A Brief Values Intervention to Support Veterans in Early Buprenorphine Treatment

拟议的职业发展奖(CDA-2)将支持临床研究的Victoria ameral博士 新英格兰精神疾病研究、教育和临床中心(MIRECC)的心理学家 最近从退伍军人协会高级成瘾联谊会毕业，她的目标是成为一名 阿片类药物使用障碍(OUD)退伍军人康复行为干预专家。用药 因为我们通过防止复发和服药过量来拯救生命，但他们并没有积极地直接解决重大的 退伍军人在早期康复中面临的功能挑战。辅助性行为干预为这一点带来了希望 但现有的方法很少能超过标准的丁丙诺啡药物管理。今年5月 是由于早期的治疗倾向于集中在已经存在的症状(即，渴望和冲动)上 通过药物治疗来解决。拟议的研究试图制定一个简短的、以价值观为基础的 干预，而不是侧重于帮助改善退伍军人的人际功能和社区 在早期治疗中整合。这两个面向恢复的概念与已知的 OUD的功能后果和是恢复结果的关键预测指标。三个阶段和 本提案的各自目标涵盖朗萨维尔方案的阶段1a和1b中概述的活动 行为疗法发展模式。具体地说，手工开发(阶段1a)将包括利益相关者 与退伍军人和退伍军人服务提供者的访谈(目标1)和一项开放试点，现场抽取一小部分退伍军人 测试干预措施(目标2)。拟议研究的最后阶段将是试点随机对照试验。 (RCT)干预与标准药物管理、护理标准和MOST的比较 与这一群体进行研究的共同比较条件(目标3)，这将提供可行性和 干预的可接受性数据。这些目标将直接支持后续的RR&D功绩提案 对由此产生的干预措施进行全面的RCT，并将为 应聘者计划的长期职业道路。目前的提议的培训目标旨在建立在Dr。 美国接受和承诺疗法的临床背景(接受和承诺疗法的理论基础 建议的干预)，在转化性实验研究方面的经验，并表现出对 退伍军人事务部在康复成瘾方面的研究生涯。这些培训目标将通过一系列正式的 培训经验以及高效退伍军人指导团队的支持和指导 拥有互补专业知识和技能的研究人员。具体地说，当前的提案将解决关键的 候选人在相关内容领域的知识和技能差距(面向恢复的研究、行为研究 干预开发、OUD药物)和方法学方法(进行临床试验， 定性方法、临床试验的统计分析)，以及领导力和专业发展 支持拟议的研究和职业计划。总而言之，目前 该提案将使阿梅拉尔博士成为以康复为导向的干预措施领域的领先研究员 为退伍军人准备的。

The proposed Career Development Award (CDA-2) would support Dr. Victoria Ameral, Clinical Research Psychologist with the VISN 1 New England Mental Illness Research, Education, and Clinical Center (MIRECC) and recent graduate of the VA Interprofessional Advanced Addiction Fellowship, in her goal of becoming an expert in recovery-oriented behavioral interventions for Veterans with Opioid Use Disorder (OUD). Medications for OUD save lives by preventing relapse and overdose, but they do not actively directly address the significant functional challenges for Veterans in early recovery. Adjunctive behavioral interventions hold promise for this area, but existing approaches rarely outperform standard buprenorphine medication management. This may be due to a tendency for early sessions to focus on symptoms (i.e., cravings and urges) that are already addressed by medication treatment. The proposed research seeks to develop a brief, values-based intervention which instead focuses on helping to improve Veterans’ interpersonal functioning and community integration during early treatment. These two recovery-oriented concepts are closely linked to the known functional consequences of OUD and are key predictors of recovery outcomes. The three phases and respective aims for the current proposal cover the activities outlined in Stages 1a and 1b of Rounsaville’s Behavioral Therapy Development Model. Specifically, manual development (Stage 1a) will include stakeholder interviews with Veterans and VA Providers (Aim 1) and an open pilot with a small sample of Veterans to field test the intervention (Aim 2). The final phase of the proposed research will be a pilot randomized controlled trial (RCT) of the intervention compared to standard medication management, the standard of care and most common comparison condition for research with this population (Aim 3), which will provide feasibility and acceptability data for the intervention. These aims will directly support a subsequent RR&D MERIT proposal to conduct a full-scale RCT of the resulting intervention and will also provide invaluable experience for the candidate’s intended long-term career path. The current proposal’s training aims are designed to build on Dr. Ameral’s clinical background in Acceptance and Commitment Therapy (the theoretical foundation for the proposed intervention), experience in translational experimental research, and demonstrated commitment to a VA research career in recovery-oriented addiction. These training aims will be met through a series of formal training experiences together with support and guidance from a mentorship team of highly productive VA researchers with complementary expertise and skills sets. Specifically, the current proposal will address critical knowledge and skills gaps for the candidate in relevant content areas (recovery-oriented research, behavioral intervention development, medications for OUD) and methodological approaches (conducting clinical trials, qualitative methods, statistical analysis for clinical trials), and leadership and professional development to support the proposed research and career plan. In sum, the research and training outlined in the current proposal will position Dr. Ameral to become a leading researcher in the area of recovery-oriented interventions for Veterans with OUD.