Lessons Shared: Implementation of a Randomized Clinical Trial for Alcohol Use Disorders with Five American Indian and Alaska Native Communities

Katherine A Hirchak,Lisa G Dirks,Dedra Buchwald,Dennis Donovan,Abigail Echo-Hawk,Dustin Bergerson,Linda Lauch,Sterling M Mcpherson,Kate Lillie,Kelley Jansen,Denise Dillard,Michael Mcdonell,Candy Jackson,Darren Calhoun,Jaedon Avey,Jennifer Shaw,Jalene Herron,John Roll,Abram J Lyons

doi:10.33596/coll.76

Abstract

This paper examines how five Tribal communities and an academic institution developed the Helping Our Native Ongoing Recovery Project. The goal of this study was to conduct a large randomized controlled trial using contingency management as an intervention for alcohol use disorders among 400 American Indian and Alaska Native (AI/AN) people. Using a community-engaged approach, including tenants of community-based participatory research and the Quality Implementation Framework, close collaboration between Tribal community and academic partners was essential to the research design and implementation. The process described has enhanced trust, positive relationships, and the successful cultural adaptation and implementation of the contingency management intervention with two of the five partnering communities. This work may provide insight for dissemination and implementation science among AI/AN communities and a process template for researchers who want to partner with Tribal communities to positively impact health outcomes.

Highlights

Despite high rates of alcohol abstinence among American Indian and Alaska Native (AI/AN) adults, problematic alcohol use and alcohol-related consequences continue to disproportionately impact AI/AN communities (Cunningham et al, 2016)
Coupled with hundreds of years of colonization, genocide, and historical trauma, Indigenous communities are justifiably apprehensive of Western institutional approaches, which include models of alcohol use disorder (AUD) treatment (Larios et al, 2011)
Because there is a divide between Indigenous belief systems and Western models of health, the numerous interventions and counseling techniques for AUD developed in a Western conceptual framework may require adaptation to increase engagement, retention, and effectiveness with AI/AN people (Prussing, 2008; Tonigan et al, 2020; Villanueva et al, 2007; Whitbeck, 2006)

Summary

Introduction

Despite high rates of alcohol abstinence among American Indian and Alaska Native (AI/AN) adults, problematic alcohol use and alcohol-related consequences continue to disproportionately impact AI/AN communities (Cunningham et al, 2016). Effectively engaging Tribal communities in research to develop and/or adapt interventions for AUD may result in greater trust in the research process, higher patient activation, and improved treatment outcomes (Hiratsuka et al, 2017; Burlew, Copeland, Ahuama-Jonas & Calsyn, 2013). Research to develop AUD treatments for AI/AN people should, include community stakeholder ownership and voice to increase engagement, cultural relevance, acceptability, and utility (Chino & DeBruyn, 2006; Israel et al, 2005; Mariella et al, 2009; Wallerstein & Duran, 2010). In addition to the River of Life, during the final phase of the research, the university research team and partnering sites considered the Quality Implementation Framework (QIF) to be appropriate for describing the facilitators and barriers to implementation and for conceptualizing the implementation of the research activities within each community setting. Using the QIF, we identified some of the activities, while others were unique to this project but recognized by the partnering communities and the university research team as an important process template for implementation of research with AI/AN communities (e.g., description of the Tribal research approval processes and CBPR)

Objectives

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Conclusion