Exercise: Addressing Stress in Relapse Prevention for Substance Use Disorders

描述(由申请人提供)：所有接受药物使用障碍(SUD)治疗的人中，约有一半在一年内复发。压力和个人对压力的生理反应是复发的重要预测因素。因此，迫切需要减少压力并使个体对压力的生理反应正常化的干预措施。锻炼可以减轻压力，改善身体对压力的调节能力。拟议的项目将利用运动作为一种新的复发预防干预措施，针对最近完成住院SUD治疗的个人。NIDA将锻炼作为一个值得研究的话题，因为锻炼有无数的身心健康益处，并有可能减少药物使用。从历史上看，运动干预措施一直受到严重的消耗和 然而，锻炼的行为干预在解决这些限制方面表现出了希望。我们的试点数据表明，复发很常见，激励性干预显着增加了个人对运动的参与度，而且与不运动的人相比，运动的药物滥用患者的禁欲时间更长。本项目将以随机抽样的方式评估运动动机干预的效果。 150例sud患者开始后续治疗的临床试验。参与者将随机接受两种干预措施之一：(1)标准护理(SC)，或(2)标准护理加三个疗程的激励增强锻炼，间隔12周，结合24周的应急管理强化锻炼(MET+CM)。MET是一种以客户为中心的指导性方法，通过探索和解决矛盾心理来增强内在的变革动机，而CM是一种行为疗法，通过向完成特定目标行为(如锻炼)的个人提供有形的奖励来利用外部动机。在24周内，MET+CM参与者将每周签约锻炼，并将获得完成和验证锻炼的奖励。将在基线、中期和治疗后(0、3和6个月)以及随访(9和12个月)测量体力活动水平、总体压力和应激反应(例如皮质醇、心率)、物质使用、心理社会功能、生活质量以及主观和客观的健康指标(例如自我报告、心血管耐力)。预计与SC相比，MET+CM干预将增加体力活动，改善应激和应激反应，改善心理社会功能和健康指标，同时减少药物使用和复发风险。参与者的特征将与治疗反应相关，包括自我效能感和渴望。这项研究的结果将推动运动作为一种新的策略，在SUD人群中加强生理应激调节和预防复发。

DESCRIPTION (provided by applicant): About half of all individuals who receive treatment for substance use disorders (SUD) relapse within a year. Stress and an individual's biological response to it are significant predictors of relapse. Thus, interventions that decrease stress and normalize an individual's biological response to stress are desperately needed. An exercise decreases stress and improves the body's regulation of stress. The proposed project will utilize exercise as a novel relapse prevention intervention with individuals who have recently completed inpatient SUD treatment. NIDA has targeted exercise as a topic worthy of investigation, as exercise has a myriad of physical and mental health benefits and potentially reduces drug use. Historically, exercise interventions have suffered from significant attrition and poor adherence, however behavioral interventions for exercise show promise in addressing these limitations. Our pilot data suggests that relapse is common and motivational interventions significantly increase individuals' engagement in exercise and that drug-abusing patients who exercise have longer durations of abstinence relative to those who do not engage in exercise. This project will evaluate the efficacy of a motivational intervention for exercise in a randomized clinical trial of 150 SUD patients beginning Aftercare treatment. Participants will be randomized to one of two interventions: (1) standard care (SC), or (2) standard care plus three sessions of motivational enhancement therapy for exercise spaced 12 weeks apart combined with 24 weeks of contingency management reinforcing exercise (MET+CM). MET is a client-centered, directive method of enhancing intrinsic motivation for change by exploring and resolving ambivalence, and CM is a behavioral treatment that utilizes extrinsic motivation by offering individuals tangibl rewards such as prizes for completion of specific target behaviors (e.g., exercise). Across 24 weeks, the MET+CM participants will contract weekly for exercise and will receive prizes for completed and verified exercise. Physical activity levels, overall stress, and stress reactivity (e.g., cortisol, heart rate), substance use, psychosocial functioning, quality of life, and subjectve and objective indicators of health (e.g., self-report, cardiovascular endurance) will be measured at baseline, mid-, and post- treatment (months 0, 3, and 6), and at follow-ups (months 9 and 12). It is expected that the MET+CM intervention will increase physical activity, improve stress and stress reactivity, psychosocial functioning and indicators of health, while decreasing substance use and risk of relapse relative to SC. Participant characteristics will be examined in association with treatment response, including self-efficacy and craving. Results from this study will advance exercise as a new strategy for enhancing physiological stress regulation and prevention of relapse in SUD populations.