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Culturally Tailored Digital Therapeutic for Substance Use Disorders with Urban Indigenous People in the United States: A Randomized Controlled Study


Campbell A, Rieckmann T, Pavlicova M, et al.


Investigate preliminary efficacy of a culturally tailored digital therapeutic education system (TES) for American Indian and Alaska Native adults (AI/AN; TES-Native). TES-Native aims to increase abstinence in adults receiving outpatient substance use disorder (SUD) treatment (primary outcome). Secondary outcomes included retention, abstinence in the last 4-weeks of treatment, post-treatment abstinence, coping skills, social connection, and HIV risk.


Fifty-three AI/AN adults were recruited for this randomized control parallel design study. They received 12 weeks of treatment as usual (TAU; n = 26) or TAU plus TES-Native (n = 27). TES-Native is comprised of 26 self-directed skills-based modules grounded in the community reinforcement approach and tailored to enhance AI/AN culture: culturally appropriate examples and metaphors, AI/AN relevant language (pace, tone, word choice), and the use of community members in skills building video vignettes.

• No significant difference was found between TAU and TAU+TES-Native on the primary abstinence outcome; all participants showed the benefit of treatment.
• Individuals randomized to the TES-Native arm demonstrated greater days of abstinence in the three months following treatment. This may indicate heightened recall and use of the relapse prevention skills taught in TES-Native.
• Individuals randomized to the TES-Native arm also showed significantly greater change in social connection at the end of treatment; TES-Native may support relevant prosocial behaviors or enhanced community involvement.
• This digital therapeutic showed some promise among an adult urban Indigenous population participating in outpatient SUD treatment.
• Indigenous people experience disparities in SUD and overdose mortality compared to other racial/ethnic groups in the U.S. primarily due to social drivers of health resulting from historical trauma and the impact of colonization.
• Cultural practices and community connection support health outcomes among AI/AN people. TES-Native tailors western developed TES to be more congruent with AI/AN worldviews, historical experience, and cultural touchstones like collectivism.
• TES-Native may facilitate abstinence longer-term and promote social connection.
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Campbell ANC, et al. (2023). Culturally tailored digital therapeutic for substance use disorders with urban Indigenous people in the United States: A randomized controlled study. J Subst Use Addict Treat, 155:209159. doi:10.1016/j.josat.2023.209159


This work was supported by the National Institutes of Health, National Institute on Drug Abuse [R34 DA040831; PIs Campbell, Rieckmann]