Opioid and Amphetamine Treatment Trends Among American Indians in the Great Plains

Feasibility and acceptability of incorporating social network visualizations into a culturally centered motivational network intervention to prevent substance use among urban Native American emerging adults: a qualitative study

Background

Coupling social network visualizations with Motivational Interviewing in substance use interventions has been shown to be acceptable and feasible in several pilot tests, and has been associated with changes in participants’ substance use and social networks. The objective of this study was to assess acceptability and feasibility of an adaptation of this behavior change approach into a culturally centered behavior change intervention for American Indian/Alaska Native (AI/AN) emerging adults living in urban areas. AI/AN populations experience high rates of health disparities and substance use. Although 70% of AI/AN people live outside of tribal lands, there are few culturally tailored health interventions for these AI/AN populations. Social networks can both increase and discourage substance use. Leveraging healthy social networks and increasing protective factors among urban AI/AN emerging adults may help increase resilience.

Methods

We conducted thirteen focus groups with 91 male and female participants (32 urban AI/AN emerging adults ages 18–25, 26 parents, and 33 providers) and one pilot test of the three workshop sessions with 15 AI/AN emerging adults. Focus group participants provided feedback on a proposed workshop-based intervention curriculum that combined group Motivational Interviewing (MI) and social network visualizations. Pilot workshop participants viewed their own social networks during group MI sessions focused on substance use and traditional practices and discussed their reactions to viewing and discussing their networks during these sessions. We used a combination of open coding of focus group and workshop session transcripts to identify themes across the group sessions and content analysis of comments entered into an online social network interview platform to assess the extent that participants had an intuitive understanding of the information conveyed through network diagrams.

Results

Focus group and pilot test participants reacted positively to the intervention content and approach and provided constructive feedback on components that should be changed. Themes that emerged included feasibility, acceptability, relevance, understandability, and usefulness of viewing personal network visualizations and discussing social networks during group MI workshops. Workshop participants demonstrated an intuitive understanding of network concepts (network composition and structure) when viewing their diagrams for the first time.

Conclusions

Social network visualizations are a promising tool for increasing awareness of social challenges and sources of resilience for urban AI/AN emerging adults. Coupled with Motivational Interviewing in a group context, social network visualizations may enhance discussions of network influences on substance use and engagement in traditional practices.

Trial Registration: ClinicalTrials.gov Identifier: NCT04617938. Registered October 26, 2020

Trending the evidence on opioid use disorder (OUD) continuum of care among rural American Indian/Alaskan Native (AI/AN) tribes: A systematic scoping review

BACKGROUND

American Indian/Alaskan Native (AI/AN) communities are second only to White Americans in mortality from opioid use disorder (OUD), while the smallest racial/ethnic minority population group in the USA. Those in rural communities experience significant health care disparities, including poorer treatment access for substance use disorder. This systematic scoping review aimed to trend the emerging evidence on opioid use disorder (OUD) management among rural AI/AN communities as well as workforce training needs.

METHOD

We searched the Medline, Embase, PsycInfo, SSCI, and Digital theses databases for empirical study publications on OUD management among AI/AN rural communities across the continuum of prevention, treatment and care. Eight studies met the following criteria: (a) focused on OUD; (b) sampled rural AI/AN members; (c) investigated prevention, treatment and/or care perspectives and/or practices or health provider preparation; and (d) published during the period 2009-2020. Included studies met the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) quality control standards.

FINDINGS

Six of eight of the studies (75%) were surveys with community members and other stakeholders on OUD management within rural AI/AN communities rather than active interventions within this population. Moreover, five of eight of the studies (63%) reported a preference for culturally grounded health and wellness interventions with rural AI/AN, involving families, and community interventionists, utilizing community reinforcement approaches. Three of eight studies (37.5%) reported need for the cultural adaption of medication-assisted treatments (MAT) and use of culturally informed recovery care approaches. One of eight studies (12.5%) proposed to use culturally adapted contingency management behavioral approaches for OUD treatment and recovery care.

CONCLUSION

The evidence is trending to endorse culturally adapted OUD management with rural AI/AN communities, prioritizing prevention education, and use of MAT with cultural adaptation and whole person approaches to sustainable recovery care. Mental health care should be a part OUD prevention, treatment and recovery care in rural AI/AN rural communities.