Culturally tailored evidence‐based substance use disorder treatments are efficacious with an American Indian Southwest tribe: an open‐label pilot‐feasibility randomized controlled trial

• Published in: Addiction (Abingdon, England) England), 2021-04, Vol.116 (4), p.949-960
• Main Authors: Venner, Kamilla L., Serier, Kelsey, Sarafin, Ruth, Greenfield, Brenna L., Hirchak, Katherine, Smith, Jane Ellen, Witkiewitz, Katie
• Format: Article
• Language: English
• Subjects: Addiction treatment outcome; Addictions; Alaska Natives; Alcohol use; American Indian or Alaska Native; American Indian/Alaska Native; American Indians; Clinical trials; community reinforcement approach; cultural adaptation; Demography; Drug abuse; Drug addiction; Drug use; Drugs; Efficacy; Evidence-based practice; Feasibility; Feasibility Studies; Female; Group counseling; Handheld computers; Health services utilization; Help seeking behavior; Humans; Indigenous; Indigenous peoples; Interviews; Male; Medical treatment; Minority & ethnic groups; Motivation; Motivational Interviewing; Native North Americans; Outpatient treatment; Prevention programs; Primary groups; randomized controlled trial; Reinforcement; Relapse; Spirituality; Substance abuse; Substance abuse treatment; Substance use disorder; Substance-Related Disorders - therapy; Treatment methods; Treatment outcomes; Treatment programs; United States
• ISSN: 0965-2140; 1360-0443
• DOI: 10.1111/add.15191

ABSTRACT Background and Aims Many evidence‐based treatments (EBTs) for substance use disorder (SUD) exist, yet few are tailored to Indigenous patients. This trial tested the efficacy of a culturally tailored EBT that combined Motivational Interviewing and the Community Reinforcement Approach (MICRA) versus treatment as usual (TAU). Design A mixed efficacy/effectiveness randomized controlled trial of MICRA (n = 38) and TAU (n = 41) using a parallel design with follow‐up assessments at 4‐, 8‐, and 12‐ months post baseline. Setting United States, reservation‐based outpatient, addiction specialty care treatment program. Participants 79 (68% male) American Indian and Alaska Native (AI/AN) Tribal members meeting criteria for SUD and seeking SUD treatment. Interventions MICRA (individual therapy sessions beginning with MI for 2–3 sessions) compared with TAU (individual and group counseling sessions in a didactic style with Twelve‐Step philosophy and elements of relapse prevention). Measures Demographics, percent days abstinent (PDA; the primary outcome at 12months assessed by Form 90D), Inventory of Drug Use Consequences, Alcohol and Drug Use Self‐Efficacy Scale, Native American Spirituality Scale, and SCID‐DSM‐IV‐TR. Findings There was no evidence for the benefit of MICRA over TAU (MICRA PDA = 72.63%, TAU = 73.62%, treatment effect: B = −4.04 (SE = 5.47); 95% CI = −14.941, 6.866; BF = 3.44) in the primary outcome. Both groups showed improvements in PDA, SUD severity, and negative consequences from baseline to the 12‐month follow‐up. Neither self‐efficacy nor spirituality were significant mediators of MICRA. Conclusions There were no treatment group differences between culturally tailored evidence‐based treatments for substance use disorder and treatment as usual in this randomized controlled trial with American Indian and Alaska Native participants. Nonetheless, participants improved over time on several substance‐related outcomes.