Distress Tolerance and Reducing Early Relapse in Buprenorphine Patients

描述(由申请人提供)：使用丁丙诺啡开始阿片类激动剂治疗的相当大比例的人在几天内转为非法使用阿片类药物。在这些早期失败者中，很少有人能够在治疗期间持续戒除非法阿片类药物，并且经常离开治疗并复发使用药物，并伴随着艾滋病毒的风险。我们认为，无法忍受阿片类药物戒断的痛苦和与早期戒断相关的负面影响是早期非法阿片类药物失效和随后丁丙诺啡治疗退出的关键因素。这项防止早期失误的提案旨在满足NIDA行为疗法开发计划的第一阶段目标。它将分两个阶段进行。该项目第一阶段(第Ia阶段)的目标是：-开发、改进和试点测试一种基于接受和承诺疗法的技能的DT疗法，以迭代方式与10名丁丙诺啡发起者一起使用，以确定可行性和可接受性。该项目第二阶段(第一阶段)的目标是：-用丁丙诺啡启动剂(n=60)进行初步随机试验，比较痛苦耐受治疗(DT)和健康教育(HE)对照干预，检查：-DT对短期和长期非法阿片类药物使用的影响-DT的影响 第一次非法阿片类药物失效的时间和丁丙诺啡治疗退出的时间--DT对艾滋病毒危险行为的影响(例如，共用注射毒品设备)。该项目将开发一种 为丁丙诺啡发起者提供明确和新颖的行为痛苦耐受治疗，以防止早期非法阿片类药物使用失误、治疗退出和重返艾滋病毒危险行为，其有效性可在未来的第二阶段随机临床试验中测试。这项研究项目还将提供关于阿片类药物戒断、负面情绪、痛苦耐受性和丁丙诺啡结果之间关系的急需知识。

DESCRIPTION (provided by applicant): A significant percentage of individuals who initiate opioid agonist treatment with buprenorphine lapse to illicit opioid use within a matter of days. Very few of these early lapsers are able to become consistently illicit opioid-free during their treatment, and often leave treatment and relapse to drug use with its attendant HIV risk. We propose that inability to tolerate the distress of opioid withdrawal and the negative affect associated with early abstinence are key factors in early illicit opioid lapse and subsequent buprenorphine treatment drop-out. This proposal to prevent early lapse is designed to meet the Stage I objectives of the NIDA Behavioral Therapies Development Program. It will take place in two phases. The Aims of the first phase (Stage Ia) of the project are: - to develop, refine, and pilot test a Distress Tolerance (DT) treatment that utilizes skills based in Acceptance and Commitment Therapy with 10 buprenorphine initiators in an iterative manner to establish feasibility and acceptability. The Aims of the second phase (Stage Ib) of the project are: - to conduct a preliminary randomized trial with buprenorphine initiators (n=60) comparing the distress tolerance treatment (DT) to a health education (HE) comparison intervention, examining: - the effects of DT on both short-and long-term illicit opioid use - the effects of DT on time to first illicit opioid lapse and time to buprenorphine treatment drop-out - the effects f DT on HIV risk behaviors (e.g., sharing of drug injection equipment). This project will develop a well-specified and novel behavioral distress tolerance treatment for buprenorphine initiators to prevent early illicit opioid use lapse, treatment drop-out and return to HIV risk behaviors, the efficacy of which can be tested in future Stage II randomized clinical trials. This research projec will also contribute much- needed knowledge about the relationship between opioid withdrawal, negative affect, distress tolerance, and buprenorphine outcomes.