Impact on opioid use of bundling medication-assisted treatment with mHealth

 描述(由申请人提供)：这份R01提案寻求将药物辅助治疗(MAT)与基于证据的智能手机提供的复发预防系统(A-CHESS)配对，以改善从阿片类药物使用障碍中的长期恢复。尽管MAT已被证明对阿片类药物依赖有效，但高复发率表明MAT是不够的。长期复苏仍是一项挑战。我们希望A-CHESS能够帮助患者将他们在治疗中学到的技能转化为治疗后的日常生活，从而， 在持续复苏方面取得更大成功。A-CHESS还将包括改善与丙型肝炎病毒和艾滋病毒感染相关的结果的工具，这些感染对阿片类药物依赖者的影响不成比例。该项目还试图了解治疗的哪些要素对谁有效以及为什么有效，以便使干预措施，特别是流动卫生干预措施更有效。该提案的基础是有证据表明，A-国际象棋可以改善那些患有酒精和阿片类药物使用障碍的人的结果。在一项随机试验中，因酒精使用障碍而离开住宅治疗的患者中，有A-象棋的患者比没有A-象棋的患者危险饮酒天数减少了57%，这一影响在阿片类药物依赖和酒精依赖的患者中甚至更大。在一项试点测试中，A-Chess与MAT捆绑在一起，用于治疗有记录在案的酒精使用障碍的暂时性退伍军人，以及据传其他药物使用率较高的退伍军人。这项测试发现，与没有A-国际象棋的人相比，有A-国际象棋的人重新入院戒毒的人数减少了71%。这项研究提出了一项为期24个月的随机临床试验，来自3个治疗机构的患者被分配到MAT+A-国际象棋或单独MAT。该项目的主要目的是确定两组人在阿片类药物使用天数方面的差异。其次，我们想要检测生活质量的差异；治疗中的保留；计划外使用医疗服务；以及，对于丙型肝炎病毒和艾滋病毒，筛查率，危险行为，检测，以及在那些感染的人中，治疗开始。我们还将检验我们假设的调节干预和结果之间关系的4个因素：自我决定理论的3个结构-能力、关联性和内在动机-加上负面影响。我们还试图了解影响干预和结果之间关系强度的因素，我们假设这些因素是性别，以及--在那些拥有A级象棋的人中--在讨论小组中的沟通风格。通过定性研究，我们将探索(1)对MAT+A棋反应更好的人与不对其反应更好的人之间的差异，(2)实施和维持干预措施的困难，以及(3)结果与使用A棋之间的关系。拟议的项目为一个几乎难以解决且日益普遍的问题提供了一种创新的方法。该项目具有重大意义，因为它具有改善长期治疗结果的潜力，并创造和分享关于可用于定制未来治疗以提高疗效和覆盖范围的因素的新知识和新理解。

 DESCRIPTION (provided by applicant): This R01 proposal seeks to pair medication-assisted treatment (MAT) with an evidence-based, smartphone- delivered relapse prevention system (A-CHESS) to improve long-term recovery from opioid use disorders. Although MAT has been shown to be effective for opioid dependence, the high rate of relapse suggests that MAT is not enough. Long-term recovery remains a challenge. Our hope is that A-CHESS will help patients transfer the skills they learn in treatment into their daily lives after treatment and as a result, have greater success in sustained recovery. A-CHESS also will include tools for improving outcomes related the hepatitis C virus and HIV-infections that disproportionately affect opioid-dependent people. The project also seeks to understand which elements of treatment work for whom and why so that interventions, especially mobile health interventions, can be made more effective. The proposal builds upon evidence that A-CHESS improves outcomes among those suffering from alcohol and opioid use disorders. In one randomized trial, patients leaving residential treatment for alcohol use disorders who had A-CHESS had 57% fewer risky drinking days than those without it, an effect that was even greater among patients who had been opioid- as well as alcohol- dependent. In a pilot test, A-CHESS was bundled with MAT to treat transient veterans with documented alcohol use disorders and, anecdotally, high rates of other drug use. This test found that readmissions to residential detox decreased 71% for those with A-CHESS compared to those without it. This study proposes a randomized clinical trial of 24 months, with patients from 3 treatment agencies assigned either to MAT + A- CHESS or MAT alone. The primary aim of the project is to determine the difference between the two groups in opioid use days. Secondarily, we want to detect differences in quality of life; retention in treatment; unscheduled use of health services; and, for HCV and HIV, screening rates, risk behaviors, testing, and among those infected, treatment initiation. We will also test the 4 factors that we hypothesize mediate the relationship between the interventions and outcomes: the 3 constructs of self-determination theory-competence, relatedness, and intrinsic motivation-plus negative affect. We also seek to understand factors that affect the strength of the relationship between intervention and outcome, which we hypothesize are gender and-among those who have A-CHESS-communication style in discussion groups. Through qualitative research, we will explore (1) the differences between people who respond better to MAT + A-CHESS vs. those who do not, (2) the struggles in implementing and sustaining the interventions, and (3) the relationship between outcomes and using A-CHESS. The proposed project offers an innovative approach to a nearly intractable and increasingly common problem. The project is significant both for its potential to improve long-term treatment outcomes and to create and share new knowledge and understanding about factors that can be used to tailor future treatments for greater effectiveness and reach.