Using Smartphones to Provide Recovery Support Services

描述（由申请人提供）：全国60种主要疾病的成本估计将酒精使用障碍列为第2位，药物使用障碍列为第7位最昂贵的健康问题两者都与与人类免疫缺陷病毒（HIV）相关的艾滋病毒风险行为的高发率有关，它们共同代表了美国十大可改变的死亡行为原因中的三个。研究表明，管理物质使用障碍（SUD）的有效战略必须解决其慢性和周期性，其中艾滋病毒风险是其中的一部分。4-9对许多人来说，药物使用造成了增加艾滋病毒风险的环境（例如，针头使用、性交易），对其他人来说，药物使用是应对生活方式选择的负面影响的一种机制（例如，非法活动、失去对子女的监护权、性交易）。弃后监测、反馈和早期再干预已成为管理许多慢性疾病的标准做法移动技术通过提供持续监测、评估和随时随地获得恢复支持干预措施的工具，有可能从根本上提高持续恢复的几率。这对于90%需要治疗却没有得到治疗的人来说尤为重要。因此，应用智能手机技术随时随地提供恢复管理具有潜在的重要意义。拟议的试验旨在通过生态瞬时评估（EMA）、生态瞬时干预（EMI）及其对物质使用障碍和艾滋病毒风险的组合，在2 × 2因子设计中测试使用智能手机提供治疗后支持服务的有效性。参与者（n=400）将在治疗出院后进行招募和访谈，随机分组，在3个月和6个月再次访谈。EMA组的患者将被要求每天6次记录他们最近接触的风险因素，然后评估这些因素使他们想要使用或恢复的程度。EMI小组中的个人将可以实时访问一套基于智能手机的康复支持服务，旨在激励他们，帮助他们应对潜在的复发诱因，并将他们与社会支持联系起来。在EMA+EMI条件下，EMA反应将用于产生复发和HIV风险的即时反馈。目的是：1)测试EMA、EMI和EMA+EMI对禁欲天数的影响；2)测试EMA、EMI和EMA+EMI对HIV危险行为的影响；3)评估禁欲天数变化对EMA、EMI和EMA+EMI对HIV危险行为的影响程度。

DESCRIPTION (provided by applicant): Nationwide cost estimates of 60 major illnesses place alcohol use disorders as the 2nd and drug use disorders as the 7th most costly health problems.3 Both are related to higher rates of HIV risk behaviors associated with the human immunodeficiency virus (HIV) and together they represent 3 of the top 10 modifiable behavioral causes of mortality in the US. Studies indicate that effective strategies for managing substance use disorders (SUD) must address its chronic and cyclical nature, of which HIV risk is a part.4-9 For many, substance use creates circumstances that increase HIV risk (e.g., needle use, trading sex) and for others, substance use is a coping mechanism for the negative impact of lifestyle choices (e.g. illegal activity, losing custody of their children, trading sex). Post-discarge monitoring, feedback and early re- intervention have become standard practice when managing numerous chronic conditions.10 Mobile technology has the potential to radically improve the odds of sustained recovery by providing tools for ongoing monitoring, assessment and access to recovery support interventions anytime and anywhere. This is particularly important for the 90% of those needing treatment that don't receive it. Therefore applying smartphone technology to provide recovery management anytime anywhere is potentially significant. The proposed trial is designed to test the effectiveness of using smartphones to provide post-treatment support services via ecological momentary assessments (EMA), ecological momentary interventions (EMI) and their combination on substance use disorders and HIV risk in a 2 x 2 factorial design. Participants (n=400) will be recruited and interviewed after treatment discharge, randomized, interviewed again at 3 and 6 months. Those in the EMA groups will be asked 6 times per day to record their recent exposure to risk factors and then rate the extent to which these factors are making them want to use or be in recovery. Individuals in the EMI groups will have real-time access to a suite of smartphone-based recovery support services designed to motivate them, help them cope with potential relapse triggers, and connect them to social support. In the EMA+EMI condition, the EMA responses will be used to generate immediate feedback on relapse and HIV risk. AIMS are to: 1) Test the effect of EMA, EMI and EMA+EMI on days of abstinence, 2) Test the effect of EMA, EMI and EMA+EMI on HIV risk behaviors, and 3) Evaluate the extent to which changes in days of abstinence mediate the effect of EMA, EMI, and EMA+EMI on HIV risk behaviors.