输入，改编Bright Horizons，由阿帕奇社区心理健康专家（CMHS）对N=10名近期严重酗酒的阿帕奇青年进行试点；3)对近期严重酗酒的阿帕奇青少年（N=100）进行随机对照试验，以检验Bright Horizons的有效性。本研究具有创新性，并将通过以下方式对文献进行补充：a)基于我们自己的理论模型设计干预措施，并根据当地数据和其他土著框架提供信息；(b)实施一项以酒精为重点的简短干预措施，同时也认识到青少年正在使用多种物质并正在改变物质使用模式；(c)使用CMHS作为转变精神卫生保健的模式，其必要性在2019冠状病毒病危机期间变得更加明显和明显。该基金由两名拥有硕士学位的阿帕奇联合调查员在当地领导，他们参加了心理健康方面的兼职博士课程，并支持另外4名阿帕奇团队成员，他们将接受药物使用干预和研究方面的培训。

While opioid use has been a necessary focus of recent national attention, general US rates of alcohol use, binge drinking, and alcohol-related deaths are rising including among adolescents, with some of the highest disparities for Native Americans. Alcohol has long been a tool of colonizers to oppress Native people and purposefully inflict harm. Substance use is being further impacted by the COVID-19 pandemic, felt more acutely for disadvantaged communities. While there are some promising, evidence-based interventions to address substance use problems, rigorous research on these interventions in Native communities is lacking. Recognizing the prevalence of binge substance use within their community and making novel use of tribal sovereignty, the White Mountain Apache Tribe mandated reporting of binge alcohol use to their suicide and self-harm surveillance system and conducted a series of research studies. Bright Horizons is a promising, culturally adapted intervention that was subsequently developed in the final phase of a previous NARCH grant based on some of this initial research but has not been evaluated. Bright Horizons is a brief intervention that includes cognitive behavioral therapy (CBT) and motivational interviewing (MI) to reduce alcohol and other substance use and connect individuals with treatment. Our study aims are to: 1) to use a qualitative positive deviance approach to identify strengths and skills of at-risk youth (12-17 years old: N=30) who do not use substances to understand unique factors that may be relevant for a substance use prevention intervention; 2) to adapt Bright Horizons, based on Aim 1 findings, the current literature, and CAB input for piloting by Apache community mental health specialists (CMHS) with N=10 Apache youth with recent serious binge alcohol use; and 3) to test the effectiveness of Bright Horizons using a randomized controlled trial with Apache adolescents (N=100) with recent serious binge alcohol use. This study is innovative and will add to the literature by: a) designing an intervention grounded in our own theoretical model informed by local data and other Indigenous frameworks; b) implementing a brief intervention that while focused on alcohol, also recognizes that adolescents, are engaged in polysubstance use and have changing substance use patterns, and c) use of CMHS which serves as a model for transforming mental health care, the necessity of which has become even more pronounced and evident during the COVID-19 crisis. This grant is locally led by two Apache Co-Investigators with their Master's degrees, enrolled in part-time doctoral programs in mental health, and supports an additional 4 Apache team members who will receive training in substance use intervention and research.