An Integrated Evaluation of Therapeutic Pathways in Opioid Addiction

经济问题和其他社会问题使许多人不仅对更好的未来失去希望，而且对他们与家庭和社区的关系也失去希望。本研究将探讨生活在这种条件下的人们如何协商信任关系并改变他们的未来感，重点关注阿片类镇痛药和成瘾治疗方案在这些过程中所起的作用。自20世纪90年代处方阿片类药物开始扩散以来，美国的阿片类药物成瘾和过量服用率急剧上升，阿片类药物成瘾者绝大多数来自去工业化、低收入的环境。这项研究将检验这些物质是如何影响人们的生活、社会网络和未来感的。它还将调查三种治疗干预措施的效果：药物辅助治疗（MAT）；毒品匿名;以及基于信仰的项目。这些解决成瘾的模式如何影响人们对未来可能性的感觉和对康复途径的感知？这些项目是如何促进或削弱人们与周围人的关系的？宗教和临床治疗是相互排斥的吗？弗吉尼亚大学的人类学家China Scherz和Joshua Burraway将通过使用定性方法分析20名现在和以前的阿片类药物成瘾者在三年内的生活轨迹来调查这些问题。这项研究将在弗吉尼亚州西南部进行，因为去工业化和农村贫困的交叉；高于全国用药过量率；以及这个地区的宗教景观。这项研究的结果将为解决成瘾的临床和社会科学研究中的希望和暂时性问题提供一个模型。本研究还将首次对阿巴拉契亚地区阿片类药物成瘾和康复的精神转变进行民族志分析，阐明宗教实践与当前流行病的历史、经济、社会政治和具体轨迹的交叉方式。最后，通过其潜在的对其他成瘾概念化方式的见解，这项研究将有助于越来越多的文献寻求超越成瘾作为慢性复发性脑疾病的日益占主导地位的医学模型。鉴于阿片类药物滥用和成瘾对公共卫生和经济造成的前所未有的损失，这是一场全国性危机。虽然药物辅助治疗（MAT）对那些受折磨的人来说仍然是一种宝贵而来之不易的治疗途径，但康复，就像成瘾本身一样，并不是在社会真空中出现的。事实上，重建有意义的社会关系和对未来的信任感，可能与调解身体戒断症状一样，是康复的一个重要方面。这项研究旨在为建立这些社会联系的机制提供新的见解，并为改善成瘾医生之间的合作奠定基础，这些医生可能认为他们的方法从根本上是不一致的。研究小组与美国和英国领先的国家精神病学和医疗机构的学者和决策者的长期联系将有助于传播研究结果，并将研究结果转化为相关和可用的政策建议。该奖项反映了美国国家科学基金会的法定使命，并通过使用基金会的知识价值和更广泛的影响审查标准进行评估，被认为值得支持。

Economic problems and other societal issues have led many people not only to lose hope of a better future but also hope in their relationships with their families and communities. This study will explore how people living under such conditions negotiate relationships of trust and to alter their sense of future, focusing on the role that opioid analgesics and addiction treatment programs play in these processes. Since the proliferation of prescription opioids began in the 1990s, opioid addiction and overdose rates in the United States have skyrocketed and those suffering from opioid addiction are overwhelmingly from deindustrialized, lower-income surroundings. This study will examine how these substances have affected people 's lives, social networks, and sense of the future. It will also investigate the effects of three therapeutic interventions: medication assisted treatment (MAT); Narcotics Anonymous; and faith-based programs. How might these modes of addressing addiction influence people 's sense of future possibility and perceived pathways to recovery? How do these programs contribute to or detract from people 's efforts to transform their relationships with those around them? Are religious and clinical therapeutics mutually exclusive? University of Virginia anthropologists, China Scherz and Joshua Burraway, will investigate these questions by using qualitative methods to analyze the life trajectories of twenty current and former opioid addicts over the course of three years. The research will be conducted in Southwest Virginia because of the intersection of deindustrialization and rural poverty; higher than national overdose rates; and this region 's religious landscape. Results from this research will provide a model for addressing questions of hope and temporality in clinical and social scientific studies of addiction. This study will also provide the first ethnographic analysis of how spiritual transformations relate to opioid addiction and recovery in an Appalachian context, illuminating the way that religious practices intersect with the historical, economic, sociopolitical, and embodied trajectories of the current epidemic. Finally, through its potential to offer insights into other ways of conceptualizing addiction, this study will contribute to a growing body of literature that seeks to think beyond the increasingly dominant medical model of addiction as a chronic relapsing brain disease. Opioid abuse and addiction present a national crisis given the unprecedented toll on both public health and the economy. While Medication Assisted Treatment (MAT) remains a valuable and hard-won therapeutic avenue for those afflicted, recovery, like addiction itself, does not emerge in a social vacuum. Indeed, rebuilding meaningful social connections and a sense of trust in the future may be just as important an aspect of recovery as mediating physical withdrawal symptoms. This study aims to offer new insights into the mechanisms through which these social connections could be built and to lay groundwork for improved collaborations between addiction practitioners who may see their approaches as fundamentally at odds. The research team 's enduring connections with academics and policy-makers at leading national psychiatric and medical facilities in the United States and UK will facilitate broadcasting the results and translating the study 's findings into relevant and usable policy recommendations.This award reflects NSF's statutory mission and has been deemed worthy of support through evaluation using the Foundation's intellectual merit and broader impacts review criteria.