Randomized Controlled Trial of Indigenous Recovery Planning for American Indians

虽然美国印第安人（AI）的禁欲率很高，但也有证据表明， 和药物使用障碍不成比例地影响土著社区。由于几代人的系统性 种族主义和历史创伤，AI经历了与物质使用相关的严重健康差异， 疾病（SUD）。SUD的有效治疗对于改善AI的健康公平性至关重要 社区，但很少有基于文化的证据为基础的干预措施开发或测试与人工智能。 通过这项研究，美洲印第安人本土恢复计划的随机对照试验，我们的目标是 帮助填补这一空白。我们的研究使用基于社区的前瞻性研究（CBPR）框架来测试 社区合作伙伴合作设计的文化适应性复发预防干预措施的效力 来自蒙大拿州东北部的佩克堡印第安人保护区， 大学土著恢复计划（IRP）雇用训练有素的Fort Peck社区成员， 手动干预内容文化上改编自复发预防（RP），这是研究最多的， 有效治疗SUD。使用4种混合方法初步研究的数据，我们密切合作， 与社区咨询委员会（CAB）一起修改RP，以专注于优势，提高保护水平， 我们的目标是，消除文化上的具体风险因素，并克服参与治疗的障碍。我们现在将 在150名SUD部落成员的前瞻性随机对照试验中，使用 waitlist控制组，社区合作伙伴所期望的设计。使用随机分配到IRP （立即干预; n = 75）或等待名单对照组（延迟干预; n = 75），我们将测试 IRP对主要结局（禁欲天数百分比）和次要结局（物质相关）的影响 结果、生活质量）进行干预后评估。我们还将检查 干预后12周随访的治疗结果，并检查假设的文化特异性 治疗效果的中介（AI身份，灵性，社区掌握，悲伤和损失， 历史创伤、横向暴力和种族主义）。最后，我们将进行一次 过程评估，检查干预措施的可接受性和可持续性，以确保IRP 解决了设计的基于证据的SUD干预措施的障碍。这项研究将填补一个重要的空白， 关于文化适应性循证治疗的有效性和可接受性的科学知识 在人工智能人群中进行测试。这些知识可以转移到具有类似文化价值观的其他社区 和治疗的障碍。通过增加获得有效治疗的机会，这项研究有可能 改善当地服务不足AI社区的健康结果并减少SUD相关的健康差异 和全国性的。

Although there are high rates of abstinence among American Indians (AIs), there also is evidence of alcohol and drug use disorders disproportionately affecting Native communities. As a result of generations of systemic racism and historical trauma, AIs experience serious health disparities associated with substance use disorders (SUDs). Effective treatments for SUD are critically needed for improving health equity in AI communities, but there are few culturally grounded evidence-based interventions developed or tested with AIs. With this study, Randomized Controlled Trial of Indigenous Recovery Planning for American Indians, we aim to help fill this gap. Our research uses a Community-Based Participatory Research (CBPR) framework to test the efficacy of a culturally adapted relapse prevention intervention designed collaboratively by community partners from the Fort Peck Indian Reservation in northeastern Montana and research partners from Montana State University. Indigenous Recovery Planning (IRP) employs trained Fort Peck community members to deliver manualized intervention content culturally adapted from Relapse Prevention (RP), one of the most studied and efficacious treatments for SUD. Using data from 4 mixed-methods preliminary studies, we have worked closely with a Community Advisory Board (CAB) to modify RP to focus on strengths, increase levels of protective factors, address culturally specific risk factors, and overcome barriers to engagement in treatment. We now will test the efficacy of IRP in a prospective randomized controlled trial with 150 tribal members with SUD using a waitlist control group, a design desired by the community partners. Using random assignment to IRP (immediate intervention; n = 75) or to a waitlist control group (delayed intervention; n = 75), we will test the effects of IRP on primary outcomes (percent days abstinent) and secondary outcomes (substance-related consequences, quality of life) assessed post-intervention. We also will examine maintenance of changes in treatment outcomes at 12-week post-intervention follow-up, and examine hypothesized culturally specific mediators of treatment effects (AI identity, spirituality, communal mastery, grief and loss, distress from historical trauma, lateral violence, and racism) identified in our preliminary studies. Finally, we will conduct a process evaluation to examine the acceptability and sustainability of the intervention to ensure that IRP addresses barriers to evidence-based SUD interventions as designed. This research will fill an important gap in scientific knowledge regarding the efficacy and acceptability of culturally adapted evidence-based treatments tested in AI populations. This knowledge may be transferable to other communities with similar cultural values and barriers to treatment. By increasing access to efficacious treatment, this research has the potential to improve health outcomes and decrease SUD-related health disparities for underserved AI communities locally and nationally.