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

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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.