Culturally tailoring a secondary suicide prevention intervention for American Indian and Alaska Native people in substance use treatment.

BACKGROUND: Substance use treatment programs are ideal places for suicide prevention interventions. People who misuse substances are at elevated risk for suicide compared to the general population. However, most treatment programs do not incorporate suicide prevention, and none have been adapted for American Indian and Alaska Native (AI/AN) people. Preventing Addiction Related Suicide (PARS) is a suicide prevention module developed for use with people in treatment for substance misuse. A previous study demonstrated increased suicide help-seeking among this population. OBJECTIVE: Culturally adapt PARS for use with AI/AN communities. METHODS: We conducted focus groups and interviews with stakeholders in three Tribal health systems. We elicited feedback on PARS content, structure, and implementation. Data were analyzed using constant comparison. Results were used to adapt PARS and member checking was used to refine it. RESULTS: Participants unanimously endorsed using PARS in their health systems. Suggested adaptations included shortening the module, using community-specific information, removing jargon and stigmatizing language, and emphasizing cultural connectedness. DISCUSSION: This community-based, qualitative study adapted the PARS module for use with AI/AN communities. Research is needed to evaluate the clinical effectiveness of the adapted module. If found effective, this would represent the first evidence-based suicide prevention intervention among AI/AN individuals in treatment for substance misuse.

Recovery from alcohol among urban Alaska Native and American Indian people.

Alaska Native and American Indian (ANAI) people experience dramatic alcohol-related health disparities compared to the general US population. Although the majority of ANAI people reside in urban settings (>70%), data are sparse on alcohol abstinence among urban ANAI people with alcohol use disorder (AUD). We conducted a qualitative study using a phenomenological approach to examine the experiences of 20 urban ANAI adults recovering from AUD. Participants' narratives had their own unique dimensions but shared a clear, interrelated trajectory of pre-alcohol recovery, a turning point, and ongoing alcohol recovery. All participants reported a combination of external and internal motivation to stop using alcohol.

Culturally Adapting Caring Contacts for Suicide Prevention in Four Alaska Native and American Indian Communities.

AIM: Despite substantial tribal, state, and federal effort, American Indian and Alaska Native (AI/AN) suicide rates have changed little in the last 30 years, prompting attention to new and innovative approaches to this persistent health disparity. Suicide prevention interventions with demonstrated success in other populations may be useful in AI/AN communities. Caring Contacts is a suicide prevention intervention that has been adapted and shown to reduce suicide ideation, attempts, and deaths in other populations. CONCLUSION: Overall, AI/AN study participants in four diverse AI/AN communities endorsed the use of Caring Contacts for suicide prevention in their communities. Intervention adaptations for use in these communities centered primarily on message frequency and timing as well as expanding access to Caring Contacts. The results of this study may be applicable to other populations that experience suicide-related health disparities. METHODS: We used a community-based participatory research approach to gather qualitative data from community members, healthcare providers, and leaders in four AI/AN communities. These data were analyzed thematically and used to adapt Caring Contacts for use in a subsequent clinical trial with AI/AN people at high risk for suicide. RESULTS: A total of 189 community members and other health system stakeholders in four tribal communities participated in focus groups and interviews. Caring Contacts was perceived in all communities to be acceptable. Feedback for intervention adaptations focused on the themes of trial eligibility criteria; instruments; message frequency, timing, and content; and cultural considerations.

Buprenorphine/Naloxone for Opioid Use Disorder Among Alaska Native and American Indian People.

OBJECTIVES: Opioid-related disparities are magnified among Alaska Native and American Indian (ANAI) people. Yet, no outcome studies on medication for addiction treatment, an effective treatment in other populations, among ANAI people exist. The objective of this study was to identify variables associated with buprenorphine/naloxone retention among ANAI people with opioid use disorder (OUD). METHODS: The sample was 240 ANAI adults in Anchorage, Alaska who received buprenorphine/naloxone treatment for an OUD. We gathered data from the electronic health record from January 1, 2015 to December 31, 2019. We used survival analysis to explore possible predictors (demographic variables, psychiatric comorbidity, medical severity, previous opioid prescriptions, previous injury, alcohol use disorder, and co-occurring substance use) of length of treatment retention (in days) while accounting for right censoring. RESULTS: We found that 63% of the 240 patients were retained in buprenorphine/naloxone treatment at 90 days, 51% at 6 months, and 40% at 1 year, slightly lower than the general US population. Younger age (hazard ratio 1.69, 95% confidence intervals 1.17-2.45) and co-occurring substance use (hazard ratio 2.95, 95% confidence intervals 1.99-4.38) were associated with increased rate of buprenorphine/naloxone treatment discontinuation. CONCLUSIONS: Younger patients and those with co-occurring substance use remain at higher risk of discontinuing buprenorphine/naloxone treatment for OUD in this population of ANAI people. Treatment programs serving ANAI people may consider paying special attention to patients with these characteristics to prevent treatment discontinuation. Our study highlights the need to address poly-substance use among ANAI people in treatment.

Assessing the Predictive Validity of the Stages of Change Readiness and Treatment Eagerness Scale (SOCRATES) in Alaska Native and American Indian People.

OBJECTIVES: The objective of this study was to examine the predictive validity of the Stages of Change Readiness and Treatment Eagerness Scale (SOCRATES) among Alaska Native and American Indian (ANAI) people with an alcohol use disorder. METHODS: The sample was 170 ANAI adults with an alcohol use disorder living in Anchorage, Alaska who were part of a larger alcohol intervention study. The primary outcome of this study was alcohol use as measured by mean urinary ethyl glucuronide (EtG). EtG urine tests were collected at baseline and then up to twice a week for four weeks. We conducted bivariate linear regression analyses to evaluate associations between mean EtG value and each of the three SOCRATES subscales (Recognition, Ambivalence, and Taking Steps) and other covariates such as demographic characteristics, alcohol use history, and chemical dependency service utilization. We then performed multivariable linear regression modeling to examine these associations after adjusting for covariates. RESULTS: After adjusting for covariates, mean EtG values were negatively associated with the Taking Steps (P = 0.017) and Recognition (P = 0.005) subscales of the SOCRATES among ANAI people living in Alaska. We did not find an association between mean EtG values and the Ambivalence subscale (P = 0.129) of the SOCRATES after adjusting for covariates. CONCLUSIONS: Higher scores on the Taking Steps and Recognition subscales of the SOCRATES at baseline among ANAI people predicted lower mean EtG values. This study has important implications for communities and clinicians who need tools to assist ANAI clients in initiating behavior changes related to alcohol use.