Examining the Relationship Between Age and Treatment Outcomes Among American Indian Adults Particpating in a Contingency Management Clinical Trial for Alcohol Use Disorders: A Mixed Methods Approach

Thesis (Ph.D.), Human Development, Washington State UniversityEXAMINING THE RELATIONSHP BETWEEN AGE AND TREATMENT OUTCOMES AMONG AMERICAN INDIAN ADULTS PARTICIPATING IN A CONTINGENCY MANAGEMENT CLINICAL TRIAL FOR ALCOHOL USE DISORDERS: A MIXED METHODS APPROACH Abstract by Katherine A. Hirchak, Ph.D. Washington State University July 2018 Chair: Sterling M. McPherson Although American Indian (AI) adults have some of the highest alcohol abstinence prevalence rates, alcohol-related health inequities negatively impact many American Indian communities. Research has demonstrated that younger and older adults differ significantly in personal development and in consumption of alcohol-related treatment services. The existing literature on treatment outcomes suggests that younger adults from diverse backgrounds do not respond as positively to available treatment as older adults. Contingency management (CM) is an effective intervention in which reinforcers are provided 2-3 times each week in exchange for objective evidence of alcohol abstinence, usually over a 12-week treatment period. This dissertation conducts qualitative research along with a secondary data analyses of the HONOR Project. The HONOR Project is a randomized controlled trial of a CM intervention that reinforces alcohol abstinence among American Indian adults residing on a rural reservation and in an urban location. Participants were randomized to receive usual care and either CM or a non-contingent control intervention for 12 weeks, with a 3-month follow-up period. This dissertation includes three studies. The first is a qualitative study examining younger adults interest in CM relative to other available treatments and culturally grounded approaches. The primary focus of the second and third study was to conduct secondary data analyses examining differences across age on psychosocial and cultural measures, treatment retention, and CM treatment efficacy across age. This research adds to the scarce literature focused on the interest, engagement and response to novel treatments among younger versus older American Indian adults. In addition, it assists in determining if younger and older American Indian adults differ in clinically meaningful ways on characteristics that may influence treatment outcomes. This research also addresses the need for feasible, low-cost, effective substance use disorder treatments that are engaging and culturally-acceptable for younger American Indian adults. This contributes significantly to their portability, a key aspect for being feasible in rural locations, and high likelihood of utilization in real-world treatment settings.Washington State University, Human DevelopmentBy student request, this dissertation cannot be exposed to search engines and is, therefore, only accessible to Washington State University users