Sustaining recovery for people on opioid agonist treatment with conversational agents

使用对话代理维持阿片类激动剂治疗患者的康复

• 批准号: 10810952
• 负责人: TIMOTHY W. BICKMORE
• 金额: $ 31.61万
• 依托单位: BOSTON MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-09-30 至 2026-08-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10810952
• 关键词: Abstinence; Address; Adherence; Behavior; Buprenorphine; Capital; Caring; Cellular Phone; Clinic; Clinical Trials; Cognitive Therapy; Computers; Control Groups; Country; Data; Drops; Education; Effectiveness; Emotional; Emotions; Engineering; Enrollment; Exercise; Goals; Health; Health Personnel; Healthcare; Hybrids; Intervention; Intuition; Measures; Opioid; Outcome; Participant; Patients; Persons; Pharmaceutical Preparations; Pilot Projects; Process; Randomized; Randomized, Controlled Trials; Recovery; Recovery Support; Resources; Sampling; Social isolation; Stigmatization; Stress; Subgroup; System; Testing; Thinking; addiction; animation; arm; buprenorphine treatment; common treatment; comparison intervention; coping; dashboard; depressive symptoms; design; effectiveness study; emotion dysregulation; experience; follow-up; group intervention; high risk; implementation study; improved; individual patient; instrument; intervention effect; intervention participants; long term recovery; low health literacy; low socioeconomic status; medication for opioid use disorder; mindfulness; motivational enhancement therapy; opioid agonist therapy; opioid epidemic; opioid use; opioid use disorder; outreach; pilot test; pressure; primary outcome; racial minority population; recovery services; recruit; relapse prevention; relapse risk; smartphone application; social; social stigma; staff intervention; substance use; sustained recovery; therapy design; treatment as usual; treatment duration; treatment program; uptake; usability

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.

项目总结/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次治疗后停止治疗。 一年，由于物质使用和药物耻辱和其他恢复挑战，如压力，情绪 失调和社会孤立我们的目标是通过以下方法提高丁丙诺啡治疗的保留率： 智能手机提供的、基于污名的康复支持干预。我们建议发展体现 会话代理（ECA），即，模拟自然和直观的面对面的动画计算机代理 对话，在几项临床试验中证明成功地帮助人们应对与健康相关的挑战。 干预措施参与者将参与与非洲经委会的互动，并最大限度地利用非洲经委会，以便他们能够 更好地科普污名化，与康复服务保持联系，并继续接受丁丙诺啡。 ECA将提供一种基于认知行为疗法的接受性干预， 结合教学成分，教育故事，体验活动，动机访谈和 正念练习，以帮助参与者克服与内化相关的消极思想和情绪 物质使用和干预污名化。ECA活动将基于我们最近完成的验收- 基于污名的干预，显示出增加阿片类药物使用障碍患者的护理参与。在 如果参与者经历了复发风险增加的危机，诊所仪表板将生成 工作人员警报提示临床医生外展。在第一年，我们将共同设计和试点测试ECA系统， 10例OBAT患者。在可用性工程和健康污名框架的指导下，我们将设计ECA 活动和诊所仪表板，以帮助MOUD上的人更有效地应对 建立恢复资本。在第2年和第3年，我们将进行多组3：1随机对照试验 一项研究，招募了100名开始丁丙诺啡治疗的人，分为三个干预亚组，每组25名参与者 每个.干预小组的参与者将采用不同的策略参与ECA的使用，以最大限度地提高使用率 并与25名在BMC办公室接受常规治疗的对照组参与者进行比较 诊所我们将估计ECA对丁丙诺啡治疗中保留的主要结局的影响12 随机化后3个月，对所有干预参与者与对照参与者进行评估， 三个亚组分别与对照组比较。同样，我们将评估干预措施的效果， 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）。这个项目还将测试过程、工具和交互 在用户、系统和OBAT诊所之间，通知随后计划的R 01混合型 实施和有效性RCT。通过解决污名化和康复挑战，这种干预措施可以 有助于改善丁丙诺啡治疗保留并支持阿片类药物使用障碍的长期恢复。