The Youth Opioid Recovery Support (YORS) Intervention: An assertive community treatment model for improving medication adherence in young adults with opioid use disorder

项目总结。患有阿片类药物使用障碍(OUD)的年轻人受 目前的阿片类药物危机，与他们的老年人相比，他们的治疗参与度和依从性更差 具有灾难性后果的对应者。因此，神经网络的识别和行为 与预防复发药物相关的治疗依从性和戒断结果的预测因素 青壮年的Moud(称为Moud)的治疗非常重要，可能会加强治疗 精细化努力，提高配伍治疗的精确度和有效性。这样做的目的是 NIDA R33DA056230的行政补充是识别神经行为功能(大脑活动， 功能连通性(FC)、认知和社会/情绪过程) 接受缓释治疗的青年患者的药物依从性和阿片类药物复发(目标1) 注射用纳曲酮(XR-NTX)或丁丙诺啡(XR-BUP)的药物治疗，并研究这些 神经行为特征在治疗期间发生改变(目标2)。副刊将使用一种以机制为重点的 与父母赠款的随机对照试验相关的前瞻性“附加”治疗前到治疗后研究设计 (RCT)通过青年阿片类药物康复支持(YORS)测试增强的康复支持的效果 计划，一种发育知情的干预措施，包括在家中接生Moud，家庭 参与、果断的外展和应急管理，以促进服药依从性。父辈 RCT将随机选择N=120名18-28岁的年轻人，寻求使用XR-NTX或XR-BUP治疗OUD YORS干预或常规治疗(TAU)，为期6个月的Moud治疗。在 补充项目，父母治疗补助金中的N=65名年轻人(估计N=32人选择XR- NTX和XR-BUP)符合MRI资格标准并随机接受YORS干预的患者将 完成治疗前和12周的功能磁共振扫描检查，并在治疗前进行深度行为表型分析 评估访问。在扫描访问期间，参与者将在休息、阿片类药物线索暴露、 情绪化的面孔呈现，以及奖励。关于阿片成瘾严重程度，戒断，渴望，冲动， 期间将收集情绪/焦虑、认知调节技能、决策和精神诊断。 行为评估访问。功能磁共振成像/表型分析补充项目的综合方面和主要 你的研究将允许调查休息状态和任务相关的大脑活动和连接是如何进行的，以及 认知和社会/情绪过程与阿片类药物复发、服药依从性和改变有关 在治疗期间接受Moud治疗的青壮年。它还将允许探索性的，尽管 动力不足，分析检查药物选择(XR-BUP与XR-NTX)对 在初步分析中确定的大脑连接、阿片类药物复发和治疗之间的关系 坚持不懈。

PROJECT SUMMARY. Young adults with opioid use disorders (OUD) are disproportionately affected by the current opioid crisis and have poorer treatment engagement and adherence compared to their older counterparts with catastrophic consequences. As such, the identification of neural networks and behavioral predictors of treatment adherence and abstinence outcomes related to relapse prevention medication treatment for OUD (termed MOUD) in young adults is of great importance and may enhance treatment refinement efforts and improve precision and efficacy of treatment matching. The purpose of this administrative supplement to NIDA R33DA056230 is to identify neurobehavioral features (brain activity, functional connectivity (FC), and cognition and social/emotional processes) at baseline that are related to medication adherence and opioid relapse (Aim 1) in young adults with OUD receiving extended-release injectable naltrexone (XR-NTX) or buprenorphine (XR-BUP) medication treatment, and investigate how these neurobehavioral features change during treatment (Aim 2). The supplement will use a mechanism-focused prospective ‘add-on’ pre-to-post-treatment study design linked to the parent grant’s randomized controlled trial (RCT) testing the efficacy of enhanced recovery support through the Youth Opioid Recovery Support (YORS) program, a developmentally-informed intervention that incorporates home delivery of MOUD, family engagement, assertive outreach, and contingency management to promote medication adherence. The parent RCT will randomize N=120 young adults ages 18-28 seeking treatment for OUD with XR-NTX or XR-BUP to either the YORS intervention or treatment as usual (TAU) for a 6-month course of MOUD treatment. In the supplement project, N=65 young adults from the parent treatment grant (estimated N=32 each choosing XR- NTX and XR-BUP) who meet MRI eligibility criteria and are randomized to receive the YORS intervention will complete pretreatment and week-12 fMRI scan visits and a pre-treatment ‘deep’ behavioral phenotyping assessment visit. During scan visits, participants will complete fMRI scans during rest, opioid cue exposure, emotional faces presentation, and reward. Data on opioid addiction severity, withdrawal, cravings, impulsivity, mood/anxiety, cognitive regulation skills, decision making, and psychiatric diagnoses will be collected during the behavioral assessment visit. Integrated aspects of the fMRI/phenotyping supplement project and main YORS study will allow for investigation of how resting-state and task-related brain activity and connectivity, and cognitive and social/emotional processes relate to opioid relapse and medication adherence and change during treatment in young adults receiving MOUD treatment. It will also allow for exploratory, albeit underpowered, analyses examining mediating effects of medication choice (XR-BUP versus XR-NTX) on relationships identified in the primary analyses between brain connectivity, opioid relapse, and treatment adherence.