Wednesday, April 2, 2025
4/2/2025
Strength in HEALing: Indigenous Community-Led Strategies to Treat Stimulant Use - Abstract Compared with other racially and ethnically diverse people, 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 drug poisoning mortality more than quadrupled over a seven-year period. The rapid implementation of culturally responsive 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 culturally adapted 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 related to the Indigenous determinants of health (IDOH) including, lower educational attainment (p<0.05), mental health severity (p<0.05), rurality (p<0.05), and perceived racial discrimination (p<0.05). IDOH are associated with low retention and non-response to treatment. Care coordination addresses the IDOH 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 systematically 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 Indigenous and Western based implementation frameworks to identify implementation 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 site and cultural 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 Indigenous frameworks on planning, adoption, competence, fidelity, uptake, and policy. This study could elucidate the rapid translation of research to practice by addressing strategies to improve culturally adapted evidence-based interventions and assess strategies to increase uptake in AI/AN communities.
HHS’ Tracking Accountability in Government Grants System (TAGGS) website provides access to detailed descriptions of grants, loans, aggregated direct payments and other types of financial assistance awarded by the HHS Operating Divisions (OPDIVs) and the Office of the Secretary Staff Divisions (STAFFDIVs).