A Randomized Clinical Trial of Culturally Tailored MI

The proposed R01 research, in response to PA 10-100, "Alcohol Use Disorders: Treatment,
Services Research, and Recovery", addresses the PA priority: Treatment for Health
Disparities/Special Populations. Latinos, the largest and fastest growing ethnic group in the
United States (U.S.), representing 14% of the population (1), are expected to grow to nearly
29% of the population by 2050 (2-3). Like many immigrant groups adapting to U.S. culture,
Latinos adopt the health behaviors of the mainstream population, such as hazardous drinking
(4-6). Hazardous drinking is a pattern of drinking associated with increased alcohol related
problems: injuries, violence, sexually transmitted diseases (7-15), and increased risk for
developing an alcohol use disorder (abuse or dependence) (7, 10, 16). Latinos report a
disproportionately greater burden of illness, injuries, workplace and legal problems (17-21)
as a result of their alcohol consumption than other racial ethnic groups, including an
elevated risk for alcohol-involved motor vehicle crashes and fatalities (20, 22).

Early intervention prevents the need for more costly and complex alcohol treatment (23).
According to the National Academy of Sciences, dissemination of empirically-based
interventions that are culturally tailored is particularly needed among Latinos (23-24)
because they suffer alcohol-related health disparities (18-20, 25-26) and because alcohol
treatment utilization rates are lower among Latinos than among other minority racial/ethnic
groups or Whites (27-29). Although evidence suggests that culturally tailored addiction
treatment improves retention and treatment outcomes (30-31), progress in the field has been
limited by the lack of prospective clinical trials comparing tailored to non-tailored
treatment (23). The PI's (New Investigator) funded K award (AA014905) provided important
pilot data demonstrating that culturally tailored motivational interviewing (CTMI)
outperformed un-tailored motivational interviewing (MI). This study will be the basis for the
current proposed study, which is a larger scale version of the pilot. The culturally tailored
MI maintained MI components. The key modification in our Social Contextual Model of Cultural
Tailoring was to tailor the MI to incorporate important acculturation stressors (32-33):
limited financial resources and opportunities, loss of social networks, discrimination
(34-38), and changing cultural values. The proposed study will investigate acculturation
stress (39) as an influence on the relationship between acculturation and alcohol consumption
behavior and treatment outcomes. Efforts will help build a comprehensive model of how
acculturation stressors influence drinking behavior among Latinos (40). The CTMI is also a
needed effort to tailor treatment to drinkers who experience the burden of multiple social
contextual sources of disadvantage, including poverty, discrimination, and acculturation
stress (40).

Because the original pilot study goal was to isolate and test the effects of tailoring
treatment, it was delivered in English. The current proposal extends the tailored treatment
to Spanish-speaking Latinos. Providing the tailored treatment in Spanish addresses a major
clinical need and increases external generalizability. The study's public health impact will
be to provide early screening and brief intervention to reduce hazardous drinking among
Latinos in communities that lack such services. By providing early screening and
intervention, we hope to minimize the burden of illness and social consequences that
disproportionately affect Latino communities. Impact on field: will be to contribute to an
understanding of whether culturally tailored motivational intervention enhances treatment
efficacy for Latinos compared to un-tailored treatment. Another contribution will be to
explore the effects of translating and of tailoring MI. Short term goals are to compare the
efficacy of an evidenced-based treatment, MI, against a culturally adapted version of MI
among Latinos. Long term goals are to disseminate an easily trainable, conceptual model of
culturally tailored empirically-based substance abuse treatment, understand how acculturation
processes confer risk for increased hazardous drinking among Latinos, and to inform further
tailoring of treatments for multiple stressors, including acculturation stress.

Research Hypotheses:

Primary Aim 1: Treatment Main Effect. Determine the efficacy of standard motivational
interviewing (MI) compared to culturally tailored MI (CTMI) at two, six, and twelve month
follow-up. We hypothesize that CTMI participants will report fewer alcohol-related negative
consequences and fewer heavy drinking days at follow-up vs. MI participants.

Primary Aim 2: Explore acculturation stress as a moderator of alcohol treatment outcomes for
Latinos. We hypothesize that among participants with high acculturation stress, those in CTMI
will improve more over time than those in MI (at 6 months). We also hypothesize that among
those who receive CTMI, those with high acculturation stress may show greater improvement
over time (at six months) than those with low acculturation stress.

Inclusion Criteria:

- Meet criteria for hazardous drinking (greater than or equal to 5/4 per occasion for
males/females), two or more times in the past 30 days.

- Latino

- Are not currently in any substance use treatment program for alcohol use disorder, nor
have been in the past year.

- 18-65 years old

- Able to speak English or Spanish

Exclusion Criteria:

- Psychotic symptoms, as evidenced by hallucinations or delusions.

- Cognitive impairment, as evidenced by inability to understand informed consent. a. To
determine comprehension, a research assistant will read informed consent aloud and
will ask 3 questions

1. Is the study voluntary

2. Can he/she drop out at any time

3. Will there be study follow-up.