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March 3, 2021

Bringing Together Behavioral Science, Community Engagement, and Cultural Adaptations to Increase Alcohol Abstinence Among American Indian and Alaska Native People Using Contingency Management Therapy

Author Affiliations
  • 1Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut
  • 2Departments of Psychiatry and Psychological Science, University of Vermont, Burlington
JAMA Psychiatry. Published online March 3, 2021. doi:10.1001/jamapsychiatry.2020.4757

Alcohol use disorder (AUD), alcohol morbidity and mortality, and low AUD treatment engagement and completion are pressing issues for American Indian and Alaska Native people.1 Efforts to improve AUD treatment among American Indian and Alaska Native populations has long warranted more research that is culturally congruent, community based, participatory, and evidence based. However, little has been done in the way of randomized clinical trials and/or multisite research studies that acknowledge the geographic, tribal, and cultural diversity among American Indian and Alaska Native populations. In other populations, contingency management (CM) has been shown2 to be a promising intervention to promote abstinence and increase engagement in treatment across the continuum of care for substance use disorders. Rooted in the basic behavioral principle of positive reinforcement, wherein environmental outcomes increase the probability that a desired response will be repeated in the future, CM provides rewards for biochemically validated abstinence or treatment adherence.3 While CM has potential, prior research on its efficacy among American Indian and Alaska Native people has been limited to a single-site proof-of-concept study among individuals with AUD who also used other drugs.4

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