Lessons Shared: Implementation of a Randomized Clinical Trial for Alcohol Use Disorders with Five American Indian and Alaska Native Communities

Abstract

This paper examines how five Tribal communities and an academic institution developed the Helping Our Native Ongoing Recovery Project. The goal of this study was to conduct a large randomized controlled trial using contingency management as an intervention for alcohol use disorders among 400 American Indian and Alaska Native (AI/AN) people. Using a community-engaged approach, including tenants of community-based participatory research and the Quality Implementation Framework, close collaboration between Tribal community and academic partners was essential to the research design and implementation. The process described has enhanced trust, positive relationships, and the successful cultural adaptation and implementation of the contingency management intervention with two of the five partnering communities. This work may provide insight for dissemination and implementation science among AI/AN communities and a process template for researchers who want to partner with Tribal communities to positively impact health outcomes.

Coming together for something good: recommendations from a scoping review for dissemination and implementation science to improve indigenous substance use disorder treatment

“…Out of the 20 studies reviewed, ten (50%) of them reported outcomes related to intervention effectiveness ( 1 , 34 , 36 , 38 , 40 , 41 , 45 , 48–50 ). There were several studies where the primary outcome was tobacco cessation [ n = 7; ( 32 , 36 , 38 , 45 , 47–49 )].…”

“…Including enhancements to Adoption focused on the staff members themselves. While some studies had specific inclusion and exclusion criteria for staff ( 32 , 38 , 48 ), Indigenous staff and level of staff buy-in were highlighted as the key to increasing Adoption ( 37 , 41 , 44 ). The duration of the intervention also impacted Adoption.…”

“…At the organizational level, Adoption was discussed in the context of recruitment success, with higher recruitment translating to better adoption ( 36 , 41 , 45 ). One study focused on tobacco cessation located at a healthcare system with different locations across the Hawaiian Islands.…”

Investigating Secondary Alcohol Outcomes in a Contingency Management Intervention among American Indian and Alaska Native Adults

“…Previous research has highlighted opportunities to partner with programs outside of the treatment context to sustain CM within Tribal communities. With the necessary infrastructure in place, other grant funding could also be sought to strengthen sustainability 38 . Furthermore, the research team continues to support and partner with Tribal communities by offering CM training and technical support to enhance implementation and sustainment of CM.…”

“…With the necessary infrastructure in place, other grant funding could also be sought to strengthen sustainability. 38 Furthermore, the research team continues to support and partner with Tribal communities by offering CM training and technical support to enhance implementation and sustainment of CM. In addition, policy efforts have recently been undertaken to reduce barriers to delivering CM (eg, restrictions around incentives).…”