Determinants of Relapse and Opportunities for Growth: Perspectives on Substance Use among American Indian Community Members

Development and Feasibility Pilot Study of Indigenous Recovery Planning: A Community-Engaged Approach to Addressing Substance Use in a Native Community

Although Native (American Indian and Alaska Native [AI/AN]) populations have high rates of abstinence from alcohol, health problems associated with substance use remain a pressing concern in many AI/AN communities. As part of a longstanding community-based participatory research (CBPR) project involving five years of relationship building and three preliminary studies, our team of academic and community co-researchers developed a culturally grounded intervention to facilitate recovery from substance use disorders among tribal members from a rural AI reservation. Our Indigenous Recovery Planning (IRP) intervention consists of six weekly sessions and aims to provide inroads to existing resources in the community, affirm and enhance Native identity, address culturally relevant risk factors, and build upon strengths. Results from a feasibility pilot study (N = 15) suggest that IRP is feasible to implement and acceptable to the community. Although there was insufficient statistical power to conduct hypothesis testing, there were changes between pretest and posttest scores in the expected directions. Future directions and limitations of this research are discussed.

Patterns of Familial and Racial Trauma and Their Associations with Substance Use Disorders among Racial/Ethnic Minority Adults

BACKGROUND

Racial/ethnic minorities in the United States often experience many different types of traumatic events. We examine the patterns of familial and racial trauma and their associations with substance use disorders (SUDs) among racial/ethnic minority adults.

METHODS

We used data from the National Epidemiologic Survey of Alcohol and Related Conditions-III. The study sample included 17,115 individuals who were Hispanic (43.6%), Black (34.9%), Asian American and Pacific Islander (17.0%), and American Indian or Alaska Native (AI/AN, 4.6%). Latent class analysis models with covariates and distal outcomes were analyzed to investigate patterns of trauma exposure and estimate binary outcomes of SUDs. Familial and racial trauma was measured by ten areas of adverse childhood experiences (ACEs) and six items of racial discrimination.

RESULTS

We found four distinctive groups: low trauma (Class 1, 62.1%), high discrimination (Class 2, 17.2%), high ACEs (Class 2, 14.9%), and high trauma (Class 4, 5.9%). Compared to Class 1, other groups were more likely to include Black and AI/AN adults. Participants in Class 2 reported greater risks for alcohol and other drug use disorders. Those in Class 3 and 4 reported greater risks for alcohol, opioid, stimulant, and other drug use disorders.

CONCLUSION

Given a higher risk of trauma exposure in Black and AI/AN adults, racially and ethnically sensitive trauma-focused interventions may help prevent and reduce SUDs in those populations.

Does substance use disorder treatment completion reduce the risk of treatment readmission in Chile?

BACKGROUND

Recovery from substance use disorders (SUD) often entails multiple treatment episodes, which clashes with a context of a treatment system with limited resources and long waiting. Treatment retention and completion have been pointed out as key elements for sustainable achievement; however, most of the evidence generated focuses on opioids and injected substances, which is hardly transferable to the Latin American context.

OBJECTIVES

This study aims to estimate the effect of SUD treatment completion on the risk of being readmitted to a SUD treatment in Chile.

METHODS

We conducted a retrospective analysis on a database of 107,559 treatment episodes from 85,048 adult patients admitted to SUD treatment during 2010-2019 in Chile. We adjusted two separate Prentice Williams and Petersen Gap Time models, to explore the association between treatment completion (vs. non-completion) and up to the third treatment readmission among residential and ambulatory modalities while controlling for time-varying covariates. To examine whether the effect of treatment completion differs between events, we included an interaction term with the stratification variable.

RESULTS

We found that completing the treatment cuts readmission risk for the first event by 17% (Average Hazard Ratio [95% CI] = 0.83 [0.78, 0.88]) and by 14% for the second entry (Average Hazard Ratio [95% CI] = 0.86 [0.78, 0.94]) in ambulatory treatments. We did not find evidence that completing a treatment reduces the readmission risk for residential treatments or third attempts in ambulatory ones.

CONCLUSION

Treatment completion was associated with benefits in cutting readmission risk for the first and second episodes in ambulatory treatments among Chilean adults. It is important to explore different mechanisms than treatment retention for residential treatments.

Advancing Health Equity through Substance Use Research

Several health inequities exist among racial/ethnic minoritized populations (REMPs) who use substances including disparities in use patterns, inequities in health and legal consequences of use, as well as in treatment access and effectiveness. To address these inequities, more research is needed to examine the associated factors and identify areas for improving treatment. Divided into three categories, this special issue includes papers that examine the social and contextual factors that are associated with substance use among REMPs, papers that consider the role of racism and discrimination on substance use, and papers that explore racial/ethnic differences in treatment access and outcomes. Recommendations for advancing health equity in substance use research are also included.