Testing the Effects of Contingency Management and Behavioral Economics on Buprenorphine-Naloxone Treatment Adherence Using a Sequential Multiple Assignment Randomized Trial (SMART) Design

项目总结 “与健康相关的耻辱”是指一个人经历与健康状况有关的排斥、排斥和/或指责。与阿片类药物使用障碍有关的耻辱对个人有几种影响，包括消极的自我评价经历，以及个人与之互动的个人和系统的有经验的歧视。当使用包括少数族裔在内的多个柱头时，“交叉柱头”被认为是发生的。对于有交叉耻辱的个人来说，歧视可能要严重得多，导致接受治疗的比率很低，即使在可以获得治疗的情况下。与NOT-OD-20-101的目标一致，我们本补编的目标是通过在个人、人际和社区层面发挥作用的多成分干预，解决与OUD治疗相关的耻辱和低收入非裔美国人社区接受治疗的障碍。我们对这三个群体的干预策略将基于行为经济学，这是家长奖的理论模型。我们将针对孟菲斯(Frayser)的一个特定社区进行耻辱减少干预。我们将通过减少耻辱、咨询和切实奖励接受治疗的方式，解决那些在当地社区或信仰组织中出现的未接受治疗的个人的耻辱问题。这些人将在干预前后接受感觉耻辱和丁丙诺啡-纳洛酮治疗摄取的测试。被转介的家庭成员或这些个人的支助人员也将被登记接受减少耻辱和支持性技能咨询。这些人将在干预前后接受针对OUD患者的污名测试。最后，将开展一项减少耻辱的运动，并通过社交媒体和广告牌向Frayser社区的普通公众进行宣传。将对社区成员在这场运动前后使用药物的污名进行随机抽样比较，并将该社区的变化分数与孟菲斯一个没有接受减少污名运动的类似社区的评估进行比较。我们在人群中的主要结果是干预前和干预后的污名评分。次要结果包括个人对治疗访问计划和治疗访问出席的接受情况。这项研究将确定可以在个人、地方和社区层面实施的战略，这些战略可能会提高OUD患者的治疗接受度。

PROJECT SUMMARY “Health-related stigma” is an individual’s experience of exclusion, rejection, and/or blame associated with a health condition Stigma associated with Opioid Use Disorder impacts the individual in several ways, including negative self-evaluative experiences and through experienced discrimination from individuals and systems with whom the individual interacts. “Intersecting stigma” is believed to occur when multiple stigmas are applied, including minority race. For individuals with intersecting stigma, discrimination may be considerably more intense, leading to low rates of uptake of treatment, even when treatment is made accessible. Consistent with the objectives of NOT-OD-20-101, our goal for this supplement is to address the stigma associated with OUD treatment and barriers to treatment uptake in low income African American communities using a multicomponent intervention that functions at the intrapersonal, interpersonal, and community levels. Our intervention strategies for these three populations will be based upon Behavioral Economics, the theoretical model of the parent award. We will direct our stigma reduction intervention toward a specific community in Memphis (Frayser). We will address stigma in untreated individuals who present with OUD at local community or faith organizations through stigma reduction counseling and tangible rewards for treatment uptake. These individuals will be tested pre- and post-intervention for perceived stigma and buprenorphine-naloxone treatment uptake. Referred family members or support persons of these individuals will also be enrolled to receive stigma reduction and supportive skills counseling. These individuals will be tested pre- and post-intervention for stigma against those with OUD. Finally, a stigma reduction campaign will be developed and administered to the general public of Frayser community via social media and billboards. A random sample of community members’ substance use stigma will be compared before and after this campaign and change scores in this community will be compared with assessment of a similar community in Memphis that does not receive the stigma reduction campaign. Our primary outcomes across populations are stigma scores, pre- and post-intervention. Secondary outcomes include uptake of treatment visit scheduling and treatment visit attendance by individuals. This research will identify strategies that can be enacted at the individual, local, and community level that may enhance treatment uptake for those with OUD.