Automated Recovery Line for Medication Assisted Treatment

描述（由申请人提供）：自2000年以来，对海洛因和处方止痛药的依赖几乎增加了两倍，导致阿片类药物依赖治疗入院人数急剧增加。然而，在持续使用激动剂的患者中，持续使用药物是常见的，并且与高复发率和治疗退出有关。尽管心理咨询已被证明是有效的，但它是昂贵的，一些病人不喜欢心理咨询，另一些病人有责任使他们难以出席，农村地区的病人往往无法获得心理治疗。因此，显然需要开发更多的可接受和具有成本效益的治疗方法。交互式语音应答（IVR）系统，已被证明可以有效地增加对药物滥用的简短干预，是一种自动化的、基于计算机的系统，通过电话传递，使用语音或键来访问不同的菜单。IVR系统可以通过任何电话访问，而不仅仅是特定的技术（例如智能手机），并且具有低成本，一致交付，扩展访问和24小时即时治疗干预的优势。康复线是一种基于认知行为疗法（CBT）的IVR系统，用于减少接受阿片类激动剂维持的患者的物质使用。我们最近完成了一项为期4周的随机试验，该试验显示可卡因的使用显著减少，应对技能的有效性也有所提高，但患者呼叫的时间比预期的要少，这表明改善患者使用的方法可能会进一步提高疗效。本Ib阶段申请提出了三个阶段来开发系统功能，以增加患者系统的使用，并测试这些功能。具体目标1（阶段1）是根据应对技能评估制定和评估定制的治疗建议。患者将被引导到模块中，根据他们对简短的初步问题的回答，帮助他们评估应对缺陷。具体目标2（阶段2）是开发和测试系统提醒消息，以评估最佳延迟（未接来电后的时间）和消息内容。我们将评估增益框架和损失框架信息，因为它们在基于信息的吸烟干预中是有效的。我们将评估提醒消息延迟，因为短的提醒延迟最初可能有效，但频繁的提醒可能会随着时间的推移而变得令人反感和无效。第一阶段和第二阶段的功能将被纳入最终的回收线原型。具体目标3（第3期）是进行一项为期12周的随机试验（N=60），临床试验，治疗后随访3个月，以获得有关开发的恢复线（与TAU相比）的可行性，可接受性和有效性的数据。将评估两个主要结果域的疗效，即非法药物尿液筛查阴性比例和每月非法药物戒断天数。次要结果测量将是治疗的保留和应对技能的有效性。

DESCRIPTION (provided by applicant): Dependence on heroin and prescription pain relievers has almost tripled since 2000, resulting in dramatic increases in opioid dependence treatment admissions. However, among agonist-maintained patients continued drug use is common and associated with high rates of relapse and treatment drop-out. Although counseling has been shown to be effective, it is costly and some patients dislike counseling, others have responsibilities that make attendance difficult, and patients in rural settings often have limited access to psychotherapy. Thus, there is a clear need to develop additional acceptable and cost-effective treatments. Interactive Voice Response (IVR) systems, which have been shown to effectively augment brief interventions for substance abuse, are automated, computer-based systems delivered via phone and use voice or keys to access different menus. IVR systems can be accessed from any phone rather than only specified technology (e.g., smart phones), and offer advantages of low cost, consistent delivery, expanded access, and 24-hour availability of immediate therapeutic intervention. The Recovery Line is a Cognitive Behavioral Therapy (CBT)-based IVR system to reduce substance use in patients receiving opioid agonist maintenance. We recently completed a pilot randomized 4-week trial which showed significant reduction in cocaine use and increased coping skill efficacy, but patients called less time than expected, suggesting methods to improve patient use may further improve efficacy. This Stage Ib application proposes three phases to develop system functions to increase patient system use and to test those functions. Specific aim 1 (Phase 1) is to develop and evaluate customized therapeutic recommendations based on coping skills assessments. Patients will be directed to modules to help them with assessed coping deficiencies based on their answers to brief preliminary questions. Specific aim 2 (Phase 2) is to develop and test system reminder messages to evaluate optimal latency (time since missed call) and message content. We will evaluate gain-framed and loss-framed messages because they have been effective in message-based smoking interventions. We will evaluate reminder message latency because short reminder latencies may be effective initially but frequent reminders may become aversive and ineffective over time. Phases 1 and 2 features will be incorporated into the final Recovery Line prototype. Specific aim 3 (Phase 3), is to conduct a 12-week pilot randomized (N=60), clinical trial with a 3 month post-treatment follow- up to obtain data regarding the feasibility, acceptability and efficacy of the developed Recovery Line (compared to TAU). Efficacy will be evaluated for the two primary outcome domains of the proportion of urine screens negative for illicit drugs and monthly days of illicit drug abstinence. Secondary outcome measures will be retention in treatment and coping skills efficacy.