Supporting Treatment Access and Recovery for Co-Occurring Opioid Use and Mental Health Disorders (STAR-COD)

支持同时发生的阿片类药物使用和精神健康障碍的治疗获取和康复 (STAR-COD)

• 批准号: 10373400
• 负责人: Gerardo Gonzalez
• 金额: $ 315.52万
• 依托单位: UNIV OF MASSACHUSETTS MED SCH WORCESTER
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-09-16 至 2025-08-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10373400
• 关键词: Affect; Assertiveness; Behavior Therapy; Capital; Characteristics; Client; Clinic; Clinical; Clinical Practice Guideline; Combination Medication; Combined Modality Therapy; Communities; Community Services; Complex; Criminal Justice; Drug Screening; Educational Curriculum; Effectiveness; Evidence based practice; Future; Goals; Gold; Group Therapy; Health; Health Services Accessibility; Healthcare; Homelessness; Hybrids; Individual; Intervention; Investments; Massachusetts; Measures; Mediating; Medical; Mental Health; Mental disorders; National Institute of Mental Health; Opiate Addiction; Opioid; Outcome; Outpatients; Overdose; Participant; Partnership Practice; Patient Self-Report; Patients; Population; Protocols documentation; Provider; Psychosocial Assessment and Care; Public Health; Quality of life; Randomized; Randomized Controlled Trials; Recovery; Relapse; Research Personnel; Service setting; Services; Severities; Strategic Planning; Structure; Suicide; Symptoms; System; Systems Integration; Testing; Therapeutic; Therapeutic Effect; Time; United States; United States Department of Veterans Affairs; addiction; arm; base; care systems; cost; cost effective; cost estimate; cost-effectiveness evaluation; demographics; design; economic evaluation; effective intervention; effectiveness evaluation; empowered; improved; improved outcome; innovation; multi-component intervention; opioid overdose; opioid use; opioid use disorder; outreach; peer support; personalized intervention; personalized medicine; predictive modeling; prescription opioid; profiles in patients; programs; psychosocial; research to practice; response; sobriety; standard of care; substance use; treatment as usual; uptake

PROJECT SUMMARY / ABSTRACT Opioid use has dramatically increased in the United States since 2000, and disproportionally affects individuals with co-occurring mental health disorders (COD). Individuals with COD are vulnerable to substance use relapses, mental health symptom exacerbations, opioid overdoses, suicide, homelessness, and criminal justice involvement. Although medication for opioid use disorder (MOUD) is the gold standard of care, engagement rates are as low as 18% which negatively impact outcomes. In addition, there is mixed evidence regarding the incremental therapeutic benefit of adding single behavioral interventions to improve MOUD outcomes, despite being recommended in clinical practice guidelines. Furthermore, while multi-component interventions exist, little is known about their incremental therapeutic effect on outcomes in conjunction with MOUD and standard medical management for those with a COD. Maintaining Independence and Sobriety through Systems Integration, Outreach and Networking (MISSION) is one such multi-component, cross-disciplinary, team-based treatment approach, combining 3 evidence-based practices along with MOUD: 1) Dual Recovery Therapy (DRT), which is integrated group therapy for COD; 2) Peer Support (PS), offering support for people in recovery by people in recovery; and 3) Critical Time Intervention (CTI), a time-limited form of assertive community treatment. Although the effectiveness of MISSION is well established, given the difficulty with implementation uptake in large systems due to its complexity and the need to improve outcomes for those with a COD who receive MOUD, a critical next step is to understand the incremental therapeutic benefit of MISSION + MOUD, and identify highest value MISSION components that drive the largest clinical improvement and offer the greatest return on investment. In response to RFA-MH-21-145, the proposed 4-year study with a half fractional factorial design, “Supporting Treatment Access and Recovery for Co-occurring Opioid Use and Mental Health Disorders (STAR-COD),” will randomize 1,000 patients with COD across 9 MOUD programs to the following 5 conditions: 1) MOUD alone; 2) full MISSION protocol (CTI & DRT & PS) + MOUD; 3) CTI & DRT + MOUD; 4) PS & DRT + MOUD; or 5) CTI & PS + MOUD. There are four specific aims. Aim 1: To evaluate the effectiveness of MISSION or its components with MOUD versus MOUD alone, as well as the incremental benefits of MISSION or bundled parts + MOUD to improve engagement, substance use and mental health symptoms. Aim 2: To examine mechanisms of action of MISSION in COD. Aim 3: To conduct a comprehensive economic evaluation of MISSION or its parts and MOUD. Exploratory Aim: 4. To construct a predictive model to match optimum combined use of MISSION parts with patient needs to improve health outcomes. This proposal is aligned with NIMH’s strategic plan goal 4 “to increase the public health impact of services studies, investigators test ways to adapt, implement, and scale effective interventions for varied populations across multiple service settings in a cost-effective manner.” Upon completion, it could offer more cost effective, robust, personalized treatments.

项目摘要 /摘要 自2000年以来，美国的阿片类药物使用急剧增加，并且对个人的影响不成比例 与共同出现的心理健康障碍（COD）。具有COD的人容易受到药物使用的继承， 心理健康症状加剧，Oioid过量，自杀，无家可归和刑事司法 尽管阿片类药物使用障碍药物（MOUD）是护理的黄金标准，参与 利率高达18％，对结果产生负面影响。此外，关于 添加单个行为干预措施以改善MOUD结果的增量治疗益处，Dospite 被推荐在临床实践指南中。此外，尽管存在多组分干预措施，但很少 知道它们与MOUD和标准医学结合的增量治疗作用 管理鳕鱼的人的管理。通过系统集成来维持独立性和清醒， 宣传和网络（任务）是这样的多组件，基于团队的跨学科治疗 方法，将3种循证实践与MOUD结合在一起：1）双重恢复疗法（DRT）， 综合组进行鳕鱼疗法； 2）同伴支持（PS），为人们提供支持的人 恢复; 3）关键时间干预（CTI），这是一种有限的自信社区待遇形式。虽然 鉴于在大型系统中实施吸收困难，任务的有效性已经很好 由于它的复杂性以及需要改善接受MOUD的鳕鱼的人的结果，接下来是关键的 步骤是了解任务 + MOUD的增量治疗益处，并确定最高价值 推动最大临床改进并提供最大投资回报的任务组件。 为了响应RFA-MH-21-145 治疗访问和恢复的阿片类药物使用和心理健康障碍（Star-COD）的恢复”将会 在9个MOUD程序中将1,000例COD患者随机为以下5个条件：1）单独使用； 2） 完整的任务协议（CTI＆DRT＆PS） + MOUD; 3）CTI和DRT + MOUD; 4）PS＆DRT + MOUD;或5）CTI＆ PS + MOUD。有四个具体目标。目标1：评估任务或其组成部分的有效性 单独使用Moud与Moud，以及任务或捆绑部件的增量益处 + MOUD 改善参与度，药物使用和心理健康症状。目标2：检查作用机制 鳕鱼任务。目标3：对任务或其部分进行全面的经济评估， 穆德。探索目的：4。构建一个预测模型以匹配任务零件的最佳组合使用 患者需要改善健康状况。该建议与NIMH的战略计划目标4保持一致。 增加服务研究的公共卫生影响，研究人员测试适应，实施和扩展的方法 以具有成本效益的方式对多个服务环境中各种人群的有效干预措施。” 完成，它可以提供更具成本效益，强大的个性化治疗方法。