Understanding How Peers Can Shift Stigma to Retain Low-Income, Minority Individuals in Opioid Treatment

了解同龄人如何改变耻辱以保留低收入少数族裔接受阿片类药物治疗

• 批准号: 10170518
• 负责人: Jessica F Magidson
• 金额: $ 24.38万
• 依托单位: UNIV OF MARYLAND, COLLEGE PARK
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-09-28 至 2022-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10170518
• 关键词: Abstinence; Address; Adherence; Adoption; Affect; Award; Baltimore; Behavior Therapy; Behavioral; COVID-19 pandemic; Caring; Cities; Client; Clinical; Communicable Diseases; Communities; Data; Discrimination; Epidemic; Ethnic Origin; Evidence based intervention; Face; Fatality rate; Focus Groups; Future; Health; Health Personnel; Health Services Accessibility; Individual; Intervention; Interview; Low income; Mental Health; Methadone; Minority; Modeling; Motivation; Opioid; Outcome; Overdose; Parents; Patient Care; Patients; Pharmaceutical Preparations; Phase; Population; Procedures; Process; Provider; Psychological reinforcement; Psychosocial Factor; Quality of life; Race; Randomized; Recovery; Relapse; Research; Services; Severities; Stigmatization; Structure; Substance Use Disorder; Testing; Time; Toxicology; Training; Translating; Treatment outcome; Underserved Population; Urine; Work; barrier to care; base; comorbidity; coronavirus disease; depressive symptoms; effectiveness evaluation; effectiveness implementation study; effectiveness implementation trial; ethnic minority population; evidence base; experience; health disparity; housing instability; improved; innovation; methadone treatment; mortality; multidisciplinary; open label; opioid use disorder; patient engagement; peer; phase 2 study; prescription opioid; racial and ethnic; reduced substance use; social stigma; theories; treatment as usual; treatment comparison; underserved minority

PROJECT SUMMARY There is an urgent need to develop and evaluate innovative strategies to reduce substance use stigma and improve opioid use disorder (OUD) treatment outcomes. Particularly in the context of the devastating health disparities of COVID-19, we must also consider how other health- and race-related stigmas further contribute to poor retention in care among low-income, minority individuals with OUD. One of the most promising strategies to reduce multiple intersecting stigmas and improve engagement in care for low-income, minority individuals is through the use of peer recovery coaches (PRCs). PRCs, individuals who have gone through the recovery process themselves, have been shown to be more acceptable for engaging and retaining low-income, racial/ethnic minority patients compared to other health workers. A predominant theory is that a PRC’s shared lived experience and background may decrease stigma, which can then translate into improved patient care. However, surprisingly little research has formally evaluated the effects of PRCs on substance use stigma, nor how PRC interventions reducing stigma may result in improved treatment outcomes. Our parent award (R61AT010799) is evaluating a PRC-delivered behavioral intervention to improve retention in methadone treatment among low-income, racial/ethnic minority individuals in Baltimore City. The overall aim of the proposed supplement is to test whether and how a PRC model can reduce multiple intersecting stigmas, and whether changes in stigma translate into improvements in methadone treatment retention. First, using in-depth, individual interviews with key stakeholders (patients, PRCs, and staff; n=24), we will explore how PRCs can shift intersecting stigmas among racial/ethnic minority individuals with OUD to improve retention in care, and how to tailor a PRC intervention to reduce these intersecting stigmas and their impact on OUD outcomes. Next, we will evaluate the effects of a PRC intervention being evaluated in the parent award on internalized and anticipated substance use stigma over 3 months (primary), methadone stigma (secondary), and other intersecting stigmas (guided by Aim 1), among low-income, minority individuals initiating methadone or demonstrating challenges with retention (n=30). As a final exploratory aim, we will examine changes in substance use and methadone stigma as predictors of methadone retention over six months. This supplement is responsive to high priority areas of NOT-OD-20-101 in that: (1) we will analyze strategies to reduce internalized and anticipated substance use and methadone stigma to improve treatment access, effectiveness, and recovery for low-income, minority patients; and (2) we will utilize existing psychometrically validated tools and theories to assess stigma that leverages our team’s work with other health-related stigma (i.e., in HIV care globally). This is the first stage development of a multicomponent approach that could be expanded and implemented for large-scale projects (i.e., in the R33 phase) and potentially scaled nationally to reduce stigma and support low-income, minority patients with OUD.

项目总结

项目成果

A Pilot Study of Training Peer Recovery Specialists in Behavioral Activation in the United States: Preliminary Outcomes and Predictors of Competence.

• DOI: 10.3390/ijerph20053902
• 发表时间: 2023-02-22
• 期刊: INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH
• 作者: Anvari, Morgan S;Kleinman, Mary B;Dean, Dwayne;Rose, Alexandra L;Bradley, Valerie D;Hines, Abigail C;Abidogun, Tolulope M;Felton, Julia W;Magidson, Jessica F
• 通讯作者: Magidson, Jessica F

Peer recovery specialist-delivered, behavioral activation intervention to improve retention in methadone treatment: Results from an open-label, Type 1 hybrid effectiveness-implementation pilot trial.

同伴康复专家提供的行为激活干预措施可提高美沙酮治疗的保留率：来自开放标签、1 型混合有效性实施试点试验的结果。

• DOI: 10.1016/j.drugpo.2022.103813
• 发表时间: 2022-10
• 期刊: INTERNATIONAL JOURNAL OF DRUG POLICY
• 影响因子: 4.4
• 作者: Magidson, Jessica F.;Kleinman, Mary B.;Bradley, Valerie;Anvari, Morgan S.;Abidogun, Tolulope M.;Belcher, Annabelle M.;Greenblatt, Aaron D.;Dean, Dwayne;Hines, Abigail;Seitz-Brown, C. J.;Wagner, Michael;Bennett, Melanie;Felton, Julia W.
• 通讯作者: Felton, Julia W.

Patient experiences of COVID-19-induced changes to methadone treatment in a large community-based opioid treatment program in Baltimore.

• DOI: 10.1016/j.josat.2022.208946
• 发表时间: 2023-02
• 期刊: Journal of substance use and addiction treatment
• 作者: Abidogun TM;Cole TO;Massey E;Kleinman M;Greenblatt AD;Seitz-Brown CJ;Magidson JF;Belcher AM
• 通讯作者: Belcher AM

"In their mind, they always felt less than": The role of peers in shifting stigma as a barrier to opioid use disorder treatment retention.

• DOI: 10.1016/j.jsat.2022.108721
• 发表时间: 2022-07
• 期刊: JOURNAL OF SUBSTANCE ABUSE TREATMENT
• 影响因子: 3.9
• 作者: Anvari, Morgan S.;Kleinman, Mary B.;Massey, Ebonie C.;Bradley, Valerie D.;Felton, Julia W.;Belcher, Annabelle M.;Magidson, Jessica F.
• 通讯作者: Magidson, Jessica F.

"Sometimes you have to take the person and show them how": adapting behavioral activation for peer recovery specialist-delivery to improve methadone treatment retention.

• DOI: 10.1186/s13011-023-00524-3
• 发表时间: 2023-03-06
• 期刊: SUBSTANCE ABUSE TREATMENT PREVENTION AND POLICY
• 影响因子: 3.3
• 作者: Kleinman, Mary B.;Anvari, Morgan S.;Bradley, Valerie D.;Felton, Julia W.;Belcher, Annabelle M.;Seitz-Brown, C. J.;Greenblatt, Aaron D.;Dean, Dwayne;Bennett, Melanie;Magidson, Jessica F.
• 通讯作者: Magidson, Jessica F.