Testing the Effects of Contingency Management and Behavioral Economics on Buprenorphine-Naloxone Treatment Adherence Using a Sequential Multiple Assignment Randomized Trial (SMART) Design

使用序贯多重分配随机试验 (SMART) 设计测试应急管理和行为经济学对丁丙诺啡-纳洛酮治疗依从性的影响

• 批准号: 10253179
• 负责人: Karen J Derefinko
• 金额: $ 20.16万
• 依托单位: UNIVERSITY OF TENNESSEE HEALTH SCI CTR
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-09-28 至 2021-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10253179
• 关键词: Abstinence; Address; Adherence; African American; Alcohol or Other Drugs use; Attention; Behavior; Behavior Therapy; Behavioral; Behavioral Research; Bundling; Cities; Clinic; Clinical Trials; Control Locus; Costs and Benefits; Data; Decision Making; Development; Drug Monitoring; Drug Prescriptions; Economic Factors; Economics; Effectiveness; Future; Goals; Heroin; Individual; Intervention; Intervention Trial; Interview; Maintenance; Medicare/Medicaid; Methadone; Methods; Motivation; Opioid; Opioid agonist; Participant; Patients; Persons; Pharmaceutical Preparations; Phase; Physicians; Population; Population Heterogeneity; Psychology; Public Assistance; Randomized; Recommendation; Research; Resistance; Rewards; Saliva; Sequential Multiple Assignment Randomized Trial; Services; Suboxone; Testing; Thinking; Time; Underserved Population; Urine; Visit; Withdrawal; addiction; arm; base; behavioral economics; brief motivational intervention; compare effectiveness; contingency management; design; discounting; drinking; follow-up; illicit opioid; improved; informant; innovation; marijuana use; medication-assisted treatment; motivational enhancement therapy; opioid use disorder; pilot trial; prospective; psychosocial; response; satisfaction; social interventions; success; treatment adherence; treatment arm; treatment effect; trial design; urban setting; voucher

PROJECT SUMMARY “Health-related stigma” is an individual’s experience of exclusion, rejection, and/or blame associated with a health condition Stigma associated with Opioid Use Disorder impacts the individual in several ways, including negative self-evaluative experiences and through experienced discrimination from individuals and systems with whom the individual interacts. “Intersecting stigma” is believed to occur when multiple stigmas are applied, including minority race. For individuals with intersecting stigma, discrimination may be considerably more intense, leading to low rates of uptake of treatment, even when treatment is made accessible. Consistent with the objectives of NOT-OD-20-101, our goal for this supplement is to address the stigma associated with OUD treatment and barriers to treatment uptake in low income African American communities using a multicomponent intervention that functions at the intrapersonal, interpersonal, and community levels. Our intervention strategies for these three populations will be based upon Behavioral Economics, the theoretical model of the parent award. We will direct our stigma reduction intervention toward a specific community in Memphis (Frayser). We will address stigma in untreated individuals who present with OUD at local community or faith organizations through stigma reduction counseling and tangible rewards for treatment uptake. These individuals will be tested pre- and post-intervention for perceived stigma and buprenorphine-naloxone treatment uptake. Referred family members or support persons of these individuals will also be enrolled to receive stigma reduction and supportive skills counseling. These individuals will be tested pre- and post-intervention for stigma against those with OUD. Finally, a stigma reduction campaign will be developed and administered to the general public of Frayser community via social media and billboards. A random sample of community members’ substance use stigma will be compared before and after this campaign and change scores in this community will be compared with assessment of a similar community in Memphis that does not receive the stigma reduction campaign. Our primary outcomes across populations are stigma scores, pre- and post-intervention. Secondary outcomes include uptake of treatment visit scheduling and treatment visit attendance by individuals. This research will identify strategies that can be enacted at the individual, local, and community level that may enhance treatment uptake for those with OUD.

项目概要 “与健康相关的耻辱”是个人因健康状况而遭受排斥、拒绝和/或责备的经历。与阿片类药物使用障碍相关的耻辱以多种方式影响个人，包括负面的自我评价经历以及来自个人和群体的歧视。据信，当存在多重耻辱时，就会出现“交叉耻辱”，对于具有交叉耻辱的个人来说，歧视可能会更加严重，导致接受治疗的比率较低，即使是在接受治疗的情况下。被制作与 NOT-OD-20-101 的目标一致，我们此补充品的目标是通过在个人、人际、人际交往中发挥作用的多成分干预措施，解决低收入非裔美国人社区中与 OUD 治疗相关的耻辱和接受治疗的障碍。我们对这三个人群的干预策略将基于行为经济学，即家长奖的理论模型，我们将针对孟菲斯的特定社区（弗雷瑟）解决耻辱问题。通过减少耻辱咨询和接受治疗的有形奖励向 OUD 提供服务的人，将在干预前和干预后接受测试，了解他们是否感到耻辱以及被推荐的家庭成员或支持人员接受丁丙诺啡-纳洛酮治疗的情况。还将招募个人接受减少耻辱和支持性技能咨询。这些人将在干预前和干预后接受针对 OUD 患者的耻辱测试，最后，将针对 Frayser 社区的公众开展和开展一项减少耻辱运动。通过社交媒体和广告牌将在该活动前后对社区成员的药物使用耻辱进行随机抽样比较，并将该社区的变化分数与孟菲斯未接受耻辱减少活动的类似社区的评估进行比较。整个人群的结果是耻辱评分，次要结果包括个人对治疗就诊安排和治疗就诊的出席率，该研究将确定可以在个人、当地和社区层面制定的策略。 OUD 患者的治疗接受情况。