A Brief Values Intervention to Support Veterans in Early Buprenorphine Treatment

The proposed Career Development Award (CDA-2) would support Dr. Victoria Ameral, Clinical Research
Psychologist with the VISN 1 New England Mental Illness Research, Education, and Clinical Center (MIRECC)
and recent graduate of the VA Interprofessional Advanced Addiction Fellowship, in her goal of becoming an
expert in recovery-oriented behavioral interventions for Veterans with Opioid Use Disorder (OUD). Medications
for OUD save lives by preventing relapse and overdose, but they do not actively directly address the significant
functional challenges for Veterans in early recovery. Adjunctive behavioral interventions hold promise for this
area, but existing approaches rarely outperform standard buprenorphine medication management. This may
be due to a tendency for early sessions to focus on symptoms (i.e., cravings and urges) that are already
addressed by medication treatment. The proposed research seeks to develop a brief, values-based
intervention which instead focuses on helping to improve Veterans’ interpersonal functioning and community
integration during early treatment. These two recovery-oriented concepts are closely linked to the known
functional consequences of OUD and are key predictors of recovery outcomes. The three phases and
respective aims for the current proposal cover the activities outlined in Stages 1a and 1b of Rounsaville’s
Behavioral Therapy Development Model. Specifically, manual development (Stage 1a) will include stakeholder
interviews with Veterans and VA Providers (Aim 1) and an open pilot with a small sample of Veterans to field
test the intervention (Aim 2). The final phase of the proposed research will be a pilot randomized controlled trial
(RCT) of the intervention compared to standard medication management, the standard of care and most
common comparison condition for research with this population (Aim 3), which will provide feasibility and
acceptability data for the intervention. These aims will directly support a subsequent RR&D MERIT proposal to
conduct a full-scale RCT of the resulting intervention and will also provide invaluable experience for the
candidate’s intended long-term career path. The current proposal’s training aims are designed to build on Dr.
Ameral’s clinical background in Acceptance and Commitment Therapy (the theoretical foundation for the
proposed intervention), experience in translational experimental research, and demonstrated commitment to a
VA research career in recovery-oriented addiction. These training aims will be met through a series of formal
training experiences together with support and guidance from a mentorship team of highly productive VA
researchers with complementary expertise and skills sets. Specifically, the current proposal will address critical
knowledge and skills gaps for the candidate in relevant content areas (recovery-oriented research, behavioral
intervention development, medications for OUD) and methodological approaches (conducting clinical trials,
qualitative methods, statistical analysis for clinical trials), and leadership and professional development to
support the proposed research and career plan. In sum, the research and training outlined in the current
proposal will position Dr. Ameral to become a leading researcher in the area of recovery-oriented interventions
for Veterans with OUD.

Grant Number: 5IK2RX003789-04
NIH Institute/Center: VA
Principal Investigator: Victoria Ameral