Bright Horizons: Designing and Evaluating a Brief Intervention to Address Alcohol, Opioid, and other Substance Use among At-Risk Apaches

虽然阿片类药物的使用是最近全国关注的一个必要焦点，但美国的酒精使用，酗酒和酒精相关死亡率正在上升，包括青少年，其中一些印第安人的差异最大。长期以来，酒精一直是殖民者压迫土著人民并故意造成伤害的工具。物质使用正进一步受到COVID-19疫情的影响，弱势社群的感受更为强烈。虽然有一些有希望的，以证据为基础的干预措施，以解决药物使用问题，在土著社区这些干预措施缺乏严格的研究。白色山区阿帕奇部落认识到在其社区内酗酒的普遍性，并利用部落主权，授权向其自杀和自我伤害监测系统报告酗酒情况，并进行了一系列研究。Bright Horizons是一种有前途的，适应文化的干预措施，随后在先前的Numbers赠款的最后阶段开发，基于一些初步研究，但尚未进行评估。Bright Horizons是一种简短的干预措施，包括认知行为疗法（CBT）和动机访谈（MI），以减少酒精和其他物质的使用，并将个人与治疗联系起来。我们的研究目的是：1）采用定性的积极偏差方法，识别边缘青少年的长处和技能（12-17岁：N=30）不使用物质，以了解可能与物质使用预防干预相关的独特因素; 2）根据目标1的研究结果、现有文献，由Apache社区心理健康专家（CMHS）与N=10名最近严重酗酒的Apache青年进行试点的CAB输入;和3）使用近期严重酗酒的Apache青少年（N=100）的随机对照试验来测试Bright Horizons的有效性。这项研究是创新的，将通过以下方式增加文献：a）根据我们自己的理论模型设计干预措施，并参考当地数据和其他土著框架; B）实施一项简短的干预措施，在重点关注酒精的同时，也认识到青少年正在使用多种物质，并有不断变化的物质使用模式，以及c）使用CMHS作为转变精神卫生保健的模式，在COVID-19危机期间，其必要性变得更加突出和明显。该补助金由两名拥有硕士学位的阿帕奇联合研究员在当地领导，他们参加了心理健康兼职博士课程，并支持另外4名阿帕奇团队成员，他们将接受药物使用干预和研究方面的培训。

While opioid use has been a necessary focus of recent national attention, general US rates of alcohol use, binge drinking, and alcohol-related deaths are rising including among adolescents, with some of the highest disparities for Native Americans. Alcohol has long been a tool of colonizers to oppress Native people and purposefully inflict harm. Substance use is being further impacted by the COVID-19 pandemic, felt more acutely for disadvantaged communities. While there are some promising, evidence-based interventions to address substance use problems, rigorous research on these interventions in Native communities is lacking. Recognizing the prevalence of binge substance use within their community and making novel use of tribal sovereignty, the White Mountain Apache Tribe mandated reporting of binge alcohol use to their suicide and self-harm surveillance system and conducted a series of research studies. Bright Horizons is a promising, culturally adapted intervention that was subsequently developed in the final phase of a previous NARCH grant based on some of this initial research but has not been evaluated. Bright Horizons is a brief intervention that includes cognitive behavioral therapy (CBT) and motivational interviewing (MI) to reduce alcohol and other substance use and connect individuals with treatment. Our study aims are to: 1) to use a qualitative positive deviance approach to identify strengths and skills of at-risk youth (12-17 years old: N=30) who do not use substances to understand unique factors that may be relevant for a substance use prevention intervention; 2) to adapt Bright Horizons, based on Aim 1 findings, the current literature, and CAB input for piloting by Apache community mental health specialists (CMHS) with N=10 Apache youth with recent serious binge alcohol use; and 3) to test the effectiveness of Bright Horizons using a randomized controlled trial with Apache adolescents (N=100) with recent serious binge alcohol use. This study is innovative and will add to the literature by: a) designing an intervention grounded in our own theoretical model informed by local data and other Indigenous frameworks; b) implementing a brief intervention that while focused on alcohol, also recognizes that adolescents, are engaged in polysubstance use and have changing substance use patterns, and c) use of CMHS which serves as a model for transforming mental health care, the necessity of which has become even more pronounced and evident during the COVID-19 crisis. This grant is locally led by two Apache Co-Investigators with their Master's degrees, enrolled in part-time doctoral programs in mental health, and supports an additional 4 Apache team members who will receive training in substance use intervention and research.