Culturally-responsive community-driven substance use recovery for Black and Latinx populations

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Program Summary/Abstract In 2020, over 85,000 people died from drug overdoses in the US, with mortality rates skyrocketing for Black and Latinx people by 140% and 118%, respectively, given the presence of fentanyl (a manufactured opioid) in the drug supply. While the national media has focused on opioid-involved deaths among White people, minimal attention has been given to the disparate morbidity and mortality related to opioid use disorder (OUD) and alcohol use disorder (AUD) among Black and Latinx people. Although overall prevalence of AUD is similar across racial and ethnic groups, or in some cases, fewer than White people, there continues to be a disproportionate burden of illness experienced among under-represented minority (URM) populations, complicated by a dearth of culturally informed addiction treatment options. Further, with COVID-19, deaths continue to worsen for URM with SUDs, making it more urgent than ever to study culturally informed treatment interventions for these populations. This disproportionate illness burden and lack of access to the gold standard in addiction treatment—medication for addiction treatment (MAT)—has been linked to a host of barriers, based in structural racism, including inadequate access to technology (a point particularly underscored in the current COVID-19 pandemic), lack of addiction providers from URM backgrounds, limited education about MAT in URM communities, and an absence of robust culturally informed harm reduction services in these communities. To tackle the unique challenges of decreased treatment initiation, engagement, and adherence to addiction treatment for Black and Latinx people with SUDs, in collaboration with key stakeholders we developed Imani (meaning Faith in Swahili) Breakthrough in 2017 through a community based participatory process. Imani Breakthrough is a faith-based, person- centered, culturally informed harm reduction recovery program that takes place in churches. This program provides an innovative approach to engaging vulnerable groups into SUD treatment, by focusing on the 8 dimensions of wellness (social determinants of health/ SDOH), 7 domains of citizenship, culturally informed SUD education, and referral to MAT for any FDA-approved pharmacotherapy for treating a SUD. The main goal of this current study is to develop and optimize methods for increasing access to, uptake of, and engagement in MAT for AUD and OUD among communities of color. Through a multilevel CBPR initiative and a rigorous RCT that incorporates elements of choice in participation, we will examine, among participants interested in MAT, whether adding a Church-based Telehealth MAT option to Imani (Imani + CTM) will improve outcomes for Black and Latinx people with AUD or OUD compared to Imani + traditional MAT Referral and Linkage (Imani + MAT R&L) in the community. Individuals who do not choose to engage in MAT will continue in the Imani group program as usual. Our CBPR process incorporates learning from and partnering with the church and larger community to increase the community's understanding of AUD and OUD, tackle MAT misconceptions, optimize Imani implementation, and establish policy recommendations to better serve Black and Latinx with SUDs.