Mindfulness Based Relapse Prevention for Stimulant Users

描述(由申请人提供)：当前研究的广泛、长期目标是通过以创新的冥想为基础的策略来加强传统的复发预防治疗，以促进情感调节技能，从而改善兴奋剂使用障碍的治疗。在基于正念的抑郁症认知疗法的基础上(西格尔、蒂斯代尔和威廉姆斯，2002)，Marlatt和他的同事最近开发了一种针对使用药物人群的治疗的手工化干预：基于正念的复发预防(MBRP)。本研究的具体目的是：1)进行一项先导性随机临床试验，以评估招募和保留个体进行大规模研究的可行性，并确定在接受应急管理(CM)的兴奋剂使用者中，MBRP相对于健康教育(ED)对照组的效果大小。MBRP和ED参与者将在基线、治疗结束和治疗后1个月进行评估。2)测试与ED相比，MBRP对负性情绪、兴奋剂使用和医疗结果的影响。3)评估MBRP和ED对参与者HIV危险行为的不同影响，以及4)研究MBRP的潜在作用机制，包括降低应激反应和觉醒的生物学指标，如血压和心率。我们推测，在减少负面情绪和兴奋剂使用方面，MBRP将比ED更有效。此外，我们预计MBRP将在HIV危险行为、应激反应和性唤醒方面产生更大的减少，这些变化将与物质使用结果相关。MBRP结合了特定的以物质为中心的认知治疗技术，并特别强调正念技能。通过提供应对技能来解决情感调节和应激反应这两个导致兴奋剂复发的重要因素，MBRP可能为兴奋剂使用者的治疗提供一种有前途的强化策略。 公共卫生相关性：与公共卫生相关性：拟议的研究具有相当大的公共卫生意义，因为它将提供基于正念的复发预防作为对兴奋剂依赖的干预的基本信息，兴奋剂依赖是一个影响广泛的严重药物问题。如果证明有效，该议定书可有助于治疗成瘾和减少接受治疗的个人使用兴奋剂，从而有效减少药物滥用和相关后果，如犯罪活动、社会破坏和由于不安全性行为频率增加而增加的艾滋病毒传播/感染风险，这在兴奋剂使用者中是一个特别突出的问题。这项拟议的项目将确定一种创新的干预方案的临床实用性，该方案以前从未在兴奋剂依赖者中进行过测试。

DESCRIPTION (provided by applicant): The broad, long-term objective of the current research is to improve treatment for stimulant use disorders by augmenting traditional relapse prevention therapy with innovative meditation-based strategies to promote affect regulation skills. Based on Mindfulness-Based Cognitive Therapy for depression (Segal, Teasdale, & Williams, 2002), Marlatt and colleagues recently developed a manualized intervention for the treatment of substance using populations: Mindfulness Based Relapse Prevention (MBRP). The specific aims of this research are 1) To conduct a pilot randomized clinical trial to assess the feasibility of recruiting and retaining individuals for a large scale study and to determine the effect size of MBRP relative to a health education (ED) control group in stimulant users receiving contingency management (CM). Both MBRP and ED participants will be assessed at baseline, treatment-end, and 1 month post-treatment. 2) To test the impact of MBRP compared to ED on negative affect, stimulant use, and healthcare outcomes. 3) To evaluate the differential effects of MBRP versus ED on HIV-risk behavior of participants, and 4) To examine potential mechanisms of action of MBRP, including reductions in stress reactivity and biological indicators of arousal such as blood pressure and heart rate. We hypothesize that MBRP will be more efficacious than ED in reducing negative affect and stimulant use. Further, we expect that MBRP will produce greater reductions in HIV-risk behaviors, stress reactivity, and arousal, and these changes will be associated with substance use outcomes. MBRP incorporates specific substance-focused cognitive therapy techniques with an additional emphasis on mindfulness skills. By providing coping skills to address affect regulation and stress reactivity, two important factors in stimulant relapse, MBRP may provide a promising augmenting strategy for the treatment of stimulant users. PUBLIC HEALTH RELEVANCE: Relevance to Public Health: The proposed research is of considerable public health significance in that it will provide foundational information on Mindfulness Based Relapse Prevention as an intervention for stimulant dependence, a serious drug problem with extensive impacts. If proven effective, the protocol could be useful in treating addiction and in reducing stimulant use among treated individuals, thereby efficiently reducing drug abuse and related consequences such as criminal activity, social disruption, and elevated risk of HIV transmission/infection due to increased frequency of unsafe sexual activities, a particularly prominent problem among stimulant users. The proposed project will determine clinical utility of an innovative intervention protocol previously untested in stimulant-dependent individuals.