Motivational Interviewing and Mindfulness-Oriented Recovery Enhancement for Tobacco Dependence and Other Drug use in Methadone Treatment

美沙酮治疗中烟草依赖和其他药物使用的动机访谈和正念导向康复增强

• 批准号: 10589481
• 负责人: Nina Cooperman
• 金额: $ 230.07万
• 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 2025-09-29
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10589481
• 关键词: Abstinence; Address; Affect; Anxiety; Behavior Therapy; Brain; Cigarette; Clinic; Data; Dissemination and Implementation; Distress; Drug usage; Effectiveness; Functional Magnetic Resonance Imaging; Future; General Population; Group Therapy; Individual; Intervention; Mental Depression; Methods; Motivation; Opioid; Outcome; Pain; Participant; Personal Satisfaction; Persons; Pharmaceutical Preparations; Pilot Projects; Population; Reach Effectiveness Adoption Implementation and Maintenance; Recovery; Relapse; Research Design; Resources; Rewards; Self Efficacy; Smoke; Smoking; Smoking Cessation Intervention; Substance Use Disorder; Support Groups; System; Time; Tobacco; Tobacco Dependence; Tobacco use; Training; United States; cigarette smoke; craving; cue reactivity; drug abstinence; drug relapse; effective intervention; effectiveness evaluation; effectiveness implementation study; emotion dysregulation; emotional distress; evidence base; experience; hedonic; illicit drug use; implementation evaluation; implementation facilitators; implementation strategy; improved; methadone treatment; mindfulness; motivational enhancement therapy; nicotine patch; nicotine replacement; novel; opioid epidemic; opioid use; opioid use disorder; polysubstance use; primary outcome; programs; randomized trial; reward processing; skills; smoking cessation; substance abuse treatment; substance use; success; therapy design; treatment as usual; treatment program; uptake

PROJECT SUMMARY Polysubstance use is common among people with an opioid use disorder (OUD), and, and although approximately 80% of people with OUD smoke cigarettes, tobacco use is rarely addressed in OUD treatment. Smoking cessation interventions that are effective in the general population have been minimally effective among people with an OUD. Yet, smoking cessation is related to reduced drug relapse in this population. Pain and distress, which affect most people receiving methadone treatment (MT) for OUD, are thought to contribute to continued opioid, tobacco, and other drug use. However, typically, MT programs and smoking cessation interventions fail to address the physical pain, emotion dysregulation, and reward processing deficits that co- occur with substance use. Novel behavioral interventions are needed to address these factors and to support opioid, tobacco, and other drug abstinence, simultaneously, in this population, to save and improve lives. Mindfulness-Oriented Recovery Enhancement (MORE) is a novel behavioral intervention that shows promise for addressing opioid, tobacco, and other substance use, separately, and has never been evaluated to address polysubstance use, simultaneously. 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 substance use disorders. Also, motivation and self-efficacy for tobacco and other drug use abstinence often differs from motivation and self-efficacy for opioid use abstinence among people in MT; therefore, we will examine the impact of motivational-interviewing (MI) relative to treatment as usual (i.e., “No MI”), prior to MORE or a support group (SG) control intervention, on treatment engagement and outcomes. We will conduct a 2 X 2 randomized trial of MORE vs. a SG, with or without MI, to address opioid, tobacco, and other drug use, simultaneously, among people in MT who smoke cigarettes. All participants will receive combination nicotine replacement therapy (C-NRT). 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. To best address potential implementation issues and to optimize future MI and MORE implementation and dissemination, in this study, we will utilize a Type 2, Hybrid Implementation-Effectiveness study design to evaluate an implementation strategy and to assess barriers and facilitators to integrating MI and MORE for polysubstance use into MT. We will: 1) determine MORE’s effectiveness for decreasing tobacco, opioid, and other drug use, simultaneously, among people in MT who smoke (N=420), 2) Determine the effectiveness of an MI session, relative to treatment as usual, for increasing treatment engagement and motivation for decreasing opioid, tobacco, and other drug use, and 3) examine barriers and facilitators to implementing MI and MORE for polysubstance use and evaluate strategies for optimizing training, fidelity, and clinic uptake.

项目摘要 在患有杀菌障碍障碍（OUD）的患者中，多物质使用是常见的，尽管 大约80％的Oud烟烟的人在OUD治疗中很少使用烟草使用。 在普通人群中有效的戒烟干预措施至少有效 在有Oud的人中。然而，戒烟与该人群的药物缓解减少有关。疼痛 遇险会影响大多数接受方法溶解治疗（MT）的人，被认为是贡献的 继续阿片类药物，烟草和其他药物使用。但是，通常是MT计划和戒烟 干预措施无法解决身体疼痛，情绪失调和奖励处理定义 发生在物质使用中。需要采取新的行为干预来解决这些因素并支持 仅在这个人群中，opioid，烟草和其他禁欲，以挽救和改善生命。 面向正念的恢复增强（更多）是一种新颖的行为干预措施 分别解决阿片类药物，烟草和其他物质使用的承诺，从未评估过 简单地解决PolySubstance使用。更多地整合了正念，重新评估和 将技能品尝到为期8周的小组疗法中，旨在补救享乐功能障碍的大脑奖励 基础物质使用障碍的系统。此外，烟草和其他药物的动力和自我效能感 使用禁欲通常与动力和自我效能感不同，以使阿片类药物使用戒酒。 公吨;因此，我们将检查动机访问（MI）相对于治疗的影响（即 在治疗参与之前，在更多或支持组（SG）控制干预之前，“无MI”） 和结果。我们将进行2 x 2的随机试验，其中有或没有MI的SG和SG，以解决 在MT吸烟的人中，opioid，烟草和其他吸毒很容易。全部 参与者将接受尼古丁替代疗法（C-NRT）。 需要加快实施和传播有效干预措施。但是，吸收 新颖的干预措施在MT中可能很慢，因为时间和资源通常受到限制。最佳解决潜力 实施问题并优化未来的MI以及更多的实施和传播，在这项研究中 我们将利用2型混合实施效应研究设计来评估实施 战略并评估障碍和促进者以整合MI的障碍，以及更多用于多物质的使用。我们 意志：1）仅仅确定减少烟草，阿片类药物和其他药物的更多有效性，简单 在MT中吸烟的人中（n = 420），2）确定MI会话的有效性 照常治疗，以增加治疗参与度和减少阿片类药物，烟草和 其他毒品使用，以及3）考试障碍和促进者，以实施MI，以及更多用于多物质的使用 并评估优化培训，忠诚度和诊所吸收的策略。