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

摘要 这项以患者为导向的研究职业发展奖(K23)指导申请寻求支持 研究培训，以增强候选人在儿童创伤和阿片类药物并存方面的知识和技能 使用障碍(OUD)来支持她成为一名独立调查员的进步。在颁奖典礼上， 候选人将开发和实施一项与基于技术的正念相关的研究计划 提高阿片类药物使用障碍药物治疗参与度的干预措施和生物标志物的使用 (穆德)那些经历过童年创伤的人。中心假设是自主神经的变化 功能和炎症在儿童创伤和治疗保留不良之间的关系 移动正念训练(MMT)在这一人群中是可行的，潜在的好处是 情绪、炎症和自主神经功能。该提案包括培训活动，以确保Dr。 梅多斯实现了以下职业目标：1)培训发现、解释和评估 评估儿童创伤和预后之间联系的潜在生物标记物，2)高级培训 设计和实施临床干预措施，以及3)数据分析和解释方面的培训。 指导小组包括以下研究领域的专家：物质使用障碍(Dr.Rush 和马丁)、干预发展(拉什博士)，以及在使用移动正念方面具有专业知识的顾问 药物使用障碍培训(雷诺兹博士)，炎症生物标记物评估(莫伊兰博士)，心率 可变性(米纳西安博士)、创伤治疗(斯普朗博士)和高级统计建模(麦克劳斯博士)。Dr。 梅多斯将运用培训中的技能来测试三个具体目标：1)展示基线差异 在有童年病史的人之间的自主神经功能、炎症和治疗参与度方面 在谅解备忘录中登记的创伤和没有童年创伤或创伤后应激障碍的人，2)实施和 对参加Moud的儿童创伤暴露者进行MMT评估，以a)证明其可行性 和可接受性，以及b)估计改善情绪健康、自主神经功能的效果大小，以及 炎症，以及3)评估MMT是否改善了Moud的治疗参与度和保持能力。这个 拟议的研究具有创新性，因为它将为潜在生物标志物之间的关系提供洞察力 以及在穆德的治疗参与。它也非常重要，因为它专注于移动干预， 可以很容易地作为现有治疗计划的附件进行调整，以改善结果。研究、培训 计划、指导和机构支持将促进梅多斯博士向独立医生的转变 医生-科学家，更好地服务于童年创伤暴露和共生的个人的需求 药物使用是治疗辍学和预后不良风险最高的人群。

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.