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Hirchak K. Closing the research-to-implementation gap for contingency management as an effective intervention for substance use disorders across diverse communities. Addiction 2024. [PMID: 38770791 DOI: 10.1111/add.16569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2024] [Accepted: 05/02/2024] [Indexed: 05/22/2024]
Affiliation(s)
- Katherine Hirchak
- Department of Community and Behavioral Health, Elson S. Floyd College of Medicine, Washington State University, Spokane, Washington, USA
- Promoting Research Initiatives in Substance Use and Mental Health Collaborative, Washington State University, Spokane, Washington, USA
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Redvers N, Larson S, Rajpathy O, Olson D. American Indian and Alaska Native recruitment strategies for health-related randomized controlled trials: A scoping review. PLoS One 2024; 19:e0302562. [PMID: 38687762 PMCID: PMC11060564 DOI: 10.1371/journal.pone.0302562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Accepted: 04/08/2024] [Indexed: 05/02/2024] Open
Abstract
BACKGROUND Significant health disparities exist among American Indian and Alaska Natives (AI/ANs), yet AI/ANs are substantially underrepresented within health-related research, including randomized controlled trials (RCTs). Although research has previously charted representation inequities, there is however a gap in the literature documenting best practice for recruitment techniques of AI/ANs into RCTs. Therefore, the aim of this review was to systematically gather and analyze the published literature to identify common strategies for AI/AN participant recruitment for RCTs in the US. METHODS A scoping review methodology was engaged with a systematic search operationalized within relevant databases to February 19, 2022, with an additional updated search being carried out up until January 1, 2023: PubMed, Embase, Web of Science, PsycINFO, CINAHL, and Google Scholar. A two-stage article review process was engaged with double reviewers using Covidence review software. Content analysis was then carried out within the included articles by two reviewers using NVivo software to identify common categories within the data on the topic area. RESULTS Our review identified forty-one relevant articles with the main categories of recruitment strategies being: 1) recruitment methods for AI/ANs into RCTs (passive advertising recruitment approaches, individual-level recruitment approaches, relational methods of recruitment); 2) recruitment personnel used within RCTs; and, 3) relevant recruitment setting. The majority of the included studies used a culturally relevant intervention, as well as a community-involved approach to operationalizing the research. CONCLUSION Increasing AI/AN representation in RCTs is essential for generating evidence-based interventions that effectively address health disparities and improve health outcomes. Researchers and funding agencies should prioritize the engagement, inclusion, and leadership of AI/AN communities throughout the RCT research process. This includes early community involvement in study design, implementation of culturally tailored recruitment strategies, and dissemination of research findings in formats accessible to AI/AN communities.
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Affiliation(s)
- Nicole Redvers
- Schulich School of Medicine & Dentistry, Western University, London, ON, Canada
- Department of Indigenous Health, School of Medicine & Health Sciences, University of North Dakota, Grand Forks, ND, United States of America
| | - Sarah Larson
- Department of Indigenous Health, School of Medicine & Health Sciences, University of North Dakota, Grand Forks, ND, United States of America
| | - Olivia Rajpathy
- Department of Population Health, School of Medicine & Health Sciences, University of North Dakota, Grand Forks, ND, United States of America
| | - Devon Olson
- Library Resources, School of Medicine & Health Sciences, University of North Dakota, Grand Forks, ND, United States of America
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Appa A, Miller AP, Fatch R, Kekibiina A, Beesiga B, Adong J, Emenyonu N, Marson K, Getahun M, Kamya M, Muyindike W, McDonell M, Thirumurthy H, Hahn JA, Chamie G, Camlin CS. Participant perspectives on incentives for TB preventative therapy adherence and reduced alcohol use: A qualitative study. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0002472. [PMID: 38656992 PMCID: PMC11042709 DOI: 10.1371/journal.pgph.0002472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 02/20/2024] [Indexed: 04/26/2024]
Abstract
Economic incentives to promote health behavior change are highly efficacious for substance use disorders as well as increased medication adherence. Knowledge about participants' experiences with and perceptions of incentives is needed to understand their mechanisms of action and optimize future incentive-based interventions. The Drinkers' Intervention to Prevent Tuberculosis (DIPT) trial enrolled people with HIV (PWH) in Uganda with latent tuberculosis and unhealthy alcohol use in a 2x2 factorial trial that incentivized recent alcohol abstinence and isoniazid (INH) adherence on monthly urine testing while on INH preventive therapy. We interviewed 32 DIPT study participants across trial arms to explore their perspectives on this intervention. Participants described 1) satisfaction with incentives of sufficient size that allowed them to purchase items that improved their quality of life, 2) multiple ways in which incentives were motivating, from gamification of "winning" through support of pre-existing desire to improve health to suggesting variable effects of extrinsic and intrinsic motivation, and 3) finding value in learning results of increased clinical monitoring. To build effective incentive programs to support both reduced substance use and increased antimicrobial adherence, we recommend carefully selecting incentive magnitude as well as harnessing both intrinsic motivation to improve health and extrinsic reward of target behavior. In addition to these participant-described strengths, incorporating results of clinical monitoring related to the incentive program that provide participants more information about their health may also contribute to health-related empowerment.
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Affiliation(s)
- Ayesha Appa
- Department of Medicine, University of California San Francisco, San Francisco, California, United States of America
| | - Amanda P. Miller
- School of Public Health, San Diego State University, San Diego, California, United States of America
| | - Robin Fatch
- Department of Medicine, University of California San Francisco, San Francisco, California, United States of America
| | - Allen Kekibiina
- Global Health Collaborative, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Brian Beesiga
- Infectious Diseases Research Collaboration (IDRC), Kampala, Uganda
| | - Julian Adong
- Global Health Collaborative, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Nneka Emenyonu
- Department of Medicine, University of California San Francisco, San Francisco, California, United States of America
| | - Kara Marson
- Department of Medicine, University of California San Francisco, San Francisco, California, United States of America
| | - Monica Getahun
- Institute for Global Health Sciences, University of California San Francisco, San Francisco, California, United States of America
| | - Moses Kamya
- Infectious Diseases Research Collaboration (IDRC), Kampala, Uganda
| | - Winnie Muyindike
- Global Health Collaborative, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Michael McDonell
- Department of Psychiatry and Behavioral Sciences, Washington State University, Spokane, Washington, United States of America
| | - Harsha Thirumurthy
- Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
| | - Judith A. Hahn
- Department of Medicine, University of California San Francisco, San Francisco, California, United States of America
| | - Gabriel Chamie
- Department of Medicine, University of California San Francisco, San Francisco, California, United States of America
| | - Carol S. Camlin
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of California San Francisco, San Francisco, California, United States of America
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Jett JD, Beck R, Tyutyunnyk D, Sanchez J, Weeks DL, Javors MA, Hill-Kapturczak N, Lopez-Cruzan M, Kriegel L, Ginsburg BC, Cabassa L, McDonell MG. Feasibility of a telehealth-based contingency management intervention for alcohol use disorders using the phosphatidylethanol (PEth) 16:0/18:1 alcohol biomarker: a pilot randomized trial. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2024; 50:162-172. [PMID: 38284925 PMCID: PMC11228813 DOI: 10.1080/00952990.2023.2283691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 11/11/2023] [Indexed: 01/30/2024]
Abstract
Background: Phosphatidylethanol (PEth) is a blood-based biomarker for alcohol consumption that can be self-collected and has high sensitivity, specificity, and a longer detection window compared to other alcohol biomarkers.Objectives: We evaluated the feasibility and acceptability of a telehealth-based contingency management (CM) intervention for alcohol use disorder (AUD) using the blood-based biomarker PEth to assess alcohol consumption.Methods: Sixteen adults (7 female, 9 male) with AUD were randomized to Control or CM conditions. Control participants received reinforcers regardless of their PEth levels. CM participants received reinforcers for week-to-week decreases in PEth (Phase 1) or maintenance of PEth consistent with abstinence (<20 ng/mL, Phase 2). Blood samples were self-collected using the TASSO-M20 device. Acceptability was assessed by retention in weeks. Satisfaction was assessed with the Client Satisfaction Questionnaire (CSQ-8) and qualitative interviews. The primary efficacy outcome was PEth-defined abstinence. Secondary outcomes included the proportion of visits with PEth-defined heavy alcohol consumption, negative urine ethyl glucuronide results, and self-reported alcohol use.Results: Retention averaged 18.6 ± 8.8 weeks for CM participants. CM participants reported high levels of satisfaction (CSQ-8, Mean = 30.3 ± 1.5). Interview themes included intervention positives, such as staff support, quality of life improvement, and accountability. 72% of PEth samples from CM participants were consistent with abstinence versus 34% for Control participants (OR = 5.0, p = 0.007). PEth-defined heavy alcohol consumption was detected in 28% of CM samples and 52% of Control samples (OR = 0.36, p = 0.159). CM participants averaged 1.9 ± 1.7 drinks/day versus 4.2 ± 6.3 for Control participants (p = 0.304).Conclusion: Results support the acceptability and satisfaction of a telehealth PEth-based CM intervention, though a larger study is needed to assess its efficacy [NCT04038021].
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Affiliation(s)
- Julianne D Jett
- PRISM Collaborative, Department of Community and Behavioral Health, Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, USA
| | - Rachael Beck
- PRISM Collaborative, Department of Community and Behavioral Health, Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, USA
| | - Diana Tyutyunnyk
- PRISM Collaborative, Department of Community and Behavioral Health, Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, USA
| | - Jesus Sanchez
- Department of Psychiatry and Behavioral Sciences, University of Texas Health San Antonio, San Antonio, TX, USA
| | - Douglas L Weeks
- PRISM Collaborative, Department of Community and Behavioral Health, Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, USA
| | - Martin A Javors
- Department of Psychiatry and Behavioral Sciences, University of Texas Health San Antonio, San Antonio, TX, USA
| | - Nathalie Hill-Kapturczak
- Department of Psychiatry and Behavioral Sciences, University of Texas Health San Antonio, San Antonio, TX, USA
| | - Marisa Lopez-Cruzan
- Department of Psychiatry and Behavioral Sciences, University of Texas Health San Antonio, San Antonio, TX, USA
| | - Liat Kriegel
- PRISM Collaborative, Department of Community and Behavioral Health, Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, USA
| | - Brett C Ginsburg
- Department of Psychiatry and Behavioral Sciences, University of Texas Health San Antonio, San Antonio, TX, USA
| | - Leopoldo Cabassa
- Brown School, Washington University St. Louis, St Louis, MO, USA
| | - Michael G McDonell
- PRISM Collaborative, Department of Community and Behavioral Health, Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, USA
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Skewes MC, Gonzalez VM, Gameon JA, Ricker A, Martell S, Reum M, Holder S. Development and Feasibility Pilot Study of Indigenous Recovery Planning: A Community-Engaged Approach to Addressing Substance Use in a Native Community. Clin Psychol Sci 2024; 12:253-269. [PMID: 38736431 PMCID: PMC11086671 DOI: 10.1177/21677026221141662] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/14/2024]
Abstract
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.
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Affiliation(s)
| | | | - Julie A. Gameon
- Trauma and Resilience Center, The University of Texas Health Science Center at Houston
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Hallihan H, Abboud S, Lee S, Rospenda K, Srimoragot M, Fink A, Ma J. A qualitative exploration of young adults' perceptions of a new intervention for alcohol use disorder. Ann Med 2024; 55:2295983. [PMID: 38175792 PMCID: PMC10769559 DOI: 10.1080/07853890.2023.2295983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 12/12/2023] [Indexed: 01/06/2024] Open
Abstract
BACKGROUND Due to the rising prevalence of alcohol use disorders among young adults, the need for effective and accessible interventions has become increasingly imperative. In acknowledgment of this issue, we developed a novel intervention known as contingency management plus problem solving therapy (CM-PST). The aim of the current study was to gain insight into the perspectives on the effectiveness of the newly developed CM-PST using focus group discussion among young adults who consume alcohol regularly. MATERIALS AND METHODS The study employed a qualitative research design, utilizing focus group discussions as the primary data collection method. Participants described their perceptions regarding the newly developed CM-PST. Semi-structured focus group sessions were conducted via Zoom in November 2022. A total of 19 young adults, aged 18-24 years old, participated in five focus group sessions. Data were analyzed using deductive content analysis. RESULTS Participants demonstrated overall positive attitudes toward the novel intervention, recognizing the potential benefits, it could offer in terms of alcohol use reduction and emotional well-being. They emphasized the importance of incentives in motivating behavioral changes, as well as the practicality of problem-solving techniques in addressing everyday challenges. Additionally, participants provided valuable insights into potential barriers and implementation challenges, highlighting the need for flexible and personalized approaches to accommodate individual preferences and needs. CONCLUSIONS The results of this study contribute to the growing body of literature on innovative intervention approaches for young adults facing alcohol use issues. The findings shed light on the acceptability and perceived effectiveness of the CM-PST intervention from the perspective of the target population.
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Affiliation(s)
- Hagar Hallihan
- Department of Medicine, University of Illinois Chicago, Chicago, IL, USA
| | - Sarah Abboud
- Department of Human Development Nursing Science, University of Illinois Chicago, Chicago, IL, USA
| | - Sangeun Lee
- Department of Human Development Nursing Science, University of Illinois Chicago, Chicago, IL, USA
| | - Kathleen Rospenda
- Department of Psychiatry, University of Illinois Chicago, Chicago, IL, USA
| | | | - Anne Fink
- Department of Biobehavioral Nursing Science, University of Illinois Chicago, Chicago, IL, USA
| | - Jun Ma
- Department of Medicine, University of Illinois Chicago, Chicago, IL, USA
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Yalniz Y, Yunusoğlu O, Berköz M, Demirel ME. Effects of fisetin on ethanol-induced rewarding properties in mice. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2024; 50:75-83. [PMID: 38235981 DOI: 10.1080/00952990.2023.2292976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Accepted: 12/05/2023] [Indexed: 01/19/2024]
Abstract
Background: Alcohol use disorder (AUD) is a chronic relapsing disorder associated with compulsive drinking of alcohol. Natural flavonoid fisetin affects a variety of transmitter systems relevant to AUD, such as aminobutyric acid, N-methyl-D-aspartate, and dopamine, as well as peroxisome proliferator-activated receptors.Objectives: This study investigated fisetin's impact on the motivational properties of ethanol using conditioned place preference (CPP) in mice (n = 50).Methods: Mice were conditioned with ethanol (2 g/kg, i.p.) or saline on alternating days for 8 consecutive days and were given intragastric (i.g.) fisetin (10, 20, or 30 mg/kg, i.g.), 45 min before ethanol conditioning. During extinction, physiological saline was injected to the control and ethanol groups, and fisetin was administered to the fisetin groups. To evaluate the effect of fisetin on the reinstatement of ethanol-induced CPP, fisetin was given 45 min before a priming dose of ethanol (0.4 g/kg, i.p.; reinstatement test day).Results: Fisetin decreased the acquisition of ethanol-induced CPP (30 mg/kg, p < .05) and accelerated extinction (20 and 30 mg/kg, p < .05). Furthermore, fisetin attenuated reinstatement of ethanol-induced CPP (30 mg/kg, p < .05).Conclusions: Fisetin appears to diminish the rewarding properties of ethanol, as indicated by its inhibitory effect and facilitation of extinction in ethanol-induced CPP. These findings imply a potential therapeutic application of fisetin in preventing ethanol-seeking behavior, promoting extinction, and reducing the risk of relapse.
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Affiliation(s)
- Yasin Yalniz
- Department of Pharmacology, Faculty of Medicine, Bolu Izzet Baysal University, Bolu, Turkey
| | - Oruç Yunusoğlu
- Department of Pharmacology, Faculty of Medicine, Bolu Izzet Baysal University, Bolu, Turkey
| | - Mehmet Berköz
- Department of Biochemistry, Faculty of Pharmacy, Van Yuzuncu Yıl University, Van, Turkey
| | - Mustafa Enes Demirel
- Emergency Department, School of Medicine, Bolu Abant Izzet Baysal University, Bolu, Turkey
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Campbell ANC, Rieckmann T, Pavlicova M, Choo TH, Molina K, McDonell M, West AE, Daw R, Marsch LA, Venner KL. Culturally tailored digital therapeutic for substance use disorders with urban Indigenous people in the United States: A randomized controlled study. JOURNAL OF SUBSTANCE USE AND ADDICTION TREATMENT 2023; 155:209159. [PMID: 37690525 PMCID: PMC10872747 DOI: 10.1016/j.josat.2023.209159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 06/15/2023] [Accepted: 09/07/2023] [Indexed: 09/12/2023]
Abstract
INTRODUCTION Indigenous people experience health disparities, including higher rates of substance use disorders (SUDs). Digital therapeutics are a growing platform for treatment services and have the potential to expand access to culturally responsive interventions for Indigenous people. As one of the first randomized controlled trials for SUDs for American Indian and Alaska Native (AI/AN) adults, the aim of this study was to pilot test the efficacy of a culturally tailored intervention among urban Indigenous adults. METHODS The study used a randomized controlled parallel design of 12 weeks of treatment-as-usual (TAU) (n = 26) versus TAU + Therapeutic Education System-Native Version (TES-NAV) (n = 27) with follow-up assessments at end of treatment and week 24 in an urban outpatient addiction treatment program for Native American adults. TAU consisted of individual/group counseling and cultural activities. The TES-NAV arm comprised TAU + 26 self-directed culturally tailored digital skills-based modules grounded in the community reinforcement approach with contingency management for abstinence and module completion. Primary outcome was longest consecutive weeks of abstinence from drugs and heavy drinking measured using self-report (Timeline Followback) and urine alcohol and drug toxicology screen during 12 weeks of treatment. Secondary outcomes were percent days abstinence during and posttreatment, coping strategies, social connectedness, and substance use and sexual risk behaviors. RESULTS The study enrolled fifty-three (52.8 % male) AI/AN adults seeking treatment for a SUD. Although the study did not detect a benefit of TAU+TES-NAV over TAU on the primary outcome (Median = 2 consecutive weeks of abstinence for both arms) at end of treatment (treatment effect: Z = -0.78, p = 0.437), TAU+TES-NAV participants did demonstrate significantly greater percent days of abstinence at the week 24 follow-up (69.3 % versus 49.0 % for TAU; t = 2.08, p = 0.045) and significantly greater change in social connectedness mean score, baseline to week 12 (Z = -2.66, p = 0.011), compared to TAU. The study detected no differences between treatment arms for coping strategies or risk behaviors. CONCLUSION The addition of TES-NAV to TAU did not significantly improve consecutive weeks of abstinence from drugs or heavy drinking; however, several secondary findings suggest promise for a culturally tailored digital therapeutic SUD intervention among urban Indigenous people. CLINICAL TRIALS GOV REGISTRATION: #NCT03363256.
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Affiliation(s)
- Aimee N C Campbell
- Department of Psychiatry, Columbia University Irving Medical Center and New York State Psychiatric Institute, 1051 Riverside Drive Box 120, New York, NY 10032, USA.
| | - Traci Rieckmann
- School of Medicine, Oregon Health & Science University, 3015 NE 44th Ave, Portland, OR 97213, USA
| | - Martina Pavlicova
- Department of Biostatistics, Columbia University Mailman School of Public Health, 722 W. 168th St, 6th floor, Room 635, New York, NY 10032, USA
| | - Tse-Hwei Choo
- Department of Psychiatry, Columbia University Irving Medical Center and New York State Psychiatric Institute, 1051 Riverside Drive Box 120, New York, NY 10032, USA
| | - Kelly Molina
- Native American Rehabilitation Association of the Northwest, Inc., 1631 SW Columbia St, Portland, OR 97201, USA
| | - Michael McDonell
- Elson S. Floyd College of Medicine, Washington State University, 412 E. Spokane Falls Blvd, Spokane, WA 99202, USA
| | - Amy E West
- Children's Hospital Los Angeles, Keck School of Medicine, University of Southern California, 4640 W. Sunset Blvd, Los Angeles, CA 90027, USA
| | | | - Lisa A Marsch
- Center for Technology and Behavioral Health, Geisel School of Medicine, Dartmouth College, 1 Rope Ferry Rd, Hanover, NH 03755, USA
| | - Kamilla L Venner
- Department of Psychology and Center on Alcohol Substance use & Addiction (CASAA), University of New Mexico, 1 University of New Mexico, MSC03 2220, Albuquerque, NM 87131, USA
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Hirchak KA, Echo-Hawk H, Parent S, Peavy KM, Webb K, Bajet K, Richardson M, Granbois A, Herron JL, Catron K, King K, Parsells E, Freese TE, Thomas LR, Rawson R, Clark HW, Roll J, McDonell MG. The urgent need for contingency management among Tribal communities in the United States: Considerations for implementation, policy, and sovereignty. Prev Med 2023; 176:107662. [PMID: 37573952 PMCID: PMC10840817 DOI: 10.1016/j.ypmed.2023.107662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 07/28/2023] [Accepted: 08/10/2023] [Indexed: 08/15/2023]
Abstract
In two randomized controlled trials, culturally adapted contingency management (i.e., incentives provided for substance-negative urine samples) was associated with reduced alcohol and drug use among geographically diverse American Indian and Alaska Native (AI/AN) adults. In response to interest in contingency management from other Tribal and AI/AN communities, our research team in collaboration with AI/AN behavioral health experts, translated the research into practice with new AI/AN community partners. Tenets of community-based participatory research were applied to develop, pilot, and refine contingency management training and implementation tools, and identify implementation challenges. In partnership with the AI/AN communities, four members of the university team developed tools and identified implementation and policy strategies to increase the successful uptake of contingency management in each location. Through our collaborative work, we identified policy barriers including inadequate federal funding of contingency management incentives and a need for further clarity regarding federal anti-kickback regulations. Adoption of contingency management is feasible and can strengthen Tribal communities' capacity to deliver evidence-based substance use disorder treatments to AI/AN people. Unfortunately, non-evidence-based limits to the use of federal funding for contingency management incentives discriminate against AI/AN communities. We recommend specific federal policy reforms, as well as other practical solutions for Tribal communities interested in contingency management.
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Affiliation(s)
- Katherine A Hirchak
- Department of Community and Behavioral Health, Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, USA; Promoting Research Initiatives in Substance Use and Mental Health Collaborative, Washington State University, Spokane, WA, USA.
| | | | - Sara Parent
- Department of Community and Behavioral Health, Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, USA; Promoting Research Initiatives in Substance Use and Mental Health Collaborative, Washington State University, Spokane, WA, USA
| | - K Michelle Peavy
- Department of Community and Behavioral Health, Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, USA; Promoting Research Initiatives in Substance Use and Mental Health Collaborative, Washington State University, Spokane, WA, USA
| | - Kellie Webb
- Doya Natsu Healing Center, Fort Washakie, WY, USA
| | - Kelsey Bajet
- Department of Community and Behavioral Health, Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, USA; Promoting Research Initiatives in Substance Use and Mental Health Collaborative, Washington State University, Spokane, WA, USA
| | - Meenakshi Richardson
- Department of Community and Behavioral Health, Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, USA; Promoting Research Initiatives in Substance Use and Mental Health Collaborative, Washington State University, Spokane, WA, USA
| | - Alexandria Granbois
- Department of Community and Behavioral Health, Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, USA; Promoting Research Initiatives in Substance Use and Mental Health Collaborative, Washington State University, Spokane, WA, USA
| | - Jalene L Herron
- Department of Psychology, University of New Mexico, Albuquerque, NM, USA
| | | | - Keli King
- Kauffman and Associates, Inc., Spokane, WA, USA
| | - Ed Parsells
- Kauffman and Associates, Inc., Spokane, WA, USA
| | | | - Lisa Rey Thomas
- Department of Community and Behavioral Health, Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, USA
| | - Richard Rawson
- University of Vermont, Burlington, VT, USA; Motivational Incentives Policy Group, USA
| | | | - John Roll
- Department of Community and Behavioral Health, Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, USA
| | - Michael G McDonell
- Department of Community and Behavioral Health, Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, USA; Promoting Research Initiatives in Substance Use and Mental Health Collaborative, Washington State University, Spokane, WA, USA
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Hirchak KA, Oluwoye O, Nadeau M, Richardson M, Bajet K, Brigman M, Herron JL, Hernandez-Vallant A, Vasquez A, Pham C, Oliver KA, Baukol P, Webb K, Belone L, McDonell MG, Venner KL, Campbell ANC. Coming together for something good: recommendations from a scoping review for dissemination and implementation science to improve indigenous substance use disorder treatment. Front Public Health 2023; 11:1265122. [PMID: 37915816 PMCID: PMC10616787 DOI: 10.3389/fpubh.2023.1265122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 09/29/2023] [Indexed: 11/03/2023] Open
Abstract
Introduction Dissemination and Implementation (D&I) science is growing among Indigenous communities. Indigenous communities are adapting and implementing evidence-based treatments for substance use disorders (SUD) to fit the needs of their communities. D&I science offers frameworks, models, and theories to increase implementation success, but research is needed to center Indigenous knowledge, enhancing D&I so that it is more applicable within Indigenous contexts. In this scoping review, we examined the current state of D&I science for SUD interventions among Indigenous communities and identified best-practice SUD implementation approaches. Methods PubMed and PsycINFO databases were queried for articles written in English, published in the United States, Canada, Australia, and New Zealand. We included key search terms for Indigenous populations and 35 content keywords. We categorized the data using the adapted and extended Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework that emphasizes equity and sustainability. RE-AIM has also been used as a primary model to consistently identify implementation outcomes. Results Twenty articles were identified from the original unduplicated count of over 24,000. Over half the articles discussed processes related to Reach, Adoption, and Implementation. Effectiveness was discussed by 50% of the studies (n = 10), with 25% of the articles discussing Maintenance/sustainability (n = 4). Findings also highlighted the importance of the application of each RE-AIM domain for meaningful, well-defined community-engaged approaches. Conclusion Finding indicated a need to prioritize Indigenous methods to culturally center, re-align and adapt Western treatments and frameworks to increase health equity and improve SUD treatment outcomes. Utility in the use of the modified RE-AIM and the continued modification for Indigenous communities was also noted.
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Affiliation(s)
- Katherine A. Hirchak
- Department of Community and Behavioral Health, Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, United States
| | - Oladunni Oluwoye
- Department of Community and Behavioral Health, Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, United States
| | - Melanie Nadeau
- Department of Indigenous Health, University of North Dakota, Grand Forks, ND, United States
| | - Meenakshi Richardson
- Department of Community and Behavioral Health, Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, United States
- Department of Human Development, Washington State University, Vancouver, WA, United States
| | - Kelsey Bajet
- Department of Community and Behavioral Health, Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, United States
| | - Mariah Brigman
- Department of Community and Behavioral Health, Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, United States
| | - Jalene L. Herron
- Center on Alcohol, Substance Use, and Addictions, University of New Mexico, Albuquerque, NM, United States
- Department of Psychology, University of New Mexico, Albuquerque, NM, United States
| | - Alexandra Hernandez-Vallant
- Center on Alcohol, Substance Use, and Addictions, University of New Mexico, Albuquerque, NM, United States
- Department of Psychology, University of New Mexico, Albuquerque, NM, United States
| | - Angel Vasquez
- Center on Alcohol, Substance Use, and Addictions, University of New Mexico, Albuquerque, NM, United States
| | - Cuong Pham
- Department of Medicine, University of Minnesota, Minneapolis, MN, United States
| | | | - Paulette Baukol
- NorthStar Node, Hennepin Healthcare Research Institute, Minneapolis, MN, United States
| | - Kellie Webb
- Eastern Shoshone Recovery Center, Fort Washakie, WY, United States
| | - Lorenda Belone
- Population Health, University of New Mexico, Albuquerque, NM, United States
| | - Michael G. McDonell
- Department of Community and Behavioral Health, Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, United States
| | - Kamilla L. Venner
- Center on Alcohol, Substance Use, and Addictions, University of New Mexico, Albuquerque, NM, United States
- Department of Psychology, University of New Mexico, Albuquerque, NM, United States
| | - Aimee N. C. Campbell
- Department of Psychiatry, Columbia University Irving Medical Center and New York State Psychiatric Institute, New York, NY, United States
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Hirchak KA, Kordas G, Lyons AJ, Herron J, Jansen K, Shaw J, McPherson SM, Roll J, Buchwald D, McDonell MG. Investigating Secondary Alcohol Outcomes in a Contingency Management Intervention among American Indian and Alaska Native Adults. J Addict Med 2023; 17:e177-e182. [PMID: 37267179 PMCID: PMC10248190 DOI: 10.1097/adm.0000000000001116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE The aim of the study is to investigate clinically meaningful, secondary outcomes in a randomized trial of a culturally adapted contingency management (CM) intervention for alcohol use in 3 diverse American Indian and Alaska Native communities. METHODS Three American Indian and Alaska Native communities located in the Northern Plains, Alaska, and the Inland Northwest were partnering sites. A total of 158 individuals were randomized to either a 12-week CM intervention or a noncontingent (NC) control group. The CM group received reinforcers for providing alcohol-negative ethyl glucuronide (EtG < 150 ng/mL) urine samples, while the NC group received reinforcers unconditionally. Outcomes included EtG as a continuous measure (range, 0-2,000 ng/mL), EtG > 499 ng/mL (a measure of higher levels of recent alcohol use), longest duration of abstinence, and time-to-first alcohol-positive EtG during the trial. Generalized estimating equations along with Cox proportional hazard and negative binomial regressions were used. RESULTS Participants randomized to the CM group had lower mean EtG levels (-241.9 ng/mL; 95% confidence interval [CI], -379.0 to -104.8 ng/mL) and 45.7% lower odds (95% CI, 0.31 to 0.95) of providing an EtG sample indicating higher levels of alcohol use during the intervention. Longest duration of abstinence was 43% longer for the CM group than the NC group (95% CI, 1.0 to 1.9). Risk of time-to-first drink during treatment did not differ significantly. CONCLUSIONS These secondary outcome analyses provide evidence that CM is associated with reductions in alcohol use and longer durations of abstinence (as assessed by EtG), both clinically meaningful endpoints and analyses that differ from the primary study outcome.
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Affiliation(s)
- Katherine A. Hirchak
- Department of Community and Behavioral Health, Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, USA
- Program of Excellence in Addictions Research, Washington State University, Spokane, WA, USA
| | - Gordon Kordas
- Department of Community and Behavioral Health, Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, USA
- Program of Excellence in Addictions Research, Washington State University, Spokane, WA, USA
| | - Abram J. Lyons
- Department of Community and Behavioral Health, Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, USA
- Program of Excellence in Addictions Research, Washington State University, Spokane, WA, USA
- School of Social Policy & Practice, University of Pennsylvania, Philadelphia, PA, USA
| | - Jalene Herron
- Center on Alcohol, Substance Use and Addictions, University of New Mexico, Albuquerque, New Mexico, USA
- Department of Psychology, University of New Mexico, Albuquerque, NM, USA
| | - Kelley Jansen
- Southcentral Foundation, Anchorage, AK, USA
- University of Montana, Missoula, MT, USA
| | | | - Sterling M. McPherson
- Department of Community and Behavioral Health, Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, USA
- Program of Excellence in Addictions Research, Washington State University, Spokane, WA, USA
- Institute for Research and Education to Advance Community Health, Washington State University, Spokane, WA, USA
| | - John Roll
- Department of Community and Behavioral Health, Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, USA
- Program of Excellence in Addictions Research, Washington State University, Spokane, WA, USA
| | - Dedra Buchwald
- Institute for Research and Education to Advance Community Health, Washington State University, Spokane, WA, USA
| | - Michael G. McDonell
- Department of Community and Behavioral Health, Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, USA
- Program of Excellence in Addictions Research, Washington State University, Spokane, WA, USA
- Institute for Research and Education to Advance Community Health, Washington State University, Spokane, WA, USA
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12
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Hirchak KA, Lyons AJ, Herron JL, Kordas G, Shaw JL, Jansen K, Avey JP, McPherson SM, Donovan D, Roll J, Buchwald D, Ries R, McDonell MG. Contingency management for alcohol use disorder reduces cannabis use among American Indian and Alaska Native adults. J Subst Abuse Treat 2022; 137:108693. [PMID: 34952747 PMCID: PMC9086134 DOI: 10.1016/j.jsat.2021.108693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 10/29/2021] [Accepted: 12/07/2021] [Indexed: 10/19/2022]
Abstract
OBJECTIVE Determine whether a culturally tailored contingency management (CM) intervention targeting alcohol abstinence resulted in secondary effects on cannabis use among American Indian and Alaska Native (AI/AN) adults. METHODS The research team conducted this secondary data analysis to examine cannabis abstinence using data from a randomized control trial of CM for alcohol use among three AI/AN-serving organizations. One hundred and fifty-eight adults met the randomization criteria (i.e., submission of 50% or more urine samples and one alcohol-positive urine test during a 4-week, pre-randomization, observation period). For 12 weeks after randomization, participants received incentives for submitting a urine test negative for ethyl glucuronide (EtG < 150 ng/mL, CM group) or incentives for submitting a urine sample regardless of abstinence (Non-contingent [NC] Control group). Generalized linear mixed effects models assessed group differences in cannabis abstinence during the intervention, verified by urine tetrahydrocannabinol negative tests (11-nor-delta-9-tetrahydrocannabinol-9-carboxylic acid <50 ng/mL). RESULTS At baseline, 42.2% (n = 35) of participants in the NC group and 40.0% (n = 30) of those in the CM group had a cannabis positive urine test. An overall intervention by time interaction was detected for a cannabis negative urine test (χ2 = 13.40, p = 0.001). Compared to the NC group, the CM group had 3.92 (95% CI:1.23-12.46) times higher odds of having a cannabis negative urine test during the intervention period and 5.13 (95% CI:1.57-16.76) times higher odds of having a negative cannabis test at the end of intervention period. CONCLUSION CM addressing alcohol misuse may be an effective strategy for decreasing cannabis use among AI/AN adults. TRIAL REGISTRATION ClinicalTrials.gov number, Identifier: NCT02174315.
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Affiliation(s)
- Katherine A Hirchak
- Department of Community and Behavioral Health, Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, USA; Program of Excellence in Addictions Research, Washington State University, Spokane, WA, USA
| | - Abram J Lyons
- Department of Community and Behavioral Health, Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, USA; Program of Excellence in Addictions Research, Washington State University, Spokane, WA, USA; School of Social Policy & Practice, University of Pennsylvania, Philadelphia, PA, USA
| | - Jalene L Herron
- Center on Alcoholism, Substance Abuse and Addictions, University of New Mexico, Albuquerque, NM, USA; Department of Psychology, University of New Mexico, Albuquerque, NM, USA
| | - Gordon Kordas
- Department of Community and Behavioral Health, Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, USA; Program of Excellence in Addictions Research, Washington State University, Spokane, WA, USA
| | | | - Kelley Jansen
- Southcentral Foundation, Anchorage, AK, USA; Department of Psychology, University of Montana, Missoula, MT, USA
| | | | - Sterling M McPherson
- Department of Community and Behavioral Health, Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, USA; Program of Excellence in Addictions Research, Washington State University, Spokane, WA, USA; Institute for Research and Education to Advance Community Health, Washington State University, Spokane, WA, USA
| | - Dennis Donovan
- Alcohol and Drug Abuse Institute, University of Washington, Seattle, WA, USA; Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA, USA
| | - John Roll
- Program of Excellence in Addictions Research, Washington State University, Spokane, WA, USA
| | - Dedra Buchwald
- Department of Community and Behavioral Health, Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, USA; Institute for Research and Education to Advance Community Health, Washington State University, Spokane, WA, USA
| | - Richard Ries
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA, USA
| | - Michael G McDonell
- Department of Community and Behavioral Health, Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, USA; Program of Excellence in Addictions Research, Washington State University, Spokane, WA, USA; Institute for Research and Education to Advance Community Health, Washington State University, Spokane, WA, USA.
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13
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Gendera S, Treloar C, Reilly R, Conigrave KM, Butt J, Roe Y, Ward J. 'Even though you hate everything that's going on, you know they are safer at home': The role of Aboriginal and Torres Strait Islander families in methamphetamine use harm reduction and their own support needs. Drug Alcohol Rev 2022; 41:1428-1439. [PMID: 35639622 PMCID: PMC9546040 DOI: 10.1111/dar.13481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Revised: 03/09/2022] [Accepted: 04/04/2022] [Indexed: 12/02/2022]
Abstract
Introduction First Nations people who use methamphetamine are overrepresented in regional and remote Australia and more likely to turn to family for support. This can place strain on families. The support needs of family members of individuals using methamphetamine are poorly understood. Methods We conducted 19 focus groups and seven interviews with mostly First Nations community, family members and service providers. In total, 147 participants across six sites participated as part of a larger study investigating First Nations perspectives of how to address methamphetamine use and associated harms. We applied a social and emotional wellbeing framework to examine support needs and role of family in mitigating methamphetamine harms. Results Findings highlighted the importance of families in providing support to people using methamphetamine and in reducing associated harms, often without external support. The support provided encompassed practical, social, emotional, financial, access to services and maintaining cultural connection. Providing support took a toll on family and negatively impacted their own social and emotional wellbeing. Discussion and Conclusions First Nations families play an important and under‐recognised role in reducing methamphetamine‐related harms and greater efforts are required to support them. Professional resources are needed to deal with impacts of methamphetamine on families; these should be pragmatic, accessible, targeted and culturally appropriate. Support for families and communities should be developed using the social and emotional wellbeing framework that recognises wellbeing and healing as intrinsically connected to holistic health, kinship, community, culture and ancestry, and socioeconomic and historical influences on peoples' lives.
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Affiliation(s)
- Sandra Gendera
- Social Policy Research Centre, UNSW Sydney, Sydney, Australia
| | - Carla Treloar
- Centre for Social Research in Health and Social Policy Research Centre, UNSW Sydney, Sydney, Australia
| | - Rachel Reilly
- Aboriginal Health Equity Theme, South Australian Health and Medical Research Institute, Adelaide, Australia
| | - Katherine M Conigrave
- Central Clinical School, Sydney Medical School, The University of Sydney, Sydney, Australia
| | - Julia Butt
- National Drug Research Institute, Curtin University, Perth, Australia.,Psychology and Criminology, School of Arts and Humanities, Edith Cowan University, Perth, Australia
| | - Yvette Roe
- College of Nursing & Midwifery, Charles Darwin University, Brisbane, Australia
| | - James Ward
- Poche Centre for Indigenous Health, School of Public Health, The University of Queensland, Brisbane, Australia
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