Does cultural adaptation have a role in substance abuse treatment?

The changing ethnic composition of the nation and increasing requirements to use evidence-based treatments (EBTs) challenge mental health professionals to adapt treatments and interventions to be appropriate for their clients. This article applies the available information on cultural adaptation to substance abuse. The most common approaches for adapting substance use interventions include some combination of either community involvement in the adaptation, existing research and literature, and/or consultation from experts to adapt EBTs. As an example of the process used to develop a culturally-adapted intervention, research stemming from National Drug Abuse Treatment Clinical Trials Network protocol CTN-0018 (Reducing HIV/STD Risk Behaviors: A Research Study for Men in Drug Abuse Treatment) is described.

This project found that the Real Men Are Safe (REMAS) protocol was less effective for black male substance users than for whites, leading the research team to develop a culturally adapted version of the intervention. After addressing the sociocultural factors associated with HIV risk behaviors among ethnic minority males abusing substances, the resulting REMAS-CA intervention (Real Men Are Safe – Culturally Adapted) was found to be more effective than the original in reducing HIV risk behaviors in black and Hispanic men. The challenges facing the development of culturally adapted interventions include the need for additional research to determine which specific EBTs warrant adaptation, the responsibility of maintaining the balance between fidelity and adaptation, and the challenge of intragroup diversity.

Related protocols: CTN-0018