Addressing Alcohol Use Related Health Disparities: A Hybrid Effectiveness Implementation Study of a Culturally Adapted MI for Latinx Alcohol and Drug Users

摘要 在拉丁裔中，饮酒是一个严重的问题，因为身体伤害的负担不成比例 与其他种族/民族群体相比，与药物使用相关的负面后果。因素 与移民相关的压力增加了使用药物的风险。一种基于理论的 激励性访谈的文化适应(CAMI)，特别是整合了压力来源的讨论 与移民有关的问题(如歧视、耻辱、社会孤立)大大减少了危害 与标准MI相比，拉美裔重度饮酒者与酒精有关，以及 与MI相比，一年后焦虑和抑郁症状减少。严格的测试，检查 从理论上讲，对成瘾有效干预措施的知情适应并不常见，但需要 先进的实施科学，因为它们解决的问题是成功的基础 实施。拟议的混合类型1有效性-实施研究是#年的重要下一步 这条研究路线，是为了调查在现实世界中实施CAMI干预的可行性 临床环境。关键问题是：CAMI会对同时使用两者的个人产生积极影响吗 毒品和酒精？供应商如何看待这种干预？我们将与一家初级保健中心合作 为主要是拉美裔客户群体提供服务，培训他们的社区健康倡导者(CWA)，以提供 CAMI适用于酗酒的患者。我们将同时对以下过程进行调查 在初级保健中实施CAMI--一项双臂随机临床疗效试验将纳入Latinx 在初级保健中心的酗酒者(18岁或以上)使用酒精(并可能使用其他药物)--并遵循 干预后12个月。具体目标是：(1)审查CAMI的影响，以及在- 关于结果的人员强化会议(仅限评估)：酗酒天数百分比，饮酒频率- 使用混合类型的相关后果、抑郁/焦虑症状和非法药物使用天数 1成效--执行设计和(2)从多个国家收集执行成果指标 利益攸关方使用混合方法。我们将遵循柯伦的框架来评估 执行和监管者衡量执行成果的框架：可接受性、采纳度、 干预的适当性、可行性、总成本(即CAMI与评估)和治疗的保真度。 我们的研究是第一次检查初级保健中适应文化的成瘾治疗的可接受性 将回答关于对拉丁裔实施循证护理的基本问题，这些问题可以改善 与物质使用有关的健康差距。长期目标是将我们的经验教训转化为 混合研究以更广泛的社区为重点，关注所有初级保健患者的人口健康。

Abstract Alcohol use is a significant problem among Latinxs because of the disproportionate burden of physical harms and negative consequences associated with substance use relative to other racial/ethnic groups. Factors associated with the stress related to being an immigrant increase risk for substance use. A theoretically-based cultural adaptation of motivational interviewing (CAMI) that specifically integrated discussion of stressors related to immigration (e.g., discrimination, stigma, social isolation) resulted in significant reductions in harms related to alcohol for those Latinx heavy drinkers with high discrimination compared to standard MI, and reduced anxiety and depressive symptoms one year later compared to MI. Rigorous tests that examine theoretically-informed adaptation of efficacious interventions for addictions are not common, yet are needed to advance implementation science because they address questions that are the basis for successful implementation. The proposed Hybrid Type 1 Effectiveness-Implementation study is an important next step in this line of research, which is to investigate the feasibility of implementing the CAMI intervention in a real-world clinical setting. The key questions are: Would CAMI have positive effects among individuals who use both drugs and alcohol? How do providers view this intervention? We will collaborate with a primary care center that serves a mainly Latinx client population to train their Community Wellness Advocates (CWAs) to deliver the CAMI to patients who are heavy drinkers. We will conduct a concurrent investigation on the process of implementing the CAMI in primary care - a two-arm randomized clinical effectiveness trial will enroll Latinx heavy drinkers (18 years or older) in primary care who use alcohol (and may use other drugs) - and follow them for 12 months after the intervention. Specific Aims are: (1) To examine the impact of CAMI plus an in- person booster session (vs. assessment only) on outcomes: % heavy drinking days, frequency of alcohol- related consequences, depressive/anxiety symptoms, and number of illicit drug use days, using a Hybrid Type 1 Effectiveness-Implementation design and (2) To gather indicators of implementation outcome from multiple stakeholders using a mixed-methods approach. We will follow Curran's framework to evaluate the process of implementation and Proctor's framework to measure implementation outcomes: acceptability, adoption, intervention appropriateness, feasibility, overall cost (i.e., CAMI vs. assessment only), and treatment fidelity. Our study, a first to examine the acceptability of culturally-adapted addiction treatments in primary care settings, will answer essential questions on implementing evidence-based care for Latinxs that can improve health disparities related to substance use. Long term goals are to translate our lessons from the proposed Hybrid study to the broader community to focus on population health for all primary care patients.