Exercise: Addressing Stress in Relapse Prevention for Substance Use Disorders

描述（由申请人提供）：大约一半接受药物使用障碍（SUD）治疗的人在一年内复发。压力和个体的生物反应是复发的重要预测因素。因此，迫切需要减少压力和使个人对压力的生物反应正常化的干预措施。运动可以减轻压力，改善身体对压力的调节。拟议的项目将利用运动作为一种新的复发预防干预与个人谁最近完成了住院SUD治疗。NIDA将运动作为一个值得研究的主题，因为运动对身体和心理健康有无数好处，并可能减少药物使用。从历史上看，运动干预遭受了重大的自然减员， 坚持性差，然而，锻炼的行为干预在解决这些限制方面显示出希望。我们的试点数据表明，复发是常见的，动机干预显着增加个人的参与运动和药物滥用患者谁行使有较长的禁欲时间相对于那些谁不从事运动。本项目将在一个随机的研究中评估动机干预对运动的有效性。 150名SUD患者开始接受后续治疗的临床试验。参与者将被随机分配到两种干预措施中的一种：（1）标准治疗（SC），或（2）标准治疗加三次间隔12周的运动动机增强治疗，并结合24周的应急管理强化运动（MET+CM）。MET是一种以客户为中心的指导性方法，通过探索和解决矛盾心理来增强改变的内在动机，CM是一种行为治疗，通过向个人提供有形奖励来利用外在动机，例如完成特定目标行为的奖励（例如，锻炼）。在24周内，MET+CM参与者将每周签订锻炼合同，并将获得完成和验证锻炼的奖品。身体活动水平、整体压力和压力反应（例如，皮质醇、心率）、物质使用、心理社会功能、生活质量，以及健康的主观和客观指标（例如，自我报告，心血管耐力）将在基线、治疗中期和治疗后（第0、3和6个月）以及随访（第9和12个月）时进行测量。预计MET+CM干预将增加体力活动，改善压力和压力反应，心理社会功能和健康指标，同时减少物质使用和相对于SC复发的风险。将检查参与者的特征与治疗反应，包括自我效能和渴望。这项研究的结果将推动运动成为增强SUD人群生理压力调节和预防复发的新策略。

DESCRIPTION (provided by applicant): About half of all individuals who receive treatment for substance use disorders (SUD) relapse within a year. Stress and an individual's biological response to it are significant predictors of relapse. Thus, interventions that decrease stress and normalize an individual's biological response to stress are desperately needed. An exercise decreases stress and improves the body's regulation of stress. The proposed project will utilize exercise as a novel relapse prevention intervention with individuals who have recently completed inpatient SUD treatment. NIDA has targeted exercise as a topic worthy of investigation, as exercise has a myriad of physical and mental health benefits and potentially reduces drug use. Historically, exercise interventions have suffered from significant attrition and poor adherence, however behavioral interventions for exercise show promise in addressing these limitations. Our pilot data suggests that relapse is common and motivational interventions significantly increase individuals' engagement in exercise and that drug-abusing patients who exercise have longer durations of abstinence relative to those who do not engage in exercise. This project will evaluate the efficacy of a motivational intervention for exercise in a randomized clinical trial of 150 SUD patients beginning Aftercare treatment. Participants will be randomized to one of two interventions: (1) standard care (SC), or (2) standard care plus three sessions of motivational enhancement therapy for exercise spaced 12 weeks apart combined with 24 weeks of contingency management reinforcing exercise (MET+CM). MET is a client-centered, directive method of enhancing intrinsic motivation for change by exploring and resolving ambivalence, and CM is a behavioral treatment that utilizes extrinsic motivation by offering individuals tangibl rewards such as prizes for completion of specific target behaviors (e.g., exercise). Across 24 weeks, the MET+CM participants will contract weekly for exercise and will receive prizes for completed and verified exercise. Physical activity levels, overall stress, and stress reactivity (e.g., cortisol, heart rate), substance use, psychosocial functioning, quality of life, and subjectve and objective indicators of health (e.g., self-report, cardiovascular endurance) will be measured at baseline, mid-, and post- treatment (months 0, 3, and 6), and at follow-ups (months 9 and 12). It is expected that the MET+CM intervention will increase physical activity, improve stress and stress reactivity, psychosocial functioning and indicators of health, while decreasing substance use and risk of relapse relative to SC. Participant characteristics will be examined in association with treatment response, including self-efficacy and craving. Results from this study will advance exercise as a new strategy for enhancing physiological stress regulation and prevention of relapse in SUD populations.