Strength in HEALing: Indigenous Community-Led Strategies to Treat Stimulant Use - While there are incredible strengths, American Indian and Alaska Native (AI/AN) adults have the highest rates of fatal poisonings from methamphetamine alone and in combination with fentanyl. AI/AN adult drug poisoning mortality more than quadrupled over a seven-year period. The rapid implementation of interventions for stimulant use is therefore desperately needed among AI/AN people. Contingency management (CM) is the most effective intervention for stimulant use disorders (StUD). CM is an intervention in which people who submit urine samples consistent with stimulant abstinence receive tangible reinforcers. Two clinical trials of Tribal CM (combined n=272) were associated with lower levels of stimulant, alcohol, and cannabis use. Alongside the positive findings from our previous CM trials, we identified additional factors important to increasing effectiveness of CM among AI/AN people. During our previous clinical trials of CM, we identified challenges to attendance and retention that among others, included mental health severity (p<0.05) and location (p<0.05). Care coordination addresses engagement of each participant-relative (i.e., study participant) by linking them to needed resources and services that support their individual needs. Findings from our clinical trials also determined a need to characterize and overcome implementation barriers (e.g., lack of organizational fit, staff shortages). The purpose of this R61/33 proposal is to work with 2 partnering American Indian communities (including 3 sites) to develop and examine the impacts of a Tribal Contingency Management and Care Coordination (TCM+CC) intervention for stimulant use disorders on CM attendance, retention, and secondary outcomes. We will utilize implementation frameworks to identify barriers (R61) and assess novel implementation solutions (R33). During the R61 phase we will 1) partner with a Scientific Review Panel, an AI/AN Community Advisory Board, and experienced Implementation Facilitators to develop and refine the TCM+CC intervention, implementation strategies, frameworks, and tools to be implemented in the R33 phase; 2) Determine additional necessary centering to enhance adoption of CM through 45 semi-structured in-depth interviews. During the R33 phase we will conduct a type 1 hybrid effectiveness/implementation randomized controlled trial comparing our TCM+CM to a Tribal CM only control group (n=240). Our aims are to 1) Examine the effects of TCM+CC compared to standard Tribal CM on attendance and retention, stimulant and other drug use, and well-being; and 2) assess TCM+CC implementation outcomes through planning, adoption, competence, fidelity, uptake, and policy.
