Improving social connectedness through digital health to enhance recovery from OUD among the justice involved population.

摘要 参与刑事司法的个人经历阿片类药物使用障碍（OUD）的发病率升高， 在从监狱/监狱释放后的第一年中，阿片类药物过量死亡的风险显著增加。 OUD药物（MOUD）是治疗OUD的循证方法，并提供广泛的益处 包括降低死亡率、非法使用阿片类药物、艾滋病毒传播、暴力犯罪和逮捕。虽然许多 惩教机构已开始实施MOUD，但继续存在重大挑战 药物/治疗，同时过渡回社区。与成瘾有关的交叉污名， 监禁的历史与更大的重返社会困难，增加孤立， 孤独感加剧缺乏社会联系进一步成为减少的风险因素。 治疗中的保留，MOUD的停止，以及恢复物质使用。同伴的支持是关键 许多基于证据的OUD恢复计划的组成部分。当与MOUD结合使用时，它具有 提高感知社会支持、自我效能和治疗参与度的潜力。然而， 由于COVID限制，实时同行支持受到挑战，凸显了对数字健康的迫切需求 平台提供同行支持。万寿菊移动的同伴支持（“MPS”）应用程序是一个专用的，安全的， 一种移动的应用程序，它采用结构化的实时对等审核来指导与组的基于文本的对话 参与者和幕后自然语言处理（NLP）自动识别“红旗” peer chats中的内容虽然初步工作证明了在门诊病人中部署MPS应用程序的实用性， 治疗设置为OUD，它还有待于在矫正设置或司法参与 人口。拟议应用的目标是推进基于证据和可扩展的治疗， OUD，通过减少孤独感和增强感知的社会支持，通过新的应用程序，建立一个 移动的应用程序中的个人从事MOUD的历史，而在监狱/监狱。本研究将 通过两个主要目标实现：（1）制定实施手册，指导MPS的交付 应用程序为那些最近（过去一年）的历史，从事MOUD，而在监狱/监狱进行深入 与潜在应用程序用户和其他关键利益相关者的访谈;以及（2）进行随机对照 评估MPS App相对于强化治疗的可行性、可接受性和初步疗效的试验- 与最近（过去一年）在监狱/监狱中从事MOUD的个人一样。结果 将用于开发R 01应用程序，以进行全动力混合动力1型 可行性-实施研究。

ABSTRACT Individuals with criminal justice involvement experience elevated rates of Opioid Use Disorder (OUD) and are at significantly higher risk of death from opioid overdose in the first year following release from jail/prison. Medications for OUD (MOUD) are an evidence-based approach to treating OUD and offer extensive benefits including lowering rates of mortality, illicit opioid use, HIV transmission, violent crime, and arrest. While many correctional settings have started to implement MOUD, there are significant challenges to continuing medication/treatment while transitioning back to the community. Intersectional stigma related to addiction and history of incarceration is associated with greater difficulties with reintegration, increased isolation, and heightened feelings of loneliness. Lack of social connectedness further serves as a risk factor for decreased retention in treatment, discontinuation of MOUD, and a return to substance use. Peer support is a key component of many evidence-based OUD recovery programs. When used in conjunction with MOUD, it has the potential to improve perceived social support, self-efficacy, and treatment engagement. However, access to live peer support has been challenged by COVID restrictions, highlighting a critical need for digital health platforms to deliver peer support. The Marigold Mobile Peer Support (“MPS”) App is a dedicated, secure, mobile application that employs structured, live peer moderation to guide text-based conversations with groups of participants and behind-the-scenes natural language processing (NLP) to automatically identify “red flag” content within peer chats. While initial work demonstrates the utility of deploying the MPS App in outpatient treatment settings for OUD, it has yet to be tested in correctional settings or among justice-involved populations. The goal of the proposed application is to advance evidence-based and scalable treatments for OUD, by decreasing loneliness and enhancing perceived social support via novel application of an established mobile app among individuals with a history of engaging in MOUD while in jail/prison. The study will be accomplished through two primary aims: (1) develop an implementation manual to guide delivery of the MPS App for those with a recent (past year) history of engaging in MOUD while in jail/prison by conducting in-depth interviews with prospective app users and other key stakeholders; and (2) conduct a randomized controlled trial to assess feasibility, acceptability, and preliminary efficacy of the MPS App relative to enhanced treatment- as-usual among individuals with a recent (past year) history of engaging in MOUD while in jail/prison. Findings from this study will be used to develop a R01 application to conduct a fully-powered Hybrid Type 1 Effectiveness-Implementation study.