Developing and testing an intervention to enhance recovery capital amid opioid use disorder pharmacotherapy: A pilot randomized trial of assertive linkage to recovery community centers

开发和测试一种干预措施，以在阿片类药物使用障碍药物治疗中增强康复资本：与康复社区中心建立肯定联系的随机试点试验

• 批准号: 10590626
• 负责人: Lauren A Hoffman
• 金额: $ 18.5万
• 依托单位: MASSACHUSETTS GENERAL HOSPITAL
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-03-15 至 2027-02-28
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10590626
• 关键词: Address; Adherence; Adopted; Aftercare; Ambulatory Care; Aphorisms; Assertiveness; Award; Buprenorphine; Capital; Chronic; Clinic; Clinical; Clinical Treatment; Communities; Coping Skills; Data; Development; Disease remission; Ensure; Evaluation; Exhibits; Feasibility Studies; Feedback; Foundations; Future; Goals; Guidelines; Happiness; Housing; Impairment; Individual; Intervention; Intervention Studies; Interview; Link; Maintenance; Manuals; Measures; Mentors; Methods; National Institute of Drug Abuse; Outcome; Overdose; Pathway interactions; Patients; Personal Satisfaction; Persons; Pharmaceutical Preparations; Pharmacotherapy; Procedures; Protocols documentation; Public Health; Publishing; Qualitative Methods; Randomized; Randomized, Controlled Trials; Recovery; Recovery Support; Research; Resources; Risk; Services; Stress; Substance Use Disorder; Telephone; Testing; Training; Visit; Work; biobehavior; buprenorphine treatment; clinical practice; clinically relevant; community center; design; experience; follow-up; health determinants; improved; insight; meetings; member; novel; opioid epidemic; opioid misuse; opioid use disorder; optimism; patient retention; peer; peer support; programs; protective effect; provider intervention; psychosocial; randomized trial; recovery services; recruit; relapse risk; retention rate; safety net; satisfaction; secondary outcome; sustained recovery; therapy development; treatment program; volunteer

(K.220) 7. Project Summary/Abstract Opioid use disorder (OUD) is associated with disproportionate deficits in the psychosocial determinants of health, with individuals exhibiting recovery capital (i.e. recovery resources) that is one standard deviation below that of other substance use disorders (SUDs) in the first year of recovery. OUD medications (MOUDs) are first-line treatments (Txs) that facilitate recovery by addressing the biophysiological disturbances caused by chronic opioid misuse. Yet, high rates of MOUD discontinuation and associated risks are ongoing concerns and, even when patients (Ps) are retained in Tx, psychosocial deficits often persist, increasing biobehavioral stress and hindering Tx/recovery. Thus, without a foundation of resources for recovery support/maintenance, current and former MOUD Ps are at ongoing risk for psychosocial impairment, which hinders recovery. The provision of recovery support services (RSS) offers one way to address extra-Tx needs and enhance recovery capital to ensure a safety net of resources and healthy coping skills to support MOUD Ps during and after Tx. Recovery Community Centers (RCCs) are a free, newly emerging, and rapidly growing tier of RSS that serve as ‘one-stop- shops’ for recovery capital, offering an array of services catered to the SUD community. RCCs seem to be especially well suited for MOUD Ps, as they operate under the maxim “many pathways [to recovery], all should be celebrated” (including MOUD), and the majority of RCC attendees have OUD and hold positive attitudes toward MOUD. Though early evidence suggests that RCCs can aid SUD recovery, its potential benefit to MOUD Ps has yet to be directly studied. Also, few MOUD Ps know of or use RCCs, and clinical linkage to them is uncommon. Thus, this 5-year project seek to advance our understanding of the clinical and public health utility of RCCs and help bridge the gap between clinical Tx and community-based RSS. As a first step in this work, we will develop and test a new intervention for peer-facilitated assertive linkage of MOUD Ps to RCCs (RCCL), relative to a matched control condition (CC). This study aims to: (1) develop, manualize, and refine RCCL/CC protocols via stakeholder feedback; (2) determine feasibility, acceptability, and preliminary efficacy (RCC attendance, service use, recovery capital) of RCCL vs. CC, via a pilot randomized controlled trial (RCT); (3) Gain in-depth insight to RCCL via qualitative interviews. This study will be the first to test RCCL for MOUD Ps, providing a foundation for larger-scale RCTs, with the potential to ultimately change clinical practice paradigms to address Ps’ extra-Tx needs and inform our ability to expand RCCL provision nationally. The aims support advanced training in: psychosocial determinants of health; RSS; intervention development/testing (via RCT); qualitative methods; ongoing OUD training, with a new focus on intervention research. Training will be fulfilled with expert guidance from Drs. John Kelly, Roger Weiss, Joanne Neale, David Best, Christine Timko, and Corrie Vilsaint. The training and experience provided by this award will serve as a critical foundation from which to build a an important and clinically relevant program of independent research.

（K.220）7.项目总结/摘要 阿片类药物使用障碍（OUD）与健康的心理社会决定因素的不成比例的缺陷有关， 个人表现出的回收资本（即回收资源）低于 其他物质使用障碍（SUD）在恢复的第一年。OUD药物（MOUD）是一线药物 通过解决慢性炎症引起的生物生理学紊乱促进恢复的治疗（Tx） 阿片类药物滥用然而，高MOUD中止率和相关风险是持续关注的问题， 当患者（Ps）留在Tx时，心理社会缺陷通常持续存在，增加生物行为压力， 阻碍Tx/恢复。因此，如果没有恢复支助/维护的资源基础， 前MOUD P持续面临心理社会障碍的风险，这阻碍了康复。提供 恢复支持服务（RSS）提供了一种解决额外Tx需求和增强恢复资本的方法， 确保资源和健康应对技能的安全网，以在治疗期间和治疗后支持MOUD P。恢复 社区中心（RCCs）是一个免费的，新兴的，快速增长的RSS层，作为“一站式”服务， 商店的回收资本，提供一系列服务，迎合南加州大学社区。RCCs似乎 特别适合MOUD P，因为他们在“许多途径[恢复]，所有人都应该”的格言下运作。 值得庆祝”（包括MOUD），大多数RCC与会者都有OUD并持积极态度 朝着MOUD。尽管早期证据表明RCC可以帮助SUD恢复，但其对MOUD的潜在益处 Ps还有待直接研究。此外，很少有MOUD P知道或使用RCC，与它们的临床联系是 少见.因此，这个为期5年的项目旨在促进我们对临床和公共卫生效用的理解 并帮助弥合临床Tx和社区RSS之间的差距。作为这项工作的第一步，我们 将开发和测试一种新的干预措施，用于将MOUD P与RCCs（RCCL）进行同侪促进的自信联系， 相对于匹配控制条件（CC）。本研究的目的在于：（1）开发、手册化和完善RCCL/CC 通过利益相关者反馈制定方案;（2）确定可行性、可接受性和初步疗效（RCC 通过一项随机对照试验（RCT）比较RCCL与CC的出勤率、服务使用、回收资本）;（3）收益 通过定性访谈深入了解RCCL。这项研究将是第一个测试RCCL的MOUD P， 为更大规模的RCT提供基础，并有可能最终改变临床实践模式 解决Ps的额外Tx需求，并告知我们在全国范围内扩大RCCL供应的能力。目标支持 高级培训：健康的社会心理决定因素; RSS;干预措施开发/测试（通过RCT）; 定性方法;正在进行的OUD培训，新的重点是干预研究。将完成培训 在约翰·凯利、罗杰·韦斯、乔安妮·尼尔、大卫·贝斯特、克莉丝汀·蒂姆科和科里博士的专家指导下 维森特该奖项所提供的培训和经验将作为一个关键的基础， 一个重要的和临床相关的独立研究计划。