Shame among Sexual Violence Survivors in Opioid Use Disorder Treatment: Event-level and longitudinal effects on Cravings, Substance Use, and Treatment Engagement

项目摘要 阿片类药物使用障碍（OUD）是一个日益增长的公共卫生问题，具有高患病率，发病率， mortality.性暴力（SV）和OUD的发生率很高。在OUD患者中，SV与 具有严重的临床过程（例如，增加的物质使用）和较差的OUD治疗结果（例如， 提前终止）。尽管SV在OUD治疗中的作用具有明确的临床相关性，但没有研究表明 导致结果恶化的详细机制。其中一个机制就是羞耻。耻辱 在OUD治疗的个体以及有SV病史的个体中明显。落实 作为耻辱感的情感核心，羞耻感在本质上是周期性的， 环境线索然而，没有研究评估了羞耻感在短期（渴望， 物质使用，药物依从性，改变物质使用的动机，改变的自我效能 药物使用）和长期临床结局（错过预约次数，治疗脱落）， 在影响治疗的其他因素（社会支持，心理， 痛苦、既往治疗史、应激事件）。K99/R 00的K99阶段的具体目标是：1） 在OUD患者中反复制定和完善生态瞬时评估（EMA）协议 有SV病史的治疗，这将有助于EMA的形成工作和培训。为了实现这一目标， 将根据先前的文献制定初步的EMA调查方案，然后进行为期30天的EMA试点（n=20- 24，分两个阶段），然后进行个人认知访谈，以告知最终的EMA措施 R 00阶段的协议。R 00阶段的具体目标是确定 羞耻感的瞬间波动和短期临床结果以及羞耻感的总体水平， 122名有终生病史的OUD治疗者的长期临床结果 SV，使用EMA。参与者将完成基线测量、30天EMA和随访评估 在3个月和6个月时。PI Bhuptani博士将与经验丰富的导师团队合作， 知识/专长领域（Ana阿布兰特斯、Jennifer梅里尔和林赛Orchowski博士），以发展专长 在与PI的职业目标相匹配的三个培训领域，包括（1）EMA方法， 分析，（2）OUD特定结果的测量，以及（3）专业发展技能。成功 完成本建议书中详述的研究和培训将使PI成为独立的 临床科学家，并制定一项研究计划，重点是确定影响临床和 治疗结果与共病物质使用和创伤条件的个人。识别事件- 羞耻感和临床结果之间的水平关联将是及时发展的第一步 采取干预措施，以改善这些结果。

Project Summary Opioid use disorder (OUD) is a growing public health concern and has a high prevalence, morbidity, and mortality. Sexual violence (SV) and OUD co-occur at high rates. Among individuals with OUD, SV is associated with a severe clinical course (e.g., increased substance use) and poorer OUD treatment outcomes (e.g., premature discontinuation). Despite clear clinical relevance of the role of SV in OUD treatment, no studies have explicated mechanisms that contribute to the worsening of outcomes. One such mechanism is shame. Shame is pronounced among individuals in OUD treatment as well as those who have a history of SV. Operationalized as the emotional core of stigma, shame is cyclical in nature and fluctuates daily in response to internal and environmental cues. However, no study has evaluated the role of shame in relation to short-term (cravings, substance use, medication adherence, motivation for changing substance use, self-efficacy for changing substance use) and long-term clinical outcomes (number of appointments missed, treatment dropout) for individuals in OUD treatment, in the context of other factors that impact treatment (social support, psychological distress, prior treatment history, stressful events). The specific aims of the K99 phase of this K99/R00 are to 1) iteratively develop and refine an ecological momentary assessment (EMA) protocol among individuals with OUD treatment with a history of SV, which will facilitate formative work and training in EMA. To accomplish this aim, an initial EMA survey protocol will be developed based on prior literature, followed by a 30-day EMA pilot (n=20- 24, in two phases), which will be then followed by individual cognitive interviews to inform the final EMA measures and protocol in the R00 phase. The specific aim of the R00 phase is to identify the associations between momentary fluctuations in shame and short-term clinical outcomes as well as aggregate levels of shame and long-term clinical outcomes among a sample of 122 individuals engaged in OUD treatment with a lifetime history of SV, using EMA. Participants will complete baseline measures, 30 days of EMA, and follow-up assessments at 3- and 6 months. The PI, Dr. Bhuptani, will work with an experienced team of mentors with complementary areas of knowledge/expertise (Drs. Ana Abrantes, Jennifer Merrill, and Lindsay Orchowski) to develop expertise in three areas of training that are well-matched to the career goals of the PI, including (1) EMA methods and analysis, (2) measurement of OUD-specific outcomes, and (3) professional development skills. Successful completion of the research and training detailed in this proposal will prepare the PI to become an independent clinical scientist and develop a program of research focused on identifying mechanisms that impact clinical and treatment outcomes among individuals with comorbid substance use and trauma conditions. Identifying event- level associations between shame and clinical outcomes will be the first step in the development of just-in-time interventions to improve such outcomes.