Document text
Principal Investigator: Kelly R. Peck
Organization: UNIVERSITY OF VERMONT & ST AGRIC COLLEGE
Fiscal Year: 2024
Award: $693,303
Funding agency: National Institute on Drug Abuse
PROJECT ABSTRACT
Nearly 90% of individuals with OUD report lifetime trauma exposure and 33% meet criteria for PTSD.
Patients with co-occurring PTSD and OUD are at significantly greater risk for poor substance use and mental
health outcomes vs. those with OUD alone. Although Prolonged Exposure (PE) therapy is a first-line treatment
for PTSD, its efficacy is commonly undermined by poor attendance. We recently demonstrated the initial
feasibility of a novel PE protocol for improving therapy attendance and PTSD symptoms among individuals
maintained on MOUD. Participants were randomly assigned to: (a) Treatment as usual (TAU) (b) Prolonged
Exposure therapy (PE) or (c) PE with attendance contingent financial incentives (PE+). Our results demonstrated
the initial efficacy of PE+, as PE+ participants attended significantly more therapy sessions than PE participants
and experienced significant improvements in PTSD symptoms. Our findings also suggest that, rather than
undermining patients’ stability with illicit drug use, PE may be associated with less illicit substance use than SUD
treatment alone.
In the proposed research, we seek to: a) conduct a more definitive evaluation of this novel PE
intervention, b) utilize a novel telemedicine platform to reach underserved patients, and c) further investigate this
promising initial data suggesting that PE therapy may also be associated with improvements in illicit drug use.
Primary Aim: To evaluate the efficacy of a novel telemedicine-delivered PE protocol for improving therapy
attendance and PTSD symptoms. We will conduct a parallel three-group RCT among 135 adults with PTSD who
are maintained on MOUD (45 TAU, 45 PE, 45 PE+). All study visits will be conducted via telemedicine and
attendance-contingent financial incentives will be delivered digitally. We hypothesize that participants assigned
to PE+ will demonstrate greater PE session attendance and decreases in PTSD severity relative to those
assigned to PE or TAU. Secondary Aims: (1) We will utilize rigorous and fine-grained assessment strategies to
evaluate whether individuals receiving PE may actually experience reductions in their illicit opioid and other drug
use. (2) We will conduct the first characterization of telemedicine-delivered PE acceptability and explore their
association with PE treatment retention and PTSD symptom reduction.
This study represents the first effort to examine the efficacy of PE delivered via telemedicine to individuals
with OUD, and our investigative team is uniquely poised to disseminate our findings to improve clinical practice
in real-world settings throughout the country.
Terms: <21+ years old><Access to Care><Adanon><Address><Adherence><Adult><Adult Human><Agonist><Althose><Biochemical><Buprenorphine><COVID crisis><COVID epidemic><COVID pandemic><COVID-19 crisis><COVID-19 epidemic><COVID-19 era><COVID-19 global health crisis><COVID-19 global pandemic><COVID-19 health crisis><COVID-19 pandemic><COVID-19 period><COVID-19 public health crisis><COVID-19 years><Cognition Therapy><Cognitive Psychotherapy><Cognitive Therapy><Cognitive treatment><Country><Data><Dolophine><Dropout><Drug usage><Enrollment><Evaluation><General Population><General Public><Grain><Health Care Providers><Health Personnel><Health Services Accessibility><Healthcare Providers><Healthcare worker><Impoverished><Individual><Intervention><Intervention Strategies><Investigation><Knowledge><Measures><Mental Health><Mental Hygiene><Methadone><Methadose><Modality><Opiates><Opioid><Outcome><Overdose><PTSD><Participant><Patient Self-Report><Patients><Persons><Pilot Projects><Population><Post-Traumatic Neuroses><Post-Traumatic Stress Disorders><Posttraumatic Neuroses><Poverty><Protocol><Protocols documentation><Psychological Health><Questionnaires><Randomized><Reporting><Research><Risk><Rural><SARS-CoV-2 epidemic><SARS-CoV-2 global health crisis><SARS-CoV-2 global pandemic><SARS-CoV-2 pandemic><SARS-coronavirus-2 epidemic><SARS-coronavirus-2 pandemic><Sampling><Self-Report><Severe Acute Respiratory Syndrome CoV 2 epidemic><Severe Acute Respiratory Syndrome CoV 2 pandemic><Severe acute respiratory syndrome coronavirus 2 epidemic><Severe acute respiratory syndrome coronavirus 2 pandemic><Severities><Substance Use Disorder><Symptoms><Telemedicine><Testing><Transportation><Trauma><Treatment outcome><Urine><Visit><Vulnerable Populations><access to health services><access to services><access to treatment><accessibility to health services><adulthood><alleviate symptom><ameliorating symptom><availability of services><care access><care as usual><clinical practice><clinical relevance><clinically relevant><cognitive behavior intervention><cognitive behavior modification><cognitive behavior therapy><cognitive behavioral intervention><cognitive behavioral modification><cognitive behavioral therapy><cognitive behavioral treatment><coronavirus disease 2019 crisis><coronavirus disease 2019 epidemic><coronavirus disease 2019 global health crisis><coronavirus disease 2019 global pandemic><coronavirus disease 2019 health crisis><coronavirus disease 2019 pandemic><coronavirus disease 2019 public health crisis><coronavirus disease crisis><coronavirus disease epidemic><coronavirus disease pandemic><coronavirus disease-19 global pandemic><coronavirus disease-19 pandemic><craving><decrease symptom><determine efficacy><digital delivery><digitally deliver><drug use><efficacy analysis><efficacy assessment><efficacy determination><efficacy evaluation><efficacy examination><enroll><evaluate efficacy><evidence base><examine efficacy><experience><exposure to trauma><fewer symptoms><financial incentive><financial reward><health care personnel><health care worker><health provider><health service access><health service use><health service utilization><health services availability><health workforce><healthcare personnel><illicit drug use><illicit opiate><illicit opioid><improved><innovate><innovation><innovative><interventional strategy><medical personnel><medication for opioid use disorder><monetary incentive><novel><opiate consumption><opiate drug use><opiate intake><opiate overdose><opiate related overdose><opiate use><opiate use disorder><opioid consumption><opioid drug overdose><opioid drug use><opioid induced overdose><opioid intake><opioid intoxication><opioid medication overdose><opioid overdose><opioid poisoning><opioid related overdose><opioid toxicity><opioid use><opioid use disorder><physical conditioning><physical health><pilot study><post-trauma stress disorder><posttrauma stress disorder><randomisation><randomization><randomly assigned><reduce symptoms><relieves symptoms><rural under served><rural underserved><satisfaction><service availability><severe acute respiratory syndrome coronavirus 2 global health crisis><severe acute respiratory syndrome coronavirus 2 global pandemic><social stigma><stigma><substance use><substance use and disorder><substance using><symptom alleviation><symptom reduction><symptom relief><trauma exposure><traumatic neurosis><treatment access><treatment as usual><treatment provider><under served community><underserved community><usual care><vulnerable group><vulnerable individual><vulnerable people>