# Shame among Sexual Violence Survivors in Opioid Use Disorder Treatment: Event-level and longitudinal effects on Cravings, Substance Use, and Treatment Engagement

> **NIH NIH K99** · RHODE ISLAND HOSPITAL · 2024 · $180,683

## Abstract

Project Summary
Opioid use disorder (OUD) is a growing public health concern and has a high prevalence, morbidity, and
mortality. Sexual violence (SV) and OUD co-occur at high rates. Among individuals with OUD, SV is associated
with a severe clinical course (e.g., increased substance use) and poorer OUD treatment outcomes (e.g.,
premature discontinuation). Despite clear clinical relevance of the role of SV in OUD treatment, no studies have
explicated mechanisms that contribute to the worsening of outcomes. One such mechanism is shame. Shame
is pronounced among individuals in OUD treatment as well as those who have a history of SV. Operationalized
as the emotional core of stigma, shame is cyclical in nature and fluctuates daily in response to internal and
environmental cues. However, no study has evaluated the role of shame in relation to short-term (cravings,
substance use, medication adherence, motivation for changing substance use, self-efficacy for changing
substance use) and long-term clinical outcomes (number of appointments missed, treatment dropout) for
individuals in OUD treatment, in the context of other factors that impact treatment (social support, psychological
distress, prior treatment history, stressful events). The specific aims of the K99 phase of this K99/R00 are to 1)
iteratively develop and refine an ecological momentary assessment (EMA) protocol among individuals with OUD
treatment with a history of SV, which will facilitate formative work and training in EMA. To accomplish this aim,
an initial EMA survey protocol will be developed based on prior literature, followed by a 30-day EMA pilot (n=20-
24, in two phases), which will be then followed by individual cognitive interviews to inform the final EMA measures
and protocol in the R00 phase. The specific aim of the R00 phase is to identify the associations between
momentary fluctuations in shame and short-term clinical outcomes as well as aggregate levels of shame and
long-term clinical outcomes among a sample of 122 individuals engaged in OUD treatment with a lifetime history
of SV, using EMA. Participants will complete baseline measures, 30 days of EMA, and follow-up assessments
at 3- and 6 months. The PI, Dr. Bhuptani, will work with an experienced team of mentors with complementary
areas of knowledge/expertise (Drs. Ana Abrantes, Jennifer Merrill, and Lindsay Orchowski) to develop expertise
in three areas of training that are well-matched to the career goals of the PI, including (1) EMA methods and
analysis, (2) measurement of OUD-specific outcomes, and (3) professional development skills. Successful
completion of the research and training detailed in this proposal will prepare the PI to become an independent
clinical scientist and develop a program of research focused on identifying mechanisms that impact clinical and
treatment outcomes among individuals with comorbid substance use and trauma conditions. Identifying event-
level associations between shame and clinical outco...

## Key facts

- **NIH application ID:** 10868650
- **Project number:** 5K99DA057993-02
- **Recipient organization:** RHODE ISLAND HOSPITAL
- **Principal Investigator:** Prachi Bhuptani
- **Activity code:** K99 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2024
- **Award amount:** $180,683
- **Award type:** 5
- **Project period:** 2023-07-01 → 2025-06-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10868650

## Citation

> US National Institutes of Health, RePORTER application 10868650, Shame among Sexual Violence Survivors in Opioid Use Disorder Treatment: Event-level and longitudinal effects on Cravings, Substance Use, and Treatment Engagement (5K99DA057993-02). Retrieved via AI Analytics 2026-05-24 from https://api.ai-analytics.org/grant/nih/10868650. Licensed CC0.

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