Alcohol treatment & health disparity in American Indians

酒精治疗

基本信息

批准号：
7478633
负责人：
R. Dale WALKER
金额：
$ 38.59万
依托单位：
OREGON HEALTH & SCIENCE UNIVERSITY
依托单位国家：
美国
项目类别：
财政年份：
2004
资助国家：
美国
起止时间：
2004-08-01 至 2010-07-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/7478633
关键词：
Abstinence Alaska Native Alcohol abuse Alcohol consumption Alcohols American Indians Behavior Therapy Caring Cherokee Indian Cities Client Clinical Treatment Cognitive Cohort Studies Collaborations Competence Data Dependence Employment Equation Family psychotherapy Funding Gender General Population Head Healed Health Health Services Research Indigenous Individual Information Systems Informed Consent Interview Law Enforcement Life Linear Models Link Measures Medicaid Medical Methods Modality Modeling Morbidity - disease rate National Institute on Alcohol Abuse and Alcoholism Native Americans Native-Born Numbers Oregon Outcome Outcome Measure Patient Self-Report Prevention Process Professional counselor Provider Psychiatrist Published Comment Randomized Clinical Trials Randomized Controlled Clinical Trials Rate Records Recruitment Activity Rehabilitation therapy Request for Applications Research Research Project Grants Reservations Resources Services Severities Structural Models Substance abuse problem Tape Recording Treatment outcome Tribes United States Walkers Washington addiction alcohol abuse therapy alcohol related problem alcohol use disorder cohort day design drinking healing health disparity indexing instrument interest member mortality programs research study response satisfaction treatment program urban Native American urban area

项目摘要

DESCRIPTION (provided by applicant): This proposal is the third submission of application number R01 AA013806-01 which was originally submitted in response to Request for Application Number AA02.002 ("Research on Alcohol Health Disparities") and most recently reviewed February 13, 2003 by the National Institute on Alcohol Abuse and Alcoholism Health Services Research Review sub-committee (AA-2). The application has again been extensively revised in response to reviewer comments. Nonetheless, this health services research study continues to be motivated by health disparities such as the high rates of morbidity and mortality related to alcohol use among American Indians. Given these health disparities, it is worrisome that there have been few studies examining relationships between treatments and outcomes for natives with alcohol problems. In particular, there is little or no research on services for urban Native Americans with alcohol abuse or dependence. This lack of information is unfortunate since most American Indians now live in cities. The proposed project will examine processes of treatment and outcomes among clients of programs focusing on American Indians in Seattle, Washington and Portland, Oregon. The Seattle Indian Health Board and the Native American Rehabilitation Association in Portland, Oregon primarily serve urban American Indians, are closely connected with general medical services, offer ancillary care such as family therapy, provide numerous treatment modalities for individuals with alcohol problems, and support ongoing research projects. Both agencies serve members of several tribes and both have clients who spend part of the year in the city and part on reservations. Both agencies have adapted for Native people and incorporated into their treatment programs standardized therapies including Motivational Enhancement and Cognitive-Behavioral Treatment. The project will use an inception cohort design. Clients presenting for treatment of alcohol problems at the study programs will be informed about the project. After informed consent is obtained, subjects will be interviewed using instruments such as the Addiction Severity Index and the Project Match Form 90. Subjects will be interviewed again six months, 12, and 18 months after baseline. Outcomes of interest will include abstinence, number of drinking days, alcohol-related problems, psychiatric problems, general medical problems, and satisfaction with services. Interviews with clients and providers, observations of treatment sessions, and reviews of taped treatment encounters will be employed to elicit details of treatment services received. Hierarchical linear models and structural equations models will be used to relate treatments to outcomes. Predictors will include variables describing culturally specific treatments provided to the Native clients as well as measures of clinician cultural competence. Administrative data will be used to compare outcomes for American Indians versus general population clients. Information generated from the project will be useful in devising optimal treatment for indigenous people living in urban areas and in planning randomized clinical trials. The research team (headed by a Cherokee psychiatrist and including members of several tribes) will disseminate results in collaboration with the newly funded American Indian and Alaska Native National Resource Center on Substance Abuse Prevention and Treatment.

说明（由申请人提供）：本提案是申请号 R01 AA013806-01 的第三次提交，最初是为了响应申请号 AA02.002（“酒精健康差异研究”）的请求而提交的，最近一次于 2 月 13 日进行审查， 2003 年由国家酒精滥用和酒精中毒研究所健康服务研究审查小组委员会 (AA-2) 审查。为了响应审稿人的意见，该应用程序再次进行了广泛的修改。尽管如此，这项卫生服务研究仍然受到健康差异的推动，例如美洲印第安人与饮酒相关的高发病率和死亡率。考虑到这些健康差异，令人担忧的是，很少有研究探讨有酗酒问题的当地人的治疗和结果之间的关系。特别是，对于为酗酒或依赖的城市美洲原住民提供的服务的研究很少或根本没有。不幸的是，由于大多数美洲印第安人现在居住在城市中，因此缺乏信息。拟议的项目将研究针对西雅图、华盛顿州和俄勒冈州波特兰的美洲印第安人项目的客户的治疗过程和结果。西雅图印第安人健康委员会和俄勒冈州波特兰的美洲原住民康复协会主要为城市美洲印第安人提供服务，与一般医疗服务密切相关，提供家庭治疗等辅助护理，为有酗酒问题的个人提供多种治疗方式，并支持持续进行的治疗研究项目。这两家机构都为多个部落的成员提供服务，并且都有一年中部分时间在城市度过、部分时间在预订的客户。两个机构都针对原住民进行了调整，并将标准化疗法纳入其治疗计划，包括动机增强和认知行为治疗。该项目将采用初始队列设计。在研究项目中接受酒精问题治疗的客户将被告知该项目。获得知情同意后，将使用成瘾严重程度指数和项目匹配表 90 等工具对受试者进行访谈。将在基线后 6 个月、12 和 18 个月再次对受试者进行访谈。感兴趣的结果将包括戒酒、饮酒天数、酒精相关问题、精神问题、一般医疗问题以及对服务的满意度。将通过与客户和提供者的访谈、治疗过程的观察以及对治疗过程的录音回顾来获取所接受治疗服务的详细信息。将使用分层线性模型和结构方程模型将治疗与结果联系起来。预测变量将包括描述向本地客户提供的文化特定治疗的变量以及临床医生文化能力的衡量标准。行政数据将用于比较美洲印第安人与一般人群客户的结果。该项目产生的信息将有助于为居住在城市地区的土著人民设计最佳治疗方法以及规划随机临床试验。该研究小组（由切罗基精神病学家领导，包括几个部落的成员）将与新资助的美洲印第安人和阿拉斯加原住民国家药物滥用预防和治疗资源中心合作传播研究结果。