Adapting and evaluating an integrated intervention for adolescent substance use and pain during oral surgery

调整和评估口腔手术期间青少年药物使用和疼痛的综合干预措施

基本信息

批准号：
10669030
负责人：
Melissa Pielech
金额：
$ 19.35万
依托单位：
BROWN UNIVERSITY
依托单位国家：
美国
项目类别：
财政年份：
2021
资助国家：
美国
起止时间：
2021-08-01 至 2026-07-31
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10669030
关键词：
15 year old Academy Accident and Emergency department Acute Acute Pain Address Adolescence Adolescent Adult Age Age of Onset Alcohols American Attenuated Behavior Behavior Therapy Child Psychology Childhood Clinical Trials Data Analyses Dental Dental Care Dental Clinics Dentists Development Ecological momentary assessment Education Enrollment Ensure Environment Evaluation Event Evidence based intervention Exposure to Feedback Focus Groups Frequencies Future Health Impairment Influentials Intervention Interview Knowledge Leadership Life Measures Medical Mentors Mentorship Methods Operative Surgical Procedures Opioid Oral Surgeon Oral Surgical Procedures Outcome Pain Pain intensity Pain management Parents Patient Self-Report Patients Pediatrics Perioperative Persons Phase Postoperative Complications Postoperative Pain Postoperative Period Practice Management Procedures Provider Public Health Randomized, Controlled Trials Recommendation Records Research Rhode Island Risk Risk Factors Screening procedure Structure Substance Addiction Substance Use Disorder Testing Time Tooth Extraction Training Universities Work Youth acceptability and feasibility addiction adolescent substance use adverse outcome brief intervention clinical encounter comparison control coping craving design evidence base experience follow up assessment high risk implementation context improved improved outcome informant innovation integrated care interdisciplinary collaboration intervention refinement marijuana use non-opioid analgesic novel opioid misuse opioid use prescription opioid primary care setting psychosocial reduced substance use risk minimization risk mitigation risk sharing satisfaction screening screening and brief intervention screening, brief intervention, referral, and treatment skills substance use substance use treatment substance user therapy development wisdom tooth young adult

项目摘要

PROJECT SUMMARY Substance use (SU) is most commonly initiated during adolescence. Earlier age of onset is associated with more significant and persistent adverse outcomes, such as impaired psychosocial and educational functioning, myriad health consequences, and long-term struggles with SU and addiction — underscoring the critical need to identify and intervene on SU as early as possible. Thus, the public health need to increase availability and quality of evidence-based interventions for adolescents (ADOL) who are using substances cannot be overstated, especially in Rhode Island where ADOL are not receiving substance use disorder treatment that they need at higher than national averages. This proposal not only aims to increase access to interventions for ADOL using substances but also improve brief interventions for ADOL by co-addressing pain in an innovative pre-surgical context. Acutely painful procedures, such as wisdom tooth extraction, are an opportune time to identify SU behaviors and engage ADOL in brief intervention due to shared risk factors between SU and pain and the potential for exposure to prescription opioids. Aim 1 is to adapt and integrate pre-existing evidence- based brief interventions for adolescent SU (MET-CBT) and acute pain coping (CBT) into a pre-surgical brief intervention (PS-BI) for ADOL and their parents. PS-BI will be developed by the PI and her interdisciplinary mentorship team in conjunction with feedback from key informants (e.g. ADOL, parents, and dental providers). Aim 2 will evaluate PS-BI in a pilot randomized controlled trial (RCT) versus a control condition of current best practice among ADOL (age 15-18 years) who use cannabis (and other substances) undergoing wisdom tooth extraction. Key outcomes for the pilot RCT (Aim 2) are feasibility and acceptability. Ecological momentary assessment (EMA) methods will be used to elucidate associations between pain, craving, and SU (Aim 3) and explore if those associations are attenuated by PS-BI (Exploratory aim). This will be the first test of within- person associations of hypothesized precursors (e.g., pain intensity), substance craving, and use in the perioperative context among ADOL who use substances. A highly structured training plan will ensure execution of the proposed research aims. Specifically, the PI will receive advanced training in (1) intervention development and clinical trial methods, (2) integrated SU interventions for ADOL, (3) EMA, (4) advanced statistical approaches, including longitudinal data analysis, and (5) mentoring and leadership skills to combine with her expertise in pediatric psychology, interdisciplinary collaboration in medical settings, and pediatric pain. Training will be guided by a stellar mentorship team with highly relevant expertise and long-standing track records of successful mentorship. The proposed research and training plan is further supported by the rich training environment at the Center for Alcohol and Addiction Studies at Brown University. Through this K23, the PI will obtain specialized training to launch her independent research focused on developing, evaluating, and implementing innovative interventions for adolescent SU and pain in integrated care settings.

项目概要物质使用（SU）最常在青春期开始，与发病年龄较早有关。更严重和持续的不良后果，例如心理社会和教育功能受损，无数的健康后果，以及与 SU 和成瘾的长期斗争——强调了迫切需要因此，公共卫生部门需要增加可用性和尽早发现和干预 SU。针对使用药物的青少年 (ADOL) 的循证干预措施的质量不能夸大了，尤其是在罗德岛州，ADOL 没有接受药物滥用障碍治疗，他们的需求高于全国平均水平。该提案不仅旨在增加获得干预措施的机会。 ADOL 使用物质，但也通过以创新的方式共同解决疼痛来改进 ADOL 的简短干预措施手术前的情况，例如拔智齿，是进行剧烈疼痛的手术的最佳时机。由于 SU 和疼痛之间共有的危险因素，识别 SU 行为并让 ADOL 进行简短干预目标 1 是调整和整合现有证据。基于青少年 SU (MET-CBT) 和急性疼痛应对 (CBT) 的简短干预措施纳入术前简介针对 ADOL 及其父母的干预 (PS-BI) 将由 PI 和她的跨学科人员制定。指导团队结合关键信息提供者（例如 ADOL、家长和牙科服务提供者）的反馈。目标 2 将在试点随机对照试验 (RCT) 中与当前最佳控制条件对比来评估 PS-BI 使用大麻（和其他物质）接受智齿治疗的 ADOL（15-18 岁）的实践试点 RCT（目标 2）的主要成果是可行性和可接受性。评估 (EMA) 方法将用于阐明疼痛、渴望和 SU 之间的关联（目标 3）和探索这些关联是否会被 PS-BI 减弱（探索性目标）。这将是内部的第一个测试。所挖掘的前体（例如疼痛强度）、物质渴望和使用的个人关联使用药物的 ADOL 的围手术期环境高度结构化的培训计划将确保执行。具体来说，PI 将接受 (1) 干预方面的高级培训。开发和临床试验方法，(2) 针对 ADOL 的综合 SU 干预措施，(3) EMA，(4) 高级统计方法，包括纵向数据分析，以及（5）结合指导和领导技能凭借她在儿科心理学、医疗环境跨学科合作和儿科疼痛方面的专业知识。培训将由具有高度相关专业知识和长期跟踪的一流导师团队指导所提出的研究和培训计划得到了富人的进一步支持。布朗大学酒精与成瘾研究中心的培训环境通过此 K23， PI 将接受专门培训来开展她的独立研究，重点是开发、评估和在综合护理环境中针对青少年 SU 和疼痛实施创新干预措施。

项目成果

期刊论文数量（3）

专著数量（0）

科研奖励数量（0）

会议论文数量（0）

专利数量（0）

Provider perspectives on pain management practices and needs in pediatric dentistry.

提供者对儿科牙科疼痛管理实践和需求的看法。

DOI：
发表时间：
2023-12
期刊：
影响因子：
0
作者：
Pielech, Melissa;Sawicki, Caroline M
通讯作者：
Sawicki, Caroline M

Provider perceptions of systems-level barriers and facilitators to utilizing family-based treatment approaches in adolescent and young adult opioid use disorder treatment.

提供者对在青少年和年轻成人阿片类药物使用障碍治疗中利用基于家庭的治疗方法的系统级障碍和促进因素的看法。

DOI：
发表时间：
2024-03-21
期刊：
影响因子：
3.7
作者：
Pielech, Melissa;Modrowski, Crosby;Yeh, Jasper;Clark, Melissa A;Marshall, Brandon D L;Beaudoin, Francesca L;Becker, Sara J;Miranda Jr, Robert
通讯作者：
Miranda Jr, Robert

Practice Patterns Among Dentist Anesthesiologists for Pediatric Patients with Autism Spectrum Disorders.

牙医麻醉师对患有自闭症谱系障碍的儿科患者的实践模式。