Motivational Interviewing and Mindfulness-Oriented Recovery Enhancement for Tobacco Dependence and Other Drug use in Methadone Treatment

美沙酮治疗中烟草依赖和其他药物使用的动机访谈和正念导向康复增强

• 批准号: 10589481
• 负责人: Nina Cooperman
• 金额: $ 230.07万
• 依托单位: RUTGERS BIOMEDICAL AND HEALTH SCIENCES
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-09-30 至 2025-09-29
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10589481
• 关键词: Abstinence; Address; Affect; Anxiety; Behavior Therapy; Brain; Cigarette; Clinic; Data; Dissemination and Implementation; Distress; Drug usage; Effectiveness; Functional Magnetic Resonance Imaging; Future; General Population; Group Therapy; Individual; Intervention; Mental Depression; Methods; Motivation; Opioid; Outcome; Pain; Participant; Personal Satisfaction; Persons; Pharmaceutical Preparations; Pilot Projects; Population; Reach Effectiveness Adoption Implementation and Maintenance; Recovery; Relapse; Research Design; Resources; Rewards; Self Efficacy; Smoke; Smoking; Smoking Cessation Intervention; Substance Use Disorder; Support Groups; System; Time; Tobacco; Tobacco Dependence; Tobacco use; Training; United States; cigarette smoke; craving; cue reactivity; drug abstinence; drug relapse; effective intervention; effectiveness evaluation; effectiveness implementation study; emotion dysregulation; emotional distress; evidence base; experience; hedonic; illicit drug use; implementation evaluation; implementation facilitators; implementation strategy; improved; methadone treatment; mindfulness; motivational enhancement therapy; nicotine patch; nicotine replacement; novel; opioid epidemic; opioid use; opioid use disorder; polysubstance use; primary outcome; programs; randomized trial; reward processing; skills; smoking cessation; substance abuse treatment; substance use; success; therapy design; treatment as usual; treatment program; uptake

PROJECT SUMMARY Polysubstance use is common among people with an opioid use disorder (OUD), and, and although approximately 80% of people with OUD smoke cigarettes, tobacco use is rarely addressed in OUD treatment. Smoking cessation interventions that are effective in the general population have been minimally effective among people with an OUD. Yet, smoking cessation is related to reduced drug relapse in this population. Pain and distress, which affect most people receiving methadone treatment (MT) for OUD, are thought to contribute to continued opioid, tobacco, and other drug use. However, typically, MT programs and smoking cessation interventions fail to address the physical pain, emotion dysregulation, and reward processing deficits that co- occur with substance use. Novel behavioral interventions are needed to address these factors and to support opioid, tobacco, and other drug abstinence, simultaneously, in this population, to save and improve lives. Mindfulness-Oriented Recovery Enhancement (MORE) is a novel behavioral intervention that shows promise for addressing opioid, tobacco, and other substance use, separately, and has never been evaluated to address polysubstance use, simultaneously. MORE integrates training in mindfulness, reappraisal, and savoring skills into an 8-week group therapy designed to remediate hedonic dysregulation in brain reward systems underpinning substance use disorders. Also, motivation and self-efficacy for tobacco and other drug use abstinence often differs from motivation and self-efficacy for opioid use abstinence among people in MT; therefore, we will examine the impact of motivational-interviewing (MI) relative to treatment as usual (i.e., “No MI”), prior to MORE or a support group (SG) control intervention, on treatment engagement and outcomes. We will conduct a 2 X 2 randomized trial of MORE vs. a SG, with or without MI, to address opioid, tobacco, and other drug use, simultaneously, among people in MT who smoke cigarettes. All participants will receive combination nicotine replacement therapy (C-NRT). Expedited implementation and dissemination of effective interventions is needed. However, uptake of novel interventions may be slow in MT because time and resources are often limited. To best address potential implementation issues and to optimize future MI and MORE implementation and dissemination, in this study, we will utilize a Type 2, Hybrid Implementation-Effectiveness study design to evaluate an implementation strategy and to assess barriers and facilitators to integrating MI and MORE for polysubstance use into MT. We will: 1) determine MORE’s effectiveness for decreasing tobacco, opioid, and other drug use, simultaneously, among people in MT who smoke (N=420), 2) Determine the effectiveness of an MI session, relative to treatment as usual, for increasing treatment engagement and motivation for decreasing opioid, tobacco, and other drug use, and 3) examine barriers and facilitators to implementing MI and MORE for polysubstance use and evaluate strategies for optimizing training, fidelity, and clinic uptake.

项目摘要 多物质使用在阿片类药物使用障碍（OUD）患者中很常见，尽管 大约80%的OUD患者吸烟，但烟草使用很少在OUD治疗中得到解决。 在一般人群中有效的戒烟干预措施效果甚微 在一个有OUD的人中。然而，戒烟与减少这一人群的药物复吸有关。疼痛 和痛苦，影响大多数接受美沙酮治疗（MT）的OUD患者，被认为有助于 继续使用阿片类药物，烟草和其他药物。然而，一般来说，MT项目和戒烟 干预措施未能解决身体疼痛，情绪失调和奖励处理缺陷，共同 发生在物质使用。需要新的行为干预措施来解决这些因素， 阿片类药物，烟草和其他药物的禁欲，同时，在这个人群中，挽救和改善生命。 正念导向恢复增强（MORE）是一种新颖的行为干预， 承诺单独解决阿片类药物，烟草和其他物质的使用，从未被评估， 同时解决多物质使用问题。MORE整合了正念，重新评估和 品味技巧融入为期8周的团体治疗，旨在纠正大脑奖励中的享乐失调 物质使用障碍的基础系统。此外，烟草和其他药物的动机和自我效能 使用戒断通常与阿片类药物使用戒断的动机和自我效能不同， 因此，我们将研究动机访谈（MI）相对于常规治疗的影响（即， “无MI”），在MORE或支持小组（SG）控制干预之前，接受治疗 和结果。我们将进行一项MORE与SG（伴或不伴MI）的2 × 2随机试验，以解决 阿片类药物，烟草和其他药物的使用，同时，在MT吸烟的人中。所有 参与者将接受尼古丁替代疗法（C-NRT）。 需要加快执行和传播有效的干预措施。然而， 新的干预措施在MT中可能是缓慢的，因为时间和资源通常是有限的。为了最好地发挥潜力， 实施问题，并优化未来的管理信息系统和MORE的实施和传播，在这项研究中， 我们将采用第二类“混合实施-效果”研究设计来评估实施情况 战略，并评估障碍和促进因素，以整合MI和MORE的多物质使用到MT。我们 将：1）确定MORE对减少烟草，阿片类药物和其他药物使用的有效性，同时， 在MT吸烟者中（N=420），2）确定MI会话的有效性，相对于 照常治疗，以增加治疗参与度和减少阿片类药物、烟草和 其他药物使用，以及3）检查实施MI和MORE用于多种药物使用的障碍和促进因素 并评估优化培训、保真度和临床应用的策略。