Native Center for Alcohol Research and Education (NCARE) Research Project 2 (RP2): Randomized Clinical Trial of Harm Reduction Talking Circles for Urban American Indians and Alaska Natives with Alcohol Use Disorders (HaRTC)

Status: Ended

Alcohol-use disorders (AUDs) are a serious public health issue for urban American Indian and Alaska Native (AI/AN) people. They have twice the levels of AUDs and alcohol problems of urban non-Hispanic whites. Unfortunately, the most widely available treatment option – abstinence-based treatment – is generally ineffective in engaging and successfully treating this underserved population. To illuminate potential solutions to this problem, we conducted pilot qualitative studies, in which urban AI/AN people with AUDs expressed interest in interventions that integrate low-barrier, nonabstinence-based harm-reduction approaches with Native cultural practices. The most commonly requested cultural practice was the talking circle. A talking circle is a gathering of people with a common concern who respectfully share their perspectives and “listen with their heart” while each individual speaks. Traditionally, talking circles have been used to address community problems, heal individuals from trauma, and bring about community harmony. Studies conducted with other populations have indicated talking circles may be an efficacious clinical intervention. We proposed using a community-based participatory research framework to guide the refinement and formal evaluation of Harm Reduction Talking Circles (HaRTC) for urban AI/AN people with AUDs. HaRTC was designed with a community advisory board made up of researchers, traditional Native healers, urban AI/AN people with the lived experience of AUDs, and representatives from the community partner for the study. Our Specific Aims were to 1) Tailor HaRTC to meet the needs of urban AI/AN people with AUDs in a clinical setting; 2) Conduct a randomized controlled trial to evaluate the efficacy of HaRTC versus treatment as usual; and 3) Perform a comprehensive economic evaluation of HaRTC with cost-benefit and cost-effectiveness analyses. We completed intervention co-development and feasibility testing. We implemented recruitment for the randomized controlled trial just as COVID-19-related stay-at-home orders were issued. We worked tirelessly with the Research Methods Core and our Tribal partners to change the in-person study to a virtual/remote study. However, the challenges became insurmountable due to: 1) difficulty recruiting and retaining unhoused AI/AN adults with AUDs in a virtual intervention; and 2) the group nature of the intervention. Although the project was discontinued, we published results of a single-arm feasibility trial (N=51) of a virtual version with AI/AN adults across the U.S. Participants attended an average of two sessions, rated the intervention as helpful and culturally aligned, and alcohol use and associated harms were reduced.

IREACH Programs

• Native Center for Alcohol Research and Education

Principal Investigator(s)

• Lonnie Nelson, PhD, MA
• Susan E. Collins, PhD

Heath Research Initiatives

• American Indian and Alaska Native Health
• Urban Health

Focus Areas

• Alcohol use
• Behavioral health
• Community-based participatory research