Implementation and Effectiveness of Mindfulness Oriented Recovery Enhancement as an Adjunct to Methadone Treatment for Opioid Use Disorder
正念导向康复增强作为美沙酮治疗阿片类药物使用障碍的辅助疗法的实施和有效性
基本信息
- 批准号:10705707
- 负责人:
- 金额:$ 68.5万
- 依托单位:
- 依托单位国家:美国
- 项目类别:
- 财政年份:2022
- 资助国家:美国
- 起止时间:2022-09-30 至 2027-07-31
- 项目状态:未结题
- 来源:
- 关键词:AbstinenceAccelerationAddressAdherenceAffectAmericanAnxietyBehavior TherapyBrainCOVID-19Case StudyClinicClinical TrialsCommunitiesDataDisparityDissemination and ImplementationDropoutDrug PrescriptionsDrug usageEducational MaterialsEffectivenessFeedbackFutureGroup TherapyHeroinInternetInterventionManualsMeasuresMental DepressionMethodsModelingOpioidPainPatient-Focused OutcomesPatientsPersonal SatisfactionPersonsPopulationProviderQuality of lifeRandomizedRandomized, Controlled TrialsReach, Effectiveness, Adoption, Implementation, and MaintenanceRecoveryRelapseResearch DesignResourcesRewardsSupervisionSystemTechnologyTimeTrainers TrainingTrainingTranslationsUnited StatesUniversitiesVideoconferencingacceptability and feasibilityaddictionarmcravingeffective interventioneffectiveness evaluationeffectiveness testingeffectiveness trialeffectiveness/implementation studyemotion dysregulationemotional distressevidence baseexperiencehealth care settingshedonicimplementation facilitatorsimplementation strategymedication for opioid use disordermethadone treatmentmindfulnessmindfulness interventionnovelopioid epidemicopioid overdoseopioid useopioid use disorderprescription opioid misusepreventprimary outcomeprogramsremediationremote deliveryreward processingsecondary outcomeskillssuccesstherapy designtimelinetreatment as usualuptake
项目摘要
PROJECT SUMMARY
The United States is experiencing an opioid use and overdose crisis. To address this crisis, programs that
provide medication for opioid use disorder (MOUD) are being expanded and enhanced. MOUD is the most
effective intervention for an OUD, and methadone treatment (MT) is the most commonly prescribed MOUD;
however, approximately half of people who begin MT discontinue within a year, and half of people retained in
MT use opioids within six months. Physical pain, emotion dysregulation, and reward processing deficits,
affecting most people on MT, could be contributing to their ongoing opioid use.
Novel behavioral interventions that address physical pain, emotion dysregulation, reward processing
deficits and opioid use among people on MOUD are needed. Mindfulness-Oriented Recovery Enhancement
(MORE) integrates training in mindfulness, reappraisal, and savoring skills into an 8-week group therapy
designed to remediate hedonic dysregulation in brain reward systems underpinning OUD. Across multiple
trials, MORE has demonstrated efficacy for reducing opioid use, craving, emotional distress, and pain in other
healthcare settings. Our R21 pilot randomized controlled trial of MORE was the first to demonstrate MORE’s
feasibility and acceptability as delivered in MT clinics, with indications of preliminary efficacy for decreasing
drug use, craving, depression, anxiety, and pain for people with OUD. Further, expedited implementation and
dissemination of effective interventions is needed. However, uptake of novel interventions may be slow in MT
because time and resources are often limited. Therefore, to best address potential implementation issues and
to optimize future MORE implementation and dissemination, in this study, we will utilize a Type 2, Hybrid
Implementation-Effectiveness study design. We will not only evaluate MORE’s effectiveness but also assess
barriers and facilitators to integrating MORE into MT and evaluate the impact of a sustainable train-the-trainer
model on provider burden, intervention fidelity and engagement, and patient outcomes. We will randomize MT
clinicians to receive training in 1) a higher intensity MORE implementation strategy consisting of a train-the-
trainer model with training in the full MORE treatment manual plus supervision and feedback or 2) a minimal
intensity implementation strategy consisting of a simple, scripted mindfulness practice (SMP) extracted from
the MORE treatment manual with minimal training, no supervision, and minimal feedback.
Specifically, we aim to: 1) using a RE-AIM (reach, effectiveness, adoption, implementation, and
maintenance) framework, examine barriers and facilitators to implementation of MORE and SMP in MT and
evaluate strategies for optimizing training, fidelity, and engagement, 2) optimize existing MORE and SMP
training and implementation toolkits, including adaptable resources that can accelerate the translation of
evidence into practice, and 3) evaluate effectiveness and treatment fidelity of a higher intensity MORE
implementation strategy versus a lower intensity SMP implementation strategy as an adjunct to MT (N=420).
项目摘要
美国正在经历阿片类药物使用和过量危机。为了解决这一危机,
为阿片类药物使用障碍(MOUD)提供药物的工作正在扩大和加强。MOUD是最
有效干预OUD,美沙酮治疗(MT)是最常用的MOUD处方;
然而,大约一半开始MT的人在一年内停止,
MT在六个月内使用阿片类药物。身体疼痛,情绪失调,奖励处理缺陷,
影响大多数MT患者,可能导致他们持续使用阿片类药物。
新的行为干预,解决身体疼痛,情绪失调,奖励处理
需要在MOUD人群中使用阿片类药物。以正念为导向的恢复增强
(更多)将正念、重新评估和品味技能的培训整合到为期8周的团体治疗中
旨在修复支撑OUD的大脑奖励系统中的享乐失调。跨多个
在临床试验中,MORE已经证明了减少阿片类药物使用,渴望,情绪困扰和其他疼痛的有效性。
医疗保健设置。我们的R21试点随机对照试验是第一个证明MORE的
在MT诊所提供的可行性和可接受性,以及降低
吸毒、渴望、抑郁、焦虑和疼痛。此外,加快执行和
需要传播有效的干预措施。然而,新的干预措施的吸收可能是缓慢的MT
因为时间和资源往往有限。因此,为了最好地解决潜在的执行问题,
为了优化未来MORE的实施和传播,在本研究中,我们将使用第2类混合型
实施效果研究设计。我们不仅会评估MORE的有效性,
将MORE纳入MT的障碍和促进因素,并评估可持续的培训员培训的影响
提供者负担、干预忠诚度和参与度以及患者结局的模型。我们将MT随机化
临床医生接受培训,1)更高强度的更多实施策略,包括培训,
培训师模型,在完整的MORE治疗手册中进行培训,加上监督和反馈,或2)最低限度
强度实施策略,包括一个简单的,脚本正念练习(SMP)提取自
更多的治疗手册,最少的培训,没有监督,最少的反馈。
具体来说,我们的目标是:1)使用RE-AIM(覆盖范围,有效性,采用,实施,
维护)框架,审查在MT中实施MORE和SMP的障碍和促进因素,
评估优化培训、忠诚度和参与度的策略,2)优化现有的MORE和SMP
培训和实施工具包,包括可加快翻译
将证据付诸实践,3)评估更高强度的有效性和治疗保真度更多
实施策略与较低强度SMP实施策略作为MT的辅助(N=420)。
项目成果
期刊论文数量(4)
专著数量(0)
科研奖励数量(0)
会议论文数量(0)
专利数量(0)
Mindfulness-Oriented Recovery Enhancement for Veterans and Military Personnel on Long-Term Opioid Therapy for Chronic Pain: A Randomized Clinical Trial.
退伍军人和军人长期阿片类药物治疗慢性疼痛的正念康复增强:一项随机临床试验。
- DOI:10.1176/appi.ajp.20230272
- 发表时间:2024
- 期刊:
- 影响因子:0
- 作者:Garland,EricL;Nakamura,Yoshio;Bryan,CraigJ;Hanley,AdamW;Parisi,Anna;Froeliger,Brett;Marchand,WilliamR;Donaldson,GaryW
- 通讯作者:Donaldson,GaryW
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Nina Cooperman其他文献
Nina Cooperman的其他文献
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{{ truncateString('Nina Cooperman', 18)}}的其他基金
Optimizing Patient-Centered Opioid Tapering with Mindfulness-Oriented Recovery Enhancement
通过以正念为导向的恢复增强来优化以患者为中心的阿片类药物逐渐减少
- 批准号:
10715903 - 财政年份:2023
- 资助金额:
$ 68.5万 - 项目类别:
Implementation and Effectiveness of Mindfulness Oriented Recovery Enhancement as an Adjunct to Methadone Treatment for Opioid Use Disorder
正念导向康复增强作为美沙酮治疗阿片类药物使用障碍的辅助疗法的实施和有效性
- 批准号:
10501361 - 财政年份:2022
- 资助金额:
$ 68.5万 - 项目类别:
Motivational Interviewing and Mindfulness-Oriented Recovery Enhancement for Tobacco Dependence and Other Drug use in Methadone Treatment
美沙酮治疗中烟草依赖和其他药物使用的动机访谈和正念导向康复增强
- 批准号:
10589481 - 财政年份:2022
- 资助金额:
$ 68.5万 - 项目类别:
Mindfulness Oriented Recovery Enhancement as an Adjunct to Methadone Treatment for Opioid Use and Chronic Pain Management
以正念为导向的恢复增强作为阿片类药物使用和慢性疼痛管理的美沙酮治疗的辅助手段
- 批准号:
10020321 - 财政年份:2018
- 资助金额:
$ 68.5万 - 项目类别:
Developing a Smoking Cessation Intervention for Methadone Maintained Smokers
为继续使用美沙酮的吸烟者制定戒烟干预措施
- 批准号:
8015155 - 财政年份:2009
- 资助金额:
$ 68.5万 - 项目类别:
Developing a Smoking Cessation Intervention for Methadone Maintained Smokers
为继续使用美沙酮的吸烟者制定戒烟干预措施
- 批准号:
8700582 - 财政年份:2009
- 资助金额:
$ 68.5万 - 项目类别:
Developing a Smoking Cessation Intervention for Methadone Maintained Smokers
为继续使用美沙酮的吸烟者制定戒烟干预措施
- 批准号:
8126470 - 财政年份:2009
- 资助金额:
$ 68.5万 - 项目类别:
Developing a Smoking Cessation Intervention for Methadone Maintained Smokers
为继续使用美沙酮的吸烟者制定戒烟干预措施
- 批准号:
7936889 - 财政年份:2009
- 资助金额:
$ 68.5万 - 项目类别:
Developing a Smoking Cessation Intervention for Methadone Maintained Smokers
为继续使用美沙酮的吸烟者制定戒烟干预措施
- 批准号:
8316390 - 财政年份:2009
- 资助金额:
$ 68.5万 - 项目类别:
Developing a Smoking Cessation Intervention for Methadone Maintained Smokers
为继续使用美沙酮的吸烟者制定戒烟干预措施
- 批准号:
7788003 - 财政年份:2009
- 资助金额:
$ 68.5万 - 项目类别:
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