Randomized Controlled Trial of CRAFT With American Indians

Treatment research with AI/AN is in its infancy. One route to address the substantial substance use related health disparities is to employ evidence-based treatments (EBTs) with AI/AN. EBTs are rarely tested with sufficiently large samples of racial ethnic groups, so outcomes are often unknown. Recently, an R01 DA021672 adapted two EBTs for substance use disorders (SUDs) (motivational interviewing and community reinforcement approach - MICRA) and conducted a randomized controlled trial (RCT) to MICRA to treatment as usual with the same AI community as involved in this proposal. The present study seeks to expand on that R01, which culturally tailored CRA for people with SUDs, but now turn our focus to working with families and concerned significant others (CSOs) who want to help engage their loved one with an addiction (identified person; IP) into treatment. The intervention, Community Reinforcement and Family Training (CRAFT), is built on reinforcement principles. CRAFT teaches CSOs to take better care of themselves, to cease any behaviors that are not working to address the IP's substance use, and to consistently reward the IP for any sober and treatment engagement behavior. Importantly, CRAFT has been shown to increase IP entry into treatment, which would address: (1) the high rates of SUDs and related problems among AI/AN, (2) low rates of AI/AN self-referrals to treatment, and (3) higher rates of AI entering treatment due to court mandates. The present study aims to conduct an RCT to compare an AI culturally adapted version of CRAFT (CRAFT-AI; n=20) to Twelve-step facilitation for CSO's (TSF-CSO) using principles and groups of Nar/Al-Anon (n=20) to examine acceptability of a culturally tailored EBT and estimate effect sizes for IP treatment entry and for CSO functioning pre to post intervention. Notably, this will be the first examination of potential mediators and moderators of CRAFT-AI including variables such as: demographic variables, severity of SUD, self-efficacy, and cultural risk and protective factors. Finally, we will examine the appropriateness of broadening the dependent variable of IPs entering formal treatment to include AI traditional healing. The methodology of this grant using a partnership between academic and tribal researchers is well-poised to contribute to nascent AI/AN SUD treatment research to impact the substantial health disparities AI/ANs and other indigenous populations endure. Positive study results will facilitate future cultural adaptation research and dissemination and diffusion of EBTs to interested AI/AN tribes and other culturally diverse populations.

Quality Assurance 1. For quality assurance of data collection, Roberta Chavez, who has over 25 years of experience working on clinical trials at University of New Mexico (UNM)/Center on Alcoholism, Substance Abuse, and Addiction (CASAA), will train the research assistant and conduct data quality assurance checks monthly. Data entry will be conducted with two passes.

For the intervention, all counselors will receive expert training in either CRAFT-AI or TSF-CSO. All counselors will be certified in CRAFT-AI or demonstrate proficiency in TSF-CSO prior to the RCT using a CRAFT coding manual and TSF-CSO coding forms. All counseling sessions will be digitally recorded and coded for fidelity to the treatment modalities. When counselors do not pass a CRAFT module or TSF-CSO component, they will receive individualized training and remediation to meet fidelity requirements.

Transmission

a. All data will be collected using pre-specified measures, instruments, and qualitative questions. b. Entry of data will occur within 30 days after it is collected. Second pass within 60 days. c. Statistician, Katie Witkiewitz, will conduct analyses to insure data fidelity upon completion of data entry and reconciliation of any discrepancies.