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BACKGROUND: Stigma associated with substance use and criminal involvement is pervasive and creates a barrier to evidence-based addiction care within the criminal legal system. Research has yet to examine a multi-level stigma intervention which targets the intersection of these stigmas among both criminal legal staff and legally-involved clients. METHODS: This paper presents the protocol for a non-randomized trial of a multi-level stigma intervention called Combatting Stigma to Aid Reentry and Recovery (CSTARR) that involves two interventions: (1) training for criminal legal staff to address public stigma and (2) group-based acceptance and commitment therapy to address self-stigma among legally-involved adults enrolled in substance use treatment. Staff and client participants are engaged with a program called the Tennessee Recovery Oriented Compliance Strategy in 6 East Tennessee counties. This study examines the feasibility, acceptability, and preliminary effectiveness of CSTARR using a type 1 hybrid implementation/effectiveness trial with pre to post follow-up. DISCUSSION: Stigma must be addressed in the criminal legal system to facilitate the uptake of evidence-based addiction care. This study is the first to evaluate a stigma intervention designed for the criminal legal setting and results will be used to inform a larger, randomized controlled trial. The rationale for this study, research design and measures, as well as potential implications for the field are described. TRIAL REGISTRATION: This clinical trial is registered at clinicaltrials.gov with the identifier NCT05152342. Registered 11/5/2021 at https://register. CLINICALTRIALS: gov/prs/app/action/SelectProtocol?sid=S000BIN8&selectaction=Edit&uid=U0005X4C&ts=2&cx=-u3wsbx .
RESUMO
The avalanche of environmental challenges, from local to global and back, has prompted responses at all levels from personal to inter-governmental. The results of these responses have fallen in the range between useful and counterproductive, with many examples on each side, but the scale of the overall challenge continues to escalate. Moving towards a zero-carbon global economy through absolute reductions in fossil fuel usage is a sure way of mitigating climate change, and a range of environmental, social and economic benefits would follow. The case for a Circular Economy (CE), however, is less clear. Whilst some CE initiatives may lead to the decoupling of economic growth from resource extraction, this does not necessarily equate to reducing the rate of extraction. Thus, the contribution of CE to the achievement of environmental objectives globally cannot be taken for granted. In terms of social impact, the best that can be said is that CE might be neutral. Technologies that promote the 'sharing economy' for instance, often suggested as a crucial CE strategy, create opportunities for individual wealth accumulation, but are also a route to the gig economy and the casualisation of labour. CE is arguably a business imperative, but definitive evidence to support the idea of a circular economy that meets social and environmental goals needs development.