title: A culturally-tailored behavioral intervention trial for alcohol use disorders in three American Indian communities: Rationale, design, and methods.
abstract: BACKGROUND
  Disproportionately high rates of alcohol use disorders are present in many American Indian/Alaska Native (AI/AN) communities, yet little information exists regarding the effectiveness of alcohol treatments in AI/AN populations. Contingency management is an intervention for illicit drug use in which tangible reinforcers (rewards) are provided when patients demonstrate abstinence as assessed by urine drug tests. Contingency management has not been widely studied as an intervention for alcohol problems because until recently, no alcohol biomarker has been available to adequately verify abstinence.
  
  
  OBJECTIVE
  The HONOR Study is designed to determine whether a culturally-tailored contingency management intervention is an effective intervention for AI/AN adults who suffer from alcohol use disorders.
  
  
  METHODS
  Participants include 400 AI/AN alcohol-dependent adults residing in one rural reservation, one urban community, as well as a third site to be decided, in the Western U.S. Participants complete a 4-week lead-in phase prior to randomization, then 12 weeks of either a contingency management intervention for alcohol abstinence, or a control condition where participants receive reinforcers for attending study visits regardless of alcohol use. Participants are then followed for 3-more months post-intervention. The primary study outcome is urinary ethyl glucuronide-confirmed alcohol abstinence; secondary outcomes include self-reported alcohol and drug use, HIV risk behaviors, and self-reported cigarette smoking.
  
  
  CONCLUSIONS
  This will be the largest randomized, controlled trial of any alcohol for AI/ANs and the largest contingency management study targeting alcohol use disorders, thus providing important information to AI/AN communities and the alcohol treatment field in general.
authors.affiliation: Partnerships for Native Health, Department of Epidemiology, University of Washington, 1100 Olive Way, Suite 1200, Box 357236, Seattle, WA 98101, USA; Elson S Floyd College of Medicine, Washington State University, USA.
authors.forename: Michael G
authors.initials: MG
authors.lastname: McDonell
authors.affiliation: Partnerships for Native Health, Department of Epidemiology, University of Washington, 1100 Olive Way, Suite 1200, Box 357236, Seattle, WA 98101, USA.
authors.forename: Jenny R
authors.initials: JR
authors.lastname: Nepom
authors.affiliation: Partnerships for Native Health, Department of Epidemiology, University of Washington, 1100 Olive Way, Suite 1200, Box 357236, Seattle, WA 98101, USA.
authors.forename: Emily
authors.initials: E
authors.lastname: Leickly
authors.affiliation: Partnerships for Native Health, Department of Epidemiology, University of Washington, 1100 Olive Way, Suite 1200, Box 357236, Seattle, WA 98101, USA.
authors.forename: Astrid
authors.initials: A
authors.lastname: Suchy-Dicey
authors.affiliation: Department of Health Policy and Administration, Washington State University, Spokane, WA 99210-1495, USA.
authors.forename: Kait
authors.initials: K
authors.lastname: Hirchak
authors.affiliation: Partnerships for Native Health, Department of Epidemiology, University of Washington, 1100 Olive Way, Suite 1200, Box 357236, Seattle, WA 98101, USA.
authors.forename: Abigail
authors.initials: A
authors.lastname: Echo-Hawk
authors.affiliation: Partnerships for Native Health, Department of Epidemiology, University of Washington, 1100 Olive Way, Suite 1200, Box 357236, Seattle, WA 98101, USA; Fred Hutchinson Cancer Research Center, 1100 Fairview Ave N, Seattle, WA 98109-1024, USA.
authors.forename: Stephen M
authors.initials: SM
authors.lastname: Schwartz
authors.affiliation: Med Star Health Research Institute, 1616 E. Indian School Rd., Phoenix, AZ 85016, USA.
authors.forename: Darren
authors.initials: D
authors.lastname: Calhoun
authors.affiliation: Department of Psychiatry and Behavioral Sciences, University of Washington, 325 Ninth Ave, Box 359911, Seattle, WA 98195, USA.
authors.forename: Dennis
authors.initials: D
authors.lastname: Donovan
authors.affiliation: Washington State University, Spokane, WA 99210-1495, USA.
authors.forename: John
authors.initials: J
authors.lastname: Roll
authors.affiliation: Department of Psychiatry and Behavioral Sciences, University of Washington, 325 Ninth Ave, Box 359911, Seattle, WA 98195, USA.
authors.forename: Richard
authors.initials: R
authors.lastname: Ries
authors.affiliation: Partnerships for Native Health, Department of Epidemiology, University of Washington, 1100 Olive Way, Suite 1200, Box 357236, Seattle, WA 98101, USA; Elson S Floyd College of Medicine, Washington State University, USA.
authors.forename: Dedra
authors.initials: D
authors.lastname: Buchwald
mesh_terms: D000072957:Alaska Natives; D000437:Alcoholism / Q000208:ethnology / Q000628:therapy* / Q000652:urine; D001521:Behavior Therapy / Q000379:methods*; D065246:Culturally Competent Care / Q000379:methods*; D017144:Focus Groups; D005965:Glucuronates / Q000652:urine; D015658:HIV Infections; D006801:Humans; D007198:Indians, North American; D036301:Qualitative Research; D012201:Reward; D012309:Risk-Taking; D012907:Smoking; D019966:Substance-Related Disorders; D014481:United States
chemical_list: D005965:Glucuronates; C093924:ethyl glucuronide
keywords: Alaska Natives; Alcohol; Alcohol biomarker; American Indians; Contingency management; Ethyl glucuronide; Treatment