Targeting Alcohol-Opioid Co-Use Among Young Adults Using a Novel MHealth Intervention

项目总结 该治疗开发项目的目标是开发和试点自适应移动健康(MHealth) 针对阿片类药物使用障碍(OUD)的年轻人同时使用酒精和阿片类药物的干预措施。 酒精是阿片类药物危机的一个被低估的贡献者，当与阿片类药物一起使用时， 增加阿片类药物过量和其他与使用有关的问题的风险。尽管有明确的公共卫生意义， 然而，目前还没有针对酒精和阿片类药物共同使用的干预措施。这种差距对年轻人来说尤其有害。 18-25岁的成年人，酒精和阿片类药物使用率最高(即，非药物处方阿片类药物或 海洛因)任何年龄段的使用和使用障碍。超过一半使用非处方阿片类药物的年轻人 据报道，过去一年酒精和阿片类药物共同使用，但很少有年轻人接受这两种物质的治疗。移动健康 使用技术(例如，智能手机应用程序)干预日常生活的干预措施 年轻人容易接触和接受的。因此，mHealth提供了一种针对酒精和阿片类药物共同使用的手段 可以接触到目前没有接受治疗的年轻人。然而，开发一种有效的移动健康干预 需要对目标行为有生态上的有效理解，这对于酒精-阿片类药物共同作用是不存在的 使用。因此，拟议项目的第一步是使用生态瞬时评估(EMA)，其中60 报告有规律的酒精和阿片类药物联合使用的轻到中度OUD的年轻人(18-25岁)将完成 EMA每天通过智能手机多次使用3周，以检查年轻人如何、为什么以及何时共同使用 酒精和阿片类药物在他们的日常生活中实时存在。使用已建立的指导方针来开发mHealth 干预措施，然后我们将使用这个EMA知识库来开发一个基于智能手机的mHealth平台 针对酒精和阿片类药物的联合使用。干预将建立在增强动机的原则上。 治疗和认知行为治疗，并根据参与者的 对EMA评估的回应。我们将根据来自两个迭代可用性的反馈来改进干预 有10名参与者的研究。最后，在60名年轻人的新样本中，我们将进行阶段1随机 临床试验，将mHealth干预与仅使用EMA和仅使用远程评估的对照条件进行比较。 我们将评估干预的可行性和可接受性，以及可能的行动机制。持续期 福利将在3个月的随访中进行评估。这项研究将处理国家优先事项，以应对 加速阿片类药物危机。它将提供关于日常生活中酒精和阿片类药物共同使用的性质的重要新信息 并开发和试点一种创新的适应性移动健康干预措施，以解决年轻人的这种行为。

PROJECT SUMMARY The goal of this treatment development project is to develop and pilot an adaptive mobile health (mHealth) intervention that targets the co-use of alcohol and opioids in young adults with opioid use disorder (OUD). Alcohol is an under-recognized contributor to the opioid crisis that, when used with opioids, substantially increases the risk of opioid overdose and other use-related problems. Despite clear public health significance, however, no existing intervention targets alcohol-opioid co-use. This gap is especially detrimental to young adults aged 18-25, who have the highest rates of alcohol and opioid (i.e., nonmedical prescription opioid or heroin) use and use disorders of any age group. Over half of young adults who use nonprescription opioids report past-year alcohol-opioid co-use, yet few young adults receive treatment for either substance. MHealth interventions, which use technology (e.g., smartphone applications) to intervene in daily life are highly accessible and acceptable to young adults. MHealth thus offers a means of targeting alcohol-opioid co-use that can reach young adults not currently in treatment. However, developing an effective mHealth intervention requires an ecologically valid understanding of the target behavior, which does not exist for alcohol-opioid co- use. Thus, the first step of the proposed project is to use ecological momentary assessment (EMA), wherein 60 young adults (ages 18-25) with mild to moderate OUD who report regular alcohol-opioid co-use will complete EMA multiple times daily via smartphone for 3 weeks to examine how, why, and when young adults co-use alcohol and opioids in real time in their daily lives. Using established guidelines for developing mHealth interventions, we will then use this EMA knowledge base to develop a smartphone-based mHealth platform targeting alcohol-opioid co-use. The intervention will be founded on principles of motivational enhancement therapy and cognitive behavioral therapy and deliver tailored micro-interventions based on participants’ responses to EMA assessments. We will refine the intervention based on feedback from two iterative usability studies with 10 participants. Finally, in a new sample of 60 young adults, we will conduct a Stage 1 randomized clinical trial, comparing the mHealth intervention to EMA-only and remote assessment-only control conditions. We will evaluate the intervention’s feasibility and acceptability and putative mechanisms of action. Sustained benefit will be evaluated at 3-month follow-up. This study will address national priorities to respond to the accelerating opioid crisis. It will provide vital new information on the nature of alcohol-opioid co-use in daily life and develop and pilot an innovative adaptive mHealth intervention to address this behavior in young adults.