Systems Approach to Modeling of Drug Use Recovery

描述（由申请人提供）：这项试点研究将建立一个基于代理人的模型，该模型将描述海洛因的使用和恢复轨迹，其背景是与当前治疗实践、以恢复为导向的服务和非法药物市场的复杂相互关系。海洛因成瘾的治疗与复发、治疗再进入和恢复的慢性循环有关，通常持续数十年。海洛因成瘾最常用的治疗方法是美沙酮疗法，这是非常有效的，但由于影响海洛因使用复发的组织，社区和政策因素的复杂相互作用，它并不总是最有效的，因此无法防止许多成瘾者的复发。迄今为止，一些研究已经收集了有关海洛因成瘾康复轨迹的信息;但是，尚未开发出将影响因素整合到一个模型中的模型，将其视为系统的一部分。所提出的努力代表了第一个系统建模方法，以解决海洛因回收的主题，包括上下文因素的影响。因此，所提出的模型的开发同时考虑了海洛因成瘾治疗策略的特征（例如，住宅与门诊部模态）和用户的上下文环境（例如，社交网络、非法毒品市场），以便更恰当地评估促进或相反地干扰恢复的过程。模型参数将从充分研究的数据集海洛因使用轨迹确定的主要专家从加州大学洛杉矶分校和板栗卫生系统，以及从其他相关的研究。由此产生的模型将用于解决有关治疗方法的最佳组合和分期的问题，并探索某些组合是否可以导致定性（例如，停止）而不是简单地定量（例如，延迟复发）恢复周期的变化。具体来说，我们的目标是（1）开发一个基于代理的海洛因使用和恢复过程的模型，该模型将描述影响恢复成功的主要系统组件，（2）通过模拟实验，评估旨在提高治疗有效性的特定复杂策略的成功，以及（3）评估最有希望的方法的可行性，解决对政策策略的潜在阻力，并评价该模型在其他药物治疗方面的可推广性。 公共卫生相关性：这项试点研究将建立一个基于代理人的模型，该模型将在与当前治疗做法、以康复为导向的服务和非法药物市场的复杂相互联系的背景下描述海洛因使用和康复轨迹。由此产生的模型将用于解决有关治疗方法的最佳组合和分期的问题，并探索某些组合是否可以导致定性（例如，停止）而不是简单地定量（例如，延迟复发）恢复过程中的变化。

DESCRIPTION (provided by applicant): This pilot study will build an agent-based model that will describe heroin use and recovery trajectories in the context of complex interconnections with current treatment practices, recovery-oriented services, and the illicit drug market. Treatment of heroin addiction is associated with a chronic cycle of relapse, treatment reentry, and recovery, often lasting for decades. The most commonly used treatment for heroin addiction is methadone therapy, which is pharmacologically efficient, but due to a complex interaction of organizational, community, and policy factors that affect relapse to heroin use, it is not always optimally effective and is thus unable to prevent relapse in many addicts. To date, a number of studies have collected information about heroin addiction recovery trajectories; however no model has yet been developed to integrate influential factors into one model, considering them as part of a system. The proposed effort represents the first systems modeling approach to address the topic of heroin recovery, including influences from contextual factors. Accordingly, the development of the proposed model simultaneously takes into account characteristics of heroin addiction treatment strategies (e.g., residential vs. outpatient modality) and the user's contextual environment (e.g., social networks, illicit drug markets) to more aptly assess the processes that promote or, conversely, interfere with recovery. Model parameters will be obtained from well studied datasets on heroin use trajectories identified by leading experts from UCLA and Chestnut Health Systems, as well as from other relevant studies. The resulting model will be used to address questions about the optimal combination and staging of treatment approaches and to explore whether some combinations could lead to qualitative (e.g., cessation) rather than simply quantitative (e.g., delayed relapse) changes in recovery cycle. Specifically, we aim to (1) Develop an agent-based model of heroin use and recovery process that would describe the main systems components influencing the success of recovery, (2) Through simulated experiments, evaluate the success of specific complex strategies aimed to increase treatment effectiveness, and (3) Evaluate the feasibility of approaches that show the most promise, address potential resistance to policy strategies, and evaluate generalizability of the model in regard to other drug treatments. PUBLIC HEALTH RELEVANCE: This pilot study will build an agent-based model that will describe heroin use and recovery trajectories in the context of complex interconnections with current treatment practices, recovery-oriented services, and the illicit drug market. The resulting model will be used to address questions about the optimal combination and staging of treatment approaches and to explore whether some combinations could lead to qualitative (e.g., cessation) rather than simply quantitative (e.g., delayed relapse) changes in recovery process.