PROJECT SUMMARY / ABSTRACT
The overarching goal of this 5-year K23 proposal is to support Taylor Crouch, PhD, in her
development as an independent investigator in the overlapping areas of chronic pain and
addiction, with a focus on enhancing uptake of evidence-based nonpharmacological chronic
pain interventions and reducing reliance on long term opioid therapy (LTOT). Evidence-based
behavioral interventions for pain are among the most effective and safe treatments, but
utilization remains low, especially among patients on LTOT. The risks of LTOT, including opioid
use disorder and overdoses, are well-established, but complex dependence can limit patients’
readiness to try something different. Two key barriers to uptake of nonpharmacological
interventions have been identified as low motivation and logistical barriers to care. Two existing
evidence-based interventions to enhance motivation and support behavior change, Motivational
Interviewing (MI) and Contingency Management (CM), have promise for enhancing readiness to
change among patients with chronic pain displaying risks on LTOT, and eHealth interventions
can improve access and reach of interventions. Therefore, the objective of this proposal is to
develop a MI/CM eHealth intervention to increase readiness to utilize nonpharmacological
treatments and reduce reliance on opioids among individuals displaying risk on LTOT. Specific
Aims are: Aim 1: To inform intervention approach, conduct exploratory testing with providers
and patients to clarify needs/barriers, consolidate existing theory/evidence using the Medical
Research Council framework, and complete initial testing of intervention ingredients. Aim 2:
Develop an alpha prototype MI/CM eHealth intervention aimed at enhancing motivation to utilize
nonpharmacological treatments and reduce opioid reliance, using the Computerized
Intervention Authoring System, and assess usability. Aim 3: Develop beta and conduct a pilot
randomized clinical trial to assess feasibility and acceptability. At the completion of the pilot trial
in Aim 3, the intervention will be ready to be tested in an R01 to evaluate its efficacy in
enhancing not only motivation, but action toward reduced opioid use and utilization of evidence-
based non-opioid CP interventions. This proposal represents a 5-year comprehensive
mentoring, training, and research plan to transition the candidate, Dr. Crouch, to a career as a
successful independent investigator. Dr. Crouch has background training and expertise in
behavior change, motivation, addictive behaviors, and behavioral chronic pain interventions,
and through her comprehensive training plan she will be positioned to become a leader in these
areas and further develop her expertise in implementation science and clinical trials.
