Sustaining recovery for people on opioid agonist treatment with conversational agents

项目摘要/摘要 几乎一半接受丁丙诺啡治疗阿片类药物使用障碍的人在第一个月内停止治疗 一年来，由于药物使用和药物耻辱以及其他康复挑战，如压力、情绪 监管失调和社会孤立。我们的目标是通过一种 智能手机提供的耻辱信息恢复支持干预。我们建议发展具体化 对话代理(ECA)，即模拟自然和直观面对面的动画计算机代理 对话，在几个临床试验中被证明是成功的，帮助与健康相关的挑战的人。 干预参与者将参与与非洲经委会的互动，并最大限度地利用它，以便他们能够 更好地应对耻辱，与康复服务保持联系，并继续接受丁丙诺啡治疗。 ECA将提供源于认知行为疗法的基于接受的干预，提供 结合教学内容、教育故事、体验活动、激励性采访和 正念练习，帮助参与者克服与内化相关的负面想法和情绪 物质使用和干预污名。非洲经委会的活动将基于我们最近完成的验收- 基于污名的干预，表明增加了阿片类药物使用障碍患者的护理参与度。在……里面 如果参与者经历了复发风险增加的危机，诊所仪表盘将生成 工作人员提醒，促使临床医生外展。在第一年，我们会共同设计和试行雇员补偿制度，包括 肥胖患者10例。在可用性工程和健康污名框架的指导下，我们将设计ECA 活动和临床仪表板，帮助Moud上的人们更有效地应对 羞辱和建立复苏资本。在第二年和第三年，我们将进行多臂3：1随机对照试验 这项研究招募了100名开始丁丙诺啡治疗的人，分为三个干预小组，共25名参与者 每个人。干预组参与者将以不同的策略参与ECA的使用，以最大限度地提高接受能力 相比之下，25名对照组参与者在BMC办公室接受常规治疗成瘾治疗 诊所。我们将评估ECA对丁丙诺啡保留治疗的主要结果的影响12 随机化后几个月，对所有干预参与者和对照组参与者进行评估，并对 三个亚组分别与对照组比较。同样，我们将评估干预的效果 关于6个月和12个月时坚持使用丁丙诺啡和阿片类药物；以及耻辱和康复的变化 资本评分(探索性结果)。该项目还将测试流程、工具和交互 在用户、系统和OBAT诊所之间，通知随后计划的R01混合类型 执行和有效性区域协调机制。通过解决耻辱和恢复挑战，这种干预可以 帮助改善丁丙诺啡治疗的保留，并支持从阿片类药物使用障碍的长期恢复。

PROJECT SUMMARY/ABSTRACT Almost half of all people receiving buprenorphine for opioid use disorder discontinue treatment within the first year, due to substance use and medication stigma and other recovery challenges such as stress, emotional dysregulation, and social isolation. We aim to improve retention in buprenorphine treatment through a smartphone-delivered, stigma-informed recovery support intervention. We propose to develop embodied conversational agents (ECA), i.e., animated computer agents that simulate natural and intuitive face-to-face conversations, proven successful in several clinical trials in assisting people with health-related challenges. Intervention participants will be engaged to interact with the ECA and maximize its uptake so that they can better cope with stigma, stay connected with recovery services and continue to receive buprenorphine. The ECA will deliver an acceptance-based intervention originating in cognitive-behavioral therapy, delivering a combination of didactic components, educational stories, experiential activities, motivational interviewing and mindfulness exercises to help participants overcome negative thoughts and emotions related to internalized substance use and intervention stigma. ECA activities will be based on our recently completed acceptance- based stigma intervention, shown to increase care engagement of people with opioid use disorder. In instances where participants experience a crisis with increased relapse risks, a clinic dashboard will generate staff alerts prompting clinician outreach. In year one, we will co-design and pilot-test the ECA system involving 10 OBAT patients. Guided by usability engineering and health stigma frameworks, we will design ECA activities and the clinic dashboard to help people on MOUD respond more effectively to manifestations of stigma and build recovery capital. In years 2 and 3, we will conduct a multi-arm 3:1 randomized, controlled pilot study, enrolling 100 people initiating buprenorphine treatment in three intervention subgroups of 25 participants each. Intervention group participants will be engaged in ECA use with different strategies to maximize uptake and compared to 25 control participants receiving usual care at the BMC office–based addiction treatment clinic. We will estimate the ECA’s effects for the primary outcome of retention in buprenorphine treatment 12 months post randomization, assessed for all intervention participants vs. control participants and pairwise for each of the three subgroups vs the control group separately. Similarly, we will assess the intervention’s effects on adherence to buprenorphine and opioid use at 6 and 12 months; and on changes in stigma and recovery capital scores (exploratory outcomes). This project will also test processes, instruments, and interactions between users, the system and the OBAT clinic, informing a subsequently planned R01 hybrid type implementation and effectiveness RCT. By addressing stigma and recovery challenges, this intervention can help improve buprenorphine treatment retention and support long-term recovery from opioid-use disorder.