Promoting Retention in Opioid Treatment among Women Experiencing Intimate Partner Violence: A Novel Stepped Care Model Targeting PTSD

摘要 患有阿片类药物使用障碍(OUD)的女性受亲密伴侣暴力(IPV)和 创伤后应激障碍，高达78%的女性接受阿片类药物使用障碍(Moud)治疗 过去6个月的IPV。无论创伤后应激障碍的诊断如何，72%-78%的W-IPV经历具有临床意义 与创伤后应激障碍相关的功能障碍。创伤后应激障碍可减少治疗滞留。干预措施有效瞄准 创伤后应激障碍以减少物质，但许多不建议用于IPV，因为它们是基于暴露的疗法 过去发生的创伤--而不是像IPV那样正在进行的创伤。针对其他人的综合干预措施 健康状况改善了Moud治疗的结果，但没有循证治疗存在 将对IPV和创伤后应激障碍的关注整合到Moud治疗中。以呈现为中心的治疗+(PCT+) 和通过赋权帮助克服创伤后应激障碍(HOPE)是两个以证据为基础的、人性化的 为经历IPV的女性设计的行为干预(W-IPV)，以减少创伤后应激障碍症状和其他 与创伤相关的结果。PCT+专注于帮助W-IPV应对当前因其 创伤性体验；它可以由非临床、专业的工作人员进行8次会议，他们可能比 在Moud治疗环境中提供且负担得起。一些女性可能不会单独对PCT+做出反应，需要 额外的治疗。HOPE是一种针对IPV的认知行为疗法，由 硕士水平的治疗师，并纳入赋权和稳定治疗模式。我们的创新 方法将这两种干预措施打包成阶梯式护理模式，以创建PCT+2HOPE。这一阶段 在美国东北部的三个Moud治疗环境中进行的研究将由 探索、准备、实施和可持续(EPIS)框架。我们将探索，准备， 然后实施随机对照试验，评估PCT+2HOPE与常规治疗的效果 收集相关数据，为未来的维持提供信息。我们将从W-IPV以及直接征求意见 要告知的服务和监督人员：用于系统地识别OUD治疗环境中的IPV的协议， 转介给家庭暴力服务提供者的程序，以及PCT+和HOPE的改编 干预措施(R33阶段)。然后，我们将评估PCT+2HOPE对促进小鼠保持的影响 治疗的同时改善二次结局(例如，创伤后应激障碍、IPV、客户定义的恢复)(R61阶段)。我们会 探索干预措施的有效性是否在种族和族裔群体之间和内部有所不同 基于SDOH。在已建立的合作伙伴关系的基础上，我们的跨学科研究团队包括社区- UD和家庭暴力服务提供商，以及在IPV、创伤后应激障碍和 OUD相关护理；成瘾药物；适应性设计的临床试验；社区合作研究； 健康差距；以及实施科学。我们的研究有可能产生很大的影响，因为我们在 一种可重复和可扩展的方法，可以通过OUD改变W-IPV独特需求的治疗方法。

Abstract Women with opioid use disorder (OUD) are disproportionately impacted by intimate partner violence (IPV) and PTSD, with up to 78% of women receiving medication for opioid use disorder (MOUD) treatment experiencing IPV in the past 6 months. Regardless of PTSD diagnosis, 72%-78% of W-IPV experience clinically significant PTSD-related impairment in functioning. PTSD reduces treatment retention. Interventions effectively target PTSD to reduce substance, but many are not advised for IPV because they are exposure-based therapies for trauma that occurred in the past – not for trauma that is ongoing, as with IPV. Integrated interventions for other health conditions improve outcomes for MOUD treatment, yet no evidence-based treatments exist that integrate a much-needed focus on IPV and PTSD into MOUD treatment. Present-Centered Therapy+ (PCT+) and Helping to Overcome PTSD through Empowerment (HOPE) are two evidence-based, manualized behavioral interventions designed for women experiencing IPV (W-IPV) to reduce PTSD symptoms and other trauma-related outcomes. PCT+ focuses on helping W-IPV cope with current stressors that arise from their traumatic experiences; it can be delivered in 8 sessions by nonclinical, professional staff who may be more available and affordable in MOUD treatment settings. Some women may not respond to PCT+ alone and need additional treatment. HOPE is an IPV-specific cognitive behavioral therapy delivered in 16 sessions by Master’s level therapists and incorporates empowerment and stabilization treatment models. Our innovative approach packages these two interventions in a stepped care model to create PCT+2HOPE. This phased study conducted in three MOUD treatment settings in the United States northeast will be guided by the Exploration, Preparation, Implementation, and Sustainment (EPIS) framework. We will explore, prepare for, and then implement a randomized controlled trial to evaluate PCT+2HOPE versus treatment as usual while collecting data relevant for informing future sustainment. We will elicit input from W-IPV as well as direct service and supervisory staff to inform: protocols for systematically identifying IPV in OUD treatment settings, processes for referral to domestic violence service providers, and adaptation of the PCT+ and HOPE interventions (R33 phase). Then, we will evaluate the impact of PCT+2HOPE on promoting retention in MOUD treatment while improving secondary outcomes (e.g, PTSD, IPV, client-defined recovery) (R61 phase). We will explore whether the effectiveness of the interventions differ across and within racial and ethnic groups and based on SDOH. Building on established partnerships, our interdisciplinary study team includes community- based OUD and domestic violence service providers, and academic partners with expertise in IPV, PTSD and OUD-related care; addiction medicine; clinical trials with adaptive designs; community-partnered research; health disparities; and implementation science. Our study has potential for high impact by generating data on a reproducible and scalable approach that may transform treatment for the unique needs of W-IPV with OUD.