Treatment of Cocaine Addiction with Integrative Meditation

用综合冥想治疗可卡因成瘾

• 批准号: 7807168
• 负责人: KEVIN W CHEN
• 金额: $ 18.56万
• 依托单位: UNIVERSITY OF MARYLAND BALTIMORE
• 依托单位国家: 美国
• 财政年份: 2009
• 资助国家: 美国
• 起止时间: 2009-04-01 至 2012-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7807168
• 关键词: Abstinence; Accounting; Anxiety; Attention; Autonomic nervous system; Behavior; Behavior Therapy; Behavioral; Breathing; China; Chinese People; Chronic; Client; Clinical; Cocaine; Cocaine Dependence; Cocaine Users; Dropout; Drops; Drug usage; FDA approved; Frequencies; Future; Guided imagery; Intervention; Learning; Manuals; Measures; Mediator of activation protein; Medicine; Meditation; Mental Depression; Modality; Nondirective Therapy; Observational Study; Outcome Measure; Outpatients; Patients; Pharmaceutical Preparations; Pharmacologic Substance; Phase; Pilot Projects; Professional counselor; Public Health; Qi Gong; Randomized Controlled Trials; Recovery; Recruitment Activity; Relapse; Relaxation; Research; Risk Factors; Self Care; Self Efficacy; Severities; Solutions; Staging; Stress; Symptoms; Testing; Therapeutic Effect; Time; Toxicology; Training; Treatment outcome; Urine; Withdrawal; Withdrawal Symptom; addiction; alcohol and other drug; base; cocaine use; control trial; coping; cost effective; craving; design; effective therapy; experience; follow-up; heart rate variability; improved; indexing; meetings; mindfulness; mindfulness meditation; negative mood; pilot trial; prevent; primary outcome; psychologic; psychosocial; public health relevance; secondary outcome; sound; standard care; theories; therapy development; tool; treatment as usual

DESCRIPTION (provided by applicant): Cocaine addiction continues to be a major public health problem in the U.S. With no FDA- approved pharmaceutical therapy, treatment often relies on psychosocial interventions, known as behavior therapy. Despite some positive progress these psychosocial interventions have limited efficacy with problems like high dropout, untreated physical symptoms and high relapse rate. Our clinical experience and pilot studies suggest that Integrative Meditation (IM) from Chinese medicine may help clients engage in treatment, reduce cravings/ withdrawal symptoms, and increase treatment retention, which appear missed by a typical behavior therapy. IM is an adaptation or simplified form of mindfulness meditation. It may enhance existing therapies to help reduce withdrawal symptoms, increase treatment engagement, and prevent relapse through step-by-step therapist facilitation. This will be a brief Stage-1b therapy development study, based on a preliminary therapist manual and an observational study. The specific aims include: (1) To conduct a pilot randomized controlled trial of 66 outpatient cocaine users with 12 weekly facilitation meetings to assess feasibility of recruiting and retaining cocaine addicts, and to determine effect size of IM-augmented treatment in comparison with Non-directive therapy (NT) control, with both groups receiving standard treatment as usual (TAU), (2) To examine the changes in attention networks and negative mood as possible mediators of treatment outcomes between the two groups. Treatment outcomes will be assessed at baseline, week 4, 8 and 12, and at the follow-up 3 months after intervention. Primary outcomes include cocaine urine toxicology, number of weeks in treatment, and intensity of cocaine use. Secondary outcome measures include Addiction Severity Index (ASI) composite scores, use of alcohol and other drugs, heart rate variability, craving, depression, anxiety, and self-efficacy. Additional measures are proposed to aid in understanding possible underlying mechanisms of IM's effect on attention networks and the autonomic nervous system. A diverse team experienced in meditation and behavior therapy development is brought together to conduct the proposed R21 project, and prepare for a full therapy development study. PUBLIC HEALTH RELEVANCE: Given the fact that cocaine addiction continues to be a major public health problem in the U.S. without a sound solution, the proposed study will implement a brief Stage-I study of adding Integrative Meditation (IM) as a self-care component to the current outpatient treatment to improve treatment outcome for cocaine addiction. IM requires minimum therapist involvement and can serve as an adjunct to other existing treatment modalities. It may not only provide the needed treatment for physical and psychological symptoms during withdrawal or abstinence at the time when a patient needs it, but also quickly engage patients in the treatment and improve patients' self-efficacy and attention network that could help keep them away from relapse. Therefore, if the study verifies its efficacy and feasibility, IM may become an important cost- effective tool in the field of addiction treatment.

描述（由申请人提供）：可卡因成瘾仍然是美国的一个主要公共卫生问题。由于没有 FDA 批准的药物治疗，治疗通常依赖于社会心理干预，称为行为疗法。尽管取得了一些积极进展，但这些心理社会干预措施对于高辍学率、未经治疗的身体症状和高复发率等问题的效果有限。我们的临床经验和试点研究表明，中医综合冥想（IM）可以帮助客户参与治疗，减少渴望/戒断症状，​​并提高治疗保留率，而典型的行为疗法似乎忽略了这一点。 IM 是正念冥想的一种改编或简化形式。它可以增强现有疗法，帮助减少戒断症状，​​增加治疗参与度，并通过治疗师的逐步引导来防止复发。这将是一项简短的 1b 阶段治疗开发研究，基于初步治疗师手册和观察性研究。具体目标包括：(1) 对 66 名门诊可卡因使用者进行试点随机对照试验，每周举行 12 次促进会议，以评估招募和保留可卡因成瘾者的可行性，并确定 IM 强化治疗与非强化治疗相比的效果大小。指导治疗（NT）控制，两组照常接受标准治疗（TAU），（2）检查注意力网络和消极情绪的变化作为两组治疗结果的可能中介。治疗结果将在基线、第 4、8 和 12 周以及干预后 3 个月的随访时进行评估。主要结局包括可卡因尿液毒理学、治疗周数以及可卡因使用强度。次要结果指标包括成瘾严重程度指数（ASI）综合评分、酒精和其他药物的使用、心率变异性、渴望、抑郁、焦虑和自我效能。提出了其他措施来帮助理解 IM 对注意力网络和自主神经系统影响的可能潜在机制。一个在冥想和行为治疗开发方面经验丰富的多元化团队聚集在一起，开展拟议的 R21 项目，并为全面的治疗开发研究做好准备。 公共健康相关性：鉴于可卡因成瘾仍然是美国的一个主要公共健康问题，且没有健全的解决方案，拟议的研究将实施一项简短的第一阶段研究，将综合冥想 (IM) 添加为自我保健的组成部分目前的门诊治疗，以改善可卡因成瘾的治疗结果。 IM 需要最少的治疗师参与，并且可以作为其他现有治疗方式的辅助手段。它不仅可以在患者需要时为戒断或禁欲期间的身体和心理症状提供所需的治疗，而且可以快速让患者参与治疗，提高患者的自我效能和注意力网络，从而帮助他们远离治疗免于复发。因此，如果研究验证其有效性和可行性，IM可能成为成瘾治疗领域重要的具有成本效益的工具。