Distress Tolerance and Reducing Early Relapse in Buprenorphine Patients

描述（由申请人提供）：相当大比例的个体开始用丁丙诺啡进行阿片类激动剂治疗，在几天内转为非法使用阿片类药物。在这些早期失学者中，很少有人能够在治疗期间始终不使用非法阿片类药物，他们往往在治疗结束后重新使用药物，并伴有艾滋病毒风险。我们认为，无法忍受阿片类药物戒断的痛苦以及与早期戒断相关的负面影响是早期非法阿片类药物失效和随后丁丙诺啡治疗退出的关键因素。预防早期失忆的建议旨在满足NIDA行为治疗发展计划的第一阶段目标。它将分两个阶段进行。项目第一阶段（Ia阶段）的目标是：开发、完善和试点测试一种痛苦耐受（DT）治疗方法，该治疗方法利用基于接受和承诺治疗的技能，使用10个丁丙诺啡引发剂，以迭代的方式建立可行性和可接受性。该项目第二阶段（Ib阶段）的目的是：-进行一项初步随机试验，用丁丙诺啡启动剂（n=60）比较痛苦耐受治疗（DT）和健康教育（HE）比较干预，检查：- DT对短期和长期非法阿片类药物使用的影响- DT的影响

DESCRIPTION (provided by applicant): A significant percentage of individuals who initiate opioid agonist treatment with buprenorphine lapse to illicit opioid use within a matter of days. Very few of these early lapsers are able to become consistently illicit opioid-free during their treatment, and often leave treatment and relapse to drug use with its attendant HIV risk. We propose that inability to tolerate the distress of opioid withdrawal and the negative affect associated with early abstinence are key factors in early illicit opioid lapse and subsequent buprenorphine treatment drop-out. This proposal to prevent early lapse is designed to meet the Stage I objectives of the NIDA Behavioral Therapies Development Program. It will take place in two phases. The Aims of the first phase (Stage Ia) of the project are: - to develop, refine, and pilot test a Distress Tolerance (DT) treatment that utilizes skills based in Acceptance and Commitment Therapy with 10 buprenorphine initiators in an iterative manner to establish feasibility and acceptability. The Aims of the second phase (Stage Ib) of the project are: - to conduct a preliminary randomized trial with buprenorphine initiators (n=60) comparing the distress tolerance treatment (DT) to a health education (HE) comparison intervention, examining: - the effects of DT on both short-and long-term illicit opioid use - the effects of DT on time to first illicit opioid lapse and time to buprenorphine treatment drop-out - the effects f DT on HIV risk behaviors (e.g., sharing of drug injection equipment). This project will develop a well-specified and novel behavioral distress tolerance treatment for buprenorphine initiators to prevent early illicit opioid use lapse, treatment drop-out and return to HIV risk behaviors, the efficacy of which can be tested in future Stage II randomized clinical trials. This research projec will also contribute much- needed knowledge about the relationship between opioid withdrawal, negative affect, distress tolerance, and buprenorphine outcomes.