title: Process and product in cross-cultural treatment research: development of a culturally sensitive women-centered substance use intervention in georgia.
abstract: Women who inject drugs (WID) are highly marginalized and stigmatized and experience ongoing discrimination in Georgia. Few opportunities exist for WID to receive publicly funded treatment for substance use disorders. The IMEDI (Investigating Methods for Enhancing Development in Individuals) project was developed in response to the need for women-specific and women-centered treatment services. This paper described our approach to understanding the Georgian culture-and WID within that culture-so that we could integrate two interventions for substance use found effective in other Western and non-Western cultures and to outline how we refined and adapted our integrated intervention to yield a comprehensive women-centered intervention for substance use. Reinforcement Based Treatment (RBT) and the Women's CoOp (WC) were adapted and refined based on in-depth interviews with WID (N = 55) and providers of health services (N = 34) to such women and focus groups [2 with WID (N = 15) and 2 with health service providers (N = 12)]. The resulting comprehensive women-centered intervention, RBT+WC, was then pretested and further refined in a sample of 20 WID. Results indicated positive pre-post changes in urine screening results and perceived needs for both RBT+WC and a case management control condition. The approach to treatment adaptation and the revised elements of RBT+WC are presented and discussed.
authors.affiliation: UNC Horizons and Department of Obstetrics and Gynecology, School of Medicine, University of North Carolina at Chapel Hill, 127 Kingston Drive, Chapel Hill, NC 27514, USA ; Departments of Psychiatry and Behavioral Sciences and Obstetrics and Gynecology, School of Medicine, Johns Hopkins University, Baltimore, MD 21224, USA.
authors.forename: Hendrée E
authors.initials: HE
authors.lastname: Jones
authors.affiliation: Addiction Research Center, Alternative Georgia, 0177 Tbilisi, Georgia ; Ilia State University, School of Arts and Science, 0162 Tbilisi, Georgia.
authors.forename: Irma
authors.identifier: 0000-0002-7498-2380
authors.initials: I
authors.lastname: Kirtadze
authors.affiliation: Addiction Research Center, Alternative Georgia, 0177 Tbilisi, Georgia.
authors.forename: David
authors.initials: D
authors.lastname: Otiashvili
authors.affiliation: Department of Psychology, University of Maryland, College Park, College Park, MD 20742, USA.
authors.forename: Kevin E
authors.initials: KE
authors.lastname: O'Grady
authors.affiliation: UNC Horizons and Department of Obstetrics and Gynecology, School of Medicine, University of North Carolina at Chapel Hill, 127 Kingston Drive, Chapel Hill, NC 27514, USA.
authors.forename: Keryn
authors.identifier: 0000-0002-9711-915X
authors.initials: K
authors.lastname: Murphy
authors.affiliation: Substance Abuse Treatment Evaluations and Interventions Research Program, RTI International, Research Triangle Park, NC 27709, USA.
authors.forename: William
authors.initials: W
authors.lastname: Zule
authors.affiliation: Department of Addictions, Bekhterev Research Psychoneurological Institute, 192019 Saint Petersburg, Russia.
authors.forename: Evgeny
authors.identifier: 0000-0002-0529-4525
authors.initials: E
authors.lastname: Krupitsky
authors.affiliation: Substance Abuse Treatment Evaluations and Interventions Research Program, RTI International, Research Triangle Park, NC 27709, USA.
authors.forename: Wendee M
authors.initials: WM
authors.lastname: Wechsberg