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

项目摘要 快感缺失，或从非药物奖励中失去快乐，在临床上对多达一半的患者具有重要意义。 阿片类药物使用障碍（OUD）是不良结局的强预测因子。然而，快感缺失是复杂的， 因为在临床环境中报告快感缺失的患者也可能报告频繁的、愉快的非药物性的， 日常生活中的奖励。OUD患者的非药物奖励可能是由动态的个人，社会和内置驱动的。 环境（即社会空间）因素。关键是研究人员要了解每个因素在 快感缺乏，以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门诊患者在真实的时间和社会空间背景下的非药物报酬异质性 俄亥俄州县。该提案提出了NIDA的研究优先事项，即确定环境，行为， 以及成瘾的社会后果，并有能力将研究结果转化为可行的干预措施。 对于OUD-申请人职业生涯的主要目标。在目标1中，我们将深入了解药物和 非药物奖励通过横断面调查（n=200），地理标记，以确定当地的情况下， 非药物奖励经验和探索性开放式问题。在目标2中，我们将检查日常 非药物奖励的经验（14天，每天2次评估; n=50，从研究1招募），在社会空间 通过生态瞬时评估（EMAs）和被动收集的GPS定位数据，我们将 还测试了非药物奖励的哪些方面可以预测OUD的恢复结果。在目标3中， 奖励经验的异质性及其社会空间背景。为了实现这些目标，分析 方法将包括回归（目标1），多层次建模集成EMA和社会空间数据（目标2）， 和多层次潜在类别分析（Aim 3）。调查结果将澄清异质性和环境背景， 非药物奖励经验，并告知非药物奖励干预措施的发展， 适应环境，以支持个人从OUD中恢复。申请人的优秀导师团队 在密集的纵向方法和建模异质性的专业知识（斯蒂芬妮兰扎），卫生地理学 和地理空间方法（路易莎霍姆斯），OUD治疗（大卫爱泼斯坦），以及物质使用和地理空间方法 分析在俄亥俄州（布里奇特Freisthler）;这个团队将提供出色的支持，因为申请人成为 独立调查员指导小组将支持以下领域的培训： 成瘾的奖励，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，收集来自不同人群的数据， 负责任地进行研究。拟议的工作将定位申请人产生新的知识， 非药物奖励在OUD中的作用，并在整个职业生涯中推进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.