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

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.