A Brief Values Intervention to Support Veterans in Early Buprenorphine Treatment

拟议的职业发展奖（CDA-2）将支持维多利亚阿梅拉尔博士，临床研究 VISN 1新英格兰精神疾病研究、教育和临床中心（MIRECC） 最近毕业于VA跨专业高级成瘾奖学金，她的目标是成为一名 阿片类药物使用障碍（OUD）退伍军人的恢复导向行为干预专家。药物 OUD通过防止复发和过量来挽救生命，但它们并没有积极地直接解决 退伍军人在早期恢复中的功能挑战。辅助性行为干预有望实现这一目标 该领域，但现有的方法很少优于标准的丁丙诺啡药物管理。这可能 这是由于早期疗程倾向于集中在症状上（即，欲望和冲动）， 通过药物治疗解决。拟议的研究旨在制定一个简短的，基于价值观的 干预，而不是专注于帮助改善退伍军人的人际功能和社区 在早期治疗过程中。这两个面向恢复的概念与已知的 OUD的功能后果，是恢复结果的关键预测因素。三个阶段和 当前提案的各自目标涵盖了Rounsaville的第1a和1b阶段中概述的活动， 行为治疗发展模式。具体而言，手册开发（阶段1a）将包括利益相关者 采访退伍军人和VA提供者（目标1）和一个开放的试点与一个小样本的退伍军人领域 测试干预措施（目标2）。拟议研究的最后阶段将是一个试点随机对照试验 (RCT)与标准药物管理相比，标准护理和大多数 与该人群进行研究的共同比较条件（目标3），这将提供可行性和 干预的可接受性数据。这些目标将直接支持随后的RR&D MERIT提案， 对由此产生的干预措施进行全面的随机对照试验，也将为 目前建议的培训目标是建立在博士的基础上。 Ameral在接受和承诺疗法（接受和承诺疗法的理论基础）方面的临床背景 建议的干预），在转化实验研究的经验，并表现出承诺， 退伍军人管理局的研究生涯中恢复为导向的成瘾。这些培训目标将通过一系列正式的 培训经验，以及高效率VA导师团队的支持和指导 具有互补专业知识和技能的研究人员。具体而言，目前的提案将解决关键问题， 候选人在相关内容领域的知识和技能差距（以恢复为导向的研究，行为 干预开发，OUD的药物治疗）和方法学方法（进行临床试验， 定性方法，临床试验的统计分析），以及领导力和专业发展， 支持拟议的研究和职业规划。总而言之，本报告概述的研究和培训工作 该提案将使Ameral博士成为以恢复为导向的干预措施领域的领先研究人员 退伍军人与OUD。

The proposed Career Development Award (CDA-2) would support Dr. Victoria Ameral, Clinical Research Psychologist with the VISN 1 New England Mental Illness Research, Education, and Clinical Center (MIRECC) and recent graduate of the VA Interprofessional Advanced Addiction Fellowship, in her goal of becoming an expert in recovery-oriented behavioral interventions for Veterans with Opioid Use Disorder (OUD). Medications for OUD save lives by preventing relapse and overdose, but they do not actively directly address the significant functional challenges for Veterans in early recovery. Adjunctive behavioral interventions hold promise for this area, but existing approaches rarely outperform standard buprenorphine medication management. This may be due to a tendency for early sessions to focus on symptoms (i.e., cravings and urges) that are already addressed by medication treatment. The proposed research seeks to develop a brief, values-based intervention which instead focuses on helping to improve Veterans’ interpersonal functioning and community integration during early treatment. These two recovery-oriented concepts are closely linked to the known functional consequences of OUD and are key predictors of recovery outcomes. The three phases and respective aims for the current proposal cover the activities outlined in Stages 1a and 1b of Rounsaville’s Behavioral Therapy Development Model. Specifically, manual development (Stage 1a) will include stakeholder interviews with Veterans and VA Providers (Aim 1) and an open pilot with a small sample of Veterans to field test the intervention (Aim 2). The final phase of the proposed research will be a pilot randomized controlled trial (RCT) of the intervention compared to standard medication management, the standard of care and most common comparison condition for research with this population (Aim 3), which will provide feasibility and acceptability data for the intervention. These aims will directly support a subsequent RR&D MERIT proposal to conduct a full-scale RCT of the resulting intervention and will also provide invaluable experience for the candidate’s intended long-term career path. The current proposal’s training aims are designed to build on Dr. Ameral’s clinical background in Acceptance and Commitment Therapy (the theoretical foundation for the proposed intervention), experience in translational experimental research, and demonstrated commitment to a VA research career in recovery-oriented addiction. These training aims will be met through a series of formal training experiences together with support and guidance from a mentorship team of highly productive VA researchers with complementary expertise and skills sets. Specifically, the current proposal will address critical knowledge and skills gaps for the candidate in relevant content areas (recovery-oriented research, behavioral intervention development, medications for OUD) and methodological approaches (conducting clinical trials, qualitative methods, statistical analysis for clinical trials), and leadership and professional development to support the proposed research and career plan. In sum, the research and training outlined in the current proposal will position Dr. Ameral to become a leading researcher in the area of recovery-oriented interventions for Veterans with OUD.