Critical Dialogue and Capacity-Building Projects Reduced Alcohol and Substance Use in a Randomized Clinical Trial...

Area of Science:

• Addiction research
• Public health interventions
• Health disparities

Background:

• Alcohol and/or substance use (ASU) rates are similar across racial groups, but consequences are more severe in Black and marginalized communities.
• Formerly incarcerated men with substance use disorders (SUD) face significant challenges, including higher rates of negative ASU consequences.
• Optimizing interventions for SUD is crucial to address health disparities in vulnerable populations.

Purpose of the Study:

• To optimize a multilevel intervention for reducing ASU among 602 formerly incarcerated men with SUD.
• To identify effective components of a multilevel intervention using a 2^4 full factorial design.
• To evaluate the impact of critical dialogue (CD), Quality of Life Wheel (QLW), capacity building projects (CBP), and facilitator type (peer vs. licensed) on ASU.

Main Methods:

• Randomized 602 formerly incarcerated men with SUD into 16 intervention conditions.
• Intervention components included CD, QLW, CBP, and delivery by trained peers or licensed facilitators.
• Outcome measured by the percentage of days with alcohol, cocaine, opioid, and/or cannabis use in the past 30 days.

Main Results:

• Initial intent-to-treat analysis did not meet selection criteria due to low attendance.
• Controlling for attendance, peer-delivered CD and CBP showed significant main and interaction effects on ASU over 5 months.
• Peer-delivered CD and CBP were selected as the optimized intervention, costing US$1,380 per 10 individuals, with no adverse effects.

Conclusions:

• Critical dialogue (CD) and capacity building projects (CBP) delivered by peers were identified as effective components for reducing ASU.
• Improving intervention attendance is a key area for future research.
• The optimized intervention will be tested against standard care in a future randomized-controlled-trial.