Motivational Interviewing and Mindfulness-Oriented Recovery Enhancement for Tobacco Dependence and Other Drug use in Methadone Treatment

项目总结 多物质使用在阿片类药物使用障碍(OUD)患者中很常见，尽管 大约80%的吸烟者吸烟，烟草的使用很少在OUD治疗中被提及。 在普通人群中有效的戒烟干预措施效果微乎其微 在有声音的人中间。然而，在这一人群中，戒烟与减少药物复发有关。疼痛 和痛苦，这影响了大多数接受美沙酮治疗(MT)的人，被认为是原因之一 持续使用阿片类药物、烟草和其他药物。然而，通常情况下，MT计划和戒烟 干预未能解决身体疼痛、情绪失调和奖赏处理缺陷，这些都是共同的 发生在使用物质的时候。需要新的行为干预措施来解决这些因素并支持 阿片类药物、烟草和其他药物的戒除，同时，在这一人群中，以拯救和改善生活。 以正念为导向的康复增强(MORE)是一种新型的行为干预，它表明 承诺单独解决阿片类药物、烟草和其他物质的使用问题，从未被评估为 同时解决多种物质的使用问题。更多地整合了正念、重新评估和 在为期8周的集体治疗中品味技能，旨在纠正大脑奖励中的享乐失调 支持药物使用障碍的系统。此外，烟草和其他药物的动机和自我效能感 戒除阿片类药物的动机和自我效能在以下人群中往往不同 因此，我们将考察激励性访谈(MI)相对于通常治疗的影响(即， 在More或支持组(SG)控制干预之前)，关于治疗参与度 和结果。我们将进行一项2×2的随机试验，将更多的人与SG进行比较，无论是否有MI，以解决 阿片类药物、烟草和其他药物的使用，同时，在MT吸烟的人中。全 参与者将接受联合尼古丁替代疗法(C-NRT)。 需要加快实施和传播有效干预措施。然而，对 新的干预措施在MT中可能会很慢，因为时间和资源往往是有限的。以最大限度地发挥潜力 在这项研究中，为了解决执行问题，并优化未来的管理信息和更多的执行和传播， 我们将利用类型2、混合实施-有效性研究设计来评估实施 战略，并评估将MI和更多多物质使用纳入MT的障碍和促进者。我们 将：1)同时确定MORE在减少烟草、阿片类药物和其他药物使用方面的有效性， 在MT中吸烟的人(N=420)中，2)决定MI治疗的有效性，相对于 照常治疗，以增加治疗参与度和减少阿片类药物、烟草和 其他药物使用，以及3)检查实施MI的障碍和促进者，以及多物质使用的更多障碍 并评估优化培训、保真度和临床应用的策略。

PROJECT SUMMARY Polysubstance use is common among people with an opioid use disorder (OUD), and, and although approximately 80% of people with OUD smoke cigarettes, tobacco use is rarely addressed in OUD treatment. Smoking cessation interventions that are effective in the general population have been minimally effective among people with an OUD. Yet, smoking cessation is related to reduced drug relapse in this population. Pain and distress, which affect most people receiving methadone treatment (MT) for OUD, are thought to contribute to continued opioid, tobacco, and other drug use. However, typically, MT programs and smoking cessation interventions fail to address the physical pain, emotion dysregulation, and reward processing deficits that co- occur with substance use. Novel behavioral interventions are needed to address these factors and to support opioid, tobacco, and other drug abstinence, simultaneously, in this population, to save and improve lives. Mindfulness-Oriented Recovery Enhancement (MORE) is a novel behavioral intervention that shows promise for addressing opioid, tobacco, and other substance use, separately, and has never been evaluated to address polysubstance use, simultaneously. MORE integrates training in mindfulness, reappraisal, and savoring skills into an 8-week group therapy designed to remediate hedonic dysregulation in brain reward systems underpinning substance use disorders. Also, motivation and self-efficacy for tobacco and other drug use abstinence often differs from motivation and self-efficacy for opioid use abstinence among people in MT; therefore, we will examine the impact of motivational-interviewing (MI) relative to treatment as usual (i.e., “No MI”), prior to MORE or a support group (SG) control intervention, on treatment engagement and outcomes. We will conduct a 2 X 2 randomized trial of MORE vs. a SG, with or without MI, to address opioid, tobacco, and other drug use, simultaneously, among people in MT who smoke cigarettes. All participants will receive combination nicotine replacement therapy (C-NRT). Expedited implementation and dissemination of effective interventions is needed. However, uptake of novel interventions may be slow in MT because time and resources are often limited. To best address potential implementation issues and to optimize future MI and MORE implementation and dissemination, in this study, we will utilize a Type 2, Hybrid Implementation-Effectiveness study design to evaluate an implementation strategy and to assess barriers and facilitators to integrating MI and MORE for polysubstance use into MT. We will: 1) determine MORE’s effectiveness for decreasing tobacco, opioid, and other drug use, simultaneously, among people in MT who smoke (N=420), 2) Determine the effectiveness of an MI session, relative to treatment as usual, for increasing treatment engagement and motivation for decreasing opioid, tobacco, and other drug use, and 3) examine barriers and facilitators to implementing MI and MORE for polysubstance use and evaluate strategies for optimizing training, fidelity, and clinic uptake.