SPOKANE, Wash. – An inexpensive, easy-to-administer intervention that uses low prices and other incentives to reward abstinence from alcohol can serve as an effective tool to reduce alcohol consumption among Native American and Alaska Native communities , suggests new research.
Posted today in JAMA Psychiatry, the study tested a culture-adapted version of an intervention known as contingency management in Native American and Alaska Native adults diagnosed with alcohol dependence, a severe form of the disorder. Alcohol consumption. The researchers’ results showed that participants who were given incentives to reward abstinence from alcohol were 70% more likely to test negative for alcohol use than control participants.
“Dealing with the unexpected can help people spark interest in reducing their alcohol consumption in a positive way, build self-confidence, feel connected and truly recognize their journey and recovery,” said the co -Study author Katherine Hirchak, descendant of the Eastern Shoshone tribe and Washington State University research assistant professor Elson S. Floyd College of Medicine.
She said the positive approach to the intervention fits well with Indigenous values and helps counteract the stigma surrounding alcohol use among Native Americans and Alaska Natives, a complex issue that defies generalizations.
Designed and conducted in partnership with three Indigenous communities in urban and rural areas in Alaska, the Pacific Northwest, and the Northern Plains, the study is the first multi-site trial to test the use of management contingencies to reduce alcohol consumption among Aboriginal adults. It follows another recent study published by researchers in the journal Addiction which showed equally promising results on a single rural reserve in the northern plains.
“Together, these two studies prove that this intervention would work in a diverse group of Indigenous communities and could be used as part of a comprehensive drug treatment system to help reduce alcohol-related inequalities in Indigenous communities.” Said lead author Michael McDonell, professor at Elson S. Floyd College of Medicine at Washington State University. He added that the studies were also two of the most important of this intervention in alcohol use disorders in any population.
As part of the multisite study, researchers conducted a 12-week trial that included 158 participants recruited from the three sites. Participants were randomized into an emergency management intervention that prompted submitting alcohol-negative urine samples on bi-weekly visits, or a control intervention that prompted simply submitting urine samples without a requirement to abstinence from alcohol.
Abstinence from alcohol has been verified by ethyl glucuronide (ETG) tests, which can detect the presence of alcohol in the urine for up to three days. Incentives were offered through raffles in which participants drew tokens that contained positive phrases, such as “good job”, or that could be redeemed for prizes ranging in value from $ 1 to $ 80. . Prizes included gift cards, culturally significant items such as fishing gear or bead supplies, and practical items like shampoo and clothing. For participants in the contingency management intervention, the number of draws at each visit increased with the length of their abstinence.
The researchers’ finding that participants in contingency management were 70% more likely to submit a negative alcohol urine sample is a small but significant effect that McDonell says is magnified by the low cost of the intervention – the median total cost of prizes per person being only $ 50. – and its public health potential for a large group of people. The intervention can be used with minimal staff training and can be conducted from any location. The recently introduced rapid urine test cups eliminated the need for expensive urinalysis equipment that was used in the study, thus removing a potential barrier to widespread adoption of contingency management.
McDonell said he is already in contact with different tribes and states interested in training communities on how to use this approach. Researchers and employees at the Southcentral Foundation – an Alaskan native-owned nonprofit health care system that served as one of the three study sites – had the opportunity to observe the benefits first-hand intervention. Southcentral Foundation’s Four Directions outpatient treatment center is considering integrating it into their intensive outpatient drug addiction treatment program.
“Participants told us that their experience of participating in the study was life-changing,” said Jennifer Shaw, senior researcher at the Southcentral Foundation and co-author of the study. “Many have said that the impact of the intervention on their self-efficacy and relationships was overwhelmingly positive, which really confirms the Nuka System of Care, the relationship-based model of health care built by indigenous people in the United States. ‘Alaska.”
The study was funded by a grant from the National Institute on Alcohol Abuse and Alcoholism at McDonell and co-principal investigator Dedra Buchwald, director of the WSU Initiative for Research and Education to do advancing community health and professor at the Elson S. Floyd College of Medicine.