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

• DOI: 10.1111/add.15191
• Publication Date: 2020-07-15T09:28:33Z
• Authors: Kamilla L. Venner; Kelsey Serier; Ruth Sarafin; Brenna L. Greenfield; Katherine Hirchak; Jane Ellen Smith; Katie Witkiewitz
• Keywords: Male; Substance-Related Disorders; Motivational Interviewing; Alaskan Natives; United States; 3. Good health; 03 medical and health sciences; 0302 clinical medicine; Feasibility Studies; Humans; Female; American Indian or Alaska Native

ABSTRACTBackground and AimsMany 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).DesignA 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.SettingUnited States, reservation‐based outpatient, addiction specialty care treatment program.Participants79 (68% male) American Indian and Alaska Native (AI/AN) Tribal members meeting criteria for SUD and seeking SUD treatment.InterventionsMICRA (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).MeasuresDemographics, 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.FindingsThere 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.ConclusionsThere 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.