Zuni MI/CRA Project

描述（由申请人提供）： 美洲原住民的物质使用障碍患病率至少是美国普通人口的两倍，相应的死亡率，健康和社会问题也很高。然而，很少有临床研究，也没有随机试验来发现和记录美洲印第安人的有效治疗方法。在为特殊人群寻求有效的治疗方法时，开始并采用具有更普遍疗效证据的方法是合理的。我们的初步研究表明，在以证据为基础的治疗方法，动机访谈（MI）和社区强化方法（CRA）显示出特别的承诺，在与保留地居住的部落人口的文化一致的方法。与更具指令性或对抗性的风格相反，MI反映了部落的沟通规范，CRA特别适合利用保留生活的大家庭和独特的氏族结构。这是一个第1阶段行为疗法开发提案，以适应和测试这两种循证方法（MICRA）与祖尼普韦布洛的组合，为随后的正式临床试验做准备。与来自祖尼社区的团队成员合作，我们建议开发一个更大的随机试验所需的研究材料：MICRA顾问手册，适应美洲原住民背景的评估工具，以及详细的研究操作手册。至少有三名祖尼行为健康专业人员将接受MICRA培训和认证，并将完成一项小型随机试验（N=60），以估计MICRA相对于常规预约治疗的效应量，并在随机化后一年进行随访。在开发和测试了该系统后，将进一步协商，评估该系统是否可推广到其他部落。

DESCRIPTION (provided by applicant): The prevalence of substance use disorders among Native Americans is at least twice that in the general U.S. population, with correspondingly high rates of mortality, health and social problems. Yet there have been very few clinical studies, and no randomized trials, to discover and document effective treatment methods for American Indians. In seeking effective treatment methods for a special population, it is reasonable to begin with and adapt approaches with more general evidence of efficacy. Our preliminary research indicates that among evidence-based treatment methods, motivational interviewing (Ml) and the community reinforcement approach (CRA) show particular promise as culturally congruent methods in working with reservation-dwelling tribal populations. In contrast to more directive or confrontational styles, Ml mirrors tribal communication norms, and CRA is particularly well suited to make use of the extended family and unique clan structure of reservation life. This is a Stage 1 Behavior Therapy Development proposal to adapt and test a combination of these two evidence-based methods (MICRA) with the Zuni pueblo, in preparation for a subsequent formal clinical trial. Working collaboratively with team members from the Zuni community, we propose to develop research materials needed for a larger randomized trial: a MICRA counselor manual, assessment instruments adapted to a Native American context, and a detailed manual of research operations. At least three Zuni behavioral health professionals will be trained and certified in MICRA, and a small randomized trial (N=60) will be completed to estimate the effect size for MICRA relative to reservation-based treatment as usual, with follow-up interviews through one year post-randomization. After development and testing of MICRA, further consultation will assess the generalizability of MICRA for use with other tribes.