Disclosure Intervention to Reduce Social Isolation and Facilitate Recovery among People in Treatment for Opioid Use Disorder

项目摘要 需要循证干预战略来解决最有害，但解决最少的问题之一， 阿片类药物使用障碍（OUD）的康复障碍：社会隔离。OUD患者被困在一个致命的 阿片类药物使用导致社会隔离的周期，社会隔离导致阿片类药物持续使用的风险增加 使用和过量。披露，包括与他人分享有关OUD历史和/或治疗的信息 其他人，可以帮助打破这种循环，作为一个网关（重新）建立社会联系的个人 进入并从事OUD治疗。然而，披露是一个具有挑战性和高风险的社会过程。是 具有挑战性，因为它涉及一系列决策（包括是否、为什么、什么、如何以及何时披露） 并且需要高级技能（包括沟通、降级和应对技能）。这是高风险的 因为它有时会导致耻辱和进一步的社会孤立，破坏恢复。虽然有 许多以证据为基础的干预措施，以支持披露的人与其他污名化的慢性 疾病，目前没有人在OUD治疗。我们开发了披露恢复：A 决策援助和工具包，这是一个简短的，一个小时的披露干预，旨在帮助人们在治疗 为OUD制定关于披露的关键决策并培养披露技能。我们对披露恢复进行了试点测试 有50人在接受治疗被随机分配到披露恢复组的参与者认为， 干预是可以接受的和可行的，并报告了更好的决策质量比参与者在 比较器条件此外，披露恢复影响披露率，并导致更大的关系 亲密在这项II期疗效研究中，我们建议测试披露恢复是否会改善 12个月随访期内的治疗和恢复相关结局。我们将随机化n=480 治疗OUD至披露恢复的参与者与等待名单比较条件。我们将抽象 数据来自参与者的医疗记录，并每3个月进行一次调查，以检查疗效 作为干预的潜在调解人和主持人。我们的具体目标是：（1）评估是否 随机分配到披露恢复干预与等待名单比较条件的参与者 经验改善治疗和恢复相关的结果;（2）测试是否改变关键关系 结果和/或社会隔离介导的干预效果（或无效果）;（3）确定是否配置文件的 恢复特征、披露目标和关系特征中度干预效应（或非干预效应） 效果）。干预措施将在特拉华州进行测试，该州是美国第三高的过量死亡率州。 美国的如果我们发现披露恢复干预是有效的，我们将遵循建议 行为干预发展的NIH阶段模型，进展到现实世界的疗效和/或 执行测试。通过帮助人们在OUD治疗期间（重新）建立社会联系， 研究将最终有助于打破社会孤立和类阿片使用的致命循环。

PROJECT SUMMARY Evidence-based intervention strategies are needed to address one of the most pernicious, yet least addressed, barriers to recovery from opioid use disorder (OUD): social isolation. People with OUD are trapped in a deadly cycle wherein opioid use leads to social isolation, and social isolation leads to increased risk of continued opioid use and overdose. Disclosure, which involves sharing information about one’s OUD history and/or treatment with others, can help to break this cycle by acting as a gateway to (re-)establishing social connection as individuals enter and engage in OUD treatment. Yet, disclosure is a challenging and high-stakes social process. It is challenging because it involves a series of decisions (including whether, why, what, how, and when to disclose) and requires an advanced skillset (including communication, de-escalation, and coping skills). It is high stakes because it sometimes leads to stigma and further social isolation, undermining recovery. Although there are numerous evidence-based interventions to support disclosure among people with other stigmatized chronic illnesses, none are currently available for people in OUD treatment. We have developed Disclosing Recovery: A Decision Aid and Toolkit, which is a brief, one-hour disclosure intervention designed to help people in treatment for OUD make key decisions regarding disclosure and build disclosure skills. We pilot tested Disclosing Recovery with 50 people in treatment for OUD. Participants randomly assigned to Disclosing Recovery perceived the intervention to be acceptable and feasible, and reported better decision-making quality than participants in the comparator condition. Moreover, Disclosing Recovery impacted disclosure rates and led to greater relationship closeness. In this Phase II efficacy study, we propose to test whether Disclosing Recovery results in improved treatment- and recovery-related outcomes over a 12-month follow-up period. We will randomize n=480 participants in treatment for OUD to Disclosing Recovery versus a waitlist comparator condition. We will abstract data from participants’ medical records and administer surveys every 3 months to examine the efficacy as well as potential mediators and moderators of the intervention. Our specific aims are to: (1) Evaluate whether participants randomly assigned to the Disclosing Recovery intervention versus a waitlist comparator condition experience improved treatment- and recovery-related outcomes; (2) Test whether changes in key relationship outcomes and/or social isolation mediate intervention effects (or non-effects); (3) Determine whether profiles of recovery characteristics, disclosure goals, and relationship characteristics moderate intervention effects (or non- effects). The intervention will be tested in Delaware, the state with the third-highest overdose death rate in the United States. If we find that the Disclosing Recovery intervention is efficacious, we will follow recommendations of the NIH Phase Model for Behavioral Intervention Development by progressing to real-world efficacy and/or implementation testing. By helping people (re-)establish social connections during OUD treatment, this line of research will ultimately contribute to breaking the deadly cycle of social isolation and opioid use.