Personalized feedback intervention to address hazardous drinking and alcohol-opioid interactions among adults with chronic pain

项目总结/摘要 超过四分之一的美国成年人从事危险饮酒（即，一种酒精消费模式， 增加有害后果的风险），这是美国可预防死亡的第三大原因。 有慢性疼痛（与无慢性疼痛相比）的人危险饮酒的比率明显较高。 此外，20%的阿片类药物处方个人支持同时使用酒精和阿片类药物，这可能 干扰慢性疼痛治疗并导致危险/潜在致命的健康影响。没有发言， 迄今为止，针对的是危险饮酒或在慢性病背景下同时使用酒精和阿片类药物。 痛苦目前的四年期R 01提案是在我们过去工作的基础上制定的一个简短的单一会议， 基于计算机的个性化反馈干预（PFI），旨在提高对不良反应的认识。 疼痛-酒精-阿片类药物的相互关系，增加减少危险饮酒的动机和意图， 关于同时使用酒精和处方阿片类药物的积极态度和意图。 具体来说，我们建议为患有慢性疼痛的危险饮酒者开发一种综合PFI， 处方阿片类药物（PA-PFI）。我们的方法将遵循与NIH指南一致的分阶段模型， 制定和规范行为干预措施。IA阶段活动将包括收集定性和 来自三个迭代焦点小组（N = 21）的定量反馈，以完善干预内容并评估 治疗的可接受性和可行性。IB阶段活动将包括概念验证和高度严格的 一项随机临床试验，旨在比较174例危险患者的PA-PFI与对照PFI（C-PFI） 目前正在服用阿片类药物的慢性疼痛饮酒者。这项研究是一个重要的 这是将基础研究转化为更有效的战略， 在患有医疗合并症的服务不足人群中危险饮酒。拟议的干预 将是高度传播和相关的数以百万计的危险饮酒者与慢性疼痛。鉴于 慢性疼痛、危险饮酒和同时使用酒精处方阿片类药物的集体公共卫生影响 使用，我们相信拟议的研究将产生的结果，提高科学知识，提高我们的 了解相互疼痛-酒精-阿片类药物关系的机制，并告知小说的发展 治疗慢性疼痛的危险饮酒者，适应性强，易于在各种 的医疗机构。

PROJECT SUMMARY/ABSTRACT Over one-quarter of American adults engage in hazardous drinking (i.e., a pattern of alcohol consumption that increases risk for harmful consequences), which is the third leading cause of preventable death in the U.S. Rates of hazardous drinking are significantly higher among individuals with (vs. without) chronic pain. Moreover, 20% of individuals prescribed opioids endorse concurrent alcohol and opioid use, which may interfere with chronic pain treatment and lead to dangerous/potentially fatal health effects. No interventions to date have targeted either hazardous drinking or concurrent use of alcohol and opioids in the context of chronic pain. The current four-year R01 proposal builds upon our past work by developing a brief, single-session, computer-based, personalized feedback intervention (PFI) designed to enhance knowledge regarding adverse pain-alcohol-opioid interrelations, increase motivation and intention to reduce hazardous drinking, and reduce positive attitudes and intention regarding concurrent use of alcohol and prescription opioid medications. Specifically, we are proposing to develop an integrated PFI for hazardous drinkers with chronic pain who are prescribed opioids (PA-PFI). Our approach will follow a staged model consistent with NIH guidelines for developing and standardizing behavioral interventions. Phase IA activities will involve collecting qualitative and quantitative feedback from three iterative focus groups (N = 21) to refine intervention content and evaluate treatment acceptability and feasibility. Phase IB activities will include a proof-of-concept and highly rigorous randomized clinical trial designed to compare PA-PFI to control PFI (C-PFI) among a sample of 174 hazardous drinkers with chronic pain who are currently prescribed opioid medications. This study represents an important and pivotal step in the larger landscape of translating basic research to more efficacious strategies for reducing hazardous drinking among underserved populations with medical comorbidities. The proposed intervention would be highly disseminable and relevant to millions of hazardous drinkers with chronic pain. Given the collective public health impact of chronic pain, hazardous drinking, and concurrent alcohol-prescription opioid use, we believe the proposed study will yield findings that enhance scientific knowledge, enhance our understanding of mechanisms in reciprocal pain-alcohol-opioid relations, and inform the development of novel treatments for hazardous drinkers with chronic pain that are adaptable and easily implemented across a variety of healthcare settings.