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.
