Developing e-Covery: An App-Based Intervention to Support Recovery from Co-occurring Alcohol Use and Opioid Use

项目总结/摘要 同时发生的酒精和阿片类药物使用是一个需要关注的公共卫生问题，并已与各种 健康问题，如机动车事故和药物中毒和过量。个人从事 多种物质使用者在完成物质使用治疗后持续恢复方面面临无数挑战 并在治疗完成后返回使用是常见的。个人在早期恢复中面临的一个挑战是 是特定的地方是如何成为渴望的触发器，从而促使人们重新使用。智能手机应用 有可能通过提供信息（或"轻推"）来减少这种触发的影响， 被确定为返回使用的触发器的位置。到目前为止，基于应用程序的干预研究尚未 独立审查这种"轻推"的效果，没有考虑其在解决共同问题方面的有效性， 使用酒精和阿片类药物。这个F31旨在改善参与共同发生的个人的健康 酒精和阿片类药物的使用跨越两个研究目标。(Aim 1）我将研究基于地点的 触发并返回酒精和/或阿片类药物使用后，完成物质使用治疗使用混合 方法：了解基于地点的触发因素如何促使个人报告后重新使用 Au/Au离开处理。首先，我将确定基于地点的触发因素如何作为回归酒精的预测因素 和/或阿片类药物使用。使用GPS跟踪和每日调查，我将收集三个月的信息， 100名个体暴露于自我认定的引发使用渴望的地方的频率和持续时间 报告同时使用酒精和阿片类药物我将使用纵向和适度/中介分析， 通过以下方式确定暴露于此类触发因素是否会显著影响恢复使用的风险和机制： 它确实做到了。然后，我将与至少20名提供以下信息的个人进行半结构化访谈 定量数据，以更好地理解这些发现，并解释如何基于地点的触发沉淀返回 酒精和/或阿片类药物使用。这将有助于开发一个解释性模型，说明基于地点的触发器 影响力回归使用，以及基于位置的消息传递如何中断这一过程。我将利用这些发现， 为制定循证干预措施提供信息，以支持参与共同发生的个人 酒精和阿片类药物用于维持恢复。(Aim 2）然后，我会进行第1b阶段试验，以测试可行性。 以及对报告同时使用酒精和阿片类药物的个人进行基于应用程序的干预的可接受性。 修改现有应用程序，以便在个人遇到自我识别的基于地点的 触发，这种干预，基于"轻推"理论，旨在支持个人报告共同发生的酒精 和阿片类药物的使用来维持恢复。我将进行为期一个月的第1b阶段试点， 物质使用治疗，以评估干预的可行性和可接受性。使用受试者内测试，我将 将一般消息传递与根据目标1的结果制作的特定于地点的消息传递进行比较。

Project Summary/Abstract Co-occurring alcohol and opioid use is a public health issue in need of attention and has been linked to various health concerns, such as motor vehicle accidents and drug poisoning and overdose. Individuals engaged in polysubstance use face myriad challenges in sustaining recovery after completion of substance use treatment and return to use after treatment completion is common. One challenge faced by individuals in early recovery is how specific places can serve as triggers for cravings that can precipitate return to use. Smartphone apps have the potential to curtail the effects of such triggers by providing messaging (or “nudging”) when individuals are in locations identified as triggers of return to use. To date, research on app-based interventions has yet to examine the effect of such “nudging” independently and has not looked at its effectiveness in addressing co- occurring alcohol and opioid use. This F31 aims to improve the health of individuals engaged in co-occurring alcohol and opioid use across two research aims. (Aim 1) I will examine the relationship between place-based triggers and return to alcohol and/or opioid use after completion of substance use treatment using a mixed methods approach to understand how place-based triggers precipitate return to use after individuals reporting AU/OU leave treatment. First, I will identify how place-based triggers act as predictors of return to alcohol and/or opioid use. Using GPS tracking and daily surveys, I will collect information over three months on the frequency and duration of exposure to self-identified places that trigger cravings to use from 100 individuals reporting co-occurring alcohol and opioid use. I will use longitudinal and moderation/mediation analyses to identify whether exposure to such triggers significantly influences risk of return to use and the mechanisms by which it does. I will then conduct semi-structured interviews with at least 20 individuals who provided quantitative data to better understand these findings and explain how place-based triggers precipitate return to alcohol and/or opioid use. This will serve to develop an explanatory model for how place-based triggers influence return to use and how place-based messaging can interrupt this process. I will use these findings to inform the development of an evidence-based intervention to support individuals engaged in co-occurring alcohol and opioid use in maintaining recovery. (Aim 2) I will then conduct a stage 1b pilot to test the feasibility and acceptability of an app-based intervention for individuals reporting co-occurring alcohol and opioid use. Modifying an existing app to send push notifications when individuals encounter self-identified place-based triggers, this intervention, based on “nudging” theory, aims to support individuals reporting co-occurring alcohol and opioid use in maintaining recovery. I will conduct a one-month stage 1b pilot with 30 individuals completing substance use treatment to assess intervention feasibility and acceptability. Using within-subject tests, I will compare general messaging to place-specific messaging crafted based on the results from Aim 1.