Behavioral Treatment Development for Co-occurring Opioid Dependence and Anxiety

描述（由申请人提供）：焦虑是使用阿片类药物的风险因素，焦虑症在阿片类药物依赖者中非常普遍。此外，患有阿片类药物依赖和焦虑症的患者在治疗后往往会出现更差的药物使用，焦虑和功能结果。尽管阿片类药物依赖和焦虑症之间存在联系，以及与其共同发生相关的风险，但对这种常见的双重诊断知之甚少，有效的治疗方案尚未确定。Rebecca Kathryn McHugh博士的职业目标是进行以患者为导向的研究，重点是物质依赖和焦虑症的共同发生。本申请中提出的综合培训和研究计划将为McHugh博士提供几个关键领域的高级培训，以加强她对这一职业目标的研究计划。在药物依赖领域国际知名领导人的指导下，培训针对以下领域：（一）共病临床研究（罗杰韦斯博士），（2）阿片类药物依赖的性质和治疗（韦斯博士），（3）行为治疗开发和测试（Shelly格林菲尔德博士），（4）压力在物质依赖中的作用（Rajita Sinha博士），和（5）纵向数据分析技术（加勒特菲茨莫里斯博士）。这些培训目标将通过教学和应用活动相结合，并通过在第1阶段行为培训中应用这些技能来实现。 治疗开发试验，涉及开发和试点测试的一种新的综合认知行为治疗共同发生的阿片类药物依赖和焦虑（I-CBT）。每个培训领域的目标学习领域与本研究的具体目标直接相关，其中包括（1）开发阿片类药物依赖和焦虑症（I-CBT）的综合认知行为治疗手册，（2）与阿片类药物依赖的标准CBT相比，试点测试I-CBT减少阿片类药物使用和焦虑症状的疗效，（3a）检查治疗前对应激的反应性与治疗后阿片类药物使用结果之间的关联，以及（3b）检查治疗后应激反应性的变化。姆克林医院和哈佛医学院为实现这些培训和研究目标提供了理想的环境，包括支持以患者为导向的研究的临床单位，指定培训领域的研讨会和课程，以及具有广泛职业发展和培训资源的高度活跃的临床和转化科学中心。该K23奖将为McHugh博士提供一系列高级技能，旨在补充她之前的培训，并在她之前的经验和她的职业目标之间提供一个重要的桥梁，以作为一名独立的科学家进行以患者为导向的积极研究计划，最终目标是减少物质依赖和焦虑症的公共卫生负担。

DESCRIPTION (provided by applicant): Anxiety is a risk factor for the use of opioids and anxiety disorders are highly prevalent among individuals with opioid dependence. Moreover, individuals with co-occurring opioid dependence and anxiety disorders often experience poorer drug use, anxiety, and functional outcomes following treatment. Despite the links between opioid dependence and anxiety disorders and the risk associated with their co-occurrence, very little is known about this common dual diagnosis, and efficacious treatment options have yet to be established. Dr. Rebecca Kathryn McHugh's career goal is to conduct patient-oriented research focused on the co-occurrence of substance dependence and anxiety disorders. The integrated training and research plans proposed in this application will provide Dr. McHugh with advanced training in several critical areas needed to enhance her program of research toward this career goal. Under the mentorship of internationally renowned leaders in the field of substance dependence, training is targeted to the following domains: (1) clinical research in co- occurring disorders (Dr. Roger Weiss), (2) the nature and treatment of opioid dependence (Dr. Weiss), (3) behavioral treatment development and testing (Dr. Shelly Greenfield), (4) the role of stress in substance dependence (Dr. Rajita Sinha), and (5) longitudinal data analytic techniques (Dr. Garrett Fitzmaurice). These training objectives will be achieved through a combination of didactic and applied activities and through the application of these skills in a Stage 1 behavioral treatment development trial involving the development and pilot testing of a novel integrated cognitive behavioral treatment for co-occurring opioid dependence and anxiety (I-CBT). Target areas for learning in each training domain are directly linked to the specific aims of this researc study, which include (1) the development of an integrated cognitive behavioral treatment manual for opioid dependence and anxiety disorders (I-CBT), (2) pilot testing the efficacy of I-CBT for reducing opioid use and anxiety symptoms compared to standard CBT for opioid dependence, (3a) the examination of the association between pre-treatment reactivity to stress and opioid use outcomes following treatment, and (3b) the examination of changes in stress reactivity following treatment. McLean Hospital and Harvard Medical School provide an ideal environment for the attainment of these training and research objectives, including clinical units supportive o patient-oriented research, seminars and courses in designating training areas, and a highly active Clinical and Translational Science Center with a wide array of resources for career development and training. This K23 Award would provide Dr. McHugh with a repertoire of advanced skills designed to complement her prior training and to provide an essential bridge between her prior experience and her career goal to conduct an active program of patient-oriented research as an independent scientist, toward the ultimate goal of reducing the public health burden of substance dependence and anxiety disorders.