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.

项目概要 多物质使用在阿片类药物使用障碍 (OUD) 患者中很常见，并且，尽管 大约 80% 的 OUD 患者吸烟，但 OUD 治疗很少涉及烟草使用问题。 对普通人群有效的戒烟干预措施收效甚微 然而，在 OUD 患者中，戒烟与减少药物复发有关。 和痛苦影响大多数接受 OUD 美沙酮治疗 (MT) 的人，被认为是造成这种情况的原因 然而，通常是 MT 计划和戒烟。 干预措施未能解决身体疼痛、情绪失调和奖励处理缺陷，这些缺陷共同 需要采取新的行为干预措施来解决这些因素并提供支持。 同时，在这一人群中戒除阿片类药物、烟草和其他药物，以拯救和改善生命。 以正念为导向的恢复增强 (MORE) 是一种新颖的行为干预措施，它表明 承诺分别解决阿片类药物、烟草和其他物质使用问题，但从未经过评估 同时解决多物质使用问题，MORE 整合了正念、重新评估和 在为期 8 周的团体治疗中品味技巧，旨在纠正大脑奖励的享乐失调 支撑物质使用障碍的系统此外，烟草和其他药物的动机和自我效能。 戒断阿片类药物的动机和自我效能通常与人们戒断阿片类药物的动机和自我效能不同。 MT；因此，我们将研究动机访谈（MI）相对于常规治疗（即， “无 MI”），在 MORE 或支持小组 (SG) 控制干预之前，关于治疗参与度 我们将进行一项 MORE 与 SG 的 2 X 2 随机试验，无论有或没有 MI，以解决问题。 MT 吸烟者同时使用阿片类药物、烟草和其他药物。 参与者将接受联合尼古丁替代疗法（C-NRT）。 然而，需要加快实施和传播有效的干预措施。 机器翻译中的新干预措施可能会很慢，因为时间和资源往往是有限的。 实施问题并优化未来 MI 和 MORE 的实施和传播，在本研究中， 我们将利用 2 类混合实施-有效性研究设计来评估实施 战略并评估将多物质使用的 MI 和 MORE 整合到 MT 中的障碍和促进因素。 将： 1) 确定 MORE 在减少烟草、阿片类药物和其他药物使用方面的有效性，同时， 在 MT 吸烟者 (N=420) 中，2) 确定 MI 疗程的有效性，相对于 照常治疗，以增加治疗参与度和动机，减少阿片类药物、烟草和 其他药物使用，以及 3) 检查针对多物质使用实施 MI 和 MORE 的障碍和促进因素 并评估优化培训、保真度和临床采用的策略。