Enhancing Exercise and Psychotherapy to Treat Comorbid Addiction and Pain for ImprovingAdherence to Medication Assisted Treatment in Opioid Use Disorders

加强运动和心理治疗以治疗共病成瘾和疼痛，以提高阿片类药物使用障碍药物辅助治疗的依从性

• 批准号: 10253180
• 负责人: Nora L. Nock
• 金额: $ 22.95万
• 依托单位: CASE WESTERN RESERVE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-09-28 至 2021-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10253180
• 关键词: Abstinence; Address; Adherence; Adult; Affect; Alcohol or Other Drugs use; American; Analgesics; Antipsychotic Agents; Anxiety; Body Weight decreased; Brain; Brain region; Brain-Derived Neurotrophic Factor; Buprenorphine; Cancer Patient; Cognitive Therapy; Communities; Data; Dopamine; Dopamine Agonists; Dose; Endometrial Carcinoma; Enrollment; Exercise; Focus Groups; Food; Growth; Health; Heroin; Individual; Informal Social Control; Inpatients; Intervention; Interview; Learning; Measures; Mechanics; Mediator of activation protein; Memory; Mental Depression; Mental Health; Mental disorders; Methadone; Modification; Motivation; Motor; Obesity; Opiate Addiction; Outpatients; Pain; Pain Threshold; Parkinson Disease; Patients; Pattern; Pharmacotherapy; Phase; Protocols documentation; Psychotherapy; Recovery; Relapse; Reporting; Residential Treatment; Rewards; Self Efficacy; Side; Sleep; Structure; Substance Use Disorder; Substance abuse problem; System; Technology; Testing; Weight; Weight Gain; Withdrawal Symptom; Work; addiction; chronic pain; chronic pain patient; comorbidity; craving; drug craving; effectiveness evaluation; exercise program; experience; illicit opioid; improved; medication-assisted treatment; motor function improvement; motor function recovery; multiphase optimization strategy; novel; opioid use; opioid use disorder; overdose death; pain outcome; pain patient; patient engagement; physical conditioning; preference; prescription opioid; prescription opioid abuse; primary outcome; programs; randomized trial; relating to nervous system; repaired; response; secondary outcome; stroke patient; substance misuse; synthetic opioid; treatment center; treatment program

PROJECT SUMMARY Over 20.3 million adults in the U.S. are estimated to have a substance use disorder (SUD); and, an estimated 2 million Americans have had an opioid use disorder (OUD) involving prescription opioids and about 600,000 have had an OUD involving heroin. The number of overdose deaths from illicit opioids including heroin and synthetic opioids has tripled from 2011 to 2015 in the U.S. Among the more than half-million adults entering addiction treatment for prescription opioid abuse every year, 50%-60% report co-morbid chronic pain and 80% report that pain triggers relapse. Individualized/self-stigma among adults with substance abuse has been shown to lead to delayed recovery, increased relapse and reduced treatment-related attendance. Stigma may induce significant burden on patients with OUD and chronic pain and there may be unique characteristics of stigma for this population due to the overlap between medical treatment and substance abuse. Multiple sources of stigma may be imposed including internalized/self-stigma as well as intragroup/peer-to-peer (“horizontal”) stigma whereby peers impose stigma upon each other based on the type and severity of past drug use (e.g., “hard” vs “soft” users,” “functional addicts” vs. “junkies”). Furthermore, stigma could be “vertical” in that stigma may be enacted by health care providers or by treatment center staff and, this “vertical” sigma may also hinder recovery. However, there is notably a lack of research and related assessment tools to measure these multidimensional facets of stigma, particularly in patients with OUD and chronic pain. Moreover, there have been no prior intervention programs that target multidimensional stigma in adults with OUD and chronic pain. Importantly, the current COVID-19 pandemic may exacerbate stigma and its effects since outbreaks are known to result in intense fear and anxiety leading to significant stigma and implicit biases that can compromise care. Thus, in response to the Notice of Special Interest on Administrative Supplements to Support Strategies to Reduce Stigma in Pain Management and OUD and Treatment (NOT-OD-20-101) and, utilizing an underlying multidimensional model of stigma, we propose to take a mixed-methods approach to expanding our Parent R61 (AT010806) to include evaluation of internalized/self-stigma, anticipated/expected stigma and enacted stigma using existing standardized surveys and, to describing horizontal intragroup/peer-to-peer) and vertical (provider/treatment center staff-to-patient) stigma in individuals with OUD and pain as well as other SUD in residential drug treatment centers at multiple sites. In addition, we propose to integrate the quantitative and qualitative information to help inform modifications to the psychotherapy component (I-STOP) of our Parent R61 intervention, which would then also target multidimensional stigma in patients with OUD and chronic pain. The program could be adapted for use in outpatient and inpatient drug treatment programs to help enhance recovery even in the face of the numerous challenges imposed by the COVID-19 pandemic.

项目摘要 据估计，美国有超过2030万成年人患有物质使用障碍（SUD）;估计有200万美国人患有涉及处方阿片类药物的阿片类药物使用障碍（OUD），约有60万人患有涉及海洛因的OUD。从2011年到2015年，美国非法阿片类药物（包括海洛因和合成阿片类药物）的过量死亡人数增加了两倍，每年有50多万成年人因处方阿片类药物滥用而接受成瘾治疗，其中50%-60%报告患有慢性疼痛，80%报告疼痛引发复发。已证明，药物滥用成年人的个体化/自我污名化会导致延迟恢复、增加复发和减少与治疗有关的就诊。耻辱可能会给OUD和慢性疼痛患者带来重大负担，并且由于医疗和药物滥用之间的重叠，该人群的耻辱可能具有独特的特征。污名化的来源可能有多种，包括内化/自我污名化以及群体内/同伴（“横向”）污名化，即同伴根据过去吸毒的类型和严重程度相互污名化（例如，“硬”与“软”用户，“功能性成瘾者”与“吸毒者”）。此外，污名可能是“垂直”的，因为污名可能由卫生保健提供者或治疗中心的工作人员制定，这种“垂直”西格玛也可能阻碍康复。然而，值得注意的是，缺乏研究和相关的评估工具来衡量这些多方面的耻辱，特别是在OUD和慢性疼痛患者。此外，还没有针对OUD和慢性疼痛成人的多维污名的先前干预计划。重要的是，目前的COVID-19大流行可能会加剧污名化及其影响，因为已知疫情会导致强烈的恐惧和焦虑，导致严重的污名化和隐性偏见，可能会损害护理。因此，为了响应关于支持减少疼痛管理和OUD和治疗中的污名的战略的行政补充的特别关注通知，（NOT-OD-20-101），并利用一个潜在的多维模型的耻辱，我们建议采取混合方法的方法来扩大我们的父母R61（AT 010806）包括使用现有标准化调查评价内化/自我污名、预期/预期污名和已实施污名，描述多个地点的住院药物治疗中心中OUD和疼痛以及其他SUD患者的水平组内/对等）和垂直（提供者/治疗中心工作人员对患者）耻辱。此外，我们建议整合定量和定性信息，以帮助修改我们的父母R61干预的心理治疗组成部分（I-STOP），然后还针对OUD和慢性疼痛患者的多维污名。该计划可适用于门诊和住院药物治疗计划，以帮助加强恢复，即使面对COVID-19大流行带来的众多挑战。