Contingency Management Treatment of Alcohol Abuse American Indian People

项目摘要/摘要 酒精依赖率高，再加上缺乏文化上可接受的治疗 美国印第安人和阿拉斯加原住民(AI/AN)面临的最严重的健康差距之一。 人工智能/ANS不成比例地患有酒精依赖及其医疗和心理社会后果 相对于其他种族和民族群体。AI/ANS接受或完成酒精治疗的可能性也较小 相对于白人。酒精依赖的一些治疗方法在非土著人群中有效，但几乎没有 了解它们对人工智能/人工智能的可接受性和益处。减少与酒精相关的健康的一种方法 差异是在AI/AN社区、临床医生和研究人员之间建立合作伙伴关系，以定制和测试 人工智能/ANS中的治疗已为其他组确立了好处。这种方法有望实现以下目标 开发文化上可接受的、有效的、可持续的和便携的治疗方法。 应急管理(CM)是一种干预措施，每周为吸毒或酗酒提供2-3次奖励 禁欲，通常超过12周的治疗。在非AI/AN人群中，CM是最有效的方法之一 以及对非法药物滥用的行为治疗进行了深入研究。与标准护理相比，CM的费率更高 治疗中8周的禁欲(58%对11%)，治疗后12个月的禁欲(30%对5%)，以及 治疗完成率(75%比40%)。然而，很少有研究研究CM对酒精依赖的影响， 主要是因为缺乏能够检测两天以上饮酒情况的生物标志物(这是一项要求 对于CM)。我们已经克服了这一关键的方法障碍，使用了一种新的和更好的最近的措施 饮酒，即乙基葡萄糖醛酸苷尿液测试，可以检测到酒精的低水平使用在 至少在过去两天。这种方法允许我们实现并准确地评估酒精的CM 成人对AI/AN的依赖。我们建议进行一项文化上可接受的随机对照试验 CM采取干预措施，鼓励和支持居住在2个保留地的3个部落的人工智能机构禁欲 人工智能/人工智能在印度城市医疗机构接受服务。在我们利用质的研究方法之后 修改CM协议以最大限度地提高每个社区(400名饮酒者)的文化可接受性 依赖者将接受照常治疗，并在随机化之前参加为期4周的诱导期 要么接受为期12周的CM干预，要么接受常规和非常规治疗的对照条件 或有奖励。我们的具体目标是1)最大限度地提高CM干预的文化可接受性；2) 确定随机分到CM组的参与者是否比对照组使用更少的酒精；2) 量化二次成瘾相关结局和酒精相关健康损害的组间差异 行为；以及3)确定人口统计学、文化和其他预测CM组治疗结果的因素。 我们的结果将为中药治疗城市酒精依赖的有效性提供确凿的证据 和农村人工智能/人工智能人口，并建立我们社区合作伙伴的研究和临床基础设施。

PROJECT SUMMARY/ABSTRACT A high prevalence of alcohol dependence, compounded by a lack of culturally acceptable treatment options, is one of the most severe health disparities faced by American Indians and Alaska Natives (AI/AN). AI/ANs suffer disproportionately from alcohol dependence and its medical and psychosocial consequences relative to other racial and ethnic groups. AI/ANs are also less likely to receive or complete alcohol treatment relative to Whites. Some treatments for alcohol dependence are effective in non-Native populations, yet little is known about their acceptability and benefit for AI/ANs. One approach to reducing alcohol-associated health disparities is to form partnerships between AI/AN communities, clinicians, and researchers to tailor and test treatments in AI/ANs that have established benefits for other groups. This approach holds promise for developing treatments that are culturally acceptable, effective, sustainable, and portable. Contingency management (CM) is an intervention that offers rewards 2-3 times weekly for drug or alcohol abstinence, typically over 12 weeks of treatment. In non-AI/AN populations, CM is one of the most effective and well-studied behavioral treatments for illicit drug abuse. Compared to standard care, CM has higher rates of 8-week in-treatment abstinence (58% vs. 11%), 12-month post-treatment abstinence (30% vs. 5%), and treatment completion (75% vs. 40%). However, few studies have examined CM for alcohol dependence, primarily because of the lack of a biomarker that can detect alcohol use over more than 2 days (a requirement for CM). We have overcome this critical methodological barrier by using a new and superior measure of recent alcohol consumption, namely, ethyl glucuronide urine tests, which can detect low levels of alcohol use for at least the past 2 days. This approach permits us to implement and accurately evaluate CM for alcohol dependence in AI/AN adults. We propose to conduct a randomized, controlled trial of a culturally-acceptable CM intervention to encourage and support abstinence among AIs from 3 tribes living on 2 reservations and AI/ANs receiving services at an urban Indian healthcare facility. After we utilize qualitative research methods to modify the CM protocol to maximize cultural acceptability in each community, 400 individuals with alcohol dependence will receive treatment-as-usual and take part in a 4-week induction period before randomization either to an intervention consisting of 12 weeks of CM, or to a control condition of treatment as usual and non- contingent rewards. Our specific aims are to 1) maximize the cultural acceptability of the CM intervention; 2) determine if participants randomized to the CM group use less alcohol than those in the control group; 2) quantify group differences in secondary addiction-related outcomes and alcohol-associated health-impairing behaviors; and 3) identify demographic, cultural, and other predictors of treatment outcome in the CM group. Our results will offer definitive evidence on the efficacy of CM as a treatment for alcohol dependence in urban and rural AI/AN populations and build the research and clinical infrastructure of our community partners.