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

Kamilla L. Venner; Kelsey Serier; Ruth Sarafin; Brenna L. Greenfield; Katherine Hirchak; Jane Ellen Smith; Katie Witkiewitz

doi:10.1111/add.15191

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

Kamilla L. Venner, Kelsey Serier, Ruth Sarafin, Brenna L. Greenfield, Katherine Hirchak, Jane Ellen Smith, Katie Witkiewitz

Family Medicine and Biobehavioral Health

Research output: Contribution to journal › Article › peer-review

29 Scopus citations

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.

Original language	English (US)
Pages (from-to)	949-960
Number of pages	12
Journal	Addiction
Volume	116
Issue number	4
DOIs	https://doi.org/10.1111/add.15191
State	Published - Aug 11 2020

Bibliographical note

Funding Information:
We thank three successive Tribal councils for reviewing and supporting this study as well as the Co‐PIs of the sub award, counselors and research assistant for their excellent work. Thanks to Dr. J. Scott Tonigan for his assistance with statistical analyses for previous poster or oral presentations at research conferences, and thanks to Angel Vasquez for his help with references. We are grateful to the participants for agreeing to be a part of our study and for their efforts to resolve addiction. Research reported in this publication was supported by the National Institute on Drug Abuse (R01 DA021672). The content is solely the responsibility of the authors and does not necessarily reflect the official views of the National Institute on Drug Abuse. In addition, research assistance with statistical analyses supported by NSF1628471.

Funding Information:
We thank three successive Tribal councils for reviewing and supporting this study as well as the Co-PIs of the sub award, counselors and research assistant for their excellent work. Thanks to Dr. J. Scott Tonigan for his assistance with statistical analyses for previous poster or oral presentations at research conferences, and thanks to Angel Vasquez for his help with references. We are grateful to the participants for agreeing to be a part of our study and for their efforts to resolve addiction. Research reported in this publication was supported by the National Institute on Drug Abuse (R01 DA021672). The content is solely the responsibility of the authors and does not necessarily reflect the official views of the National Institute on Drug Abuse. In addition, research assistance with statistical analyses supported by NSF1628471.

Publisher Copyright:
© 2020 Society for the Study of Addiction

Keywords

Addiction treatment outcome
American Indian/Alaska Native
Indigenous
community reinforcement approach
cultural adaptation
motivational interviewing
randomized controlled trial
substance use disorder

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1111/add.15191

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

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.",

keywords = "Addiction treatment outcome, American Indian/Alaska Native, Indigenous, community reinforcement approach, cultural adaptation, motivational interviewing, randomized controlled trial, substance use disorder",

author = "Venner, {Kamilla L.} and Kelsey Serier and Ruth Sarafin and Greenfield, {Brenna L.} and Katherine Hirchak and Smith, {Jane Ellen} and Katie Witkiewitz",

note = "Funding Information: We thank three successive Tribal councils for reviewing and supporting this study as well as the Co‐PIs of the sub award, counselors and research assistant for their excellent work. Thanks to Dr. J. Scott Tonigan for his assistance with statistical analyses for previous poster or oral presentations at research conferences, and thanks to Angel Vasquez for his help with references. We are grateful to the participants for agreeing to be a part of our study and for their efforts to resolve addiction. Research reported in this publication was supported by the National Institute on Drug Abuse (R01 DA021672). The content is solely the responsibility of the authors and does not necessarily reflect the official views of the National Institute on Drug Abuse. In addition, research assistance with statistical analyses supported by NSF1628471. Funding Information: We thank three successive Tribal councils for reviewing and supporting this study as well as the Co-PIs of the sub award, counselors and research assistant for their excellent work. Thanks to Dr. J. Scott Tonigan for his assistance with statistical analyses for previous poster or oral presentations at research conferences, and thanks to Angel Vasquez for his help with references. We are grateful to the participants for agreeing to be a part of our study and for their efforts to resolve addiction. Research reported in this publication was supported by the National Institute on Drug Abuse (R01 DA021672). The content is solely the responsibility of the authors and does not necessarily reflect the official views of the National Institute on Drug Abuse. In addition, research assistance with statistical analyses supported by NSF1628471. Publisher Copyright: {\textcopyright} 2020 Society for the Study of Addiction",

year = "2020",

month = aug,

day = "11",

doi = "10.1111/add.15191",

language = "English (US)",

volume = "116",

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T2 - an open-label pilot-feasibility randomized controlled trial

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AU - Serier, Kelsey

AU - Sarafin, Ruth

AU - Greenfield, Brenna L.

AU - Hirchak, Katherine

AU - Smith, Jane Ellen

AU - Witkiewitz, Katie

N1 - Funding Information: We thank three successive Tribal councils for reviewing and supporting this study as well as the Co‐PIs of the sub award, counselors and research assistant for their excellent work. Thanks to Dr. J. Scott Tonigan for his assistance with statistical analyses for previous poster or oral presentations at research conferences, and thanks to Angel Vasquez for his help with references. We are grateful to the participants for agreeing to be a part of our study and for their efforts to resolve addiction. Research reported in this publication was supported by the National Institute on Drug Abuse (R01 DA021672). The content is solely the responsibility of the authors and does not necessarily reflect the official views of the National Institute on Drug Abuse. In addition, research assistance with statistical analyses supported by NSF1628471. Funding Information: We thank three successive Tribal councils for reviewing and supporting this study as well as the Co-PIs of the sub award, counselors and research assistant for their excellent work. Thanks to Dr. J. Scott Tonigan for his assistance with statistical analyses for previous poster or oral presentations at research conferences, and thanks to Angel Vasquez for his help with references. We are grateful to the participants for agreeing to be a part of our study and for their efforts to resolve addiction. Research reported in this publication was supported by the National Institute on Drug Abuse (R01 DA021672). The content is solely the responsibility of the authors and does not necessarily reflect the official views of the National Institute on Drug Abuse. In addition, research assistance with statistical analyses supported by NSF1628471. Publisher Copyright: © 2020 Society for the Study of Addiction

PY - 2020/8/11

Y1 - 2020/8/11

N2 - 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.

AB - 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.

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KW - American Indian/Alaska Native

KW - Indigenous

KW - community reinforcement approach

KW - cultural adaptation

KW - motivational interviewing

KW - randomized controlled trial

KW - substance use disorder

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

Abstract

Bibliographical note

Keywords

UN SDGs

Publisher link

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