A Pilot Randomized Controlled Trial Evaluating Peer Recovery Coaches for Addiction Recovery among Indigenous Americans

Abstract

Addiction is a common and devastating problem among many Indigenous American (IA) groups around the United States. Too few IA health care providers are available to deliver care in a way that leverages IA values and traditions to support addiction recovery. Peer Recovery Coaches (PRCs) are individuals who have lived experience of addiction and have received specialized training in helping others in recovery. IA PRCs hold significant potential in helping to fill the gap of culturally-specific support in addiction. In this feasibility trial, we recruited a total of 120 adult (≥19 years) IAs with a substance use disorder through Facebook advertisements. Ninety participants were randomized to the PRC (experimental) group which received support from PRC and 30 to the Attention-Control (AC) group which received support from research nurse. Both groups received weekly support for 12 weeks. Participants completed weekly surveys during the 12-week intervention and monthly surveys during a three-month follow-up phase. The two groups had similar quantities of alcohol consumed, days of alcohol use, and days of drug use except that the PRC group had fewer days of alcohol use in the first three weeks of the intervention phase (2.05 days v. 3.5 days, p=0.04). We found that “support and advocacy” was the most common intervention provided by the PRC. The PRC intervention was widely accepted and appreciated by individuals who completed the program with 79% of individuals giving positive feedback regarding the PRCs and the remaining 21% giving neutral feedback. This trial provides some insights upon which future trials can draw to further evaluate the potential of PRCs in this hard-to-reach population with a high level of need. Trials or programs that rely on national recruitment may be successful in reaching a sufficient number of individuals but they may lack the more intensive in-person capacity that will likely help with retention. Despite this limitation, the current pilot demonstrated that racially-concordant PRC services likely have a high degree of acceptability among IA populations. Future studies may draw on these findings by having trained IA coaches recruit and work with individuals in-person to assist with higher levels of retention.