A scoping review of cultural adaptations of substance use disorder treatments across Latinx communities: Guidance for future research and practice

Abstract

Introduction: Much of the substance use disorder (SUD) treatment efficacy and effectiveness research is lacking consensus on which scientifically rigorous approach to employ for culturally adapting evidence-based treatments (EBTs) and evidence-based preventions (EBPs) for SUDs among Latinx communities. The aim of this paper is to provide a scoping review of the literature on cultural adaptations of SUD treatment for Latinx communities.

Methods: We examined the justifications for cultural adaptations, processes of adaptations, cultural adaptations described, and efficacy and effectiveness of culturally adapted SUD interventions. The study followed Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA). Inclusion criteria consisted of whether the intervention had been culturally adapted based upon an existing EBT or EBP for SUD. Through the search of four databases, expert knowledge and reviewing the reference list of applicable articles, 30 articles met inclusion criteria, which included 14 treatment or prevention outcome articles, one single group pre-post study article, and 15 methods papers on cultural adaptations. Justifications for cultural adaptations centered on SUD health inequities among Latinx populations.

Results: Four research groups employed adaptation models to culturally tailor evidence-based interventions and most often used elements of community-based participatory research (CBPR). Using Bernal, Bellido, & Bonilla's (1995) Ecological Validity Framework of eight dimensions, the most common cultural adaptations centered on language, context, content, and persons. Efficacy trials with Latinx populations are nascent though growing and reveal: (1) significant time effects for EBTs and most EBPs, (2) superior SUD outcomes for culturally adapted EBTs compared to standard EBTs or other comparison conditions by three research groups, (3) significant prevention intervention effects by three research groups, and (4) significant cultural or social moderators by two groups suggesting Latinx with higher cultural identity, parental familism, or baseline discrimination improve significantly more in the culturally adapted EBTs.

Conclusion: These findings suggest that the science of culturally adapting EBTs is improving in rigor with the use of models to guide the work and the conduct of clinical trials. Measurement of cultural and social variables allows for tests of moderation to understand for whom cultural adaptations are most effective. Future hybrid efficacy/effectiveness trials and implementation research should continue moving the science of cultural adaptation forward.

Keywords: Cultural adaptation; Evidence-based interventions; Latinx; Review; Substance use disorder.