# Brief Digitally-Enhanced Intervention for Managing Emotional Pain and Reducing Alcohol Use during Medication for OUD

> **NIH NIH R34** · OHIO STATE UNIVERSITY · 2024 · $315,000

## Abstract

ABSTRACT
Heavy, problematic alcohol use is highly prevalent within individuals receiving medications for opioid use disorder
(MOUD) and contributes to increased risk of opioid overdose and poorer MOUD treatment outcomes. The
recently proposed CANUE model (Catastrophizing, Anxiety, Negative Urgency, and Expectancy) suggests that
emotional pain (or psychological distress) is a robust proximal antecedent to alcohol and opioid use via negative
reinforcement. More importantly, the CANUE model posits that several modifiable risk factors influence ‘self-
medication’ of emotional pain with alcohol during MOUD. Two key factors implicated in this model are anxiety
sensitivity (AS) and intolerance of uncertainty (IU) which are theorized to independently and synergistically
interact to amplify the negative reinforcement cycle of addiction and play a unique role in alcohol use during
MOUD. Along these lines, our team has developed a brief, digitally-enhanced, virtual psychotherapeutic
intervention called IMPROVE: Managing Physical Reactions to Overwhelming Emotions. IMPROVE is
associated with large reductions in IU and AS in college students with elevated anxiety. The overall objective of
this proposal is to further develop and refine IMPROVE to be used as a brief intervention to reduce alcohol use
among individuals engaged in MOUD. We will also use this planning project to collect preliminary data on
whether changes in AS/IU targets are linked to changes in alcohol use. This R34 study will lay the groundwork
for a large-scale clinical trial of IMPROVE to reduce heavy drinking and enhance MOUD outcomes. The current
study will leverage the infrastructure of our university-based addiction treatment center and a community partner
to complete two study phases. In Phase One (Aim 1; Year 1) we will adapt IMPROVE’s content, delivery, and
digital tools using the Delphi method with key experts and stakeholders. We will also develop an implementation
protocol through field usability sessions. Aim 1 will yield a customized, feasible, and acceptable IMPROVE
package ready for implementation. In Phase Two (Years 2-3) we will conduct a pilot randomized control trial of
the adapted IMPROVE protocol as compared to our active control intervention on drinking behavior in individuals
receiving MOUD. Heavy alcohol users receiving MOUD will be assigned to IMPROVE or a control health
promotion intervention (N=40 per arm). All participants will complete daily ecological momentary assessments
(EMA) delivered to participants’ mobile phones to capture real-world alcohol use before, during, and after the
intervention. We will evaluate the impact of IMPROVE (vs. control) on daily alcohol use (primary) and MOUD
adherence (secondary), and explore treatment-related changes in the antecedents of drinking behavior (Aim 2).
Phase Two will also include a multimodal battery of self-report and objective lab-based measures of AS and IU
involving startle eyeblink potentiation and event-related pote...

## Key facts

- **NIH application ID:** 11001353
- **Project number:** 1R34DA061589-01
- **Recipient organization:** OHIO STATE UNIVERSITY
- **Principal Investigator:** Nicholas Paul Allan
- **Activity code:** R34 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2024
- **Award amount:** $315,000
- **Award type:** 1
- **Project period:** 2024-08-01 → 2027-06-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/11001353

## Citation

> US National Institutes of Health, RePORTER application 11001353, Brief Digitally-Enhanced Intervention for Managing Emotional Pain and Reducing Alcohol Use during Medication for OUD (1R34DA061589-01). Retrieved via AI Analytics 2026-05-25 from https://api.ai-analytics.org/grant/nih/11001353. Licensed CC0.

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