Community Mental Health Journal 2015;51(4):393-403. [doi: 10.1007/s10597-014-9764-1]
Aimee N. C. Campbell, PhD, MSW (Columbia University, GNY Node), Eva Turrigiano, MS (New York State Psychiatric Institute, GNY Node), Michelle Moore (City/County Drug and Alcohol Program, South Dakota), Gloria M. Miele, PhD (Columbia College of Physicians and Surgeons, GNY Node), Traci R. Rieckmann, PhD (Oregon Health & Science University, WS Node), Mei-Chen Hu, PhD (Columbia University, GNY Node), Frankie B. Kropp, MS (University of Cincinnati Addiction Sciences Division, OV Node), Roz Ringor-Carty, MSW (NARA Northwest, WS Node), Edward V. Nunes, MD (Columbia College of Physicians and Surgeons, GNY Node).
Longstanding disparities in substance use disorders and treatment access exist among American Indians/Alaska Natives (AI/AN). Computerized, web-delivered interventions have the potential to increase access to quality treatment and improve patient outcomes. National Drug Abuse Treatment Clinical Trials Network (CTN) protocol CTN-0044 established the efficacy in lowering drop-out rates and increasing abstinence of an interactive, web-based version of the Community Reinforcement Approach (CRA) intervention plus incentives, the Therapeutic Education System (TES). However, TES has not been tested among AI/AN populations. This mixed method acceptability study was conducted at two urban outpatient substance abuse treatment programs affiliated with the Clinical Trials Network; one in the Northern Plains region, the other on the Pacific Northwest. The sample consisted of 40 urban AI/AN, and results found TES acceptable across seven indices (range 7.8-9.4 on 0-10 scales with 10 indicating highest acceptability). Clients gave the highest ratings of acceptability to TES modules that included HIV/STI information, as well as managing triggers that can lead to risky sexual or drug using behavior. Modules receiving lower ratings tended to be those completed earlier; lower rating may reflect features of TES functionality, such as getting comfortable with the interface and answering questions to demonstrate learning to be able to move from one module to the next. Initial, lower acceptable rates, and the relatively low use of the internet of the population at baseline, may indicate that web-based interventions need more comprehensive introduction in this population.
Conclusions: Overall, findings suggest that core TES content is acceptable among a diverse population of AI/AN clients in outpatient substance use treatment. Qualitative interviews suggest adaptation of the TES content specific to AI/AN culture could improve adoption. Additional efforts to adapt TES and conduct a larger effectiveness study are warranted. (Article (Peer-Reviewed), PDF, English, 2015)
Keywords: Alaska Natives | Behavior therapy | Community health services | Community Reinforcement Approach (CRA) | CTN platform/ancillary study | Cultural competence | Internet counseling | Minority groups | Motivational incentives | Native Americans | Therapeutic Education System (TES) | Community Mental Health Journal (journal)
Document No: 1080, PMID: 25022913, PMCID: PMC4295007 (available 1/15/2016).
Submitted by CTN Dissemination Librarians, 7/21/2014.