Targeting Military Opioid Misuse with Mindfulness-Oriented Recovery Enhancement

描述(由申请人提供)：患有慢性疼痛的现役军人(ADSM)中处方阿片类药物的滥用和成瘾对美国军方构成严重的公共卫生威胁。许多ADSM在服务过程中遭受持续的疼痛状况，需要适当的阿片类药物治疗。然而，相当一部分患有慢性疼痛的ADSM存在发展成阿片成瘾的风险。慢性疼痛患者中的阿片成瘾涉及认知、情感和行为的放松，这往往会导致严重的功能障碍和健康风险。对处方阿片类药物的上瘾可能是由于长期参与阿片类药物的滥用行为，如剂量增加、使用非法阿片类药物或使用阿片类药物自我治疗负面情绪。虽然已经开发出成瘾倾向较低的阿片类药物输送系统，但在没有维持药物治疗的情况下，现有治疗的成功率很低。此外，寻求慢性疼痛治疗的人对现有的成瘾治疗反应特别差。如果没有长期的维持，传统的药物疗法可能效果有限，因为它们无法靶向并持久地改变失控的认知-情感习惯回路，这些回路支配着由疼痛、压力和药物线索引起的食欲反应。因此，迫切需要预防干预措施，以有效解决从慢性疼痛到阿片类药物滥用和成瘾等风险链的关键认知-情感调节因素。我们建议测试一种新的选择性预防干预措施，面向正念的康复增强(More)，它集成了正念训练、认知重新评估和自然奖励处理的增强，以增强心理健康，打破导致阿片成瘾发展的疼痛、渴望和负面情绪的循环。这项建议的首要目标是确定是否有更多的阿片类药物滥用，并防止处于军事生命周期重新融入阶段并表现出阿片类药物滥用行为的慢性疼痛成瘾者形成阿片成瘾。120名阿片类药物滥用ADSM伴慢性疼痛的样本将从科罗拉多州卡森堡招募，并随机分配到8个小组，其中多人或传统支持组(SG)。将在治疗前和治疗后进行评估，并每月进行6次随访。我们假设，与SG相比，更多的药物将导致阿片类药物滥用的显著减少(主要结果)，以及阿片类药物渴望和疼痛的显著减少(次要结果)。我们假设临床结果将通过注意偏向(AB)、情绪调节、自主神经线索反应性和积极心理过程的变化来调节。此外，我们假设AB和线索诱导的心率变异性在治疗后将预测阿片类药物滥用复发的发生和时间。R34对这项早期随机对照试验的资助将允许对ADSM的创新预防干预进行严格测试，该干预基于认知、情感和神经生物学科学的模型。这项R34建议建立在PI在这一领域长达十年的临床和研究工作的基础上，包括他之前由NIDA资助的R03。

DESCRIPTION (provided by applicant): Prescription opioid misuse and addiction among active duty service members (ADSM) with chronic pain present significant public health threats to the U.S. Military. Many ADSM suffer from persistent pain conditions incurred in the line of service that require appropriate medical treatment with opioids. Yet, a substantial subset of ADSM with chronic pain is at risk for developing opioid addiction. Opioid addiction among persons with chronic pain involves cognitive, affective, and behavioral deregulation that often results in serious functional impairment and health risks. Addiction to prescription opioids may emerge from prolonged engagement in opioid misusing behaviors, such as dose escalation, use of illicit opioids, or use of opioids to self-medicate negative emotions. Although opioid delivery systems with lower addiction liability have been developed, extant treatments have low rates of successful outcomes in the absence of maintenance pharmacotherapy. Moreover, persons seeking treatment for chronic pain respond especially poorly to existing addictions treatments. Conventional pharmacotherapies may have limited efficacy without long-term maintenance because they fail to target and durably alter deregulated cognitive-affective habit circuits which govern appetitive responses elicited by pain, stress, and drug cues. As such, prevention interventions are urgently needed to effectively address key cognitive-affective mediators of the risk chain from chronic pain to opioid misuse and addiction among ADSM. We propose to test a novel selective prevention intervention, Mindfulness-Oriented Recovery Enhancement (MORE), which integrates mindfulness training, cognitive reappraisal, and enhancement of natural reward processing to augment psychological health and break the cycle of pain, craving, and negative affect leading to the development of opioid addiction. The overarching aim of this proposal is to determine whether MORE reduces opioid misuse and prevents the development of opioid addiction among ADSM with chronic pain that are in the reintegration stage of the Military Lifecycle and exhibiting opioid misuse behaviors. A sample of 120 opioid misusing ADSM with chronic pain will be recruited from Fort Carson, CO, and randomly assigned to 8 group sessions of MORE or a conventional support group (SG). Assessments will be conducted at pre- and post-treatment, as well for 6 monthly follow-ups. We hypothesize that MORE will result in significantly greater reductions in opioid misuse (primary outcome) than the SG, as well as significantly greater decreases in opioid craving and pain (secondary outcomes). We hypothesize that clinical outcomes will be mediated by changes in attention bias (AB), emotion regulation, autonomic cue-reactivity, and positive psychological processes. Furthermore, we hypothesize that AB and cue- elicited heart rate variability following treatment will predict the occurrence and timing of relapse to opioid misuse. R34 funding for this early stage randomized controlled trial will allow for a rigorous test of an innovative prevention intervention for ADSM grounded in models from cognitive, affective, and neurobiological science. This R34 proposal builds on the PI's decade-long clinical and research work in this area, including his prior NIDA-funded R03.