Effect of Mindfulness Training on Opioid Use and Anxiety During Primary Care Buprenorphine Treatment

正念训练对初级保健丁丙诺啡治疗期间阿片类药物使用和焦虑的影响

基本信息

批准号：
10021545
负责人：
Zev David Schuman Olivier
金额：
$ 80.8万
依托单位：
CAMBRIDGE HEALTH ALLIANCE
依托单位国家：
美国
项目类别：
财政年份：
2018
资助国家：
美国
起止时间：
2018-09-20 至 2024-08-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/10021545
关键词：
Abstinence Accidental Injury Address Alcohol or Other Drugs use Anxiety Attention Behavior Therapy Behavioral Benzodiazepines Buprenorphine Cellular Phone Clinical Cocaine Compassion Continuity of Patient Care Contracts County Dangerousness Dose Drops Drug usage Emotions Feedback Funding Generations HIV risk Health Health Personnel Health behavior change Hour Individual Informal Social Control Insurance Lead Link Maintenance Manuals Mediating Mental Depression Mindfulness Training Motivation Opioid Outcome Overdose Patient Care Patient Self-Report Patients Phase Post-Traumatic Stress Disorders Preparation Primary Health Care Provider Psychosocial Stress Publishing Randomized Recovery Regulation Relapse Reporting Research Risk Behaviors Sampling Science Self Efficacy Site Stress Suboxone Support Groups Time Toxicology Training Trauma United States National Institutes of Health United States Substance Abuse and Mental Health Services Administration Urine addiction anxiety reduction anxiety symptoms base behavior change buprenorphine treatment care providers chronic pain cognitive control comorbidity comparative effectiveness trial compare effectiveness design disorder later incidence prevention distress tolerance emotion dysregulation emotion regulation emotional distress evidence base flexibility improved innovation medication-assisted treatment mindfulness mindfulness intervention mobile application opioid mortality opioid overdose opioid use opioid use disorder overdose death patient oriented prevent primary outcome programs psychiatric symptom skills stress disorder stress reduction stress symptom therapy design treatment group treatment site waiver

项目摘要

Opioid Use Disorder (OUD) is a national health crisis. Office-Based Opioid Treatment (OBOT) with buprenorphine/naloxone (B/N) prevents overdose deaths. Psychosocial stress and psychiatric problems (e.g., Anxiety) are major reasons for OBOT drop out and relapse. Many patients turn to benzodiazepines (BZD) to address anxiety and emotional distress with dangerous consequences, non- pharmacologic approaches to anxiety, stress, and emotion dysregulation are needed during primary care OBOT, which is the primary access point for OUD treatment in most US counties. Mindfulness- Based Interventions (MBI) safely and reliably reduce the impact of stress, anxiety, depression, and chronic pain, which could increase OBOT retention, while reducing rates of relapse and overdose deaths. However, current 8-week standard MBIs do not appear to have strong, sustained impact on substance use outcomes, suggesting longer or enhanced MBIs are needed in the OUD treatment setting. This project proposes to adapt, refine and compare the effectiveness of the 6-month Mindful Recovery OUD Care Continuum (M-ROCC) delivered within Group-Based Opioid Treatment (GBOT) versus standard GBOT alone. M-ROCC is derived a three phase program derived from the evidence-based, established Mindfulness Training for Primary Care (MTPC) program, which has been adapted for Opioid Use Disorder. M-ROCC includes a flexible, patient-centered, motivationally responsive design, including a 4-week Low Dose Mindfulness Entry Group, Mindfulness Maintenance Check-in Support Group, and an 8-week intensive Mindfulness Training for Primary Care (MTPC-OUD) Group. M-ROCC builds on the previously demonstrated ascending mindfulness practice dose ladder approach, which helps individuals with OUD nurture motivation and resolve ambivalence for mindfulness practice. MTPC has been shown of lower anxiety, stress, and depression, while increasing self-efficacy and capacity for behavioral change by engaging self-regulation mechanisms. During the R21 phase, we will prepare for a multi-site RCT by 1) adapting the M-ROCC manual; 2) training providers at 5 MA primary care sites to lead M-ROCC; 3) piloting M-ROCC assessing qualitative feedback for iterative refinement; 4) manualizing GBOT and offering training to MA OBOT sites; and 5) preparing for the R33 phase by obtaining necessary approvals and site contracts. In the R33 phase, we will conduct a five-site RCT comparing M-ROCC plus GBOT with GBOT alone for 200 primary care patients prescribed B/N for OUD, primarily evaluating its impact on opioid use and anxiety, but also on cocaine and BZD use, as well as aspects of self-regulation needed for sustained addiction recovery.

阿片类药物使用障碍 (OUD) 是一场全国性的健康危机。办公室阿片类药物治疗 (OBOT) 丁丙诺啡/纳洛酮 (B/N) 可预防过量死亡。社会心理压力和精神科问题（例如焦虑）是 OBOT 退出和复发的主要原因。许多患者转向苯二氮卓类药物（BZD）用于解决焦虑和情绪困扰，带来危险后果，非初级阶段需要药物治疗焦虑、压力和情绪失调。 care OBOT，这是美国大多数县 OUD 治疗的主要接入点。正念—— 基于干预 (MBI) 安全可靠地减少压力、焦虑、抑郁和慢性疼痛，这可以增加 OBOT 保留率，同时降低复发率和用药过量率死亡人数。然而，目前的 8 周标准 MBI 似乎并没有对物质使用结果表明 OUD 治疗环境中需要更长或增强的 MBI。该项目建议调整、完善和比较 6 个月正念恢复的有效性 OUD Care Continuum (M-ROCC) 在基于团体的阿片类药物治疗 (GBOT) 中提供，与仅标准GBOT。 M-ROCC 是一个三阶段计划，源自基于证据的、建立了初级保健正念培训（MTPC）计划，该计划已针对阿片类药物使用障碍。 M-ROCC 包括灵活的、以患者为中心、积极响应的设计，包括为期 4 周的低剂量正念入门小组、正念维护登记支持小组，以及为期 8 周的初级保健强化正念训练 (MTPC-OUD) 小组。 M-ROCC 建立在先前展示的上升正念练习剂量阶梯方法的基础上，该方法帮助具有 OUD 的个人培养正念练习的动力并解决矛盾心理。 MTPC 已被证明可以降低焦虑、压力和抑郁，同时提高自我效能感和通过自我调节机制改变行为的能力。在R21阶段，我们将通过 1) 改编 M-ROCC 手册来准备多中心 RCT； 2) 5 MA小学的培训提供者领导 M-ROCC 的护理场所； 3) 试点 M-ROCC 评估迭代细化的定性反馈； 4) GBOT 手动化并向 MA OBOT 站点提供培训； 5) 为 R33 阶段做准备获得必要的批准和现场合同。在R33阶段，我们将进行五中心RCT 对 200 名处方 B/N 的初级保健患者进行 M-ROCC 加 GBOT 与单独 GBOT 的比较 OUD，主要评估其对阿片类药物使用和焦虑的影响，但也评估其对可卡因和 BZD 使用的影响，如以及持续成瘾康复所需的自我调节方面。

项目成果

期刊论文数量（4）

专著数量（0）

科研奖励数量（0）

会议论文数量（0）

专利数量（0）

Corrigendum to "Feasibility and acceptability of mindful recovery opioid use care continuum (M-ROCC): A concurrent mixed methods study" [Journal of Substance Abuse Treatment 130 (2021) 108415].

DOI：
10.1016/j.jsat.2021.108469
发表时间：
2022-03
期刊：
Journal of substance abuse treatment
影响因子：
3.9
作者：
Fatkin T;Moore SK;Okst K;Creedon TB;Samawi F;Fredericksen AK;Roll D;Oxnard A;Cook BL;Schuman-Olivier Z
通讯作者：
Schuman-Olivier Z