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

项目总结 需要以证据为基础的干预策略来应对最有害、但最不受关注的疾病之一， 从阿片使用障碍(OUD)中恢复的障碍：社会孤立。患有OUD的人被困在致命的 阿片类药物使用导致社会孤立的循环，社会孤立导致继续使用阿片类药物的风险增加 吸毒和服药过量。披露，包括与他人分享自己的病史和/或治疗情况 其他人，可以通过充当(重新)建立个人社会关系的门户来帮助打破这种循环 进入并参与OUD治疗。然而，披露信息是一个具有挑战性和高风险的社交过程。它是 具有挑战性，因为它涉及一系列决定(包括是否、为什么、什么、如何以及何时披露) 并需要高级技能(包括沟通、降级和应对技能)。这事关重大。 因为它有时会导致耻辱和进一步的社会孤立，破坏经济复苏。尽管有 许多基于证据的干预措施，以支持其他污名化慢性疾病患者的信息披露 在疾病方面，目前没有一种疾病可供接受治疗的人使用。我们已经制定了披露追回：A 决策辅助和工具包，这是一个简短的、一小时的披露干预，旨在帮助治疗中的人 因为我们做出了关于披露的关键决策，并建立了披露技能。我们对披露恢复进行了试点测试 有50人在接受OUD治疗。随机分配到披露追回信息的参与者认为 干预措施是可接受和可行的，并且报告的决策质量比参与调查的参与者更好 比较器条件。此外，披露回收影响了披露比率，并导致了更大的关系 亲密。在这项第二阶段的疗效研究中，我们建议测试披露恢复情况是否会带来改善 在12个月的随访期内取得与治疗和康复相关的结果。我们将n=480随机 接受OUD治疗的参与者披露康复情况与等待名单比较的情况。我们将抽象 从参与者的医疗记录中获取数据，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调解人。我们的具体目标是：(1)评估是否 随机分配到披露恢复干预的参与者与等待名单比较条件的参与者 体验更好的治疗和恢复相关结果；(2)测试关键关系是否发生变化 结果和/或社会隔离对干预效果(或无效果)起中介作用；(3)决定 恢复特征、披露目标和关系特征适中干预效果(或非 效果)。这项干预措施将在特拉华州进行测试，该州的过量服药死亡率在全球排名第三 美国。如果我们发现披露追回干预措施有效，我们将遵循建议 美国国立卫生研究院行为干预发展阶段模型的研究进展到实际效果和/或 实施测试。通过在OUD治疗期间帮助人们(重新)建立社会关系，这一系列 研究最终将有助于打破社会孤立和阿片类药物使用的致命循环。

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.