Improving Opioid Use Disorder Treatment Retention Outcomes Using Mindfulness in Childhood Trauma Survivors

ABSTRACT This Mentored Patient-Oriented Research Career Development Award (K23) application seeks support for research training to augment the candidate’s knowledge and skills in co-occurring childhood trauma and opioid use disorder (OUD) in order to support her progress to become an independent investigator. During the award, the candidate will develop and implement a research program related to technology-based mindfulness interventions and use of biomarkers to improve engagement in medication treatment for opioid-use disorder (MOUD) in those who have experienced childhood trauma. The central hypothesis is that changes in autonomic function and inflammation mediate the relationship between childhood trauma and poor treatment retention in MOUD, and that mobile mindfulness training (mMT) is feasible in this population with potential benefits to emotional, inflammatory, and autonomic function. This proposal includes training activities to ensure Dr. Meadows achieves the following career goals: 1) Training in the discovery, interpretation, and assessment of potential biomarkers to assess the link between childhood trauma and outcomes, 2) Advanced training in the design and implementation of clinical interventions, and 3) Training in the analysis and interpretation of data. The mentorship team includes experts in the following areas of research: substance use disorders (Drs. Rush and Martin), intervention development (Dr. Rush), and advisors with expertise in the use of mobile mindfulness training for substance use disorder (Dr. Reynolds), inflammatory biomarker evaluation (Dr. Moylan), heart rate variability (Dr. Minassian), trauma treatment (Dr. Sprang), and advanced statistical modeling (Dr. McLouth). Dr. Meadows will apply the skills from the training to test the three specific aims: 1) Demonstrate baseline differences in autonomic function, inflammation, and treatment engagement between those with a history of childhood trauma and those without childhood trauma or post-traumatic stress disorder enrolled in MOU, 2) Implement and evaluate mMT in childhood trauma-exposed individuals enrolled in MOUD in order to a) demonstrate feasibility and acceptability and b) estimate effect sizes for improvements in emotional health, autonomic function, and inflammation, and 3) Assess whether mMT improves treatment engagement and retention in MOUD. The proposed research is innovative because it will provide insight into the relationship between potential biomarkers and treatment engagement in MOUD. It is also highly significant because it focuses on a mobile intervention that can be readily adapted as an adjunct to existing treatment programs to improve outcomes. The research, training plan, mentorship, and institutional support will facilitate Dr. Meadows’s transition to becoming an independent physician-scientist to better serve the needs of individuals with co-occurring childhood trauma exposure and substance use who are at the highest risk of treatment dropout and poor outcomes.