Delivering Psychosocial Treatment to Substance Abusers via Mobile Technologies

描述(申请人提供)：阿片使用障碍(OUD)是一个重要的和日益严重的公共卫生问题；超过三分之一的寻求药物滥用治疗的人有OID，OID的年成本超过300亿美元。美沙酮维持治疗(MMT)已被广泛证明是安全和有效的治疗，特别是当循证心理社会干预是治疗的一部分。不幸的是，与其他类型的药物治疗计划相比，MMT计划提供的心理社会治疗水平最低。目前的申请是根据行为和综合治疗发展方案(PA 07-111)提交的。目标1是开发一个移动治疗系统(MTS)，提供循证心理社会干预(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、药物拒绝技能、解决问题以及社交和娱乐咨询。参与者将获得无限制的日常提示，以鼓励使用程序，并将获得无限制的移动应用程序访问权限。我们的迭代开发过程将包括来自MMT(n=24)客户的焦点小组的投入，来自该领域专家的投入，以及来自MMT(n=30)客户对基于移动电话的程序的测试版的反馈。目的2：我们将评估这种移动工具的疗效，参与者在治疗的前三个月(n=219)进入美沙酮维持治疗(MMT)。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)基于移动的控制条件对治疗保留和阿片类药物使用的主要结果(通过尿毒学)和其他物质使用的次要结果(通过尿毒理学和自我报告)、改变药物使用行为的准备情况、应对技能、阿片类药物渴求、艾滋病毒危险行为和心理社会功能的相对初步疗效。疗效的持久性将在1个月和3个月的随访中进行检查。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、基于证据的心理社会干预，这种干预可以很容易地在个人的自然环境中获得，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。我们将估计MTS相对于标准护理和移动控制组的增量成本和增量成本-效果比(ICER)。一级ICER将考虑每增加戒断时间的成本(临床疗效)，二级ICER将考虑每增加质量调整生命年的成本(经济效果)。成本数据对于未来在社区系统传播有效流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，并可能在改善治疗机会和各种问题(例如，精神和行为健康)的有效性方面产生巨大影响，同时显著限制成本。 公共卫生相关性：目前约有230万美国人滥用海洛因或处方阿片类药物，阿片类药物使用障碍(OUD)每年造成的成本超过300亿美元。不幸的是，包括药物使用障碍在内的大多数药物使用障碍患者没有得到治疗，而接受治疗的少数人由于费用和其他操作障碍，通常得不到有效的心理社会治疗干预。拟议的移动治疗系统是一种通过移动电话提供的针对SUD的新颖、互动的心理社会干预措施，可以提供可广泛传播的有效和成本效益高的治疗，从而在限制成本的同时显著改善包括OUD患者在内的各种人群的SUD治疗的机会和效果。

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. PUBLIC HEALTH RELEVANCE: Approximately 2.3 million Americans currently abuse heroin or prescription opioids, with the cost of opioid use disorders (OUDs) annually exceeding $30 billion. Unfortunately, most individuals with substance use disorders (SUDs), including OUDs do not receive treatment, and the minority that receive treatment do not typically receive effective psychosocial treatment interventions due to cost and other operational barriers. The proposed Mobile Therapeutic System, a novel, interactive, psychosocial intervention for SUDs delivered via mobile phones, may allow for the provision of effective and cost-effective treatment that may be widely disseminated, thereby significantly improving access and effectiveness of SUD treatment in a variety of populations, including individuals with OUDs, while limiting costs.