Mindful MAT Adherence: Mindfulness-Based Relapse Prevention (MBRP) to improve extended-release naltrexone (XR-NTX) adherence and drug-use outcomes for opioid use disorder (OUD).

正念 MAT 依从性：基于正念的复发预防 (MBRP)，可改善阿片类药物使用障碍 (OUD) 的缓释纳曲酮 (XR-NTX) 依从性和药物使用结果。

• 批准号: 10045615
• 负责人: MICHAEL JOHN GAWRYSIAK
• 金额: $ 41.7万
• 依托单位: WEST CHESTER UNIVERSITY OF PENNSYLVANIA
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-09-30 至 2024-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10045615
• 关键词: Address; Adherence; Aftercare; American; Area; Awareness; Behavior Therapy; Behavioral; Career Choice; Clinical; Combined Modality Therapy; Diagnosis; Drug Screening; Drug usage; Enrollment; Exposure to; Face; Foundations; Funding; Future; Group Therapy; Guidelines; Individual; Injections; Intervention; Measures; Mediating; Medical; Mental Health; Monitor; Naltrexone; Nature; Opioid; Outcome; Overdose; Participant; Patient Self-Report; Patients; Pharmaceutical Preparations; Pharmacological Treatment; Procedures; Randomized; Recovery; Relapse; Reporting; Research; Research Activity; Research Assistant; Research Design; Research Methodology; Research Personnel; Research Proposals; Research Support; Residential Treatment; Schedule; Self Care; Severities; Students; Substance Use Disorder; Testing; Trauma; Treatment outcome; Urine; addiction; base; craving; disorder later incidence prevention; distress tolerance; evidence base; follow up assessment; follow-up; group intervention; heroin use; improved; medication compliance; medication-assisted treatment; mindfulness; mindfulness intervention; negative affect; opioid epidemic; opioid use disorder; overdose death; post-traumatic stress; post-traumatic symptoms; premature; prescription opioid; programs; psychologic; research study; stress management; training opportunity; trauma exposure; treatment adherence; treatment as usual; treatment effect; treatment program; undergraduate student; university student

PROJECT SUMMARY/ABSTRACT This proposal aims to determine whether an adjunctive Mindfulness-Based Relapse Prevention (MBRP) treatment program improves medication adherence and reduces drug-use among opioid use disorder (OUD) patients receiving extended-release naltrexone (XR-NTX). The broad long-term objectives of this project are to investigate how integrative pharmacological and behavioral treatments improve OUD treatment outcomes. XR-NTX is an evidenced based medication-assisted treatment (MAT) for OUD that has demonstrated utility in reducing opioid craving and rates of relapse and overdose deaths. However, a large portion of OUD patients demonstrate poor adherence to this medication and subsequently face increased vulnerability to future drug- use. Limited research has examined how behavioral treatments can increase MAT adherence. Mindfulness (i.e., present-centered nonjudgmental awareness), associates with self-care and addiction severity among with substance use disorders (SUD). MBRP is an evidenced-based behavioral group intervention that has demonstrated efficacy in reducing drug-use among patients in recovery from SUD. Emerging research suggests that combining MBRP into MAT for OUD may improve medication adherence and reduce drug-use. The primary study aim is to determine whether MBRP, compared to treatment-as-usual (TAU), delivered to OUD patients receiving XR-NTX through enrollment in a residential addiction treatment facility, results in improved MAT adherence and reduced drug-use following residential discharge. As MBRP is understood to improve self-care and mental health via increases in mindfulness and distress tolerance, the second study aim will test whether these mechanisms of change mediate XR-NTX adherence and drug-use outcomes. As prior trauma exposure is observed to undermine treatment efforts for SUDs a third exploratory study aim will determine the extent to which baseline trauma exposure and posttraumatic stress undermine XR-NTX adherence and drug-use. Expected outcomes are that MBRP participants will demonstrate (1) increased XR- NTX adherence and reduced drug-use monitored across three-months post-treatment, (2) that increased mindfulness and distress tolerance will mediate these outcomes, and (3) that prior trauma exposure and posttraumatic stress will moderate outcomes for TAU participants, but not for MBRP participants. Executing this project will provide enriching research opportunities for student research assistants. Providing students with systematic training and opportunities for exposure to research activities is fundamental to the study PI’s career aspirations and is an essential component to the successful execution of this research proposal. Findings from this research proposal will contribute to endeavor to improve addiction treatment efforts, will provide substantive opportunities for student researchers, and will provide foundational support for the PI’s pursuit of additional R01 funding prior to the conclusion of this study.

项目总结/摘要 这项建议旨在确定是否有一个连续的正念为基础的复发预防（MBRP） 治疗计划提高了药物依从性，减少了阿片类药物使用障碍（OUD）的药物使用 接受纳洛酮缓释剂（XR-NTX）的患者。该项目的广泛长期目标是 研究药物和行为综合治疗如何改善OUD治疗结果。 XR-NTX是一种基于证据的OUD药物辅助治疗（MAT），已证明其在以下方面的实用性： 减少对阿片类药物的渴望以及复发率和过量死亡率。然而，大部分OUD患者 表现出对这种药物的依从性差，随后面临对未来药物的脆弱性增加， 使用.有限的研究已经研究了行为治疗如何增加MAT的依从性。正念 (i.e.,以现在为中心的非判断性意识），与自我护理和成瘾严重程度相关， 物质使用障碍（SUD）。MBRP是一种基于证据的行为团体干预， 证明了在从SUD恢复的患者中减少药物使用的有效性。新兴研究 提示将MBRP与MAT结合用于OUD可能会提高药物依从性并减少药物使用。 主要研究目的是确定与常规治疗（TAU）相比，MBRP是否能达到 OUD患者通过入组住宅成瘾治疗机构接受XR-NTX，导致 改善MAT依从性并减少住院出院后的药物使用。由于MBRP被理解为 通过增加正念和痛苦容忍度来改善自我照顾和心理健康，第二项研究 目的是测试这些变化机制是否介导XR-NTX依从性和药物使用结果。作为 观察到先前的创伤暴露会破坏SUD的治疗效果，第三个探索性研究的目的是 确定基线创伤暴露和创伤后应激损害XR-NTX的程度 坚持和药物使用。预期结果是MBRP参与者将证明（1）XR增加- 在治疗后3个月内监测NTX依从性和减少药物使用，（2）增加 正念和痛苦容忍将介导这些结果，（3）先前的创伤暴露和 创伤后应激将缓和TAU参与者的结果，但不适用于MBRP参与者。 执行该项目将为学生研究助理提供丰富的研究机会。提供 学生有系统的培训和接触研究活动的机会是至关重要的 研究PI的职业抱负，是成功执行本研究的重要组成部分 提议这项研究提案的结果将有助于努力改善成瘾治疗 努力，将为学生研究人员提供实质性的机会，并将提供基础支持， PI在本研究结束前寻求额外的R01资金。