Social Network Intervention for Syringe Exchange Registrants

 说明(由注射器交换计划(SEP)的申请者参与者提供，通常患有未经治疗或治疗不足的物质使用障碍，这种情况与巨大的个人和公共卫生成本有关(Degenjardt等人，2010年)。这些人还例行公事地扎根于加强持续吸毒和危险行为的社交网络(Latkin等人，2013a)。这些人的福利和公众的健康 可以通过旨在降低吸毒风险和扩大无毒支持的干预措施来改善(Kidorf&King，2008)。我们研究小组以前的工作表明，将降低风险/治疗就绪组与行为意外事件相结合的干预措施与长达一年的治疗登记和重新参与率的增加以及药物使用和注射行为的减少高度相关(例如，Kidorf等人，2009年)。目前的R34应用程序扩展了这项工作，为减少风险/治疗准备小组增加了一个新的组成部分，旨在扩大社会支持和促进社会网络变化。这种干预要求SEP注册者与其个人网络中的非毒品家庭或朋友一起参加该小组，这些家庭或朋友可以提供稳定的支持，并鼓励减少伤害和寻求治疗。这一干预使用了改变网络变化模型(瓦伦特，2012)，并假设反复暴露于无毒社区支持附带减少了对支持危险行为的网络成员的暴露。这一模式还提供了一种途径，通过促进与戒毒家庭和朋友的个人社交网络的互动来修改现有的社交网络。这一干预措施得到了研究的支持，研究表明，吸毒者报告他们的社交网络中有大量不吸毒的家人或朋友(Bohnert等人，2010年；Kidorf等人，2005年b)。它还得到了社区强化原则的支持，这些原则在治疗样本中显示了有效性(Roozen等人，2004年)，但尚未应用于未接受治疗的吸毒者。这项研究将激活和描述SEP参与者的个人社交网络中的无毒支持，评估与无毒家人和朋友合作的为期6周的社区支持降低风险干预的可行性，并评估这种干预在6个月内的效果。主要结果包括1)减少药物使用的网络支持，以及2)注射危险行为(共享设备、使用率)的变化，而二级分析将评估与吸毒者和不吸毒者在一起的时间变化。数据将用于支持RCT，以隔离社区参与在降低风险、扩大无毒支持和促进社交网络变化方面的好处。

 DESCRIPTION (provided by applicant Participants of syringe exchange programs (SEPs) routinely suffer from untreated or under-treated substance use disorder, a situation that is associated with significant individual and public health costs (Degenjardt et al., 2010). These individuals are also routinely embedded within social networks that reinforce continued drug use and risk behaviors (Latkin et al., 2013a). The welfare of these individuals and the public's health can be improved by interventions directed toward reducing drug use risks and expanding drug-free support (Kidorf & King, 2008). Previous work by our research group has demonstrated that an intervention combining a risk reduction/treatment readiness group with behavioral contingencies is highly associated with increased rates of treatment enrollment and re-engagement, and reduced rates of drug use and injection behaviors, for up to one year (e.g., Kidorf et al., 2009). The present R34 application extends this work by adding a new component to the risk reduction/treatment readiness group designed to expand social support and facilitate social network change. This intervention requires SEP registrants to attend the group with a drug-free family or friend from their personal network that can provide stable support and encourage harm reduction and treatment seeking. This intervention uses an alteration network change model (Valente, 2012) and posits that repeated exposure to drug-free community support collaterally reduces exposure to network members that support risk behaviors. This model also provides a pathway to modifying existing social networks by facilitating interaction with the personal social networks of drug-free family and friends. The intervention is supported by research showing that substance users report substantial pockets of drug-free family or friends in their social networks (Bohnert et al., 2010; Kidorf et al., 2005b). It is also supportedby community reinforcement principles that have shown efficacy in treatment samples (Roozen et al., 2004), but have not been applied to out-of-treatment drug users. The study will activate and characterize drug-free support in the personal social networks of SEP participants, evaluate the feasibility of a 6-week Community Supported Risk Reduction intervention that partners with drug- free family and friends, and evaluate the efficacy of this intervention over 6-months. Primary outcomes include changes in 1) network support for reducing drug use, and 2) injection risk behaviors (sharing equipment, rates of use), while secondary analyses will evaluate changes in time spent with drug using and non-using individuals. Data will be used to support an RCT isolating the benefits of community involvement for reducing risks, expanding drug-free support, and facilitating social network change.