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J Subst Abuse Treat. 2018 Jul;90:57-63. doi: 10.1016/j.jsat.2018.04.014. Epub 2018 May 3.

Focus groups to increase the cultural acceptability of a contingency management intervention for American Indian and Alaska Native Communities.

Author information

1
Initiative for Research and Education to Advance Community Health, Washington State University, Spokane, WA, USA; Program of Excellence in Addictions Research, Washington State University, Spokane, WA, USA.
2
Department of Psychology, Portland State University, Portland, OR, USA.
3
Initiative for Research and Education to Advance Community Health, Washington State University, Spokane, WA, USA.
4
Southcentral Foundation, Anchorage, AK, USA.
5
Program of Excellence in Addictions Research, Washington State University, Spokane, WA, USA; Department of Medical Education and Clinical Sciences, Washington State University Elson S. Floyd College of Medicine, Spokane, WA, USA; Providence Medical Research Center, Providence Health Care, Spokane, WA, USA.
6
Alcohol and Drug Abuse Institute, University of Washington, Seattle, WA, USA; Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA.
7
Initiative for Research and Education to Advance Community Health, Washington State University, Spokane, WA, USA; Department of Medical Education and Clinical Sciences, Washington State University Elson S. Floyd College of Medicine, Spokane, WA, USA.
8
Initiative for Research and Education to Advance Community Health, Washington State University, Spokane, WA, USA; Program of Excellence in Addictions Research, Washington State University, Spokane, WA, USA; Department of Medical Education and Clinical Sciences, Washington State University Elson S. Floyd College of Medicine, Spokane, WA, USA. Electronic address: mmcdonell@wsu.edu.

Abstract

INTRODUCTION:

Many American Indian and Alaska Native (AI/AN) people seek evidence-based, cost-effective, and culturally acceptable solutions for treating alcohol use disorders. Contingency management (CM) is a feasible, low-cost approach to treating alcohol use disorders that uses "reinforcers" to promote and support alcohol abstinence. CM has not been evaluated among AI/AN communities. This study explored the cultural acceptability of CM and adapted it for use in diverse AI/AN communities.

METHODS:

We conducted a total of nine focus groups in three AI/AN communities: a rural reservation, an urban health clinic, and a large Alaska Native healthcare system. Respondents included adults in recovery, adults with current drinking problems, service providers, and other interested community members (n = 61). Focus group questions centered on the cultural appropriateness of "reinforcers" used to incentivize abstinence and the cultural acceptability of the intervention. Focus groups were audio-recorded, transcribed, and coded independently by two study team members using both a priori and emergent codes. We then analyzed coded data.

RESULTS:

Across all three locations, focus group participants described the importance of providing both culturally specific (e.g., bead work and cultural art work supplies), as well as practical (e.g., gas cards and bus passes) reinforcers. Focus group participants underscored the importance of providing reinforcers for the children and family of intervention participants to assist with reengaging with family and rebuilding trust that may have been damaged during alcohol use. Respondents indicated that they believed CM was in alignment with AI/AN cultural values. There was consensus that Elders or a well-respected community member implementing this intervention would enhance participation. Focus group participants emphasized use of the local AI/AN language, in addition to the inclusion of appropriate cultural symbols and imagery in the delivery of the intervention.

CONCLUSIONS:

A CM intervention for alcohol use disorders should be in alignment with existing cultural and community practices such as alcohol abstinence, is more likely to be successful when Elders and community leaders are champions of the intervention, the intervention is compatible with counseling or treatment methodologies, and the intervention provides rewards that are both culturally specific and practical.

KEYWORDS:

Alcohol use treatment; American Indian/Alaska Natives; Contingency management; Treatment adaptation

PMID:
29866384
PMCID:
PMC6014612
DOI:
10.1016/j.jsat.2018.04.014
[Indexed for MEDLINE]
Free PMC Article

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