Mindful MAT Adherence: Mindfulness-Based Relapse Prevention (MBRP) to improve extended-release naltrexone (XR-NTX) adherence and drug-use outcomes for opioid use disorder (OUD).

正念 MAT 依从性：基于正念的复发预防 (MBRP)，可改善阿片类药物使用障碍 (OUD) 的缓释纳曲酮 (XR-NTX) 依从性和药物使用结果。

• 批准号: 10440607
• 负责人: MICHAEL JOHN GAWRYSIAK
• 金额: $ 13.12万
• 依托单位: WEST CHESTER UNIVERSITY OF PENNSYLVANIA
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-09-30 至 2024-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10440607
• 关键词: Address; Adherence; Administrative Supplement; African American; Aftercare; Alcohols; Applications Grants; Appointment; Awareness; Behavior Therapy; Clinical Research; Clinical Trials; Cocaine; Cognitive Therapy; Collaborations; Discrimination; Drug Screening; Drug usage; Enrollment; Exposure to; Funding; Future; Group Therapy; Heterogeneity; Imprisonment; Individual; Knowledge; Link; Measures; Mediating; Medical; Mental Health; Mindfulness Training; Monitor; Naltrexone; National Institute of Drug Abuse; Opioid; Outcome; Outpatients; Parents; Participant; Patient Noncompliance; Patient Self-Report; Patients; Pharmacological Treatment; Play; Preparation; Prevalence; Procedures; Race; Randomized; Randomized Clinical Trials; Recording of previous events; Recovery; Reporting; Research; Research Activity; Research Design; Research Proposals; Residential Treatment; Role; Schedule; Secure; Self Care; Severities; Substance Use Disorder; Testing; Trauma; Treatment outcome; Underrepresented Minority; United States National Institutes of Health; Urine; Vulnerable Populations; addiction; base; behavioral pharmacology; black patient; caucasian American; design; disorder later incidence prevention; disparity reduction; drug misuse; effective therapy; evidence base; experience; follow up assessment; follow-up; health disparity; health equity; health equity promotion; improved; intervention effect; medication compliance; medication-assisted treatment; mindfulness; opioid mortality; opioid use; opioid use disorder; prevent; programs; psychiatric symptom; racial discrimination; racial diversity; resilience; substance misuse; substance use; symptomatic improvement; therapy outcome; trauma exposure; trauma symptom; traumatic stress; treatment adherence; treatment as usual; treatment program; treatment response

PROJECT SUMMARY/ABSTRACT The aims of the parent-study are to determine whether an adjunctive Mindfulness-Based Relapse Prevention (MBRP) treatment program improves medication adherence and reduces drug-use among opioid use disorder (OUD) patients receiving Medication Assisted Treatment (MAT). The broad long-term objectives of this project are to investigate how integrative pharmacological and behavioral treatments improve OUD treatment outcomes. The aim of this Administrative Supplement to Existing NIH-NIDA Grants proposal is to enhance the focus on racial health equity issues within the context of the randomized clinical trial (RCT) parent-study. Although a strong evidence-base exists supporting MAT for OUD, Black Americans often contend with additional inequities and hardships that may render such approaches less effective. Specifically, exposure to racial discrimination and subsequent race-based traumatic stress has been linked to drug misuse among Black Americans. However, these specific variables have not been examined in the context of OUD treatment. Moreover, there is limited research investigating the general role of race as a moderating factor on OUD treatment outcome. Mindfulness (i.e., present-centered nonjudgmental awareness), associates with self-care and addiction severity among with SUD and has been observed to function as a resilience factor that moderates the relationship between exposure to racial discrimination and psychiatric symptoms. MBRP is an evidenced-based behavioral intervention that has demonstrated efficacy in reducing drug-use among patients in SUD recovery. There is a notable dearth of research examining the role of race, exposure to racial discrimination, and race-based trauma symptoms on OUD treatment engagement or drug-use outcomes. As there is reason to believe that the mindfulness training included in MBRP may address race-based trauma symptoms in addition to MAT adherence and drug-use outcomes, further research is critical to promote mental health equity among Black Americans. The primary study aim is to determine whether MBRP, compared to treatment-as-usual (TAU), delivered to Black OUD patients receiving MAT through enrollment in a residential addiction treatment facility, results in (1) improved MAT adherence, and reduced drug-use following residential discharge and (2) reduced race-based trauma symptoms. As race-based trauma symptoms are understood to associate with SUD severity, A second study aim will test the extent to which exposure to racial discrimination and severity of race-based trauma symptoms predict pre-treatment (1) OUD severity and (2) poorer treatment adherence and increased drug-use measured following residential discharge for Black TAU participants (but not Black MBRP participants). As prior trauma exposure is observed to undermine treatment efforts for SUDs a third exploratory study aim will determine the extent to which reductions in race-based trauma symptoms (pre-to-post MBRP) mediate beneficial outcomes for Black MBRP participants. Expected outcomes are that Black MBRP participants will demonstrate (1) increased MAT adherence and reduced drug-use monitored across 3-months post-treatment, (2) that reduced race-based trauma symptoms will partially mediate these outcomes, and (3) that prior racial discrimination and race-based trauma symptoms will moderate outcomes for TAU, but not for MBRP participants. Executing this supplemental research proposal will fill important knowledge gaps by clarifying the role that race and race-based trauma plays in OUD severity and treatment response, will solidify collaborative research efforts focused on mental health equity for Black Americans and will inform future preparation of proposals to secure federal funding to further this line of research.

项目总结/摘要 父母研究的目的是确定是否有一个连续的正念为基础的复发预防 （MBRP）治疗计划提高了阿片类药物使用障碍的药物依从性并减少了药物使用 (OUD)接受药物辅助治疗（MAT）的患者。该项目的长期目标 目的是研究综合药物和行为治疗如何改善OUD治疗结果。 本NIH-NIDA现有赠款提案的行政补充旨在加强对以下方面的关注 随机临床试验（RCT）父母研究背景下的种族健康公平问题。 虽然有一个强大的证据基础存在支持MAT为OUD，黑人美国人往往与额外的竞争， 不平等和困难可能使这种办法不那么有效。具体来说，接触种族歧视 歧视和随后的基于种族的创伤性压力与黑人滥用药物有关 美国人然而，这些具体的变量还没有在OUD治疗的背景下进行检查。 此外，关于种族作为OUD调节因素的一般作用的研究有限 治疗结果 正念（即，以现在为中心的非判断性意识），与自我护理和成瘾严重程度相关 与SUD之间，并已被观察到作为一个弹性因素，缓和的关系 种族歧视和精神症状之间的联系MBRP是一种基于证据的行为 已证明有效减少SUD恢复期患者的药物使用的干预措施。有一个 明显缺乏研究种族的作用，暴露于种族歧视和基于种族的创伤 OUD治疗参与或药物使用结果的症状。因为有理由相信 MBRP中包含的正念训练可以解决基于种族的创伤症状以及MAT依从性 和药物使用结果，进一步的研究对于促进美国黑人的心理健康公平至关重要。 主要研究目的是确定与常规治疗（TAU）相比，MBRP是否能达到 通过在住宅成瘾治疗机构登记接受MAT的黑人OUD患者，导致（1） 改善MAT依从性，并减少住院出院后的药物使用，以及（2）减少基于种族的 创伤症状由于基于种族的创伤症状被认为与SUD的严重程度有关， 这项研究的目的是测试暴露于种族歧视的程度和基于种族的创伤的严重程度 症状预测治疗前（1）OUD严重程度和（2）治疗依从性较差和药物使用增加 在黑人TAU参与者（但不是黑人MBRP参与者）的住宅出院后测量。作为现有 观察到创伤暴露会破坏SUD的治疗效果，第三个探索性研究的目的是 确定基于种族的创伤症状（MBRP前后）减少的程度 黑人MBRP参与者的结果。预期结果是，黑人MBRP参与者将证明 (1)在治疗后3个月内监测MAT依从性增加和药物使用减少，（2） 减少基于种族的创伤症状将部分介导这些结果，（3）先前的种族 歧视和基于种族的创伤症状将缓和TAU的结果，但对MBRP参与者则不然。 执行这一补充研究提案将通过澄清种族的作用来填补重要的知识空白。 以及基于种族的创伤在OUD严重程度和治疗反应中的作用，将巩固合作研究工作， 专注于美国黑人的心理健康公平，并将为未来的提案准备提供信息，以确保 联邦基金来推进这一研究。