Methamphetamine use is a scourge of rural communities - and the problem is getting worse. The combination of declining local economies, secluded sites for concealing illegal activities and use of chemicals common in farming result in disproportionately more meth labs located in rural than in urban communities. Not only is meth use greater in rural communities, but barriers to effective treatment and prevention are greater as well. Two barriers exist to reaching youth in rural communities: geographic barriers impede frequent contact between youth and service providers and it is difficult to maintain the interest of youth. Drawing on research from two distinct areas: substance abuse intervention and educational video games, Crossroads: A Game of Choices is an interactive video game that teaches knowledge and skills to improve decision-making by Native American youth affected by methamphetamine use in rural communities, intervening in the intergenerational cycle of addiction. Phase I is focused on prototype development, usability testing, creation of customized assessments and educational resources. Crossroads combines cutting-edge game design and graphics with effective therapeutic methods -- Community Reinforcement and Family Therapy and Motivational Interviewing (MI) - that are adaptable to computer-assisted learning. The result is a product that will engage youth at risk of meth use/abuse and teach/model healthy decision-making. Data collection will be within the context of the game, integrated into the storyline. Positive choices will be rewarded with gameplay, while negative choices will route users to software that allows users to participate in MI remotely, in a media format that accommodates for any below grade-level communication skills. Data is collected continuously throughout the game and used for game improvement, e.g., to raise the rate of module completion. Counselors receive MI feedback from users to incorporate in support and services offered to game users. Users access Crossroads on the devices they are most comfortable using, remotely and at their convenience. In Phase I, we will focus on game and educational design with the emphasis on product creation and refinement based on usability testing feedback. We will conduct two rounds of testing with tribal youth ages 11-18 on the Fort Berthold reservation in North Dakota; an initial 15-person on-site usability testing, followed by a 10-person off-site usability study. The project offers significant short-term benefit applied to methamphetamine abuse, and vastly greater long-term benefit as a successful Phase I project can be extended to other types of substance abuse and other risk behaviors under a Phase II.
