Targeting Military Opioid Misuse with Mindfulness-Oriented Recovery Enhancement
通过以正念为导向的恢复增强来打击军事阿片类药物滥用
基本信息
- 批准号:8655958
- 负责人:
- 金额:$ 22.35万
- 依托单位:
- 依托单位国家:美国
- 项目类别:
- 财政年份:2013
- 资助国家:美国
- 起止时间:2013-09-15 至 2016-07-31
- 项目状态:已结题
- 来源:
- 关键词:Addictive BehaviorAddressAffectAffectiveAftercareAreaAttentionBehaviorBehavioralBuprenorphineChronic DiseaseClinicalClinical ResearchCognitionCognitiveControl GroupsCuesDevelopmentDiseaseDoseEducational InterventionEmotionsEsthesiaEventExhibitsExposure toFeasibility StudiesFundingHabitsHealthIndividualLeadLogisticsMaintenanceMeasuresMediatingMediator of activation proteinMedicalMental HealthMilitary PersonnelModelingNational Institute of Drug AbuseNeurobiologyOpiate AddictionOpioidOpioid AnalgesicsOutcomePainPain managementParticipantPatient Self-ReportPersistent painPersonsPharmaceutical PreparationsPharmacotherapyPilot ProjectsPreventionPreventive InterventionProcessProtocols documentationPublic HealthRandomizedRandomized Controlled TrialsRecording of previous eventsRecoveryRecruitment ActivityRegulationRelapseResearchResearch PersonnelResearch ProposalsRiskSamplingScienceSensoryServicesSignal TransductionSiteSoldierStagingStressSupport GroupsSymptomsSystemTestingTimeTranslational ResearchTreatment outcomeWorkaddictionchronic paincognitive trainingcomparative efficacycravingcue reactivitydrug abuse preventionemotion regulationexperiencefollow-upfunctional disabilityheart rate variabilityimprovedinnovationmembermindfulnessneural circuitnovelopioid misuseprescription drug abuseprescription opioidpreventprimary outcomepsychologicpublic health relevanceresponsereward processingsecondary outcomeselective preventiontherapy designtreatment responsetrial comparingwillingness
项目摘要
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.
慢性疼痛现役军人(ADSM)处方阿片类药物滥用和成瘾
对美国军队的公共健康构成重大威胁许多ADSM患有持续性疼痛状况
在需要使用阿片类药物进行适当治疗的服务行业中发生的。然而,
有慢性疼痛的ADSM有发展成阿片类药物成瘾的风险。吸毒者中的类阿片成瘾
慢性疼痛涉及认知、情感和行为失调,常常导致严重的功能性疼痛,
损害和健康风险。处方阿片类药物成瘾可能源于长期参与
阿片类药物滥用行为,如剂量递增、使用非法阿片类药物或使用阿片类药物自我治疗
负面情绪尽管已经开发出具有较低成瘾倾向的阿片样物质递送系统,但现存的阿片样物质递送系统仍然存在。
在没有维持药物治疗的情况下,治疗的成功率很低。
此外,寻求治疗慢性疼痛的人对现有成瘾反应特别差
治疗。如果没有长期维持,常规药物治疗可能疗效有限
因为他们未能针对并持久地改变失调的认知情感习惯回路,
由疼痛、压力和药物引起的食欲反应。因此,迫切需要采取预防措施,
需要有效地解决从慢性疼痛到阿片类药物的风险链的关键认知情感介质
滥用和成瘾。我们建议测试一种新的选择性预防干预,
正念导向的恢复增强(更多),它集成了正念训练,认知
重新评估,并加强自然奖励处理,以增强心理健康,打破
疼痛,渴望和负面影响的循环导致阿片类药物成瘾的发展。首要目标
这项提案的目的是确定MORE是否减少阿片类药物滥用并防止阿片类药物的发展。
成瘾的ADSM与慢性疼痛谁是在军队的重返社会阶段,
表现出阿片类药物滥用行为将招募120例阿片类药物滥用ADSM伴慢性疼痛的样本
来自科罗拉多州的卡森堡,随机分配到8个MORE组或传统支持组
(塞内加尔)。将在治疗前和治疗后以及6个月随访时进行评估。我们
假设MORE将导致阿片类药物滥用(主要结局)的显著减少,
SG,以及阿片类药物渴望和疼痛的显著更大减少(次要结局)。我们
假设临床结果将通过注意力偏差(AB),情绪调节,
自主线索反应和积极的心理过程。此外,我们假设AB和cue-
治疗后引起的心率变异性将预测阿片类药物复发的发生和时间
误用这项早期随机对照试验的R34资金将允许对一项
基于认知、情感和神经生物学模型的ADSM创新预防干预
科学这项R34提案建立在PI在该领域长达十年的临床和研究工作的基础上,包括他的
之前NIDA资助的R03。
项目成果
期刊论文数量(0)
专著数量(0)
科研奖励数量(0)
会议论文数量(0)
专利数量(0)
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Eric Lee Garland其他文献
Eric Lee Garland的其他文献
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{{ truncateString('Eric Lee Garland', 18)}}的其他基金
Analgesic and Opioid Sparing Brain Mechanisms of Mindfulness-Oriented Recovery Enhancement for Chronic Low Back Pain
镇痛剂和阿片类药物保护慢性腰痛正念导向恢复的大脑机制
- 批准号:
10518975 - 财政年份:2022
- 资助金额:
$ 22.35万 - 项目类别:
Mindful interoceptive mapping: Elucidating a novel mechanism for treating opioid misuse and chronic pain
正念内感受映射:阐明治疗阿片类药物滥用和慢性疼痛的新机制
- 批准号:
10378500 - 财政年份:2021
- 资助金额:
$ 22.35万 - 项目类别:
Targeting Military Opioid Misuse with Mindfulness-Oriented Recovery Enhancement
通过以正念为导向的恢复增强来打击军事阿片类药物滥用
- 批准号:
8731855 - 财政年份:2013
- 资助金额:
$ 22.35万 - 项目类别:
Mindfulness-Oriented Recovery Enhancement For Chronic Pain Patients Receiving Opi
接受 OPI 的慢性疼痛患者以正念为导向的康复增强
- 批准号:
8216332 - 财政年份:2011
- 资助金额:
$ 22.35万 - 项目类别:
Mindfulness-Oriented Recovery Enhancement For Chronic Pain Patients Receiving Opi
接受 OPI 的慢性疼痛患者以正念为导向的康复增强
- 批准号:
8335373 - 财政年份:2011
- 资助金额:
$ 22.35万 - 项目类别:
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