Contingency management with stepped care for unhealthy alcohol use among individuals with HIV: Protocol for a randomized controlled trial.

BACKGROUND: Although unhealthy alcohol use is associated with increased morbidity and mortality among people with HIV (PWH), many are ambivalent about engaging in treatment and experience variable responses to treatment. We describe the rationale, aims, and study design for the Financial Incentives, Randomization, with Stepped Treatment (FIRST) Trial, a multi-site randomized controlled efficacy trial. METHODS: PWH in care recruited from clinics across the United States who reported unhealthy alcohol use, had a phosphatidylethanol (PEth) >20 ng/mL, and were not engaged in formal alcohol treatment were randomized to integrated contingency management with stepped care versus treatment as usual. The intervention involved two steps; Step 1: Contingency management (n = 5 sessions) with potential rewards based on 1) short-term abstinence; 2) longer-term abstinence; and 3) completion of healthy activities to promote progress in addressing alcohol consumption or conditions potentially impacted by alcohol; Step 2: Addiction physician management (n = 6 sessions) plus motivational enhancement therapy (n = 4 sessions). Participants' treatment was stepped up at week 12 if they lacked evidence of longer-term abstinence. Primary outcome was abstinence at week 24. Secondary outcomes included alcohol consumption (assessed by TLFB and PEth) and the Veterans Aging Cohort Study (VACS) Index 2.0 scores; exploratory outcomes included progress in addressing medical conditions potentially impacted by alcohol. Protocol adaptations due to the COVID-19 pandemic are described. CONCLUSIONS: The FIRST Trial is anticipated to yield insights on the feasibility and preliminary efficacy of integrated contingency management with stepped care to address unhealthy alcohol use among PWH. CLINICALTRIALS: gov identifier: NCT03089320.

An exploratory study of healing circles as a strategy to facilitate resilience in an undocumented community

Within the United States, the COVID-19 pandemic highlighted critical inequalities affecting undocumented communities and resulting in particularly heightened stress for members of these communities. In addition to the stress associated with COVID-19, immigrants in the United States were more than ever subjected to a hostile antiimmigrant climate under Trump's administration. Given this compounded stress, the impact of the pandemic on mental health is likely to be disproportionately experienced by undocumented immigrants. In response, a group of psychologists partnered with a leading immigrant rights advocacy organization and formed a reciprocal collaboration to support undocumented communities. A major focus of the collaboration is to foster learning, supporting members of the immigrant community to contribute to their own well-being and others in the community. Accordingly, the collaborative developed and delivered a web-based mental health education session to the immigrant community and to practitioners serving this population. The session presented the use of healing circles as a strength-based approach to building resilience and also sought feedback regarding specific features of healing circles that can enhance their effectiveness in managing distress. Survey data and qualitative findings from this study show that those who participated in the web-based program perceived the session as validating and informative. Findings also underscored the need for creating safe spaces for community members to be vulnerable about their lived experiences while promoting ownership of their narratives. We discuss practical implications pertaining to the development and facilitation of social support groups for immigrants led by nonspecialist community members trained for this role. (PsycInfo Database Record (c) 2023 APA, all rights reserved) Impact Statement We describe a reciprocal collaboration between psychologists and an immigrant-led advocacy organization for the purposes of supporting undocumented immigrants in tailoring culturally congruent therapeutic approaches for fostering resilience as they face multiple stressors due to interlocking crises, such as the COVID-19 pandemic and antiimmigrant policies. The collaboration led to the development and delivery of a web-based session that provided immigrant community members and practitioners with recommendations for facilitating healing circles as a strength-based and culturally responsive approach to fostering peer-led social support during stressful times. Findings highlight the need for creating such safe spaces for community members to be vulnerable about their lived experiences and feel validated. (PsycInfo Database Record (c) 2023 APA, all rights reserved) Abstract (Spanish) En los Estados Unidos (EE.UU.), la pandemia de COVID-19 puso en evidencia desigualdades criticas que afectan a las comunidades indocumentadas y que provocan un estres particularmente elevado entre sus miembros. Ademas del estres asociado con la COVID-19, los inmigrantes en EE.UU. se vieron sometidos mas que nunca a un clima hostil antiinmigracion bajo la administracion Trump. Dado este mayor estres, es probable que los inmigrantes indocumentados hayan sufrido de manera desproporcionada el impacto de la pandemia en la salud mental. En respuesta, un grupo de psicologos se asocio con una organizacion importante de defensa de los derechos de los inmigrantes y acordaron una colaboracion reciproca para apoyar a las comunidades indocumentadas. Uno de los principales objetivos de la colaboracion es promover el aprendizaje, apoyando a los miembros de la comunidad inmigrante para que incidan en su propio bienestar y en el de los demas miembros de la comunidad. En consecuencia, gracias a esta colaboracion, se desarrollo una sesion educativa sobre salud mental basada en Internet, que se impartio a la comunidad inmigrante y a los profesionales que atienden a esta poblacion. En la sesion se presento el uso de los circulos de sanacion como un enfoque basado en las fortalezas para fomentar la resiliencia. Asimismo, se recabo retroalimentacion sobre las caracteristicas especificas de los circulos de sanacion que pueden ser mas eficaces en la gestion del estres. Los datos de la encuesta y los hallazgos cualitativos de este estudio muestran que quienes participaron en el programa basado en Internet percibieron la sesion como informativa y promotora de sentimientos de valor. Los resultados tambien subrayaron la necesidad de crear espacios seguros para que los miembros de la comunidad se muestren vulnerables acerca de sus experiencias, al tiempo que se promueve la apropiacion de sus narrativas. Analizamos las implicaciones practicas relativas al desarrollo y la facilitacion de grupos de apoyo social para inmigrantes dirigidos por miembros de la comunidad no especializados que han recibido una capacitacion para esta funcion. (PsycInfo Database Record (c) 2023 APA, all rights reserved)

A tale of two crises: The compounded effect of COVID-19 and anti-immigration policy in the United States.

The COVID-19 pandemic is highlighting some important sources of health disparities that assail our society's most vulnerable people, particularly undocumented immigrants and asylum seekers. The focus of this commentary is on uncovering those sources of health disparities and making a call for action. (PsycInfo Database Record (c) 2020 APA, all rights reserved).