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).
项目总结
美国正在经历阿片类药物的使用和过量危机。为了解决这场危机,计划
为阿片使用障碍(MOUD)提供药物的工作正在扩大和加强。穆德是最多的
对OUD进行有效干预,美沙酮治疗(MT)是最常用的MUD处方;
然而,大约一半开始进行机器翻译的人在一年内停止,一半的人保留在
MT在6个月内使用阿片类药物。身体疼痛,情绪失调,以及奖赏处理缺陷,
影响大多数服用MT的人,可能是导致他们持续使用阿片类药物的原因。
解决身体疼痛、情绪失调、奖励处理的新型行为干预
需要在服用Moud的人中出现缺乏症和阿片类药物使用。以正念为导向的康复强化
(更多)将正念、重新评估和品味技能的训练整合到为期8周的团体治疗中
旨在补救支撑OUD的大脑奖励系统中的享乐失调。跨多个
更多的试验表明,在减少阿片类药物的使用、渴求、情绪困扰和其他方面的疼痛方面是有效的
医疗保健设置。我们的R21 Pilot随机对照试验More是第一个展示More
MT临床应用的可行性和可接受性,并有初步疗效的迹象
药物使用、渴求、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,MT患者接受新干预措施的速度可能较慢
因为时间和资源往往是有限的。因此,为了最好地解决潜在的实施问题和
为了优化未来更多的实施和传播,在本研究中,我们将使用类型2,混合
实施效果研究设计。我们不仅会评估MORE的有效性,还会评估
将更多培训人员整合到MT中的障碍和促进者,并评估可持续培训培训人员的影响
关于提供者负担、干预忠诚度和参与度以及患者结果的模型。我们将随机化MT
临床医生将接受1)更高强度、更多实施战略的培训,包括培训-
培训师模型与培训在完整的更多的治疗手册加上监督和反馈或2)最低限度
强化实施策略,由简单的脚本化正念练习(SMP)组成
更多的治疗手册,只需最少的培训,没有监督,最少的反馈。
具体地说,我们的目标是:1)使用RE-AIM(覆盖范围、有效性、采用、实施和
维护)框架,检查在MT和SMP中实施MORE和SMP的障碍和促进者
评估优化培训、保真度和参与度的策略,2)优化现有的More和SMP
培训和实施工具包,包括可加速翻译的适应性资源
证据付诸实践,以及3)更高强度的疗效和治疗保真度评价
实施策略与低强度的SMP实施策略作为MT的辅助工具(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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