Mindful MAT Adherence: Mindfulness-Based Relapse Prevention (MBRP) to improve extended-release naltrexone (XR-NTX) adherence and drug-use outcomes for opioid use disorder (OUD).

正念 MAT 依从性：基于正念的复发预防 (MBRP)，可改善阿片类药物使用障碍 (OUD) 的缓释纳曲酮 (XR-NTX) 依从性和药物使用结果。

• 批准号: 10440607
• 负责人: MICHAEL JOHN GAWRYSIAK
• 金额: $ 13.12万
• 依托单位: WEST CHESTER UNIVERSITY OF PENNSYLVANIA
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-09-30 至 2024-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10440607
• 关键词: Address; Adherence; Administrative Supplement; African American; Aftercare; Alcohols; Applications Grants; Appointment; Awareness; Behavior Therapy; Clinical Research; Clinical Trials; Cocaine; Cognitive Therapy; Collaborations; Discrimination; Drug Screening; Drug usage; Enrollment; Exposure to; Funding; Future; Group Therapy; Heterogeneity; Imprisonment; Individual; Knowledge; Link; Measures; Mediating; Medical; Mental Health; Mindfulness Training; Monitor; Naltrexone; National Institute of Drug Abuse; Opioid; Outcome; Outpatients; Parents; Participant; Patient Noncompliance; Patient Self-Report; Patients; Pharmacological Treatment; Play; Preparation; Prevalence; Procedures; Race; Randomized; Randomized Clinical Trials; Recording of previous events; Recovery; Reporting; Research; Research Activity; Research Design; Research Proposals; Residential Treatment; Role; Schedule; Secure; Self Care; Severities; Substance Use Disorder; Testing; Trauma; Treatment outcome; Underrepresented Minority; United States National Institutes of Health; Urine; Vulnerable Populations; addiction; base; behavioral pharmacology; black patient; caucasian American; design; disorder later incidence prevention; disparity reduction; drug misuse; effective therapy; evidence base; experience; follow up assessment; follow-up; health disparity; health equity; health equity promotion; improved; intervention effect; medication compliance; medication-assisted treatment; mindfulness; opioid mortality; opioid use; opioid use disorder; prevent; programs; psychiatric symptom; racial discrimination; racial diversity; resilience; substance misuse; substance use; symptomatic improvement; therapy outcome; trauma exposure; trauma symptom; traumatic stress; treatment adherence; treatment as usual; treatment program; treatment response

PROJECT SUMMARY/ABSTRACT The aims of the parent-study are to determine whether an adjunctive Mindfulness-Based Relapse Prevention (MBRP) treatment program improves medication adherence and reduces drug-use among opioid use disorder (OUD) patients receiving Medication Assisted Treatment (MAT). The broad long-term objectives of this project are to investigate how integrative pharmacological and behavioral treatments improve OUD treatment outcomes. The aim of this Administrative Supplement to Existing NIH-NIDA Grants proposal is to enhance the focus on racial health equity issues within the context of the randomized clinical trial (RCT) parent-study. Although a strong evidence-base exists supporting MAT for OUD, Black Americans often contend with additional inequities and hardships that may render such approaches less effective. Specifically, exposure to racial discrimination and subsequent race-based traumatic stress has been linked to drug misuse among Black Americans. However, these specific variables have not been examined in the context of OUD treatment. Moreover, there is limited research investigating the general role of race as a moderating factor on OUD treatment outcome. Mindfulness (i.e., present-centered nonjudgmental awareness), associates with self-care and addiction severity among with SUD and has been observed to function as a resilience factor that moderates the relationship between exposure to racial discrimination and psychiatric symptoms. MBRP is an evidenced-based behavioral intervention that has demonstrated efficacy in reducing drug-use among patients in SUD recovery. There is a notable dearth of research examining the role of race, exposure to racial discrimination, and race-based trauma symptoms on OUD treatment engagement or drug-use outcomes. As there is reason to believe that the mindfulness training included in MBRP may address race-based trauma symptoms in addition to MAT adherence and drug-use outcomes, further research is critical to promote mental health equity among Black Americans. The primary study aim is to determine whether MBRP, compared to treatment-as-usual (TAU), delivered to Black OUD patients receiving MAT through enrollment in a residential addiction treatment facility, results in (1) improved MAT adherence, and reduced drug-use following residential discharge and (2) reduced race-based trauma symptoms. As race-based trauma symptoms are understood to associate with SUD severity, A second study aim will test the extent to which exposure to racial discrimination and severity of race-based trauma symptoms predict pre-treatment (1) OUD severity and (2) poorer treatment adherence and increased drug-use measured following residential discharge for Black TAU participants (but not Black MBRP participants). As prior trauma exposure is observed to undermine treatment efforts for SUDs a third exploratory study aim will determine the extent to which reductions in race-based trauma symptoms (pre-to-post MBRP) mediate beneficial outcomes for Black MBRP participants. Expected outcomes are that Black MBRP participants will demonstrate (1) increased MAT adherence and reduced drug-use monitored across 3-months post-treatment, (2) that reduced race-based trauma symptoms will partially mediate these outcomes, and (3) that prior racial discrimination and race-based trauma symptoms will moderate outcomes for TAU, but not for MBRP participants. Executing this supplemental research proposal will fill important knowledge gaps by clarifying the role that race and race-based trauma plays in OUD severity and treatment response, will solidify collaborative research efforts focused on mental health equity for Black Americans and will inform future preparation of proposals to secure federal funding to further this line of research.

项目摘要/摘要 父母研究的目的是确定是否基于辅助正念的复发预防 （MBRP）治疗计划改善药物依从性并减少阿片类药物使用障碍的药物使用 （OUD）接受药物辅助治疗的患者（MAT）。该项目的广泛长期目标 正在研究综合药理和行为治疗如何改善OUD治疗结果。 这种行政补充对现有NIH-NIDA赠款建议的目的是增强对 在随机临床试验（RCT）父母研究的背景下，种族健康公平问题。 尽管有强大的证据库是为Oud提供了支持MAT，但黑人美国人经常与其他 可能导致这种方法的不平等和艰辛效率较低。具体而言，暴露于种族 歧视和随后的基于种族的创伤压力与黑人的药物滥用有关 美国人。但是，这些特定变量尚未在OUD处理的背景下进行检查。 此外，研究有限的研究对种族作为调节因素的总体作用有限 治疗结果。 正念（即以现为中心的非判断意识），与自我保健和成瘾的严重性联系在一起 在SUD中，已被观察到可以作为适度关系的弹性因素发挥作用 在暴露于种族歧视和精神病症状之间。 MBRP是一种基于证据的行为 已经证明在减少SUD恢复患者药物使用方面有效的干预措施。有一个 显着的研究缺乏研究种族的作用，暴露于种族歧视和基于种族的创伤的作用 OUD治疗参与或药物使用结果的症状。有理由相信 MBRP中包括的正念训练可能还可以解决基于种族的创伤症状 和药物使用结果，进一步的研究对于促进黑人美国人的心理健康公平至关重要。 主要的研究目的是确定MBRP是否与治疗方式相比（TAU）是否交付给 黑色OUD患者通过在住宅成瘾治疗设施中注册而接受MAT的患者，导致（1） 改善了垫子的依从性，并减少了住宅出院后的药物使用，（2）基于种族的降低 创伤症状。由于理解为基于种族的创伤症状与SUD严重程度相关 研究目标将测试暴露于种族歧视和基于种族创伤的严重程度的程度 症状预测治疗前（1）OUD严重程度和（2）依从性较差和药物使用量增加 黑色TAU参与者（但不是黑人MBRP参与者）的住院后测量。作为先验 观察到创伤暴露以破坏SUD的治疗工作，第三个探索性研究目标 确定基于种族的创伤症状（从头到尾MBRP）的减少程度介导了有益的 黑人MBRP参与者的结果。预期的结果是黑人MBRP参与者将证明 （1）在治疗后3个月内监测的MAT依从性和减少药物使用，（2） 减少基于种族的创伤症状将部分调解这些结果，（3）先前的种族 歧视和基于种族的创伤症状将适应TAU的结果，但对于MBRP参与者而言不会适度。 执行这项补充研究建议将通过阐明种族的角色来填补重要的知识差距 基于种族的创伤在OUD严重性和治疗反应方面发挥了作用，将巩固协作研究工作 专注于黑人美国人的心理健康公平，并将告知未来的建议以确保 联邦资助以进一步研究这一研究。