"Testing a Video and Text Messaging Intervention to reduce PTSD and Opioid Misuse Among Sexual Violence Survivors"

响应NIH的帮助结束成瘾长期（HEAL）倡议NOSI题为“阿片类药物使用障碍 有暴力史的个人的护理途径”，这一R61/R33项目旨在制定 并评估在急诊科（艾德）提供的简短视频和短信干预， 预防阿片类药物使用的发作或升级，滥用，或最近的性侵犯（SA）幸存者的障碍。 超过四分之一的女性在一生中会经历强奸未遂或强奸未遂。PTSD和阿片类药物 滥用在性暴力之后普遍存在，阿片类药物的流行正在对 女性，处方阿片类药物死亡增加幅度较大， 使用障碍（OUD），与男性相比，共病精神健康状况的可能性增加。艾德访视 在过去的二十年里，性侵犯医学法医检查（SAMFEs）增加了1500%以上 并可能提供一个重要的机会，干预，以防止创伤后应激障碍和阿片类药物的发作或升级， 误用和混乱。我们的团队开发和测试了一个简短的视频干预交付的艾德妇女 在两项随机对照试验中进行SAMFE。与常规治疗（TAU）相比， 与减少创伤后应激障碍，抑郁症，自杀，酒精，大麻和尼古丁的使用有关， 随访6个月以上的存活者亚组。然而，在我们的第二个随机对照试验中， 与TAU相比，正念视频更好地减少了SA前阿片类药物幸存者的SA后阿片类药物使用 误用因此，我们建议开发一个新的视频，主动恢复技能培训（星星）的基础上， 这两个视频的循证原则，以更好地解决创伤后应激障碍和阿片类药物滥用。在之前的RCT中， 幸存者在SAMFE报告了大量的痛苦;考虑到痛苦会损害记忆编码，我们 我建议开发一个为期3周的每日短信计划，名为TextSTAR，将加强内容 但让幸存者有机会在不同的环境中接触这些材料， 在更长的一段时间内。在R61期间，我们建议开发星星视频和文本星星，并获得 性侵犯幸存者社区咨询委员会对《公约》措辞和表述的反馈 最大限度地提高可接受性和实用性。我们将使用单独的样本对星星和文本星星进行试点测试 的幸存者（N = 50）从更美好的明天网络，一个研究网络， SAMFE在美国各地的项目，以收集有关我们的招聘方法，可接受性， 和有效性。在R33中，我们将进行SMART试验，幸存者将被随机分配 在艾德接受星星或没有视频，在1周时评估，以及高于急性应激/PTSD阈值的患者 或阿片类药物使用、误用或疾病将随机接受TextSTAR或无文本干预3周。 我们将在1个月、3个月和6个月时重新评估PTSD和阿片类药物滥用和紊乱。如果有效，这种干预 是一种低成本，易于传播的方法，以减少创伤后应激障碍和阿片类药物的结果SA幸存者。

Responding to NIH’s Helping to End Addiction Long-term (HEAL) initiative NOSI titled “Opioid Use Disorder Care Pathways for Individuals with Histories of Exposure to Violence,” this R61/R33 project seeks to develop and evaluate a brief video and text messaging intervention delivered in the emergency department (ED) to prevent the onset or escalation of opioid use, misuse, or disorder among recent sexual assault (SA) survivors. More than 1 in 4 women will experience an attempted or completed rape in her lifetime. PTSD and opioid misuse are prevalent in the wake of sexual violence, and the opioid epidemic is having a unique impact on women, with sharper increases in prescription opioid deaths, a greater likelihood of meeting criteria for opioid use disorder (OUD), and increased likelihood of comorbid mental health conditions compared to men. ED visits for sexual assault medical forensic exams (SAMFEs) have increased more than 1500% in the last two decades and may provide an important opportunity to intervene to prevent the onset or escalation of PTSD and opioid misuse and disorder. Our team developed and tested a brief video intervention delivered in the ED to women presenting for a SAMFE in two randomized controlled trials. Compared to treatment as usual (TAU), the video was associated with reductions in PTSD, depression, suicidality, alcohol, marijuana, and nicotine use for subgroups of survivors when followed over 6 months. However, in our second RCT, an active control mindfulness video better reduced post-SA opioid use compared to TAU for survivors with pre-SA opioid misuse. Thus, we propose to develop a new video, Skills Training in Active Recovery (STAR) based on the evidence-based principles of both videos to better address PTSD and opioid misuse. In the previous RCTs, survivors reported substantial distress at the SAMFE; given that distress can impair memory encoding, we propose to develop a 3-week daily text messaging program called TextSTAR that will reinforce content presented in the video but give opportunities for survivors to engage with the material in a different setting and over a longer period of time. During the R61, we propose to develop the STAR video and TextSTAR and get feedback from a community advisory board of sexual assault survivors about the wording and presentation of the content to maximize acceptability and utility. We will pilot test STAR and TextSTAR with a separate sample of survivors (N = 50) recruited from 5 ED sites within the Better Tomorrow Network, a research network of SAMFE programs throughout the US, to gather preliminary data about our recruitment approach, acceptability of the intervention, and efficacy. In the R33, we will conduct a SMART trial where survivors will be randomized to receive STAR or no video at the ED, assessed at 1 week, and those above threshold for acute stress/PTSD or opioid use, misuse or disorder will be randomized to receive TextSTAR or no text intervention for 3 weeks. We will re-assess PTSD and opioid misuse and disorder at 1, 3, and 6 months. If efficacious, this intervention is a low-cost and easy-to-disseminate approach to reduce PTSD and opioid outcomes among SA survivors.