Designing Deaf-MET: A Deaf-Accessible Pre-Treatment for Alcohol Use Disorder

This study will conduct the first clinical pilot of DeafMET, a Deaf-accessible adaptation of Motivational Enhancement Therapy (MET) for alcohol use disorder (AUD) in Deaf adults. The U.S. Deaf community-over one million Americans who use American Sign Language (ASL)-experiences disproportionate rates of high-risk alcohol use and barriers to behavioral health care. Studies indicate that Deaf adults face significantly higher rates of lifetime problem drinking and are less likely to access evidence-based AUD treatment compared to their hearing peers. Unique challenges, such as limited English literacy, lack of available mental health resources in ASL, and low health literacy, contribute to poor health outcomes and marginalization within existing care systems.

While motivational interviewing and enhancement therapies are widely validated for treating substance use disorders in hearing populations, there are currently no evidence-based behavioral health interventions specifically adapted for Deaf individuals. Existing AUD treatments rely heavily on written English materials and verbal processing, limiting their accessibility and effectiveness among ASL users. Research demonstrates that Deaf people's average English reading level is at grade four, and health-related comprehension closely matches that of non-English-speaking immigrants. These disparities underscore the urgent need for linguistically and culturally tailored treatment protocols.

To address these barriers, the study team developed and refined the DeafMET prototype through comprehensive literature review, stakeholder input, and community engagement. The intervention features:

• Deaf-friendly client materials such as visual handouts revised for plain text and created with input from Deaf artists
• Translated ASL educational content
• Interactive components leveraging visual and narrative strategies that are accessible to Deaf clients with varied health literacy

The adaptation was developed in collaboration with Deaf clinicians, persons in recovery, and other stakeholders to maximize relevance, clarity, and engagement. The study design is a single-cycle pilot enrolling 30 Deaf adults who report past-month high-risk alcohol consumption and related problems. Recruitment will utilize networks within Deaf-serving organizations, behavioral health programs, and community outreach to ensure broad reach. Participants will receive the DeafMET intervention delivered by a Deaf therapist fluent in ASL. Sessions may be conducted in-person or remotely.