Addressing health disparities by providing evidence-based treatment in the Black Church

摘要 黑人/非洲裔美国人使用酒精和非法药物的比例与他们的白色同行相同，但 更有可能遭受与物质有关的负面后果。此外，他们不太可能发起 治疗时，与其他种族群体相比，当他们这样做，是不太可能完成 治疗或提供循证治疗。耻辱，对医疗系统的不信任，缺乏健康 护理覆盖面，复杂的护理途径，较低的社会经济地位，以及缺乏文化信息 治疗可能都是导致治疗启动率和参与率低的因素。因此，提供治疗， 替代设置，如黑人教会，一个高度信任的实体在黑人社区，是一个小说， 一个潜在的高度传播的战略，以改善获得循证治疗和酒精 这一重要人群的治疗效果。基于技术的治疗是一种新兴的策略， 接触得不到充分服务的人群，并能够解决在新环境中提供干预措施的障碍。一 这种策略，认知行为疗法的计算机培训（CBT 4CBT），已经得到证明 在多项随机临床试验中， 相对于标准治疗，作为附加治疗和作为独立治疗。 我们最近证明了进行严格的临床试验以及提供 CBT 4CBT在黑人教堂，这表明了压倒性的兴趣和热情，从 患有AUD的黑人成年人，以及非常有希望的参与和治疗完成水平。我们现在 我建议进行一项为期8周的随机临床试验，将200名患有原发性AUD的黑人成年人随机分配至 无论是CBT 4CBT在黑人教堂或转介到标准治疗的专业成瘾设置，与9- 随访1个月，评价治疗效果的持久性。主要结果包括保留（开始 治疗，订婚至少4周）和戒酒天数百分比（PDA）。选择 参与者特征（例如，性别、种族认同、宗教信仰、AUD严重程度、心理健康诊断， 和健康的社会决定因素中的脆弱性）将作为结果的潜在调节因素进行评估。 次要结果包括对护理的满意度，社会支持网络的扩大， 饮酒天数和WHO饮酒水平、对共病物质使用的影响以及总体生活质量。 此外，如果CBT 4CBT被证明对这种情况下患有AUD的黑人成年人有效， 是一种解决健康差距的廉价战略，可以相对容易地传播 在美国为黑人服务的大型教派网络中。

ABSTRACT Black/African-Americans use alcohol and illicit drugs at the same rates as their White counterparts but are much more likely to suffer negative substance related consequences. Moreover, they are less likely to initiate treatment when compared with other racial groups; and when they do, are significantly less likely to complete treatment or to be offered evidence-based treatments. Stigma, mistrust of the medical system, lack of health care coverage, complex pathways to care, lower socioeconomic status, and the scarcity of culturally-informed treatment may all be factors underlying low treatment initiation and engagement. Thus, offering treatment in alternative settings, such as the Black Church, a highly trusted entity in Black communities, is a novel, and potentially highly disseminable strategy for improving both access to evidence-based treatments and alcohol treatment outcomes for this important population. Technology-based treatments are an emerging strategy for reaching underserved populations and can address barriers to delivering interventions in novel settings. One such strategy, computer-based training for Cognitive Behavioral Therapy (CBT4CBT), has been demonstrated in multiple randomized clinical trials to be safe and effective in reducing alcohol and other substance use, both as an add on to treatment, and as a stand-alone treatment, relative to standard care. We recently demonstrated the feasibility of both conducting a rigorous clinical trial as well as delivering CBT4CBT in the Black Church, which demonstrated overwhelming levels of interest and enthusiasm from Black adults with AUD, as well as highly promising levels of engagement and treatment completion. We now propose an 8-week randomized clinical trial in which 200 Black adults with primary AUD will be randomized to either CBT4CBT in the Black church or referral to standard treatment in a specialty addiction setting, with a 9- month follow-up to evaluate durability of treatment effects. Primary outcomes include retention (initiation of treatment, engagement for at least 4 weeks) and percent days abstinent from alcohol (PDA). Selected participant characteristics (e.g., gender, ethnic identity, religiosity, severity of AUD, mental health diagnoses, and vulnerabilities in the social determinants of health) will be evaluated as potential moderators of outcome. Secondary outcomes include satisfaction with care, expansion of social support networks, reduction in heavy drinking days and in WHO drinking levels, effects on comorbid substance use, and overall quality of life. Moreover, if CBT4CBT is demonstrated to be effective with Black adults with AUD in this setting, this would represent an inexpensive strategy to address health disparities that could be disseminated with relative ease among the large network of denominations serving Black individuals in the US.