Developing a modified brief alcohol-focused intervention tailored for patients with alcohol use disorder in opioid agonist treatment

7.项目总结/摘要 这个K23指导的以患者为导向的研究职业发展奖涉及补充研究 和培训计划，以开发和试点修改后的动机增强疗法和认知 针对酒精使用障碍患者的目标酒精使用量的行为治疗（MET-CBT）干预 (AUD)阿片激动剂治疗（OAT）。酒精使用是阿片类药物危机的一个未被充分认识的因素， 这大大增加了与阿片类药物一起使用时过量的风险。此外，酒精使用和相关 问题在OAT患者中普遍存在，并显着增加阿片类药物复发的风险， 治疗中途退出。基于维生素B2的丁丙诺啡治疗，一种快速生长的OAT， 阿片类药物使用障碍和阿片类药物过量的风险降低，但复发率在第一年很高， 治疗每天有近130人死于阿片类药物过量， COVID-19大流行期间过量用药增加，迫切需要增加治疗 潴留在接受丁丙诺啡的患者中减少酒精使用和使用相关问题可能具有 对改善丁丙诺啡结局有显著的间接影响。然而，过去的随机临床试验 随机对照试验（RCT）发现，对OAT患者进行短暂的以酒精为重点的干预没有影响， 有大量证据表明，这些干预措施在减少酒精使用方面普遍有效。关键是，过去 这项工作检查了标准的酒精干预措施，这些措施并不适合OAT中的个人，这表明， 在接受丁丙诺啡的患者中进行酒精干预存在独特且重大的挑战。这 K23项目将首先在基于办公室的丁丙诺啡的第一年对AUD患者进行定性访谈 治疗和丁丙诺啡提供者直接告知对现有MET-CBT方案的修改， 调整干预措施，以适应丁丙诺啡治疗的需求和挑战。治疗后 开发和完善，60名参与者将随机接受两次MET-CBT会议，或 在概念验证RCT中进行常规治疗。关键RCT结果将是 改良MET-CBT干预。还将在1个月和3个月随访时评价持续获益， 探索性分析。通过解决接受OAT的人的澳元问题，这项建议与 国家优先事项，以改善OAT相关结果并应对阿片类药物过量危机。

7. Project Summary/Abstract This K23 Mentored Patient-Oriented Research Career Development Award involves complementary research and training plans to develop and then pilot a modified motivational enhancement therapy and cognitive behavioral therapy (MET-CBT) intervention tailored to target alcohol use in patients with alcohol use disorder (AUD) in opioid agonist treatment (OAT). Alcohol use is an under-recognized contributor to the opioid crisis, greatly increasing the risk of overdose when used together with opioids. Further, alcohol use and related problems are prevalent among patients in OAT and significantly increase the risk of opioid relapse and treatment dropout. Office-based buprenorphine treatment, a fast-growing form of OAT, is effective at treating opioid use disorder and decreasing risk of opioid overdose, but relapse rates are high in the first year of treatment. With nearly 130 individuals dying each day from an opioid overdose and evidence of recent increases in overdoses during the COVID-19 pandemic, there is an urgent need to increase treatment retention. Reducing alcohol use and use-related problems in patients receiving buprenorphine may have a significant indirect effect on improving buprenorphine outcomes. However, past randomized clinical trials (RCTs) have found no condition effect for brief alcohol-focused intervention for patients in OAT, despite considerable evidence that these interventions are generally effective at reducing alcohol use. Critically, past work examined standard alcohol interventions that were not tailored to individuals in OAT, suggesting that there are unique and significant challenges to alcohol intervention in patients receiving buprenorphine. This K23 project will first qualitatively interview patients with AUD in their first year of office-based buprenorphine treatment and buprenorphine providers to directly inform modifications to an existing MET-CBT protocol, tailoring the intervention to fit the needs and challenges of buprenorphine treatment. Following treatment development and refinement, 60 participants will be randomized to receive two MET-CBT sessions or treatment as usual in a proof-of-concept RCT. Key RCT outcomes will be the feasibility and acceptability of the modified MET-CBT intervention. Sustained benefit will also be evaluated at 1- and 3-month follow-ups in exploratory analyses. Through addressing AUD in people receiving OAT, this proposal is closely aligns with national priorities to improve OAT-related outcomes and to respond to the opioid overdose crisis.