Development of a Culturally Grounded, Trauma-Informed Alcohol Intervention with a Reserve-Dwelling First Nation Group

项目摘要/摘要 酒精是当今土著居民面临的健康差距的主要决定因素之一。 土著人口表现出最高的酗酒和酗酒比率，终生(43.4%)和12%- 1个月的酒精使用障碍发生率(19.2%)大大高于其他种族/民族。 此外，土著居民完成酒精治疗的可能性大大降低；完成酒精治疗的人 治疗越容易复发，表现出更严重的酒精使用模式。有一个稀缺的 由土著社区设计并为土著社区设计的基于经验的干预措施，使社区和 研究伙伴依赖于对现有基于经验的干预措施的适应，这些干预措施最初是为非 原住民。土著居民越来越主张将卫生干预措施 文化根深蒂固。基于文化的方法涉及社区之间的密切合作和 研究人员在干预工作的设计中植根于土著知识、协议和做法。这 汲取文化力量，利用土著历史、语言、价值观和治愈传统作为一种方式 土著人民有权恢复他们的文化信仰和习俗。在文化上应用的研究 解决酒精干预中历史创伤的扎根框架是改善 土著居民的健康和福祉。土著居民曾面临种族灭绝的历史， 破坏健康和福祉的殖民、强迫同化和排斥。历史创伤 导致了饮酒文化的转变。由于殖民而产生的压迫行为，如禁止 传统的治疗方法使土著人民没有应对情绪痛苦的机制。这 再加上历史创伤的情感后遗症，使土著人民容易发展 不适应的应对方式。土著居民开始使用酒精作为自我治疗的一种方式 逃避或避免与历史创伤相关的创伤记忆和情感痛苦。 这个项目的目标是开发和获得关于一个有文化基础的创伤的初步数据- 知情的酒精干预。具体目标是(1)使用基于社区的参与性研究 通过能力建设和知识共享，深化与Kingsclear First Nation的伙伴关系； (2)收集和应用定性数据，以开发基于文化的、了解创伤的酒精干预 它侧重于历史创伤，用于第一民族样本；和(3)进行一项试验性随机对照研究，以 检查干预的可接受性、可持续性和初始疗效数据，并与等待名单对照进行比较。 研究团队(PI：Spillane和Weiss；Co-I：Yang；顾问：Gore和Moore)拥有专业知识 在研究内容(例如，土著居民的酒精使用和历史创伤)和方法(例如， 干预发展、临床试验)。这项工作是重要的、及时的、具有创新性的。解决饮酒问题 对土著居民的健康有重要影响。

PROJECT SUMMARY/ABSTRACT Alcohol is one of the primary determinants of health disparity facing Indigenous populations today. Indigenous populations exhibit the highest rates of binge and heavy drinking, and lifetime (43.4%) and 12- month (19.2%) rates of alcohol use disorder are substantially higher than among other racial/ethnic groups. Further, Indigenous populations are significantly less likely to complete alcohol treatment; those that complete treatment are quicker to relapse and display more severe patterns of alcohol use. There is a paucity of empirically based interventions designed by and for Indigenous communities, which has led communities and research partners to rely on adaptations of existing empirically based interventions originally designed for non- Indigenous populations. Indigenous populations have increasingly advocated for health interventions to be culturally grounded. A culturally grounded approach involves close collaboration among communities and researchers in the design of intervention efforts rooted in Indigenous knowledge, protocols, and practices. This draws from cultural strengths, using Indigenous history, language, values, and healing traditions as a way for Indigenous populations to reclaim their cultural beliefs and practices. Research that applies a culturally grounded framework to address historical trauma in alcohol interventions is a critical next step to improving the health and well-being of Indigenous populations. Indigenous populations have faced histories of genocide, colonization, forced assimilation, and exclusion that undermine health and well-being. Historical trauma resulted in cultural shifts in alcohol use. Acts of oppression stemming from colonization such as the banning of traditional ways of healing left Indigenous people without mechanisms for coping with emotional distress. This coupled with the emotional aftereffects of historical trauma made Indigenous people vulnerable to developing maladaptive ways of coping. Indigenous populations began using alcohol as a way of self-medicating to escape or avoid traumatic memories and emotional pain associated with historical trauma. The objective of this project is to develop and obtain preliminary data on a culturally grounded, trauma- informed alcohol intervention. The specific aims are to (1) use Community-Based Participatory Research methods to deepen partnerships with Kingsclear First Nation through capacity-building and knowledge sharing; (2) collect and apply qualitative data to develop a culturally grounded, trauma-informed alcohol intervention that is focused on historical trauma for use with a First Nation sample; and (3) conduct a pilot RCT study to examine acceptability, sustainability, and initial efficacy data of the intervention compared to waitlist control. The research team (PIs: Spillane and Weiss; Co-I: Yang; Consultants: Gore and Moore) has expertise in the study content (e.g., alcohol use and historical trauma among Indigenous populations) and methods (e.g., intervention development, clinical trials). This work is important, timely, and innovative. Addressing alcohol use has important implications for the health of Indigenous populations.