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

7.项目摘要/摘要 K23指导的以患者为导向的研究职业发展奖包括补充研究 和培训计划，以制定并试点修改后的动机增强疗法和认知 为酒精使用障碍患者量身定制的行为疗法(MET-CBT)干预 (AUD)阿片类激动剂治疗(OAT)。酒精使用是阿片类药物危机的一个被低估的贡献者， 当与阿片类药物一起使用时，大大增加了过量服药的风险。此外，酒精的使用和相关 问题在燕麦片患者中普遍存在，并显著增加阿片类药物复发和 治疗辍学。办公室丁丙诺啡治疗，一种快速增长的燕麦片形式，在治疗方面是有效的 阿片类药物使用障碍和降低阿片类药物过量的风险，但复发率在#年第一年很高 治疗。每天有近130人死于阿片类药物过量，最近有证据表明 新冠肺炎大流行期间过量用药增加，迫切需要增加治疗 留存。丁丙诺啡患者减少酒精使用和与酒精使用相关的问题可能会有 对改善丁丙诺啡疗效有显著的间接影响。然而，过去的随机临床试验 (RCT)发现对燕麦中的患者进行短暂的酒精干预没有条件影响，尽管 相当多的证据表明，这些干预措施通常在减少酒精使用方面是有效的。关键的是，过去 工作检查了标准的酒精干预，这些干预不是为燕麦片中的个人量身定做的，表明 在接受丁丙诺啡治疗的患者中，酒精干预面临着独特而重大的挑战。这 K23项目将首先定性采访AUD患者在办公室使用丁丙诺啡的第一年 治疗和丁丙诺啡提供者直接通知对现有MET-CBT方案的修改， 调整干预措施以适应丁丙诺啡治疗的需要和挑战。后续治疗 开发和改进，60名参与者将被随机分配到两个MET-CBT课程或 在一项概念验证随机对照试验中照常治疗。循证医学研究的主要成果将是 改良MET-CBT干预。持续的收益也将在1个月和3个月的跟踪中进行评估 探索性分析。通过解决领取燕麦片的人中的AUD问题，这一建议与 改善与燕麦片有关的结果和应对阿片类药物过量危机的国家优先事项。

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.