NEURAL MECHANISMS IN WOMEN’S TREATMENT AND EARLY RECOVERY

 描述（由申请人提供）：心理压力是物质使用障碍（SUD）发病机制和复发风险的因果因素。低收入妇女报告说，除了适应住院治疗需求的挑战外，由于重大的经济和家庭压力，在SUD住院治疗中压力很大。无法控制的压力，特别是在住院治疗的早期阶段，是一个主要问题，因为它会增加辍学率。从住院治疗中退出使妇女面临药物使用复发的风险。知识差距持续存在，关于使用基于正念的干预措施（MBIs）与种族和民族多样化的低收入妇女SUD，特别是关于适应MBIs的有效性，以防止住宅辍学和减少复发。本申请的长期目标是通过针对压力、住院辍学和复发改善黑人、西班牙裔和白色低收入SUD女性的治疗结局。我们已经完全适应，开发和试点测试了一种新的MBI，在妇女的恢复时刻：基于正念的复发预防妇女（MBRP-W），支持妇女在住院治疗的需求。它在物质使用和感知压力结果方面显示出有希望的结果，并且结果没有种族或民族差异。该MBI整合了复发预防，解决了识字水平问题，并与处境不利妇女的治疗和复发相关压力因素有关。中心假设将通过追求三个具体目标进行检验：（1）检验MBRP-W对黑人、西班牙裔和白色低收入妇女住院治疗（a）保留和（B）药物使用复发的疗效，以确定;（2）MBRP-W计划背后的变化机制;以及（3）与自我报告的压力相比，作为慢性压力标志物的头发皮质醇的变化是否提供了更有力的压力测量作为变化机制。MBRP-W的一个基本原理是，在住院治疗的早期压力阶段，SUD女性需要自我启动的压力管理技能，这会增加辍学和复发的风险。该应用程序的独特优势在于其专注于服务不足的人群，居住辍学和复发结果，以及首次将慢性压力生物标志物以头发皮质醇的形式纳入MBI研究。拟议的工作是创新的，因为它打算减少妇女的压力，以改善保留和复发的结果。预期的结果将定义一个可行的综合治疗，可以提高压力管理技能和治疗结果，并将评估慢性压力的生物标志物的效用。本研究的结果将对不同低收入妇女群体的药物使用恢复结果产生积极影响，并确定行动机制，为未来的SUD治疗提供信息。该项目的公共卫生影响达到了NIDA的目标，因为它打算通过向不应得的妇女提供一种新的治疗方法来防止成瘾及其健康后果的升级，这种治疗方法有望减少与成瘾有关的种族和民族以及基于性别的健康差异。

 DESCRIPTION (provided by applicant): Psychological stress is a causal factor in the pathogenesis of substance use disorder (SUD) and relapse risk. Low-income women report high levels of stress in SUD residential treatment stemming from significant economic and family stressors in addition to challenges adjusting to residential treatment demands. Unmanaged stress, especially in early stages of residential treatment, is a major concern because it can increase dropout. Dropout from residential treatment places women at risk of substance use relapse. A gap in knowledge persists regarding the use of mindfulness-based interventions (MBIs) with racially and ethnically diverse low-income women with SUDs, especially regarding the efficacy of adapted MBIs for preventing residential dropout and decreasing relapse. The long-term goal of this application is to improve treatment outcomes in Black, Hispanic and White low-income women with SUDs by targeting stress, residential dropout, and relapse. We have fully adapted, developed, and pilot tested a novel MBI, Moment-by-Moment in Women's Recovery: Mindfulness Based Relapse Prevention for Women (MBRP-W), that supports the needs of women in residential treatment. It showed promising results in substance use and perceived stress outcomes and no racial or ethnic differences in outcomes. This MBI integrates relapse prevention, addresses literacy level, and is relevant to issues surrounding treatment- and relapse-related stressors of disadvantaged women. The central hypothesis will be tested by pursuing three specific aims: (1) to test the efficacy of MBRP-W on residential treatment (a) retention and (b) substance use relapse in Black, Hispanic and White low-income women to determine; (2) the mechanisms of change underlying the MBRP-W program; and (3) if changes in hair cortisol as a marker of chronic stress provide a more powerful measure of stress compared to self- reported stress as a mechanism of change. A rationale for MBRP-W is the need for self-initiated stress management skills in women with SUDs during the early stressful periods of residential treatment that increase risk of dropout and relapse. The unique strengths of this application are its focus on underserved populations, residential dropout, and relapse outcomes, and the first-ever inclusion of a chronic stress biomarker in MBI research in the form of hair cortisol. The proposed work is innovative in that it intends to reduce stress in women to improve both retention and relapse outcomes. The expected results will define a viable integrative treatment that can improve stress management skills and treatment outcomes and will evaluate the utility of a biomarker of chronic stress. Results of this study will have a positive impact on substance use recovery outcomes in diverse groups of low-income women and identify mechanisms of action to inform future SUD treatment. The project's public health impact meets NIDA goals because it intends to prevent the escalation of addiction and its health consequences by offering a novel treatment accessible to undeserved women that is expected to decrease addiction-related racial and ethnic and gender-based health disparities.