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

项目摘要 与阿片类药物使用障碍相关的污名以几种方式影响个体，包括负面的自我评价经历以及与个体互动的个人和系统的歧视。“交叉成见”被认为是在包括少数民族在内的多重成见被施加时发生的。对于有交叉污名的个人，歧视可能更为严重，导致接受治疗的比例较低，即使在提供治疗的情况下。与NOT-OD-20-101的目标一致，我们的目标是解决与OUD治疗相关的耻辱感和低收入非洲裔美国人社区使用在个人内部，人际和社区层面发挥作用的多组分干预措施进行治疗的障碍。我们对这三个群体的干预策略将基于行为经济学，即父母奖励的理论模型。我们将针对孟菲斯（Frayser）的一个特定社区进行减少耻辱感的干预。我们将通过减少污名咨询和对接受治疗的有形奖励，解决在当地社区或宗教组织中出现OUD的未经治疗的个人的污名问题。这些人将在干预前和干预后接受测试，以了解他们的耻辱感和丁丙诺啡-纳洛酮治疗吸收情况。这些人的转介家庭成员或支持者也将被招募接受减少耻辱和支持技能咨询。这些人将在干预前后接受测试，以了解对OUD患者的耻辱感。最后，将通过社交媒体和广告牌，为Frayser社区的公众制定和管理减少耻辱的运动。在这一运动之前和之后，将对社区成员的物质使用耻辱进行随机抽样比较，并将该社区的变化分数与孟菲斯一个没有接受减少耻辱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耻辱评分。次要结局包括个人接受治疗访视安排和治疗访视出勤率。这项研究将确定可以在个人，地方和社区层面制定的策略，这些策略可能会提高OUD患者的治疗效果。

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.