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Cited by 46Substance Abuse Treatment and OutcomesIndigenous Health, Education, and RightsOpioid Use Disorder Treatment

Culturally tailored evidence-based substance use disorder treatments are efficacious with an American Indian Southwest tribe: an open-label pilot-feasibility randomized controlled trial

Open access
Venner, Kamilla L., Serier, Kelsey, Sarafin, Ruth, Greenfield, Brenna L., Hirchak, Katherine, Smith, Jane Ellen, Witkiewitz, Katie·2021·Addiction
DOI 10.1111/add.15191PMC PMC13712119
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Abstract

Background and Aims: Many evidence‐based treatments (EBTs) for substance use disorder (SUD) exist, yet few are tailored to Indigenous patients. This trial tested the efficacy of a culturally tailored EBT that combined Motivational Interviewing and the Community Reinforcement Approach (MICRA) versus treatment as usual (TAU). Design: A mixed efficacy/effectiveness randomized controlled trial of MICRA ( n = 38) and TAU ( n = 41) using a parallel design with follow‐up assessments at 4‐, 8‐, and 12‐ months post baseline. Setting: United States, reservation‐based outpatient, addiction specialty care treatment program. Participants: 79 (68% male) American Indian and Alaska Native (AI/AN) Tribal members meeting criteria for SUD and seeking SUD treatment. Interventions: MICRA (individual therapy sessions beginning with MI for 2–3 sessions) compared with TAU (individual and group counseling sessions in a didactic style with Twelve‐Step philosophy and elements of relapse prevention). Measures: Demographics, percent days abstinent (PDA; the primary outcome at 12months assessed by Form 90D), Inventory of Drug Use Consequences, Alcohol and Drug Use Self‐Efficacy Scale, Native American Spirituality Scale, and SCID‐DSM‐IV‐TR. Findings: There was no evidence for the benefit of MICRA over TAU (MICRA PDA = 72.63%, TAU = 73.62%, treatment effect: B = −4.04 (SE = 5.47); 95% CI = −14.941, 6.866; BF = 3.44) in the primary outcome. Both groups showed improvements in PDA, SUD severity, and negative consequences from baseline to the 12‐month follow‐up. Neither self‐efficacy nor spirituality were significant mediators of MICRA. Conclusions: There were no treatment group differences between culturally tailored evidence‐based treatments for substance use disorder and treatment as usual in this randomized controlled trial with American Indian and Alaska Native participants. Nonetheless, participants improved over time on several substance‐related outcomes.

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  • Effective programs integrate Indigenous knowledge systems with evidence-based practices like motivational interviewing, creating interventions that are both culturally resonant and empirically supported.

    “Finally, effective programs integrate Indigenous knowledge systems with evidence-based practices like motivational interviewing, creating interventions that are both culturally resonant and empirically supported (D’Amico et al., 2020; Dickerson et al., 2016; Venner et al., 2021).”

    From Bridging Traditions and Prevention: Insights into Implementing and Sustaining Substance Use Programs for Urban AI/AN Communities (2026) · cites this paper as Venner et al., 2021

    The Introduction and MICRA sections describe combining motivational interviewing with culturally adapted treatment, including Tribal language, introductions, spirituality, and family practices. The Discussion says these adaptations incorporated the community’s worldview, but also notes a lack of superior results for MICRA and uncertainty about whether the adapted treatment was as effective as the original. This supports the culturally resonant, evidence-based approach, but not the broad implication that integrating the two makes programs effective. (LLM, conf=0.87)

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  • Of the four RCT studies, one (25%) was given a bias rating of 4.

    “one (25%) was given a bias rating of 4 (Venner et al., 2021)”

    From Culturally tailored substance use interventions for Indigenous people of North America: a systematic review (2023) · cites this paper as Venner et al., 2021

    The Design section (page unavailable) confirms that Venner et al. conducted a randomized controlled trial, so the citation identifies an RCT. The paper does not report a bias rating of 4 or establish the citing document’s four-study denominator; searches for a bias rating and quality-assessment score found no such passage. (LLM, conf=0.83)

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  • Results resonate with themes from prior research, particularly the importance of culturally grounded approaches and community engagement in effectively addressing substance use issues within these communities.

    “Overall, results resonate with themes from prior research (Brown et al., 2024; Palimaru et al., 2022; Venner et al., 2021), particularly the importance of culturally grounded approaches and community engagement in effectively addressing substance use issues within these communities.”

    From Bridging Traditions and Prevention: Insights into Implementing and Sustaining Substance Use Programs for Urban AI/AN Communities (2026) · cites this paper as Venner et al., 2021

  • In total, six studies (33.33%) were rated a bias rating of 4.

    “six studies (33.33%) were rated a bias rating of 4 (Gone and Calf Looking, 2015; Kelley et al., 2017, 2018; Venner et al., 2021; Wright et al., 2011)”

    From Culturally tailored substance use interventions for Indigenous people of North America: a systematic review (2023) · cites this paper as Venner et al., 2021

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Research works printed but not linked: 6

  1. [8]8. U.S. Department of Health and Human Services IHS. Trends in Indian Health 2014 Edition 2014.
  2. [46]46. First M. B., Spitzer R. L., Gibbon M., Williams J. B. W. Struc- tured clinical interview for DSM-IV-TR Axis I disorders: patient edition. New York, NY: Biometrics Research Department, New York State Psychiatric Institute; 2002.
  3. [49]49. Miller W. R., Tonigan J. S., Longabaugh R. The Drinker Inven- tory of Consequences (DrInC). An Instrument for Assessing Adverse Consequences of Alcohol Abuse, Test Manual. Vol. 4, … MATCH monograph series. Rockville, MD: U.S. Dept. of Health and Human Services, Public Health Service, National Insti- tutes of Health, National Institute on Alcohol Abuse and Alcoholism; 1995.
  4. [53]53. Miller W. Combine Monograph Series, Vol. 1: Combined Behav- ioral Intervention Manual: A Clinical Research Guide for Therapists Treating People with Alcohol Abuse and Dependence. Bethesda, MD: NIAAA; 2004.
  5. [56]56. Moyers T. B., Martin T., Manuel J. K., Miller W. R., Ernst D. Re- vised Global Scales: Motivational Interviewing Treatment Integrity 3.0 (MITI 3.0) [Internet]. Vol. 1, University of New … Albuquerque, NM: Unpublished manuscript; 2007. Avail- able at: http://www.motivationalinterview.org/Documents/ miti3_1.pdf
  6. [58]58. MacKinnon D. P. Introduction to Statistical Mediation Analy- sis (Multivariate Applications Series) [Internet]. Taylor & Francis Group/Lawrence Erlbaum Associates. 2008 [cited 2020 Mar 17]. Available at: http://psycnet.apa.org/record/ 2008-04188-000

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Authors
Venner, K. L., Serier, K., Sarafin, R., Greenfield, B. L., Hirchak, K., Smith, J. E., & Witkiewitz, K.
Affiliations
  • University of New Mexico (US)
  • University of Minnesota, Duluth (US)
  • Center on Alcoholism, Substance Abuse, and Addiction Albuquerque New Mexico USA
Corresponding author
Venner, Kamilla L.
ORCID
Venue
Addiction
Publisher
Wiley
Published
2020-08-11
Volume
116
Issue
4
Pages
949-960
ISSN
  • 0965-2140 (ISSN-L)
  • 1360-0443
DOI
10.1111/add.15191
PMC
PMC13712119
OpenAlex
W3043475770
Cited by
46
References
77
Citations by year
2026: 6 · 2025: 6 · 2024: 5 · 2023: 12 · 2022: 12 · 2021: 3 · 2020: 2
FWCI
5.19
Type
journal article
Language
en
Open access
Licence
onlinelibrary.wiley.com/termsAndConditions#vor (vor)
Locations
  • Addiction (publishedVersion)
  • PubMed (publishedVersion)
  • PubMed Central (publishedVersion)
  • UNM’s Digital Repository (University of New Mexico) (submittedVersion)
Funders
National Institute on Drug Abuse (R01 DA021672, NSF1628471)
Topics
  • Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
  • Social Sciences › Health › Indigenous Health, Education, and Rights
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Opioid Use Disorder Treatment
Keywords
substance use disorders, American Indians and Alaska Natives, motivational interviewing, community reinforcement approach, Micra, usual care, abstinence, spirituality, self-efficacy, addiction treatment
MeSH terms
Alaska Natives, Feasibility Studies, Female, Humans, Male, United States, Substance-Related Disorders, American Indian or Alaska Native, Motivational Interviewing

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