Disclosure Intervention to Reduce Social Isolation and Facilitate Recovery among People in Treatment for Opioid Use Disorder

PROJECT SUMMARY Evidence-based intervention strategies are needed to address one of the most pernicious, yet least addressed, barriers to recovery from opioid use disorder (OUD): social isolation. People with OUD are trapped in a deadly cycle wherein opioid use leads to social isolation, and social isolation leads to increased risk of continued opioid use and overdose. Disclosure, which involves sharing information about one’s OUD history and/or treatment with others, can help to break this cycle by acting as a gateway to (re-)establishing social connection as individuals enter and engage in OUD treatment. Yet, disclosure is a challenging and high-stakes social process. It is challenging because it involves a series of decisions (including whether, why, what, how, and when to disclose) and requires an advanced skillset (including communication, de-escalation, and coping skills). It is high stakes because it sometimes leads to stigma and further social isolation, undermining recovery. Although there are numerous evidence-based interventions to support disclosure among people with other stigmatized chronic illnesses, none are currently available for people in OUD treatment. We have developed Disclosing Recovery: A Decision Aid and Toolkit, which is a brief, one-hour disclosure intervention designed to help people in treatment for OUD make key decisions regarding disclosure and build disclosure skills. We pilot tested Disclosing Recovery with 50 people in treatment for OUD. Participants randomly assigned to Disclosing Recovery perceived the intervention to be acceptable and feasible, and reported better decision-making quality than participants in the comparator condition. Moreover, Disclosing Recovery impacted disclosure rates and led to greater relationship closeness. In this Phase II efficacy study, we propose to test whether Disclosing Recovery results in improved treatment- and recovery-related outcomes over a 12-month follow-up period. We will randomize n=480 participants in treatment for OUD to Disclosing Recovery versus a waitlist comparator condition. We will abstract data from participants’ medical records and administer surveys every 3 months to examine the efficacy as well as potential mediators and moderators of the intervention. Our specific aims are to: (1) Evaluate whether participants randomly assigned to the Disclosing Recovery intervention versus a waitlist comparator condition experience improved treatment- and recovery-related outcomes; (2) Test whether changes in key relationship outcomes and/or social isolation mediate intervention effects (or non-effects); (3) Determine whether profiles of recovery characteristics, disclosure goals, and relationship characteristics moderate intervention effects (or non- effects). The intervention will be tested in Delaware, the state with the third-highest overdose death rate in the United States. If we find that the Disclosing Recovery intervention is efficacious, we will follow recommendations of the NIH Phase Model for Behavioral Intervention Development by progressing to real-world efficacy and/or implementation testing. By helping people (re-)establish social connections during OUD treatment, this line of research will ultimately contribute to breaking the deadly cycle of social isolation and opioid use.