"Guide them to have a future orientation": qualitative findings in developing a reinforcement-based intervention to...

The present study used qualitative research methods to assess interest in contingency management (CM; where incentives are provided after the return of an alcohol negative urine sample) enhanced with substance-free activities among emerging adults residing on a rural reservation. The research informs the future development and implementation of a clinical trial to address alcohol use among American Indian and Alaska Native (AI/AN) 18-29-year-olds.

Semi-structured qualitative interviews and two focus groups were conducted at a rural reservation outpatient treatment healing center. Participant- relatives (i.e., study participants) were 18-29 years old and currently using alcohol or in recovery; family members of emerging adults who were currently using alcohol or in recovery; or Elders and healthcare professionals (N = 32). Applying the Healing Center Medicine Wheel (i.e., a framework that focuses on holistic health related to the physical, mental, emotional, and spiritual as well as the structural factors impacting health), a codebook was developed using a qualitative descriptive approach and data analyzed under the guidance of a Community Advisory Board (CAB).

Five themes were identified: (1) Importance of Culture and Ceremony; (2) Substance-Free Activities with Higher Levels of Enjoyment-Physical, Mental, Emotional and Spiritual; (3) Substance Free Activities: Barriers and Engagement; (4) Family Impact on Alcohol Use and Recovery; and (5) Views on Health and Recovery.

Through community-driven strategies, frameworks and CAB guidance, a culturally responsive CM intervention was developed and is ongoing. This research provides a culturally informed process template for other Indigenous communities interested in addressing alcohol use among younger adults.