“有时你必须让这个人看到并告诉他们怎么做”：改编行为激活以由同伴康复专家提供，以改善美沙酮治疗的保留率。
"Sometimes you have to take the person and show them how": adapting behavioral activation for peer recovery specialist-delivery to improve methadone treatment retention.
机构信息
Department of Psychology, University of Maryland at College Park, College Park, Maryland, USA.
Center for Health Policy and Health Services Research, Henry Ford Health System, Detroit, MI, USA.
出版信息
Subst Abuse Treat Prev Policy. 2023 Mar 6;18(1):15. doi: 10.1186/s13011-023-00524-3.
BACKGROUND
Despite efficacy of medication for opioid use disorder, low-income, ethno-racial minoritized populations often experience poor opioid use disorder treatment outcomes. Peer recovery specialists, individuals with lived experience of substance use and recovery, are well-positioned to engage hard-to-reach patients in treatment for opioid use disorder. Traditionally, peer recovery specialists have focused on bridging to care rather than delivering interventions. This study builds on research in other low-resource contexts that has explored peer delivery of evidence-based interventions, such as behavioral activation, to expand access to care.
METHODS
We sought feedback on the feasibility and acceptability of a peer recovery specialist-delivered behavioral activation intervention supporting retention in methadone treatment by increasing positive reinforcement. We recruited patients and staff at a community-based methadone treatment center and peer recovery specialist working across Baltimore City, Maryland, USA. Semi-structured interviews and focus groups inquired about the feasibility and acceptability of behavioral activation, recommendations for adaptation, and acceptability of working with a peer alongside methadone treatment.
RESULTS
Participants (N = 32) shared that peer recovery specialist-delivered behavioral activation could be feasible and acceptable with adaptations. They described common challenges associated with unstructured time, for which behavioral activation could be particularly relevant. Participants provided examples of how a peer-delivered intervention could fit well in the context of methadone treatment, emphasizing the importance of flexibility and specific peer qualities.
CONCLUSIONS
Improving medication for opioid use disorder outcomes is a national priority that must be met with cost-effective, sustainable strategies to support individuals in treatment. Findings will guide adaptation of a peer recovery specialist-delivered behavioral activation intervention to improve methadone treatment retention for underserved, ethno-racial minoritized individuals living with opioid use disorder.
背景
尽管阿片类药物使用障碍的药物治疗有效，但收入较低、少数民族裔的人群通常治疗效果不佳。同伴康复专家，即有药物使用和康复经验的个人，非常适合让难以接触到的患者参与阿片类药物使用障碍的治疗。传统上，同伴康复专家主要专注于提供转介服务，而不是提供干预措施。这项研究基于其他资源匮乏环境中的研究，这些研究探索了同伴提供基于证据的干预措施，如行为激活，以扩大获得护理的机会。
方法
我们寻求了关于同伴康复专家提供的行为激活干预措施的可行性和可接受性的反馈，该干预措施通过增加正强化来支持美沙酮治疗的保留率。我们招募了位于美国马里兰州巴尔的摩市的一家社区美沙酮治疗中心的患者和工作人员，以及一名跨区域工作的同伴康复专家。半结构式访谈和焦点小组询问了行为激活的可行性和可接受性、改编建议以及与同伴一起接受美沙酮治疗的可接受性。
结果
参与者（N=32）表示，同伴康复专家提供的行为激活具有一定的可行性和可接受性，但需要进行调整。他们描述了与非结构化时间相关的常见挑战，行为激活对此可能特别相关。参与者提供了一些例子，说明同伴提供的干预措施如何在美沙酮治疗背景下很好地适应，强调了灵活性和特定同伴素质的重要性。
结论
改善阿片类药物使用障碍的药物治疗效果是国家的优先事项，必须采取具有成本效益和可持续性的策略，以支持接受治疗的个人。研究结果将指导对同伴康复专家提供的行为激活干预措施进行改编，以改善美沙酮治疗对服务不足的、少数民族裔的阿片类药物使用障碍患者的保留率。
Zotero 插件