Smartphone Addiction Recovery Coach for Young Adults (SARC-YA) Experiment

摘要 接受物质使用障碍（SUD）治疗的青少年有很高的恢复率， 治疗结束后使用药物。虽然复发预防被广泛纳入SUD 青少年的治疗、持续康复的工具往往缺乏或不足。智能手机 有潜力通过提供生态瞬时评估（EMA）来满足这一需求; EMA是一个 自我监控干预，可以用来帮助人们识别和更好地理解前因， 使用药物的模式和后果。此外，智能手机可以提供即时访问 通过生态瞬时干预（EMI）提供的一系列恢复支持。 作为私家侦探的一部分的MERIT奖（R37 DA 011323 -14），该研究小组开发的智能手机 青少年成瘾康复教练（SARC-A）移动的应用程序，基于动态模型 预防复吸，并利用智能手机提供以恢复为导向的干预措施。申请人团队 完成了两项试点研究，其中通过智能手机向青少年提供EMA和EMI， 单独和组合。结果表明，EMA是可靠的完成（每天5至6）和准确的 预测未来7天内使用的风险。此外，参与者平均完成20个或更多的环境管理信息 每天使用EMI的人数和EMI的使用与未来7天内物质使用的减少有关。 基于这些发现，申请人提出了以下实验研究。青少年 （N=400）将在他们从4个门诊治疗项目之一出院时招募，并随机 分配至4种条件之一：（1）恢复支持作为常规控制，（2）仅EMA，（3）仅EMI，或（4） EMA+EMI实验条件。出院后6个月内将提供干预措施，每季度一次 9个月的评估。数据包括标准化评估、尿检、移动的手机Meta数据， EMA响应和EMI利用率。将使用多水平生存分析检验研究假设 纵向数据建模和结构方程建模。这项研究的目的如下： 目标1：测试EMA、EMI和EMA+EMI（v控制）对物质使用频率的影响;目标2： 评估基线物质使用频率对上述影响的调节程度;目标3： 测试物质使用频率在多大程度上介导EMA、EMI和EMA+EMI对 恢复的其他方面，包括SUD症状，HIV风险行为，生活质量，心理健康， 目标4：确定EMA反应和EMI利用率预测持续时间的程度。 禁欲

Abstract Adolescents who receive treatment for substance use disorders (SUD) have high rates of resuming substance use after they leave treatment. Although relapse prevention is widely incorporated within SUD treatment for adolescents, tools for sustaining recovery are frequently lacking or inadequate. Smartphones have the potential to address this need by delivering Ecological Momentary Assessments (EMA); EMA is a self-monitoring intervention that can be used to help people identify and better understand the antecedents, patterns, and consequences of substance use. In addition, smartphones can provide immediate access to a range of recovery supports delivered via Ecological Momentary Interventions (EMI). As part of the P.I.’s MERIT award (R37 DA011323-14), the research team developed the Smartphone Addiction Recovery Coach for Adolescents (SARC-A) mobile application, which is based on a dynamic model of relapse prevention and utilizes smartphones to deliver recovery-oriented interventions. The applicant team completed two pilot studies in which EMAs and EMIs were delivered to adolescents via smartphones, both separately and combined. Results indicated that EMAs were reliably completed (5 to 6 per day) and accurately predicted the risk of use in the next 7 days. In addition, participants completed an average of 20 or more EMIs per day and EMI utilization was associated with reduced substance use in the next 7 days. Building on these findings, the applicants propose the following experimental study. Adolescents (N=400) will be recruited upon their discharge from 1 of 4 outpatient treatment programs and randomly assigned to 1 of 4 conditions: (1) recovery support as usual control, (2) EMA-only, (3) EMI-only, or (4) EMA+EMI experimental conditions. Interventions will be delivered for 6 months post-discharge with quarterly assessments through 9 months. Data include standardized assessments, urine tests, mobile phone meta data, EMA responses, and EMI utilization. Study hypotheses will be tested using survival analysis, multi-level modeling and structural equation modeling of longitudinal data. The study has the following aims: Aim 1: Test the effects of EMA, EMI, and EMA+EMI (v control) on the frequency of substance use; Aim 2: Evaluate the extent to which the above effects are moderated by baseline substance use frequency; Aim 3: Test the extent to which the frequency of substance use mediates the effects of EMA, EMI, and EMA+EMI on other aspects of recovery including SUD symptoms, HIV risk behavior, quality of life, mental wellness, days of school; and Aim 4: Determine the degree to which EMA responses and EMI utilization predict the duration of abstinence.