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

项目摘要/摘要 超过四分之一的美国成年人从事危险饮酒(即，一种 增加有害后果的风险)，这是美国可预防的死亡的第三大原因。 有慢性疼痛的人(与没有慢性疼痛的人相比)的危险饮酒率明显更高。 此外，20%的处方阿片类药物个人赞同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。没有任何干预措施 Date的目标是在慢性疾病背景下危险饮酒或同时使用酒精和阿片类药物 疼痛。目前为期四年的R01提案建立在我们过去工作的基础上，制定了一个简短的、单一的、 基于计算机的个性化反馈干预(PFI)旨在增强有关不良反应的知识 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，并减少 对同时使用酒精和处方阿片类药物持积极态度和意愿。 具体地说，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指南一致的阶段性模式 制定和规范行为干预措施。IA阶段的活动将包括收集质量和 来自三个迭代焦点小组(N=21)的定量反馈，以细化干预内容并进行评估 治疗可接受性和可行性。IB阶段的活动将包括概念验证和高度严格的 在174个危险样本中比较PA-PFI和对照PFI(C-PFI)的随机临床试验 患有慢性疼痛的饮酒者，目前正在服用阿片类药物。这项研究代表了一项重要的 在将基础研究转化为更有效的战略方面迈出关键一步 有医疗合并症的服务不足人群中的危险饮酒。拟议的干预措施 对数百万患有慢性疼痛的危险饮酒者来说，将具有高度的传播性和相关性。给定 慢性疼痛、危险饮酒和同时使用酒精处方阿片类药物对集体公共健康的影响 我们相信，拟议的研究将产生增强科学知识、增强我们的 了解疼痛-酒精-阿片类药物相互作用的机制，并为新药的发展提供信息 针对患有慢性疼痛的危险饮酒者的治疗方法，适应性强，易于在各种情况下实施 医疗保健设置。

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.