Improving Opioid Use Disorder Treatment Retention Outcomes Using Mindfulness in Childhood Trauma Survivors

摘要 这个指导以患者为导向的研究职业发展奖（K23）申请寻求支持， 研究培训，以增加候选人在共同发生的儿童创伤和阿片类药物的知识和技能 使用障碍（OUD），以支持她成为一名独立调查员。颁奖期间， 候选人将开发和实施与基于技术的正念相关的研究计划 干预措施和生物标志物的使用，以改善阿片类药物使用障碍的药物治疗参与 （MOUD）在那些经历过童年创伤的人身上。核心假设是，自主神经系统的变化 功能和炎症介导了儿童创伤和治疗保留不良之间的关系， MOUD，并且移动的正念训练（mMT）在这一人群中是可行的，具有潜在的益处， 情绪炎症和自主神经功能本建议书包括培训活动，以确保Dr. 梅多斯实现了以下职业目标：1）在发现，解释和评估的培训 评估儿童创伤与结果之间联系的潜在生物标志物，2） 临床干预措施的设计和实施，以及3）数据分析和解释方面的培训。 导师团队包括以下研究领域的专家：物质使用障碍（Drs. Rush 和马丁），干预发展（拉什博士），和顾问与专业知识的使用移动的正念 物质使用障碍培训（Reynolds博士）、炎症生物标志物评价（Moylan博士）、心率 变异性（Minassian博士），创伤治疗（Sprang博士）和高级统计建模（McLouth博士）。博士 Meadows将应用培训中的技能来测试三个具体目标：1）展示基线差异 在自主神经功能、炎症和治疗参与方面， 创伤和那些没有童年创伤或创伤后应激障碍的人参加谅解备忘录，2）实施和 在MOUD中登记的儿童期创伤暴露个体中评估mMT，以a）证明可行性 和可接受性，以及B）估计情绪健康、自主神经功能和 3）评估mMT是否改善MOUD中的治疗参与和保留。的 拟议的研究是创新的，因为它将提供深入了解潜在的生物标志物之间的关系， 和治疗参与MOUD。它也非常重要，因为它侧重于移动的干预， 可以很容易地作为现有治疗方案的辅助手段来改善结果。研究，培训 计划，指导和机构支持将促进梅多斯博士成为一个独立的过渡 医生-科学家，以更好地服务于共同发生的儿童创伤暴露的个人的需求， 药物使用者退出治疗和结果不佳的风险最高。

ABSTRACT This Mentored Patient-Oriented Research Career Development Award (K23) application seeks support for research training to augment the candidate’s knowledge and skills in co-occurring childhood trauma and opioid use disorder (OUD) in order to support her progress to become an independent investigator. During the award, the candidate will develop and implement a research program related to technology-based mindfulness interventions and use of biomarkers to improve engagement in medication treatment for opioid-use disorder (MOUD) in those who have experienced childhood trauma. The central hypothesis is that changes in autonomic function and inflammation mediate the relationship between childhood trauma and poor treatment retention in MOUD, and that mobile mindfulness training (mMT) is feasible in this population with potential benefits to emotional, inflammatory, and autonomic function. This proposal includes training activities to ensure Dr. Meadows achieves the following career goals: 1) Training in the discovery, interpretation, and assessment of potential biomarkers to assess the link between childhood trauma and outcomes, 2) Advanced training in the design and implementation of clinical interventions, and 3) Training in the analysis and interpretation of data. The mentorship team includes experts in the following areas of research: substance use disorders (Drs. Rush and Martin), intervention development (Dr. Rush), and advisors with expertise in the use of mobile mindfulness training for substance use disorder (Dr. Reynolds), inflammatory biomarker evaluation (Dr. Moylan), heart rate variability (Dr. Minassian), trauma treatment (Dr. Sprang), and advanced statistical modeling (Dr. McLouth). Dr. Meadows will apply the skills from the training to test the three specific aims: 1) Demonstrate baseline differences in autonomic function, inflammation, and treatment engagement between those with a history of childhood trauma and those without childhood trauma or post-traumatic stress disorder enrolled in MOU, 2) Implement and evaluate mMT in childhood trauma-exposed individuals enrolled in MOUD in order to a) demonstrate feasibility and acceptability and b) estimate effect sizes for improvements in emotional health, autonomic function, and inflammation, and 3) Assess whether mMT improves treatment engagement and retention in MOUD. The proposed research is innovative because it will provide insight into the relationship between potential biomarkers and treatment engagement in MOUD. It is also highly significant because it focuses on a mobile intervention that can be readily adapted as an adjunct to existing treatment programs to improve outcomes. The research, training plan, mentorship, and institutional support will facilitate Dr. Meadows’s transition to becoming an independent physician-scientist to better serve the needs of individuals with co-occurring childhood trauma exposure and substance use who are at the highest risk of treatment dropout and poor outcomes.