Targeting Military Opioid Misuse with Mindfulness-Oriented Recovery Enhancement

伴有慢性疼痛的现役军人处方阿片类药物滥用和成瘾 对美国军方构成重大的公共卫生威胁。许多ADSM患者患有持续性疼痛 在需要适当的阿片类药物治疗的服务行业中发生的。然而，一个相当大的子集 患有慢性疼痛的ADSM患者有发展成阿片成瘾的风险。患有阿片类药物者中的阿片成瘾 慢性疼痛涉及认知、情感和行为失调，通常会导致严重的功能障碍 损害和健康风险。对处方阿片类药物的上瘾可能是由于长期参与 阿片类药物滥用行为，如剂量增加、使用非法阿片类药物或使用阿片类药物自我用药 负面情绪。虽然已经开发出成瘾倾向较低的阿片类药物输送系统，但现有的 在没有维持性药物治疗的情况下，治疗的成功率很低。 此外，寻求慢性疼痛治疗的人对现有的成瘾反应特别差 治疗。如果没有长期的维持，传统的药物治疗可能效果有限。 因为它们不能针对并持久地改变支配着 由疼痛、压力和药物线索引起的食欲反应。因此，迫切需要采取预防干预措施。 需要有效解决从慢性疼痛到阿片类药物等风险链的关键认知-情感调节因素 青少年成瘾者的滥用和成瘾情况。我们建议测试一种新的选择性预防干预措施， 以正念为导向的恢复增强(MORE)，它将正念训练、认知 重新评估，并加强自然奖励处理，以增强心理健康和打破 疼痛、渴望和负面影响的循环导致阿片成瘾的发展。最重要的目标 这项建议的目的是确定是否更多地减少阿片类药物的滥用和防止阿片类药物的发展 处于军事生命周期重新融入阶段的慢性疼痛成瘾者的成瘾情况 表现出阿片类药物滥用行为。120例阿片类药物滥用ADSM合并慢性疼痛的样本将被招募 来自科罗拉多州卡森堡，并随机分配到8个小组会议或一个传统的支持小组 (SG)。将在治疗前和治疗后进行评估，并每月进行6次随访。我们 假设更多的阿片类药物滥用将显著减少(主要结果) SG组，以及阿片类药物渴求和疼痛(次要结果)的显著减少。我们 假设临床结果将通过注意偏差(AB)、情绪调节、 自主线索反应性和积极的心理过程。此外，我们假设AB和CUE- 治疗后诱发的心率变异性将预测阿片类药物复发的发生和时间 滥用。R34为这项早期随机对照试验提供资金将允许对 基于认知、情感和神经生物学模型的ADSM创新预防干预 科学。这份R34提案建立在PI在这一领域长达十年的临床和研究工作的基础上，包括他的 之前由NIDA资助的R03。

Prescription opioid misuse and addiction among active duty service members (ADSM) with chronic pain present significant public health threats to the U.S. Military. Many ADSM suffer from persistent pain conditions incurred in the line of service that require appropriate medical treatment with opioids. Yet, a substantial subset of ADSM with chronic pain is at risk for developing opioid addiction. Opioid addiction among persons with chronic pain involves cognitive, affective, and behavioral dysregulation that often results in serious functional impairment and health risks. Addiction to prescription opioids may emerge from prolonged engagement in opioid misusing behaviors, such as dose escalation, use of illicit opioids, or use of opioids to self-medicate negative emotions. Although opioid delivery systems with lower addiction liability have been developed, extant treatments have low rates of successful outcomes in the absence of maintenance pharmacotherapy. Moreover, persons seeking treatment for chronic pain respond especially poorly to existing addictions treatments. Conventional pharmacotherapies may have limited efficacy without long-term maintenance because they fail to target and durably alter dysregulated cognitive-affective habit circuits which govern appetitive responses elicited by pain, stress, and drug cues. As such, prevention interventions are urgently needed to effectively address key cognitive-affective mediators of the risk chain from chronic pain to opioid misuse and addiction among ADSM. We propose to test a novel selective prevention intervention, Mindfulness-Oriented Recovery Enhancement (MORE), which integrates mindfulness training, cognitive reappraisal, and enhancement of natural reward processing to augment psychological health and break the cycle of pain, craving, and negative affect leading to the development of opioid addiction. The overarching aim of this proposal is to determine whether MORE reduces opioid misuse and prevents the development of opioid addiction among ADSM with chronic pain who are in the reintegration stage of the Military Lifecycle and exhibiting opioid misuse behaviors. A sample of 120 opioid misusing ADSM with chronic pain will be recruited from Fort Carson, CO, and randomly assigned to 8 group sessions of MORE or a conventional support group (SG). Assessments will be conducted at pre- and post-treatment, as well for 6 monthly follow-ups. We hypothesize that MORE will result in significantly greater reductions in opioid misuse (primary outcome) than the SG, as well as significantly greater decreases in opioid craving and pain (secondary outcomes). We hypothesize that clinical outcomes will be mediated by changes in attentional bias (AB), emotion regulation, autonomic cue-reactivity, and positive psychological processes. Furthermore, we hypothesize that AB and cue- elicited heart rate variability following treatment will predict the occurrence and timing of relapse to opioid misuse. R34 funding for this early stage randomized controlled trial will allow for a rigorous test of an innovative prevention intervention for ADSM grounded in models from cognitive, affective, and neurobiological science. This R34 proposal builds on the PI's decade-long clinical and research work in this area, including his prior NIDA-funded R03.