Skip to main content

Table 4 Study methods and outcomes

From: What can primary care services do to help First Nations people with unhealthy alcohol use? A systematic review: Australia, New Zealand, USA and Canada

Author (year)a

Participant characteristics

Classification of alcohol consumption

Study type

Length of follow-up

Client outcomesb: effectiveness or perceptions

Staff/service outcomesb

Treatment effectiveness

Savard [75]

(1968)

1) n = 30 alcoholic males

2a) n = 62 alcoholic males

2b) n = 39 non-abstinent, non-alcoholic males

ndpc

1) Follow up study of 30 disulfiram-treated alcoholics (sic)

2ab) Quantitative (cross-sectional)

1) 18 months

2ab) baseline interview only

1) decreased binge drinking and increased sober periods;

2ab) disulfiram is accepted excuse to decline alcohol and social pressures reduced (consumption not measured).

 

Ferguson [73]

(1970)

65 clan groups;

1) Intervention group n = 115

2) Comparison group n = 60

WHO ‘alcoholism’

Non-randomised controlled trial

6 months

Reduced incarceration; n = 50/115 sober 12–24 month following disulfiram therapy; sobriety not measured in controls.

 

O’Malley et al. [24] (2008)

12 tribal groups; n = 68 American Indian/Alaska Native (AI/AN) participants

DSM-IV; CIWA-Ar

RCT

68 weeks

Significant decrease in alcohol-related consequences for naltrexone monotherapy vs placebo (p < 0.026)

 

Venner et al. [69] (2016)

n = 8 members of one tribe

DSM-IV

Uncontrolled,

pre-post study

8 months

Increase in days abstinent; decrease Addiction Severity Scores

 

Implementation research

Kahn and Fua [72] (1992)

n = 240 participants

ndp

Uncontrolled pre-post study

N/Ad

n = 138/145 maintained sobriety post-graduation

 

Clifford and Shakeshaft [59] (2011)

n = 32 health staff;

n = 24 clients

ndp

Mixed methods,

pre-post study

N/A

 

Increased staff confidence to deliver BI; increase documentation and delivery;

high-risk drinkers resistant to alcohol referral

Clifford et al. [61] (2013)

n = 4 Indigenous health services

n = total of 50 clients

2001 NHMRC  guidelines

Uncontrolled,

pre-post study

N/A

 

Increased BIs

D’Abbs et al. [62] (2013)

n = 19 clients;

n = 30 quasi control;

n = 32 program staff/other stakeholders

ndp

Trial with quasi-controls

N/A

n = 15/19 reported decrease or stop drinking post program contact.

n = 21/30 quasi-control with similar result.

Implementation challenges incl: time constraints, staff turnover, GP hesitancy to prescribe naltrexone; strengths incl multidisciplinary care, flexibility

Lovett et al. [67] (2014)

n = 34 health service staff

ndp

Mixed methods:

quantitative (cross-sectional);

literature review

N/A

 

Proposed ‘yarning style’ BI; implementation challenges noted; staff least confident in BI when client not seeking help

Brett et al. [29] (2017)

Qual: n = 7 staff (1 GP, 1 GP trainee, 2 nurses, 3 Aboriginal DandA workers), n = 4 clients; n = 8 community stakeholders (incl. 4 Elders)

Quant: n = 8 clients

2009 NHMRC guidelines

Mixed methods (cross-sectional)

N/A

Qual: clients rate program as accessible, streamlined and holistic; challenges also noted.

Quant: n = 5/8 abstinent at 6-week follow up; n = 8/8 still engaged with supports. No major adverse events reported during detox

Qual: desired model principles incl. cultural safety, privacy (preventing community shame), keeping family together, peer support, accessible and streamlined. Feedback given on strengths and challenges of model as implemented

Treatment access and/or acceptability

Hall [74]

(1986)

n = 44 servicese

ndp

Quantitative (descriptive)

N/A

 

n = 22 services incl. sweat lodge or encouraged use at external sites; n = 8 provided access to community-based sweat lodge; medicine man used on and off-site

Brady et al. [70]

(1998)

n = 29 services

ndp

Quantitative (cross-sectional)

N/A

 

Aboriginal health services more likely to offer exclusive abstinence-based/Minnesota model of care; BI offered in half of services

Huriwai et al. [76]

(2000)

n = 6 servicesf;

total n = 105 clients

ndp

Quantitative (cross-sectional)

N/A

Clients rated strongly the importance of cultural elements in treatment

 

Robertson et al. [77] (2001)

n = 90 alcohol and drug-user treatment services; n = 217 staff

ndp

Quantitative (cross-sectional)

N/A

 

Strong support for cultural interventions with Māori clients

Brady et al. [71]

(2002)

n = 8 health care workers; n = 6 general practitioners; n = 25 clients

AUDIT (tnsg) and 2Q’s on consumption

Qualitative (not clearly specified)

18 months

 

5/6 doctors still using BI

DeVerteuil and Wilson [63]

(2010)

n = 7 servicese; total of n = 24 frontline staff; n = 1 staff member identified as Aboriginal

ndp

Qualitative (service case study)

N/A

 

n = 6 services refer for off-site cultural activities; n = 1 service has on-site cultural programs (incl. sweat lodge accessible by non-residents)

Panaretto et al. [68] (2010)

n = 4 health services; total of n = 46 staff

ndp

Mixed methods

(cross-sectional)

N/A

 

n = 3/4 services offered BI in past 12mths; challenges noted

Allan [54]

(2010)

n = 47 staff (DandA workers; primary health care workers)

ndp

Qualitative (action research)

N/A

 

Conflicting approaches to care between staff

Gone [64]

(2011)

n = 4 current/former administrators;

n = 4 counsellors;

n = 11 clientsh

ndp

Qualitative (ethnography)

N/A

 

Program philosophy was based on medicine wheel and spiritual elements of AA; positive client experiences documented

Allan and Campbell [55]

(2011)

n = 149 Aboriginal people attending community events; n = 16 sewing group participants; n = 5 DandA and Aboriginal health workers

ndp

Uncontrolled

pre-post study

N/A

Strong client engagement and client acceptability

 

Clifford et al. [60] (2012)

n = 5 ACCHSs; total of n = 37 health staff

ndp

Qualitative (descriptive)

N/A

 

Scepticism of BI effectiveness and outcomes

Conigrave et al. [30] (2012)

n = 47 participants

AUDIT score of 8 + 

Mixed methods

(cross-sectional)

N/A

Participants unaware of outpatient treatments e.g. ambulatory withdrawal and medicines

 

Legha and Novins [66] (2012)

n = 18 substance abuse treatment programs serving AI/AN communities (representing 3 tribes across 7 states);

n = 77 service providers (n = 22 clinical admin staff; n = 55 frontline staff)

ndp

Qualitative (grounded theory)

N/A

 

Cultural beliefs/values core to program; adapted western models used

Calabria et al. [57] (2013)

Clients of an ACCHS or DandA service n = 110 Indigenous; n = 6 non-Indigenous but have Indig. spouse or child

AUDIT (tns)

Quantitative (cross-sectional)

N/A

Strong client acceptability ratings

 

Lee et al. [65]

(2013)

n = 21 staff; n = 24 female Aboriginal clients

AUDIT-C score of 4 + 

Mixed methods

cross-sectional survey;

qualitative (descriptive)

N/A

Participant self-esteem and identity improved

 

Brett et al. [56]

(2014)

n = 4 Indigenous health services;

n = 1–3 staff at each service

2009 NHMRC guidelines

Qualitative (descriptive)

N/A

 

Feedback for/on implementation of outpatient detox

Calabria et al. [58] (2014)

n = 19 DandA treatment agency staff; n = 3 ACCHS health staff

ndp

Qualitative (not clearly specified)

N/A

 

Tailoring process is documented and feedback gathered for adapting the counselling and counsellor certification process and improving feasibility

Hirchak et al. [31] (2018)

n = 61 participants (incl. individuals with AUDs, treatment providers, and community members)

ndp

Qualitative (not clearly specified)

N/A

Rated culturally acceptable

 
  1. aStudies are ordered in tables according to their focus and year of publication
  2. bThese columns contain the outcome data, qualitative or quantitative with regard to the type of participants (clients or staff and services) included in the study
  3. cNo definition provided
  4. dNot applicable
  5. eAll services were residential. Study was included as sweat lodge available for outpatients on-site or in a community-based facility
  6. fStudy included data from residential and outpatient services. Only outpatient service data was included
  7. gThreshold score not specified
  8. hService offered residential and outpatient programs with facilities also open to broader community. All data included is relevant to outpatient settings