Automated Recovery Line for Medication Assisted Treatment

描述(申请人提供)：对海洛因和处方止痛药的依赖自2000年以来几乎增加了两倍，导致阿片依赖治疗入院人数急剧增加。然而，在激动剂维持治疗的患者中，持续用药是常见的，并与高复发率和治疗放弃有关。尽管咨询已被证明是有效的，但它的成本很高，一些患者不喜欢咨询，其他人的责任使看病变得困难，农村地区的患者获得心理治疗的机会往往有限。因此，显然有必要开发更多可接受和成本效益高的治疗方法。交互式语音应答(IVR)系统已被证明有效地增加了对药物滥用的短暂干预，它是通过电话提供的基于计算机的自动化系统，使用语音或键访问不同的菜单。IVR系统可以从任何电话访问，而不是仅从指定的技术(例如智能电话)访问，并提供低成本、一致的交付、更广泛的访问和24小时即时治疗干预的优势。恢复线是一个基于认知行为治疗(CBT)的IVR系统，旨在减少接受阿片类激动剂维持的患者的物质使用。我们最近完成了一项为期4周的试点随机试验，结果显示可卡因的使用显著减少，应对技能的有效性增加，但患者呼叫的时间比预期的要短，这表明改善患者使用的方法可能会进一步提高疗效。这个Ib阶段的应用提出了三个阶段来开发系统功能，以增加患者系统的使用率，并测试这些功能。具体目标1(阶段1)是根据应对技能评估制定和评估定制的治疗建议。患者将被引导至模块，以帮助他们根据对简短初步问题的回答来评估应对缺陷。具体目标2(阶段2)是开发和测试系统提醒消息，以评估最佳延迟(未接来电后的时间)和消息内容。我们将评估获得框架和丢失框架的消息，因为它们在基于消息的吸烟干预中是有效的。我们将评估提醒消息延迟，因为短提醒延迟最初可能是有效的，但随着时间的推移，频繁提醒可能会变得令人厌恶和无效。第一阶段和第二阶段的功能将被纳入最终的回收线原型。具体目标3(阶段3)，是进行为期12周的随机(N=60)临床试验，并在治疗后进行3个月的随访，以获得有关开发的Recovery Line的可行性、可接受性和有效性的数据(与TAU相比)。将评估两个主要结果领域的效果，即非法药物尿检阴性的比例和每月非法药物戒除天数。次要结果指标将是在治疗中的保留和应对技能的有效性。

DESCRIPTION (provided by applicant): Dependence on heroin and prescription pain relievers has almost tripled since 2000, resulting in dramatic increases in opioid dependence treatment admissions. However, among agonist-maintained patients continued drug use is common and associated with high rates of relapse and treatment drop-out. Although counseling has been shown to be effective, it is costly and some patients dislike counseling, others have responsibilities that make attendance difficult, and patients in rural settings often have limited access to psychotherapy. Thus, there is a clear need to develop additional acceptable and cost-effective treatments. Interactive Voice Response (IVR) systems, which have been shown to effectively augment brief interventions for substance abuse, are automated, computer-based systems delivered via phone and use voice or keys to access different menus. IVR systems can be accessed from any phone rather than only specified technology (e.g., smart phones), and offer advantages of low cost, consistent delivery, expanded access, and 24-hour availability of immediate therapeutic intervention. The Recovery Line is a Cognitive Behavioral Therapy (CBT)-based IVR system to reduce substance use in patients receiving opioid agonist maintenance. We recently completed a pilot randomized 4-week trial which showed significant reduction in cocaine use and increased coping skill efficacy, but patients called less time than expected, suggesting methods to improve patient use may further improve efficacy. This Stage Ib application proposes three phases to develop system functions to increase patient system use and to test those functions. Specific aim 1 (Phase 1) is to develop and evaluate customized therapeutic recommendations based on coping skills assessments. Patients will be directed to modules to help them with assessed coping deficiencies based on their answers to brief preliminary questions. Specific aim 2 (Phase 2) is to develop and test system reminder messages to evaluate optimal latency (time since missed call) and message content. We will evaluate gain-framed and loss-framed messages because they have been effective in message-based smoking interventions. We will evaluate reminder message latency because short reminder latencies may be effective initially but frequent reminders may become aversive and ineffective over time. Phases 1 and 2 features will be incorporated into the final Recovery Line prototype. Specific aim 3 (Phase 3), is to conduct a 12-week pilot randomized (N=60), clinical trial with a 3 month post-treatment follow- up to obtain data regarding the feasibility, acceptability and efficacy of the developed Recovery Line (compared to TAU). Efficacy will be evaluated for the two primary outcome domains of the proportion of urine screens negative for illicit drugs and monthly days of illicit drug abstinence. Secondary outcome measures will be retention in treatment and coping skills efficacy.