Delivering Psychosocial Treatment to Substance Abusers via Mobile Technologies

描述（由申请人提供）：阿片类药物使用障碍 (OUD) 是一个重要且日益严重的公共卫生问题；超过三分之一寻求药物滥用治疗的人拥有 OUD，每年 OUD 的费用超过 300 亿美元。美沙酮维持治疗（MMT）已被广泛证明在治疗 OUD 方面是安全有效的，特别是当基于证据的心理社会干预是治疗的一部分时。不幸的是，与其他类型的药物治疗计划相比，MMT 计划提供的心理社会治疗水平最低。目前的申请是根据行为和综合治疗开发计划 (PA 07-111) 提交的。目标 1 是开发一种移动治疗系统 (MTS)，提供循证心理社会干预（社区强化方法；CRA）的关键要素，包括目标设定和监测、药物使用功能分析、自我管理、拒绝药物技能、问题解决以及社会和娱乐咨询。参与者将获得无限制的每日提示，以鼓励计划的使用，并将无限制地访问移动应用程序。我们的迭代开发流程将包括 MMT 客户焦点小组 (n=24) 的意见、该领域专家的意见以及 MMT 客户 (n=30) 对基于手机的程序测试版的反馈。目标 2：我们将评估该移动工具对在治疗前三个月接受美沙酮维持治疗 (MMT) 的参与者 (n=219) 的功效。我们将在 3 个月的干预阶段评估 (1) 标准治疗、(2) 标准治疗加 MTS 和 (3) 基于移动设备的控制条件对治疗保留和阿片类药物使用（通过尿液毒理学）的主要结果和其他物质使用的次要结果（通过尿液毒理学和自我报告）、改变药物使用行为的准备情况、应对技能、阿片类药物渴望、艾滋病毒危险行为和心理社会功能的相对初步疗效。将在 1 个月和 3 个月的随访中检查效果的持久性。据我们所知，这项研究将是第一个使用移动电话技术针对非法药物使用提供全面、交互式、基于证据的心理社会干预的研究，该干预可以在个人的自然环境中轻松获取并按需提供治疗。目标 3：我们将在基于社区的 MMT 中对 MTS 进行经济分析。我们将估计 MTS 相对于标准护理和移动对照组的增量成本和增量成本效益比 (ICER)。主要 ICER 将考虑每增加禁欲时间的成本（临床功效），次要 ICER 将考虑每增加质量调整生命年的成本（经济功效）。成本数据对于未来在社区系统中传播有效的移动干预措施的转化项目至关重要。如果结果有希望，MTS 将很容易适应，并且可能对改善各种问题（例如精神和行为健康）的治疗可及性和有效性产生巨大影响，同时显着限制成本。

DESCRIPTION (provided by applicant): Opioid use disorders (OUDs) are a significant and growing public health issue; over a third of persons seeking substance abuse treatment have an OUD and the annual cost of OUDs is over $30 billion. Methadone maintenance treatment (MMT) has been widely shown to be safe and effective in treating OUDs, especially when evidence-based psychosocial interventions are part of treatment. Unfortunately, MMT programs offer the lowest level of psychosocial treatment relative to other types of drug treatment programs. The current application is being submitted under the Behavioral & Integrative Treatment Development Program (PA 07- 111). Aim 1 is to develop a Mobile Therapeutic System (MTS) that offers key elements of an evidence-based psychosocial intervention (Community Reinforcement Approach; CRA) including Goal Setting and Monitoring, Functional Analysis of Drug Use, Self-Management, Drug Refusal Skills, Problem-Solving, and Social and Recreational Counseling. Participants will be provided unlimited daily prompts to encourage program use and will be provided with unlimited access to the mobile application. Our iterative development process will include input from focus groups with clients in MMT (n=24), input from experts in the field, and feedback from clients in MMT (n=30) on a beta-version of the mobile phone-based program. Aim 2: We will evaluate the efficacy of this mobile tool with participants entering methadone maintenance treatment (MMT) during the first three months of their treatment (n=219). We will evaluate the relative preliminary efficacy of (1) standard treatment, (2) standard treatment plus MTS and (3) a mobile-based control condition on the primary outcomes of treatment retention and opioid use (via urine toxicology) and secondary outcomes of other substance use (via urine toxicology and self-report), readiness to change drug use behavior, coping skills, opioid craving, HIV risk behavior, and psychosocial functioning during the 3-month intervention phase. Durability of effects will be examined at 1 and 3 month follow-ups. To our knowledge, this study would be the first to use mobile phone technology to deliver a comprehensive, interactive, evidence-based psychosocial intervention targeting illicit drug use that can be easily accessed in an individual's natural environment and provide treatment on-demand. Aim 3: We will perform an economic analysis of MTS in community-based MMT. We will estimate the incremental costs and the incremental cost-effectiveness ratio (ICER) of MTS relative to standard care and the mobile control group. The primary ICER will consider costs per increased abstinence time (clinical efficacy) and the secondary ICER will consider costs per increased quality adjusted life year (economic efficacy). Cost data are vital to future translationl projects to disseminate effective mobile interventions in community systems. If results are promising, MTS would be easily adaptable and may have enormous impact on improving treatment access and effectiveness for a variety of issues (e.g., mental and behavioral health) while significantly limiting costs.