Delivering Psychosocial Treatment to Substance Abusers via Mobile Technologies

描述（由申请人提供）：阿片类药物使用障碍（OUDs）是一个重要的和日益增长的公共卫生问题；在寻求药物滥用治疗的人中，有超过三分之一的人患有慢性阻塞性肺病，每年治疗慢性阻塞性肺病的费用超过300亿美元。美沙酮维持治疗（MMT）已被广泛证明是安全有效的，特别是当循证心理社会干预是治疗的一部分时。不幸的是，与其他类型的药物治疗项目相比，MMT项目提供的心理治疗水平最低。目前的申请是在行为与综合治疗发展项目（PA 07- 111）下提交的。目标1是开发一个移动治疗系统（MTS），提供基于证据的社会心理干预（社区强化方法；CRA）的关键要素，包括目标设定和监测、药物使用功能分析、自我管理、拒绝药物技能、问题解决以及社会和娱乐咨询。参与者将获得无限制的每日提示，以鼓励计划的使用，并可以无限制地访问移动应用程序。我们的迭代开发过程将包括来自与MMT客户（n=24）的焦点小组的输入，来自该领域专家的输入，以及来自MMT客户（n=30）对基于手机的程序的测试版的反馈。目的2：我们将评估该移动工具在治疗的前三个月（n=219）进入美沙酮维持治疗（MMT）的参与者的疗效。在为期3个月的干预阶段，我们将评估(1)标准治疗、(2)标准治疗加MTS和(3)基于移动的对照条件的相对初步疗效，包括治疗保留和阿片类药物使用的主要结果（通过尿液毒理学）和其他物质使用的次要结果（通过尿液毒理学和自我报告）、改变药物使用行为的准备程度、应对技能、阿片类药物渴望、艾滋病毒风险行为和心理社会功能。在1个月和3个月的随访中检查效果的持久性。据我们所知，这项研究将是第一次使用移动电话技术提供针对非法药物使用的全面、互动、基于证据的社会心理干预，这种干预可以在个人的自然环境中轻松获得，并按需提供治疗。目标3：我们将对社区MMT中的MTS进行经济分析。我们将评估MTS相对于标准护理和流动对照组的增量成本和增量成本-效果比（ICER）。初级ICER将考虑每增加禁欲时间的成本（临床疗效），次级ICER将考虑每增加质量调整生命年的成本（经济疗效）。成本数据对于未来在社区系统中传播有效移动干预措施的翻译项目至关重要。如果结果是有希望的，MTS将很容易适应，并可能对改善各种问题（例如精神和行为健康）的治疗机会和有效性产生巨大影响，同时大大限制费用。

DESCRIPTION (provided by applicant): Opioid use disorders (OUDs) are a significant and growing public health issue; over a third of persons seeking substance abuse treatment have an OUD and the annual cost of OUDs is over $30 billion. Methadone maintenance treatment (MMT) has been widely shown to be safe and effective in treating OUDs, especially when evidence-based psychosocial interventions are part of treatment. Unfortunately, MMT programs offer the lowest level of psychosocial treatment relative to other types of drug treatment programs. The current application is being submitted under the Behavioral & Integrative Treatment Development Program (PA 07- 111). Aim 1 is to develop a Mobile Therapeutic System (MTS) that offers key elements of an evidence-based psychosocial intervention (Community Reinforcement Approach; CRA) including Goal Setting and Monitoring, Functional Analysis of Drug Use, Self-Management, Drug Refusal Skills, Problem-Solving, and Social and Recreational Counseling. Participants will be provided unlimited daily prompts to encourage program use and will be provided with unlimited access to the mobile application. Our iterative development process will include input from focus groups with clients in MMT (n=24), input from experts in the field, and feedback from clients in MMT (n=30) on a beta-version of the mobile phone-based program. Aim 2: We will evaluate the efficacy of this mobile tool with participants entering methadone maintenance treatment (MMT) during the first three months of their treatment (n=219). We will evaluate the relative preliminary efficacy of (1) standard treatment, (2) standard treatment plus MTS and (3) a mobile-based control condition on the primary outcomes of treatment retention and opioid use (via urine toxicology) and secondary outcomes of other substance use (via urine toxicology and self-report), readiness to change drug use behavior, coping skills, opioid craving, HIV risk behavior, and psychosocial functioning during the 3-month intervention phase. Durability of effects will be examined at 1 and 3 month follow-ups. To our knowledge, this study would be the first to use mobile phone technology to deliver a comprehensive, interactive, evidence-based psychosocial intervention targeting illicit drug use that can be easily accessed in an individual's natural environment and provide treatment on-demand. Aim 3: We will perform an economic analysis of MTS in community-based MMT. We will estimate the incremental costs and the incremental cost-effectiveness ratio (ICER) of MTS relative to standard care and the mobile control group. The primary ICER will consider costs per increased abstinence time (clinical efficacy) and the secondary ICER will consider costs per increased quality adjusted life year (economic efficacy). Cost data are vital to future translationl projects to disseminate effective mobile interventions in community systems. If results are promising, MTS would be easily adaptable and may have enormous impact on improving treatment access and effectiveness for a variety of issues (e.g., mental and behavioral health) while significantly limiting costs.