The Role of Nondrug Reward in Recovery from Opioid Use Disorder: Intrapersonal and Socio-spatial Contexts in Daily Life

项目总结 快感缺失，或从非药物奖励中失去快感，对多达一半的患有 阿片类药物使用障碍(OUD)，是不良结果的强烈预测因素。然而，快感缺乏症很复杂， 因为在临床环境中报告快感缺乏的患者也可能报告频繁、愉快的非药物 日常生活中的回报。OUD患者的非药物奖励可能受到动态的个人、社会和内在因素的驱动 环境(即社会空间)因素。至关重要的是，研究人员必须了解每个因素在 快感缺乏，以便建立有效的非药物奖励干预措施。拟议的研究将审查 富兰克林OUD门诊患者的非药物奖励异质性的实时和社会空间背景 俄亥俄州的县。该提案涉及NIDA研究的优先事项，即确定环境、行为、 和成瘾的社会后果，并处于有利地位，将调查结果转化为可操作的干预措施 对于OUD-申请者职业生涯的一个主要目标。在目标1中，我们将深入了解毒品和 通过横断面调查(n=200)进行非药物奖励，进行地理标记以确定典型的 非药物奖励体验和探索性开放式问题。在目标2中，我们将检查日常工作 社会空间中的非药物奖励经历(14天，每天两次评估；n=50来自研究1) 通过生态瞬时评估(EMAS)和被动收集的全球定位系统定位数据，对环境进行监测。我们会 还要测试非药物奖励的哪些方面可以预测OUD康复结果。在目标3中，我们将描述 奖励体验的异质性及其社会空间背景。为了实现这些目标，分析性的 办法将包括回归(目标1)、综合环境管理和社会空间数据的多层次建模(目标2)、 和多层次潜在类分析(目标3)。这些发现将澄清 非药物奖励体验和非药物奖励干预措施的发展 根据背景进行调整，以支持个人从OUD中恢复。申请者的杰出导师团队拥有 在密集纵向方法和异质性建模方面的专长(斯蒂芬妮·兰扎)，健康地理学 和地理空间方法(路易莎·霍姆斯)、乌德治疗(大卫·爱泼斯坦)以及物质使用和地理空间 俄亥俄州分析(Bridget Freisthler)；该团队将在申请者成为 独立调查员。指导小组将支持以下领域的培训：非药物的作用 成瘾奖励、健康的社会空间决定因素、地理空间分析和表征方法 异质性，与成瘾治疗中心合作，从不同的人群收集数据，以及 负责任的研究行为。拟议的工作将使申请者能够在以下方面产生新的知识 非药物奖励在OUD中的作用，并在他的职业生涯中推进OUD治疗的科学。

PROJECT SUMMARY Anhedonia, or loss of pleasure from nondrug rewards, is clinically significant for up to half of patients with an opioid use disorder (OUD) and is a strong predictor of poor outcome. Anhedonia is complex, however, because patients who report anhedonia in clinical settings may also report frequent, enjoyable nondrug rewards in daily life. Nondrug reward in people with OUD may be driven by dynamic personal, social, and built- environmental (i.e. socio-spatial) factors. It is critical that researchers understand the role of each factor in anhedonia, in order to build effective nondrug-reward interventions. The proposed studies will examine nondrug-reward heterogeneity in real time and socio-spatial context among OUD outpatients in Franklin County, Ohio. This proposal addresses the NIDA research priority of identifying the environmental, behavioral, and social consequences of addiction and is well positioned to translate findings into actionable interventions for OUD—a primary goal of the applicant’s career. In Aim 1 we will gain insight into experiences of drug and nondrug reward through a cross-sectional survey (n=200), geotagging to identify local contexts of typical nondrug reward experiences, and exploratory open-ended questions. In Aim 2 we will examine day-to-day experiences of nondrug reward (14 days, 2 assessments per day; n=50 recruited from Study 1) in socio-spatial contexts via ecological momentary assessments (EMAs) and passively collected GPS location data. We will also test which aspects of nondrug reward predict OUD recovery outcomes. In Aim 3 we will characterize heterogeneity in experiences of reward and their socio-spatial contexts. To achieve these aims, the analytical approach will include regression (Aim 1), multilevel modeling integrating EMA and socio-spatial data (Aim 2), and multilevel latent class analysis (Aim 3). Findings will clarify heterogeneity and environmental contexts of nondrug reward experiences and inform development of nondrug reward interventions that are personally and contextually adapted to support individuals’ recovery from OUD. The applicant’s exceptional mentor team has expertise in intensive longitudinal methods and modeling heterogeneity (Stephanie Lanza), health geography and geospatial methods (Louisa Holmes), OUD treatment (David Epstein), and substance use and geospatial analysis in Ohio (Bridget Freisthler); this team will provide outstanding support as the applicant becomes an independent investigator. The mentorship team will support training in the following areas: the role of nondrug reward in addiction, socio-spatial determinants of health, methods for geospatial analysis and characterizing heterogeneity, partnering with addiction treatment centers to collect data from diverse populations, and the responsible conduct of research. The proposed work will position the applicant to generate new knowledge on the role of nondrug reward in OUD and to advance the science of OUD treatment throughout his career.