Kipiyecipakiciipe "coming home": Establishing clinical cultural neuroscience as a tool for understanding the role of traditional cultural engagement in mitigating substance misuse and disorder

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PROJECT SUMMARY Inequities in substance use disorders (SUDs) among American Indian (AI) populations persist despite decades of awareness and research. Advancements in heretofore separate areas of SUD research have (1) underscored the importance of community based and culturally grounded research approaches in AI populations and (2) shown the promise of clinical neuroscience's role in addressing SUD. Merging these approaches through clinical-cultural neuroscience is a missing link in the field which holds large promise for advancing both SUD disparities research in AIs and underserved populations, and the neuroscientific understanding of SUD and recovery more broadly. This proposal integrates Community Based Participatory Research (CBPR) and clinical-neuroscience approaches to better delineate the brain processes that are important for SUD and that are impacted by traditional cultural engagement (TCE). The study aims to leverage the large promise of multimodal neuroimaging techniques as a method for probing TCE using objective markers of brain structure and function. Conceptualization of TCE will be done in collaboration with partners from the Shawnee Tribe (ST). This partnership is critical to the current project as culture comprises a broad category of human experiences common to a group of people and is often conflated with race, ethnicity, geographic distribution, and religion. This complexity has made it difficult to parse the influence of cultural factors and meaningfully incorporate TCE into disease and treatment models. Recently, advances in health disparities research among AI communities have conceptualized features of TCE under the framework of social determinants of health (SDH) to delineate specific risk and resilience factors for SUD. Furthermore, TCE has been supported as protective against and as treatment for SUD. The ST recognizes the impact of historical loss and degradation of cultural practices as a key factor in the prevalence of SUD and is committed to centering community engagement in developing evidence-based intervention and prevention efforts informed by and integrating traditional cultural knowledge and practices. Kipiyeecipsakiciipe “coming home” is a Shawnee word chosen by the ST partners to represent the effort of advancing the science of TCE in mitigating SUD disparities. A community advisory board of Shawnee adults will oversee the design, implementation, and interpretation of the study. A three phased approach will be used to provide a multi-level understanding of TCE as a protective SDH. Phase 1 will consist of focus groups aimed at refining a conceptualization of TCE specific to the ST to provide deep conceptual validity for behavioral probes and stimuli for neural probes of TCE. Phase 2 will examine neural probes of TCE and neurobehavioral and cognitive risk factors for SUD across individuals with varying degrees of TCE as defined by the CAB. Phase 3 will extend results to a sample of individual with SUD and healthy controls. This study will provide a framework for studying analogous cultural factor across other racial minority groups to advance health equity.