School of Social Work, The University of Illinois, Urbana-Champaign, Illinois, USA.
North Jersey Community Research Initiative, Newark, New Jersey, USA.
Subst Use Misuse. 2024;59(11):1574-1585. doi: 10.1080/10826084.2024.2352611. Epub 2024 Jun 19.
Rates of alcohol and/or substance use (ASU) among residents of predominantly Black and marginalized communities are similar to ASU rates in White communities. Yet ASU has worse consequences in predominantly Black and marginalized communities (e.g., higher incarceration). We randomized participants to one of 16 intervention conditions using a 2 full factorial design to optimize a multilevel intervention reducing ASU among 602 formerly incarcerated men with substance-use-disorders (SUD). Candidate intervention components included (1) critical dialogue (CD; six weekly 2-hour-long group sessions vs. no CD sessions), (2) Quality of Life Wheel (QLW; six weekly 1-hour-long group sessions vs. no QLW sessions), (3) capacity building projects (CBP; six weekly 1-hour-long group sessions vs. no CBP sessions), and (4) delivery by a trained peer versus licensed facilitators. Outcome was percentage of days in which participants used alcohol, cocaine, opioid, and/or cannabis in previous 30 days. Intent-to-treat analysis did not meet a priori component selection criteria due to low intervention attendance. After controlling for intervention group attendance (percentage of sessions attended), peer-delivered CD and CBP produced statistically and clinically significant main and interaction effects in ASU over 5 months. Per the multiphase optimization strategy framework, we selected peer-delivered CD and CBP for inclusion as the optimized version of the intervention with a cost of US$1,380 per 10 individuals. No adverse intervention effects occurred. CD and CBP were identified as the only potentially effective intervention components. Future research will examine strategies to improve attendance and test the optimized intervention against standard of care in a randomized-controlled-trial.
在以黑人和边缘社区为主的社区中，居民的酒精和/或物质使用（ASU）率与白人社区的 ASU 率相似。然而，ASU 在以黑人和边缘社区的后果更糟（例如，更高的监禁率）。我们使用 2 全因子设计将参与者随机分配到 16 种干预条件中的一种，以优化一项多层次干预措施，减少 602 名患有物质使用障碍（SUD）的前囚犯中的 ASU。候选干预因素包括：（1）批判性对话（CD；六次每周 2 小时的小组会议与无 CD 会议）；（2）生活质量轮（QLW；六次每周 1 小时的小组会议与无 QLW 会议）；（3）能力建设项目（CBP；六次每周 1 小时的小组会议与无 CBP 会议）；（4）由经过培训的同伴而非持照治疗师提供。结果是参与者在前 30 天内使用酒精、可卡因、阿片类药物和/或大麻的天数百分比。意向治疗分析未达到预先设定的组件选择标准，因为干预参与率低。在控制干预组出勤率（参加会议的百分比）后，同伴提供的 CD 和 CBP 在 5 个月内对 ASU 产生了统计学和临床意义上的主要和交互作用。根据多阶段优化策略框架，我们选择了同伴提供的 CD 和 CBP，作为该干预措施的优化版本，每 10 人成本为 1380 美元。没有发生不良的干预效应。CD 和 CBP 被确定为唯一可能有效的干预因素。未来的研究将研究提高出勤率的策略，并在随机对照试验中测试优化后的干预措施与标准护理的效果。
