Adaption of the STAIR-NT Trauma Intervention for Polysubstance Populations

项目摘要 这一及时而重要的R34提案的目的是适应以证据为基础的创伤后应激 在接受阿片类药物治疗的多物质人群中使用的精神障碍(PTSD)干预 美沙酮维持治疗(MMT)计划中的障碍。高风险组合的多物质使用， 例如非法阿片类药物和兴奋剂，是一个严重的公共卫生问题。从事这些高风险工作的个人 混合体更有可能有童年创伤、多发性创伤、创伤后应激障碍和更严重的创伤后应激障碍的病史 与使用单一物质的个人相比，严重程度。创伤，共病心理健康障碍，如 由于创伤后应激障碍和多物质的使用使治疗结果复杂化。这一创新的试点将使用三个目标来 适应现有的循证创伤后应激障碍干预，情感和人际调节方面的技能培训 使用叙事疗法(STAIR-NT)，通过集中治疗模式(即，浓缩治疗计划) MMT中从事非法阿片类兴奋剂多物质使用的患者。以下是目标 建议：(1)调整循证干预阶梯适用于多物质使用人群 通过适应-ITT框架，(2)评估临时适应的可行性和可接受性 STAIR-NT通过开放试点(n=10)通知进一步的适应，以及(3)进行小规模随机 使用适应的干预措施检查实施情况的控制试点(即可行性和可接受性)和 MMT患者短期多物质使用与创伤后应激障碍症状结局 非法使用阿片类兴奋剂多物质。研究目标的完成将导致一项完全改编的议定书可供使用 在适应的STAIR-NT方法的多点随机试验中。这项研究的长期目标是 通过以下途径改善高危多物质使用人群的健康和治疗结果 阿片类药物治疗方案中创伤知情的循证干预措施的补充分层。

PROJECT ABSTRACT The purpose of this timely and significant R34 proposal is to adapt an evidence-based posttraumatic stress disorder (PTSD) intervention for use among a polysubstance population receiving treatment for opioid use disorder in a methadone maintenance treatment (MMT) program. Polysubstance use of high-risk combinations, such as illicit opioids and stimulants, is a critical public health issue. Individuals who engage in these high-risk combinations are more likely to have histories of childhood trauma, multiple traumas, PTSD, and greater PTSD severity as compared to mono-substance using individuals. Trauma, co-morbid mental health disorders such as PTSD, and polysubstance use complicate treatment outcomes. This innovative pilot will use three aims to adapt an existing evidence-based PTSD intervention, Skills Training in Affective and Interpersonal Regulation with Narrative Therapy (STAIR-NT), via a massed treatment model (i.e., condensed treatment schedule) for patients in MMT who are engaged in illicit opioid-stimulant polysubstance use. The following aims are proposed: (1) to adapt the evidence-based intervention STAIR-NT for polysubstance use populations informed by the ADAPT-ITT framework, (2) to assess the feasibility and acceptability of the provisionally adapted STAIR-NT via an open pilot (n=10) to inform further adaptations, and (3) to conduct a small-scale randomized control pilot using the adapted intervention to examine implementation (i.e., feasibility and acceptability) and short-term polysubstance use and PTSD symptomology outcomes among MMT patients who are engaged in illicit opioid-stimulant polysubstance use. Completion of study aims will result in a fully adapted protocol for use in a multi-site randomized trial of the adapted STAIR-NT approach. The long-term goal of this research is to improve the health and treatment outcomes of populations who engage in high-risk polysubstance use through complementary layering of trauma-informed evidence-based interventions in opioid treatment programs.