RESEARCH REPORT © 2004 Society for the Study of Addiction Addiction, 99 (Suppl. 2), 140–150. Blackwell Science, Ltd Oxford, UK ADDAddiction 0965-2140© 2004 Society for the Study of Addiction 99Original Article Empirical examples from the ATTAIN ProjectAndrés G. Gil et al. Correspondence to: Andrés G. GilFlorida International UniversityCollege of Health and Urban AffairsSchool of Social WorkFlorida International UniversityCommunity-Based Intervention GroupUniversity ParkMARC 31011200 SW 8th StreetMiamiFL 33199USA E-mail: [email protected] RESEARCH REPORT Culturally sensitive substance abuse intervention for Hispanic and African American adolescents: empirical examples from the Alcohol Treatment Targeting Adolescents in Need (ATTAIN) Project Andrés G. Gil, Eric F. Wagner & Jonathan G. Tubman The Community-Based Intervention Research Group, Florida International University, College of Health and Urban Affairs, School of Social Work, Miami, FL, USA ABSTRACT Aims This study presents preliminary analyses examining the effects of analcohol and other drug use (AOD) intervention with minority juvenile offend-ers. Furthermore, the study investigates the impact of cultural factors on base-line AOD use among Hispanic and African American youth, as well as ontreatment outcome. Design, setting and participants Participants were 213 juvenile offendersreferred for treatment (mean age = 15.7 years), 97 of whom have completedtreatment to date. The intervention was carried out in clinics placed within theneighborhoods in which the participants resided. Intervention Alcohol Treatment Targeting Adolescents in Need (ATTAIN) is acontrolled clinical trial evaluating the effectiveness of a brief motivational,cognitive behavioral intervention, guided self-change (GSC). Participants areassigned randomly to the individual format of guided self-change (I-GSC), thefamily involved format of guided self-Change (F-GSC), choice of one of these two,or a waiting list control condition. Only participants involved in active interven-tion are included in the present report. Measurements Data were collected via structured face-to-face interviews.Alcohol and marijuana use measures were collected using the Time-lineFollow-back interview (TLFB). Findings There were significant reductions in alcohol and marijuana use forall ethnic groups from baseline to post-intervention. Cultural factors (discrim-ination, acculturation, ethnic pride and cultural mistrust) were associated withpre-intervention levels of alcohol and marijuana use. Among Hispanics, pre-intervention level of substance use were higher among foreign-born than US-born youth. Analyses conducted with the US-born Hispanic group showed thatethnic orientation and ethnic pride were associated positively with greaterreductions in alcohol use. Conclusions The intervention provided through ATTAIN appears to be effec-tive with a multi-ethnic population of juvenile delinquents. Cultural factors,such as ethnic orientation and ethnic mistrust, appear to constitute amenabil-ity to treatment factors, with US-born Hispanic youth lower in acculturationresponding better to the intervention. KEYWORDS Acculturation, African Americanm AOD use, discrimina- tion, Hispanic, juvenile delinquent.Empirical examples from the ATTAIN Project 141 © 2004 Society for the Study of Addiction Addiction, 99 (Suppl. 2), 140–150. INTRODUCTION Why is cultural sensitivity important? Multiple intervention approaches have been developedduring the past three decades to address adolescent alco-hol and other drug (AOD) use and abuse. Unfortunately,little is known about which of these approaches is mosteffective for which individuals. Currently, several investi-gators are conducting controlled clinical trials of variousadolescent substance abuse interventions (Wagner et al .1999; Wagner & Waldron 2001). The limited researchavailable indicates that while improvement varies acrossdomains of functioning (e.g. school, emotional distress,family relations), no intervention is clearly superior toany other (Catalano et al . 1990; Brown et al . 1996; Wag-ner et al . 1999; Williams & Chang 2000). Even less isknown about variations in intervention effectivenessacross different ethnic or cultural groups. While it haslong been recognized that social and cultural factors arelikely to impact multiple aspects of the alcohol abusetreatment process (Collins 1993), little empiricalresearch has examined the effectiveness of substanceabuse treatment for ethnic minorities (Gil & Vega 2001;Gil et al . 2001).While it appears that cultural sensitivity (or congru-ency) may enhance the degree to which a specific inter-vention may address AOD use problems among clientsfrom specific ethnic/cultural groups (Perez-Arce et al .1993; Longshore et al . 1999; Longshore & Grills 2000),how ethnicity/culture may moderate treatment processand outcome and how interventions may be modified toimprove cultural congruency remain highly under-researched topics. This is especially pertinent to studiesthat have examined the effectiveness of substance abuseinterventions with teenagers. Clearly, adolescents fromdifferent ethnic groups differ in risks and rates of sub-stance use/abuse (Vega & Gil 1998; Ellickson & Morton1999; Moon et al . 1999; Resnicow et al . 1999; Gil et al .2000; Gil & Vega 2001; Johnston et al . 2001); they alsomay differ in responsiveness to various interventions.Individual difference variables likely to affect treat-ment response have been labeled ‘amenability to treat-ment’ or ‘matching’ factors (Kazdin 1995; Project MatchResearch Group 1997). Factors likely to influenceamenability to treatment among minority adolescentsinclude perceived discrimination, cultural mistrust andacculturation. Among African Americans, studies havesuggested that perceived discrimination may significantlyinfluence psychological adaptation (Keefe & Padilla1987; Aries & Moorehead 1989; Semons 1991; Cross &Fhagen-Smith 1996). Cultural mistrust has been identi-fied as providing a psychological defense mechanismfor African Americans against perceived discrimination(Thompson et al . 1990; Grier & Cobbs 1992). While cul-tural mistrust can be protective, it may become maladap-tive for some adolescents who become motivated towithdraw from activities that are essential to access theopportunities and reward structures of the dominantsociety (Biafora et al . 1993; Taylor et al . 1997).Various researchers have