The Youth Opioid Recovery Support (YORS) Intervention: An assertive community treatment model for improving medication adherence in young adults with opioid use disorder

青年阿片类药物康复支持 (YORS) 干预：一种自信的社区治疗模式，用于改善患有阿片类药物使用障碍的年轻人的药物依从性

• 批准号: 10594594
• 负责人: MARC FISHMAN
• 金额: $ 49.26万
• 依托单位: MARYLAND TREATMENT CENTERS, INC.
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-08-28 至 2024-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10594594
• 关键词: Abstinence; Address; Adherence; Administrative Supplement; Affect; Aftercare; Age; Amygdaloid structure; Anxiety; Assertiveness; Behavior Therapy; Behavior assessment; Behavioral; Behavioral Mechanisms; Biological Markers; Brain; Buprenorphine; Clinical; Cognition; Cognitive; Communities; Corpus striatum structure; Cues; Data; Data Collection; Decision Making; Development; Dose; Eligibility Determination; Emotional; Emotions; Exhibits; Face; Family; Functional Magnetic Resonance Imaging; Future; Grant; Home; Impulsivity; Injectable; Inpatients; Intervention; Investigation; Knowledge; Link; Magnetic Resonance Imaging; Measures; Mediating; Modeling; Moods; Naltrexone; National Institute of Drug Abuse; Opiate Addiction; Opioid; Outcome; Parents; Participant; Pathway Analysis; Persons; Pharmaceutical Preparations; Phenotype; Population; Process; Psychiatric Diagnosis; Randomized; Randomized Controlled Trials; Recovery Support; Relapse; Research Design; Residential Treatment; Rest; Rewards; Risk; Scanning; Selection for Treatments; Severities; System; Techniques; Treatment Efficacy; Treatment outcome; United States National Institutes of Health; Ventral Striatum; Visit; Withdrawal; Youth; adherence rate; base; behavioral phenotyping; brain behavior; cognitive reappraisal; contingency management; craving; disorder later incidence prevention; efficacy testing; executive function; functional MRI scan; improved; individual variation; innovation; interest; medication compliance; medication nonadherence; neural network; neurobehavioral; neuroimaging; neuromechanism; opioid epidemic; opioid use disorder; outreach; parent grant; parent project; pilot test; predictive modeling; prognostic; programs; prospective; protocol development; relating to nervous system; skills; social; standard of care; treatment adherence; treatment as usual; treatment program; treatment response; uptake; young adult

PROJECT SUMMARY. Young adults with opioid use disorders (OUD) are disproportionately affected by the current opioid crisis and have poorer treatment engagement and adherence compared to their older counterparts with catastrophic consequences. As such, the identification of neural networks and behavioral predictors of treatment adherence and abstinence outcomes related to relapse prevention medication treatment for OUD (termed MOUD) in young adults is of great importance and may enhance treatment refinement efforts and improve precision and efficacy of treatment matching. The purpose of this administrative supplement to NIDA R33DA056230 is to identify neurobehavioral features (brain activity, functional connectivity (FC), and cognition and social/emotional processes) at baseline that are related to medication adherence and opioid relapse (Aim 1) in young adults with OUD receiving extended-release injectable naltrexone (XR-NTX) or buprenorphine (XR-BUP) medication treatment, and investigate how these neurobehavioral features change during treatment (Aim 2). The supplement will use a mechanism-focused prospective ‘add-on’ pre-to-post-treatment study design linked to the parent grant’s randomized controlled trial (RCT) testing the efficacy of enhanced recovery support through the Youth Opioid Recovery Support (YORS) program, a developmentally-informed intervention that incorporates home delivery of MOUD, family engagement, assertive outreach, and contingency management to promote medication adherence. The parent RCT will randomize N=120 young adults ages 18-28 seeking treatment for OUD with XR-NTX or XR-BUP to either the YORS intervention or treatment as usual (TAU) for a 6-month course of MOUD treatment. In the supplement project, N=65 young adults from the parent treatment grant (estimated N=32 each choosing XR- NTX and XR-BUP) who meet MRI eligibility criteria and are randomized to receive the YORS intervention will complete pretreatment and week-12 fMRI scan visits and a pre-treatment ‘deep’ behavioral phenotyping assessment visit. During scan visits, participants will complete fMRI scans during rest, opioid cue exposure, emotional faces presentation, and reward. Data on opioid addiction severity, withdrawal, cravings, impulsivity, mood/anxiety, cognitive regulation skills, decision making, and psychiatric diagnoses will be collected during the behavioral assessment visit. Integrated aspects of the fMRI/phenotyping supplement project and main YORS study will allow for investigation of how resting-state and task-related brain activity and connectivity, and cognitive and social/emotional processes relate to opioid relapse and medication adherence and change during treatment in young adults receiving MOUD treatment. It will also allow for exploratory, albeit underpowered, analyses examining mediating effects of medication choice (XR-BUP versus XR-NTX) on relationships identified in the primary analyses between brain connectivity, opioid relapse, and treatment adherence.

项目摘要。患有绿o的年轻人使用障碍（OUD）受到了不成比例的影响 当前的阿片类药物危机与年龄较大 灾难性后果的对应物。因此，神经网络和行为的识别 预测与预防药物有关的治疗依从性和禁欲结果 在年轻人中对OUD（称为Moud）的治疗非常重要，可能会增强治疗 改进工作并提高治疗匹配的精度和效率。这个目的 NIDA R33DA056230的行政补充是确定神经行为特征（大脑活动， 基线的功能连通性（FC）以及认知和社会/情感过程）与 OUD接受延长释放的年轻人中的药物依从性和阿片类中继（AIM 1） 可注射的纳曲酮（XR-NTX）或丁丙诺啡（XR-BUP）药物治疗，并研究这些如何 神经行为特征在治疗过程中变化（AIM 2）。该补充剂将使用以机制为中心的 潜在的“附加”前处理研究设计与父母赠款的随机对照试验有关 （RCT）通过青年阿片类药物恢复支持（YORS）测试增强恢复支持的有效性 计划，一种发达的干预措施，纳入了穆德（Moud）的送货服务 参与，自信外展和应急管理，以促进药物依从性。父母 RCT将随机n = 18-28岁的120名年轻人寻求用XR-NTX或XR-BUP治疗 YORS的干预措施或治疗（TAU）进行了6个月的MOUD治疗。在 补充项目，n = 65名来自父母治疗赠款的年轻人（估计n = 32个选择XR- 符合MRI资格标准并随机接受YORS干预的NTX和XR-BUP）将 完整的预处理和第12周的fMRI扫描访问和预处理的“深”行为表型 评估访问。在扫描访问期间，参与者将在休息期间完成fMRI扫描，阿片类药物提示暴露， 情感面孔的表现和奖励。有关Ooid成瘾严重程度，戒断，渴望，冲动性的数据 情绪/焦虑，认知调节技能，决策和精神诊断将在期间收集 行为评估访问。 fMRI/表型补充项目的综合方面和主要方面 YORS研究将允许投资静止状态和与任务相关的大脑活动和连通性以及 认知和社会/情感过程与阿片类中继和药物依从性和变化有关 在接受MOUD治疗的年轻人治疗期间。它也将允许探索性，尽管 能力不足的分析检查药物选择的中介作用（XR-BUP与XR-NTX）对 在大脑连通性，阿片类中继和治疗之间的主要分析中确定的关系 坚持。