Targeting Military Opioid Misuse with Mindfulness-Oriented Recovery Enhancement

通过以正念为导向的恢复增强来打击军事阿片类药物滥用

基本信息

  • 批准号:
    8731855
  • 负责人:
  • 金额:
    $ 22.35万
  • 依托单位:
  • 依托单位国家:
    美国
  • 项目类别:
  • 财政年份:
    2013
  • 资助国家:
    美国
  • 起止时间:
    2013-09-15 至 2016-07-31
  • 项目状态:
    已结题

项目摘要

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.
描述(由申请人提供):患有慢性疼痛的现役军人(ADSM)中的处方阿片类药物滥用和成瘾对美国军队构成了重大的公共卫生威胁。许多ADSM遭受持续性疼痛的条件下发生的服务,需要适当的药物治疗阿片类药物。然而,有慢性疼痛的ADSM的一个重要子集有发展阿片类药物成瘾的风险。慢性疼痛患者的阿片类药物成瘾涉及认知、情感和行为失调,通常导致严重的功能障碍和健康风险。处方阿片类药物成瘾可能源于长期从事阿片类药物滥用行为,如剂量递增,使用非法阿片类药物或使用阿片类药物自我抑制负面情绪。虽然已经开发出具有较低成瘾倾向的阿片类药物递送系统,但在缺乏维持药物治疗的情况下,现有治疗的成功率较低。此外,寻求治疗慢性疼痛的人对现有成瘾治疗的反应特别差。传统的药物治疗在没有长期维持的情况下可能具有有限的功效,因为它们未能靶向并持久地改变失调的认知情感习惯回路,该回路控制由疼痛、压力和药物线索引起的食欲反应。因此,迫切需要采取预防干预措施,以有效解决ADSM中从慢性疼痛到阿片类药物滥用和成瘾的风险链中的关键认知情感介导因素。我们建议测试一种新的选择性预防干预,正念导向的恢复增强(MORE),它整合了正念训练,认知重新评估和自然奖励处理的增强,以增强心理健康,打破疼痛,渴望和负面影响的循环,导致阿片类药物成瘾的发展。该提案的总体目标是确定MORE是否减少阿片类药物滥用,并防止处于军事康复阶段并表现出阿片类药物滥用行为的慢性疼痛ADSM中阿片类药物成瘾的发展。将从CO的卡森堡招募120例阿片类药物滥用ADSM伴慢性疼痛的患者,并随机分配至8个MORE组或常规支持组(SG)。将在治疗前和治疗后以及6个月随访时进行评估。我们假设,MORE将导致阿片类药物滥用(主要结局)的减少比SG显著更大,以及阿片类药物渴望和疼痛(次要结局)的显著减少。我们假设,临床结果将介导的变化,注意力偏差(AB),情绪调节,自主线索反应,积极的心理过程。此外,我们假设治疗后AB和提示引起的心率变异性将预测阿片类药物滥用复发的发生和时间。这项早期随机对照试验的R34资金将允许对基于认知,情感和神经生物学科学模型的ADSM创新预防干预进行严格测试。这个R34提案建立在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。

项目成果

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Eric Lee Garland其他文献

Eric Lee Garland的其他文献

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{{ truncateString('Eric Lee Garland', 18)}}的其他基金

Analgesic and Opioid Sparing Brain Mechanisms of Mindfulness-Oriented Recovery Enhancement for Chronic Low Back Pain
镇痛剂和阿片类药物保护慢性腰痛正念导向恢复的大脑机制
  • 批准号:
    10518975
  • 财政年份:
    2022
  • 资助金额:
    $ 22.35万
  • 项目类别:
Mindful interoceptive mapping: Elucidating a novel mechanism for treating opioid misuse and chronic pain
正念内感受映射:阐明治疗阿片类药物滥用和慢性疼痛的新机制
  • 批准号:
    10378500
  • 财政年份:
    2021
  • 资助金额:
    $ 22.35万
  • 项目类别:
Targeting Military Opioid Misuse with Mindfulness-Oriented Recovery Enhancement
通过以正念为导向的恢复增强来打击军事阿片类药物滥用
  • 批准号:
    8655958
  • 财政年份:
    2013
  • 资助金额:
    $ 22.35万
  • 项目类别:
Mindfulness-Oriented Recovery Enhancement For Chronic Pain Patients Receiving Opi
接受 OPI 的慢性疼痛患者以正念为导向的康复增强
  • 批准号:
    8216332
  • 财政年份:
    2011
  • 资助金额:
    $ 22.35万
  • 项目类别:
Mindfulness-Oriented Recovery Enhancement For Chronic Pain Patients Receiving Opi
接受 OPI 的慢性疼痛患者以正念为导向的康复增强
  • 批准号:
    8335373
  • 财政年份:
    2011
  • 资助金额:
    $ 22.35万
  • 项目类别:

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