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Published Online: 17 July 2017

National Overview of Medication-Assisted Treatment for American Indians and Alaska Natives With Substance Use Disorders

Traci Rieckmann, Ph.D. [email protected], Laurie Moore, M.P.H., Calvin Croy, Ph.D., Gregory A. Aarons, Ph.D., and Douglas K. Novins, M.D.Authors Info & Affiliations
Publication: Psychiatric Services
Volume 68, Number 11
https://doi.org/10.1176/appi.ps.201600397
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Abstract

Objective:

American Indians and Alaska Natives (AI/ANs) experience higher rates of substance use disorders and less access to high-quality care compared with other racial-ethnic groups. The objective of this study was to better understand the use of medication-assisted treatment (MAT) of substance use disorders for AI/ANs and barriers to broader implementation.

Methods:

Representatives of 192 substance abuse treatment programs completed a survey about their use of MAT. On the basis of implementation science frameworks, the authors examined survey items about program structure, workforce, and other services provided in order to develop logistic regression models that explored significant associations between workforce and program characteristics and use of MAT.

Results:

Of the 192 programs, 28% reported implementing MAT. Multivariate logistic regression models indicated that programs with staff that perceived MAT to be consistent with their program’s treatment approach and philosophy and programs reporting that MAT fit with staff expertise and training were more likely to implement MAT. Programs with nurses on staff and those reporting a perceived gap in the use of evidence-based treatments (EBTs) were less likely to implement MAT.

Conclusions:

Low rates of MAT implementation suggest racial disparities in access to MAT among AI/ANs, a population with historically high rates of substance use disorders. Study findings also highlight the important role of treatment culture and organizational fit in the implementation of MAT in treatment programs serving AI/AN populations. Results also speak to the importance of adapting existing EBTs in a culturally competent way to best serve the needs of the AI/AN community.

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Information & Authors

Information

Published In

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Cover: Still Life of Fruit, anonymous, circa 1865. Gift of Edgar William and Bernice Chrysler Garbisch, National Gallery of Art, Washington, D.C.

Psychiatric Services
Volume 68 • Number 11 • November 01, 2017
Pages: 1136 - 1143
PubMed: 28712352

History

Received: 29 August 2016
Revision received: 1 February 2017
Revision received: 10 April 2017
Accepted: 21 April 2017
Published online: 17 July 2017
Published in print: November 01, 2017

Keywords

  1. Alcohol &amp
  2. drug abuse, American Indians/Native Americans, Drug treatment/psychopharmacology, Drug abuse

Authors

Details

Traci Rieckmann, Ph.D. [email protected]
Dr. Rieckmann is with the School of Public Health, Oregon Health and Science University–Portland State University, Portland. Ms. Moore, Dr. Croy, and Dr. Novins are with the Centers for American Indian and Alaska Native Health, University of Colorado, Aurora. Dr. Novins is also with the Department of Psychiatry, University of Colorado, Aurora. Dr. Aarons is with the Department of Psychiatry and the Child and Adolescent Services Research Center, University of California, San Diego.
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Laurie Moore, M.P.H.
Dr. Rieckmann is with the School of Public Health, Oregon Health and Science University–Portland State University, Portland. Ms. Moore, Dr. Croy, and Dr. Novins are with the Centers for American Indian and Alaska Native Health, University of Colorado, Aurora. Dr. Novins is also with the Department of Psychiatry, University of Colorado, Aurora. Dr. Aarons is with the Department of Psychiatry and the Child and Adolescent Services Research Center, University of California, San Diego.
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Calvin Croy, Ph.D.
Dr. Rieckmann is with the School of Public Health, Oregon Health and Science University–Portland State University, Portland. Ms. Moore, Dr. Croy, and Dr. Novins are with the Centers for American Indian and Alaska Native Health, University of Colorado, Aurora. Dr. Novins is also with the Department of Psychiatry, University of Colorado, Aurora. Dr. Aarons is with the Department of Psychiatry and the Child and Adolescent Services Research Center, University of California, San Diego.
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Gregory A. Aarons, Ph.D.
Dr. Rieckmann is with the School of Public Health, Oregon Health and Science University–Portland State University, Portland. Ms. Moore, Dr. Croy, and Dr. Novins are with the Centers for American Indian and Alaska Native Health, University of Colorado, Aurora. Dr. Novins is also with the Department of Psychiatry, University of Colorado, Aurora. Dr. Aarons is with the Department of Psychiatry and the Child and Adolescent Services Research Center, University of California, San Diego.
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Douglas K. Novins, M.D.
Dr. Rieckmann is with the School of Public Health, Oregon Health and Science University–Portland State University, Portland. Ms. Moore, Dr. Croy, and Dr. Novins are with the Centers for American Indian and Alaska Native Health, University of Colorado, Aurora. Dr. Novins is also with the Department of Psychiatry, University of Colorado, Aurora. Dr. Aarons is with the Department of Psychiatry and the Child and Adolescent Services Research Center, University of California, San Diego.
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Notes

Send correspondence to Dr. Rieckmann (e-mail: [email protected]).
Some preliminary findings were presented at the Addiction Health Services Research Conference, New York, October 17–19, 2012.

Competing Interests

The authors report no financial relationships with commercial interests.

Funding Information

U.S. National Library of Medicine10.13039/100000092: 1RC4LM010852
National Institute on Drug Abuse10.13039/100000026: K23 DA021225
Health Resources and Services Administration10.13039/100000102: UB2HA20235
This research was supported by grants RO1DA022239 and K23 DA021225 from the National Institute on Drug Abuse. The OCHIN infrastructure was supported by grant 1RC4LM010852 from the National Library of Medicine, National Institutes of Health; and by grant UB2HA20235 from the Health Resources and Services Administration.

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