Developing and testing an intervention to enhance recovery capital amid opioid use disorder pharmacotherapy: A pilot randomized trial of assertive linkage to recovery community centers

开发和测试一种干预措施，以在阿片类药物使用障碍药物治疗中增强康复资本：与康复社区中心建立肯定联系的随机试点试验

• 批准号: 10427936
• 负责人: Lauren A Hoffman
• 金额: $ 18.52万
• 依托单位: MASSACHUSETTS GENERAL HOSPITAL
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-03-15 至 2027-02-28
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10427936
• 关键词: Address; Adherence; Adopted; Aphorisms; Assertiveness; Award; Buprenorphine; Capital; Chronic; Clinic; Clinical; Clinical Treatment; Communities; Coping Skills; Data; Development; Disease remission; Ensure; Evaluation; Exhibits; Feasibility Studies; Feedback; Foundations; Future; Goals; Guidelines; Happiness; Health; Housing; Impairment; Individual; Intervention; Intervention Studies; Interview; Link; Maintenance; Manuals; Measures; Mentors; Methods; National Institute of Drug Abuse; Outcome; Outpatients; Overdose; Pathway interactions; Patient Recruitments; Patients; Personal Satisfaction; Persons; Pharmaceutical Preparations; Pharmacotherapy; Procedures; Protocols documentation; Public Health; Publishing; Qualitative Methods; Randomized; Randomized Controlled Trials; Recovery; Recovery Support; Research; Resources; Risk; Services; Stress; Substance Use Disorder; Sum; Telephone; Testing; Training; Treatment Efficacy; Visit; Work; base; biobehavior; clinical practice; clinically relevant; community center; design; experience; follow-up; implementation fidelity; improved; insight; meetings; member; novel; opioid epidemic; opioid misuse; opioid use disorder; peer; peer support; programs; protective effect; provider intervention; psychosocial; randomized trial; relapse risk; retention rate; safety net; satisfaction; secondary outcome; service intervention; therapy development; volunteer

(K.220) 7. Project Summary/Abstract Opioid use disorder (OUD) is associated with disproportionate deficits in the psychosocial determinants of health, with individuals exhibiting recovery capital (i.e. recovery resources) that is one standard deviation below that of other substance use disorders (SUDs) in the first year of recovery. OUD medications (MOUDs) are first-line treatments (Txs) that facilitate recovery by addressing the biophysiological disturbances caused by chronic opioid misuse. Yet, high rates of MOUD discontinuation and associated risks are ongoing concerns and, even when patients (Ps) are retained in Tx, psychosocial deficits often persist, increasing biobehavioral stress and hindering Tx/recovery. Thus, without a foundation of resources for recovery support/maintenance, current and former MOUD Ps are at ongoing risk for psychosocial impairment, which hinders recovery. The provision of recovery support services (RSS) offers one way to address extra-Tx needs and enhance recovery capital to ensure a safety net of resources and healthy coping skills to support MOUD Ps during and after Tx. Recovery Community Centers (RCCs) are a free, newly emerging, and rapidly growing tier of RSS that serve as ‘one-stop- shops’ for recovery capital, offering an array of services catered to the SUD community. RCCs seem to be especially well suited for MOUD Ps, as they operate under the maxim “many pathways [to recovery], all should be celebrated” (including MOUD), and the majority of RCC attendees have OUD and hold positive attitudes toward MOUD. Though early evidence suggests that RCCs can aid SUD recovery, its potential benefit to MOUD Ps has yet to be directly studied. Also, few MOUD Ps know of or use RCCs, and clinical linkage to them is uncommon. Thus, this 5-year project seek to advance our understanding of the clinical and public health utility of RCCs and help bridge the gap between clinical Tx and community-based RSS. As a first step in this work, we will develop and test a new intervention for peer-facilitated assertive linkage of MOUD Ps to RCCs (RCCL), relative to a matched control condition (CC). This study aims to: (1) develop, manualize, and refine RCCL/CC protocols via stakeholder feedback; (2) determine feasibility, acceptability, and preliminary efficacy (RCC attendance, service use, recovery capital) of RCCL vs. CC, via a pilot randomized controlled trial (RCT); (3) Gain in-depth insight to RCCL via qualitative interviews. This study will be the first to test RCCL for MOUD Ps, providing a foundation for larger-scale RCTs, with the potential to ultimately change clinical practice paradigms to address Ps’ extra-Tx needs and inform our ability to expand RCCL provision nationally. The aims support advanced training in: psychosocial determinants of health; RSS; intervention development/testing (via RCT); qualitative methods; ongoing OUD training, with a new focus on intervention research. Training will be fulfilled with expert guidance from Drs. John Kelly, Roger Weiss, Joanne Neale, David Best, Christine Timko, and Corrie Vilsaint. The training and experience provided by this award will serve as a critical foundation from which to build a an important and clinically relevant program of independent research.

(K.220) 7. 项目总结/摘要 阿片类药物使用障碍（OUD）与健康的心理社会决定因素的不成比例的缺陷有关， 个人表现出的回收资本（即回收资源）比以下一个标准差 康复第一年的其他物质使用障碍 (SUD)。 OUD 药物 (MOUD) 是一线药物 通过解决慢性病引起的生物生理紊乱来促进康复的治疗（Txs） 阿片类药物滥用。然而，MOUD 的高终止率和相关风险一直令人担忧，甚至 当患者 (Ps) 留在 Tx 中时，心理社会缺陷通常会持续存在，从而增加生物行为压力和 阻碍 Tx/恢复。因此，如果没有恢复支持/维护的资源基础，当前和 前 MOUD P 持续面临社会心理障碍的风险，这阻碍了康复。提供 恢复支持服务 (RSS) 提供了一种解决额外 Tx 需求并增强恢复资本的方法 确保资源安全网和健康的应对技能，以在 Tx 期间和之后支持 MOUD P。恢复 社区中心 (RCC) 是一种免费、新兴且快速增长的 RSS 层级，可提供“一站式服务” 商店的回收资本，提供一系列迎合 SUD 社区的服务。农村信用社似乎 特别适合 MOUD P，因为它们遵循“许多途径（恢复），都应该 值得庆祝”（包括 MOUD），大多数 RCC 与会者都有 OUD 并持有积极态度 走向MOUD。尽管早期证据表明 RCC 可以帮助 SUD 复苏，但它对 MOUD 的潜在好处 Ps尚未直接研究。此外，很少有 MOUD P 了解或使用 RCC，并且与它们的临床联系是 罕见。因此，这个为期 5 年的项目旨在增进我们对临床和公共卫生效用的理解 的 RCC 并帮助弥合临床 Tx 和基于社区的 RSS 之间的差距。作为这项工作的第一步，我们 将开发和测试一种新的干预措施，用于同行促进的 MOUD P 与 RCC (RCCL) 的肯定联系， 相对于匹配的控制条件（CC）。本研究旨在：(1) 开发、手册化和完善 RCCL/CC 通过利益相关者的反馈制定协议； (2) 确定可行性、可接受性和初步有效性（RCC RCCL 与 CC 的出勤率、服务使用、回收资本），通过试点随机对照试验 (RCT) 进行； (3) 增益 通过定性访谈深入了解 RCCL。这项研究将是第一个针对 MOUD Ps 测试 RCCL 的研究， 为更大规模的随机对照试验提供基础，有可能最终改变临床实践范式 满足 Ps 的额外 Tx 需求，并告知我们在全国范围内扩大 RCCL 供应的能力。目标支持 高级培训：健康的社会心理决定因素； RSS；干预开发/测试（通过随机对照试验）； 定性方法；正在进行的 OUD 培训，新的重点是干预研究。培训将圆满完成 在博士的专家指导下。约翰·凯利、罗杰·韦斯、乔安妮·尼尔、大卫·贝斯特、克里斯汀·蒂姆科和科里 维尔圣。该奖项提供的培训和经验将作为构建的重要基础 一项重要且与临床相关的独立研究计划。