In collaboration with three Native communities in the western United States, University of Washington researchers are embarking on one of the largest alcohol addiction-treatment trials ever conducted among American Indian and Alaska Native adults.

By using motivational incentives and a novel urine test, they hope to provide a culturally acceptable, low-cost, low-resource option for treating alcohol addiction in these communities. The study is called the HONOR Project. The acronym stands for Helping Our Natives' Ongoing Recovery.

"Native communities experience high rates of substance abuse as a result of colonization and historical trauma," said Abigail Echo-Hawk, a Pawnee tribal member and associate director of the UW's Partnerships for Native Health. "Yet due to lack of funding at the federal, state and tribal levels, Native people often do not have access to treatments that may be available to other populations. The HONOR Project is an exciting step forward in addressing this disparity."
 
UW researchers worked with the American Indian communities to design an intervention that integrates indigenous knowledge and existing resources, while also addressing expressed community needs. The result is an intervention with motivational incentives and rewards such as vouchers and gift cards for alcohol abstinence. In this case, 400 American Indians and Alaska Natives who are alcohol-dependent will receive prizes tailored to their community when they demonstrate they haven't used alcohol.

"Many people suffering from alcohol addiction have few positives in their lives," said Michael McDonell, UW associate professor of psychiatry and behavioral sciences. "Incentives give people the extra motivation they need to stay sober."

Data suggests such incentives are effective in treating patients with drug addiction, but only a few studies of any population have focused on alcohol addiction. Until recently, there hasn't been an effective way to verify that a person abstained from alcohol.

That changed with the emergence of the EtG urine sample test, which detects ethyl glucuronide, a metabolite of alcohol use.

"The biomarker test allows us for the first time to implement and evaluate a motivational incentive intervention for alcohol addiction," said McDonell. He and Dedra Buchwald, UW professor of  medicine and of epidemiology, are co-principal investigators of the study.

"Our understanding of what treatments might work in American Indian and Alaska Native communities is inadequate," said Buchwald, who directs UW's Partnership for Native Health. "Motivational incentives and the EtG test are low-cost and easy. We have high hopes that the HONOR Project will provide important information that can be used to improve treatment for alcohol use disorders."
 
Recruitment begins this month for the study, which is expected to be completed in 2018.  The National Institute on Alcohol Abuse and Alcoholism and the Office of Behavioral and Social Sciences Research, both part of the National Institutes of Health, are funding the project.