Developing a modified brief alcohol-focused intervention tailored for patients with alcohol use disorder in opioid agonist treatment

点击翻译按钮获取中文摘要

7. Project Summary/Abstract This K23 Mentored Patient-Oriented Research Career Development Award involves complementary research and training plans to develop and then pilot a modified motivational enhancement therapy and cognitive behavioral therapy (MET-CBT) intervention tailored to target alcohol use in patients with alcohol use disorder (AUD) in opioid agonist treatment (OAT). Alcohol use is an under-recognized contributor to the opioid crisis, greatly increasing the risk of overdose when used together with opioids. Further, alcohol use and related problems are prevalent among patients in OAT and significantly increase the risk of opioid relapse and treatment dropout. Office-based buprenorphine treatment, a fast-growing form of OAT, is effective at treating opioid use disorder and decreasing risk of opioid overdose, but relapse rates are high in the first year of treatment. With nearly 130 individuals dying each day from an opioid overdose and evidence of recent increases in overdoses during the COVID-19 pandemic, there is an urgent need to increase treatment retention. Reducing alcohol use and use-related problems in patients receiving buprenorphine may have a significant indirect effect on improving buprenorphine outcomes. However, past randomized clinical trials (RCTs) have found no condition effect for brief alcohol-focused intervention for patients in OAT, despite considerable evidence that these interventions are generally effective at reducing alcohol use. Critically, past work examined standard alcohol interventions that were not tailored to individuals in OAT, suggesting that there are unique and significant challenges to alcohol intervention in patients receiving buprenorphine. This K23 project will first qualitatively interview patients with AUD in their first year of office-based buprenorphine treatment and buprenorphine providers to directly inform modifications to an existing MET-CBT protocol, tailoring the intervention to fit the needs and challenges of buprenorphine treatment. Following treatment development and refinement, 60 participants will be randomized to receive two MET-CBT sessions or treatment as usual in a proof-of-concept RCT. Key RCT outcomes will be the feasibility and acceptability of the modified MET-CBT intervention. Sustained benefit will also be evaluated at 1- and 3-month follow-ups in exploratory analyses. Through addressing AUD in people receiving OAT, this proposal is closely aligns with national priorities to improve OAT-related outcomes and to respond to the opioid overdose crisis.