Implementation and Effectiveness of Mindfulness Oriented Recovery Enhancement as an Adjunct to Methadone Treatment for Opioid Use Disorder

正念导向康复增强作为美沙酮治疗阿片类药物使用障碍的辅助疗法的实施和有效性

• 批准号: 10705707
• 负责人: Nina Cooperman
• 金额: $ 68.5万
• 依托单位: RUTGERS BIOMEDICAL AND HEALTH SCIENCES
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-09-30 至 2027-07-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10705707
• 关键词: Abstinence; Acceleration; Address; Adherence; Affect; American; Anxiety; Behavior Therapy; Brain; COVID-19; Case Study; Clinic; Clinical Trials; Communities; Data; Disparity; Dissemination and Implementation; Dropout; Drug Prescriptions; Drug usage; Educational Materials; Effectiveness; Feedback; Future; Group Therapy; Heroin; Internet; Intervention; Manuals; Measures; Mental Depression; Methods; Modeling; Opioid; Pain; Patient-Focused Outcomes; Patients; Personal Satisfaction; Persons; Population; Provider; Quality of life; Randomized; Randomized, Controlled Trials; Reach, Effectiveness, Adoption, Implementation, and Maintenance; Recovery; Relapse; Research Design; Resources; Rewards; Supervision; System; Technology; Time; Trainers Training; Training; Translations; United States; Universities; Videoconferencing; acceptability and feasibility; addiction; arm; craving; effective intervention; effectiveness evaluation; effectiveness testing; effectiveness trial; effectiveness/implementation study; emotion dysregulation; emotional distress; evidence base; experience; health care settings; hedonic; implementation facilitators; implementation strategy; medication for opioid use disorder; methadone treatment; mindfulness; mindfulness intervention; novel; opioid epidemic; opioid overdose; opioid use; opioid use disorder; prescription opioid misuse; prevent; primary outcome; programs; remediation; remote delivery; reward processing; secondary outcome; skills; success; therapy design; timeline; treatment as usual; uptake

PROJECT SUMMARY The United States is experiencing an opioid use and overdose crisis. To address this crisis, programs that provide medication for opioid use disorder (MOUD) are being expanded and enhanced. MOUD is the most effective intervention for an OUD, and methadone treatment (MT) is the most commonly prescribed MOUD; however, approximately half of people who begin MT discontinue within a year, and half of people retained in MT use opioids within six months. Physical pain, emotion dysregulation, and reward processing deficits, affecting most people on MT, could be contributing to their ongoing opioid use. Novel behavioral interventions that address physical pain, emotion dysregulation, reward processing deficits and opioid use among people on MOUD are needed. Mindfulness-Oriented Recovery Enhancement (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 OUD. Across multiple trials, MORE has demonstrated efficacy for reducing opioid use, craving, emotional distress, and pain in other healthcare settings. Our R21 pilot randomized controlled trial of MORE was the first to demonstrate MORE’s feasibility and acceptability as delivered in MT clinics, with indications of preliminary efficacy for decreasing drug use, craving, depression, anxiety, and pain for people with OUD. Further, 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. Therefore, to best address potential implementation issues and to optimize future MORE implementation and dissemination, in this study, we will utilize a Type 2, Hybrid Implementation-Effectiveness study design. We will not only evaluate MORE’s effectiveness but also assess barriers and facilitators to integrating MORE into MT and evaluate the impact of a sustainable train-the-trainer model on provider burden, intervention fidelity and engagement, and patient outcomes. We will randomize MT clinicians to receive training in 1) a higher intensity MORE implementation strategy consisting of a train-the- trainer model with training in the full MORE treatment manual plus supervision and feedback or 2) a minimal intensity implementation strategy consisting of a simple, scripted mindfulness practice (SMP) extracted from the MORE treatment manual with minimal training, no supervision, and minimal feedback. Specifically, we aim to: 1) using a RE-AIM (reach, effectiveness, adoption, implementation, and maintenance) framework, examine barriers and facilitators to implementation of MORE and SMP in MT and evaluate strategies for optimizing training, fidelity, and engagement, 2) optimize existing MORE and SMP training and implementation toolkits, including adaptable resources that can accelerate the translation of evidence into practice, and 3) evaluate effectiveness and treatment fidelity of a higher intensity MORE implementation strategy versus a lower intensity SMP implementation strategy as an adjunct to MT (N=420).

项目摘要 美国正在经历阿片类药物的使用和过量危机。为了解决这一危机，计划 为阿片类药物使用障碍提供药物（MOUD）正在扩大和增强。穆德是最大的 OUD的有效干预措施和Metagadone治疗（MT）是最常见的穆德； 但是，大约一半在一年内开始停产的人中，一半的人留在 MT在六个月内使用阿片类药物。身体疼痛，情绪失调和奖励处理缺陷， 影响大多数MT上的人可能会导致他们正在进行的阿片类药物使用。 解决身体疼痛，情绪失调，奖励处理的新型行为干预措施 需要在MOUD上的人中使用不足和阿片类药物。面向正念的恢复增强 （更多）将正念，重新评估和品尝技能的培训整合到为期8周的小组疗法中 旨在补救概括OUD的大脑奖励系统中的享乐功能障碍。跨多个 试验，更多的表现出了减少阿片类药物使用，渴望，情绪困扰和痛苦的效率 医疗保健设置。我们的R21飞行员随机对照试验的More是第一个证明更多的 在MT诊所提供的可行性和可接受性，并具有降低的初步效率 毒品使用，渴望，抑郁，焦虑和痛苦和痛苦。此外，加快实施和 需要传播有效的干预措施。但是，新颖的干预措施的吸收可能很慢。 因为时间和资源通常受到限制。因此，最好解决潜在的实施问题和 为了优化未来的更多实施和传播，在这项研究中，我们将使用2型混合动力车 实施效果研究设计。我们不仅会评估更多的有效性，还将评估 障碍和促进者将更多融入MT并评估可持续火车训练者的影响 提供者Burnen的模型，干预保真度和参与度以及患者的结果。我们将随机化MT 临床医生接受培训1）更高强度的更多实施策略，包括火车 培训师模型，并在全部治疗手册以及监督和反馈中进行培训或2）最小 强度实施策略由简单的脚本正念实践（SMP）组成 使用最少的培训，没有监督和最小反馈的治疗手册。 具体而言，我们的目标是：1）使用re-aim（触及，有效性，采用，实施和 维护）框架，检查障碍和促进者，以在MT和MT中实施更多和SMP 评估优化培训，保真度和参与度的策略，2）优化现有和SMP 培训和实施工具包，包括可以加速翻译的适应性资源 进行实践的证据，以及3）评估更高强度的有效性和治疗保真度 实施策略与较低强度SMP实施策略作为MT的辅助（n = 420）。

项目成果

Mindfulness-Oriented Recovery Enhancement for Veterans and Military Personnel on Long-Term Opioid Therapy for Chronic Pain: A Randomized Clinical Trial.

退伍军人和军人长期阿片类药物治疗慢性疼痛的正念康复增强：一项随机临床试验。

• DOI: 10.1176/appi.ajp.20230272
• 发表时间: 2024
• 期刊: The American journal of psychiatry
• 作者: Garland,EricL;Nakamura,Yoshio;Bryan,CraigJ;Hanley,AdamW;Parisi,Anna;Froeliger,Brett;Marchand,WilliamR;Donaldson,GaryW
• 通讯作者: Donaldson,GaryW