Integrated Digital Health Intervention to Promote Engagement in and Adherence to Medication-Assisted Treatment

项目总结/摘要 在美国，阿片类药物使用和相关疾病的流行率已达到流行病的程度。 药物辅助治疗（MAT），即药物治疗与行为治疗相结合， 与非法阿片类药物使用的显著减少有关。丁丙诺啡，一种部分阿片激动剂， MAT的药理学选择越来越受欢迎，因为它通过以下方式更灵活地给药： 基于办公室的方案尽管它有许多优点，但近一半的参与者在实现 丁丙诺啡稳定。遇险容忍度（DT），定义为感知或实际处理能力 厌恶的身体或情绪状态，是一个transdiagnosis脆弱性因素牵连的发展 和维持物质使用。在物质使用治疗期间靶向DT可以通过以下方式改善结果： 促进坚持目标导向活动的能力（例如，禁欲），即使在经历身体或 情绪困扰个性化反馈干预（PFI）是一种很有前途的方法， 鼓励参与和坚持丁丙诺啡治疗，特别是在个人中 特点是DT低。这些干预措施一般简短，量身定制，并有可能 经由移动的平台（例如，计算机、文本消息）。兰登博士的职业目标是 以患者为导向的研究重点是开发和评估新的数字健康干预措施， 加强对MAT的参与和坚持。本报告提出的综合培训和研究计划 应用程序将提供兰登博士在几个关键领域需要提高她的高级培训 为实现这一职业目标而进行的研究计划。与她的导师合作，培训将针对 以下领域：1）阿片类药物使用障碍的性质和治疗; 2）治疗开发; 3）数字健康 干预措施; 4）临床试验方法;和5）专业发展。这些培训目标将是 通过教学和应用活动的结合，以及在一个 第一阶段行为治疗开发试验。学习的目标领域与具体目标直接相关 本研究的研究，其中包括（1）互动的计算机和文本的发展和完善 消息传递PFI，其中包括DT技能培训，为积极寻求门诊MAT的人（PFI- DT）;（2）试点测试PFI-DT的有效性，以增加动机，禁欲，坚持和保留， 与健康教育比较条件相比的治疗;以及（3）检查潜在机制 这可能是PFI-DT在改善结局方面的疗效的基础，包括痛苦耐受力、自我 监管和负面影响。这个K23奖将为兰登博士提供一系列先进的技能， 旨在补充她之前的培训，使她能够成功地过渡到一个独立的科学家 侧重于通过制定有效的， 易于传播、技术增强的干预措施。

PROJECT SUMMARY/ABSTRACT The prevalence of opioid use and related disorders has reached epidemic rates in United States. Medication-assisted treatment (MAT), the use of pharmacotherapy in combination with behavioral therapies, is associated with significant reductions in illicit opioid use. Buprenorphine, a partial opioid agonist, is one pharmacological option for MAT that is growing in popularity because of its more flexible administration through office-based programs. Despite its many advantages, nearly half of participants are unsuccessful in achieving buprenorphine stabilization. Distress tolerance (DT), defined as the perceived or actual ability to handle aversive physical or emotional states, is a transdiagnostic vulnerability factor implicated in the development and maintenance of substance use. Targeting DT during substance use treatment may improve outcomes by promoting the ability to persist in goal directed activity (e.g., abstinence) even when experiencing physical or emotional distress. Personalized feedback interventions (PFI) represent a promising method to effectively motivate engagement in and adherence to buprenorphine treatment, particularly among individuals characterized by low DT. These interventions are generally brief, individually tailored, and have the potential to be delivered via mobile platforms (e.g., computers, text message). Dr. Langdon's career goal is to conduct patient-oriented research focused on the development and evaluation of novel digital health interventions to enhance engagement in and adherence to MAT. The integrated training and research plans proposed in this application will provide Dr. Langdon with advanced training in several critical areas needed to enhance her program of research toward this career goal. In collaboration with her mentors, training will be targeted to the following domains: 1) nature and treatment of opioid use disorders; 2) treatment development; 3) digital health interventions; 4) clinical trial methodology; and 5) professional development. These training objectives will be achieved through a combination of didactic and applied activities as well as the application of these skills in a Stage 1 behavioral treatment development trial. Target areas for learning are directly linked to the specific aims of this research study, which include (1) the development and refinement of an interactive computer- and text message-delivered PFI, that incorporates DT skills training, for persons actively seeking outpatient MAT (PFI- DT); (2) pilot testing the efficacy of PFI-DT for increasing motivation, abstinence, adherence, and retention to treatment compared to a health education comparison condition; and, (3) examination of potential mechanisms that may underlie the efficacy of the PFI-DT in improving outcomes, including distress tolerance, self- regulation, and negative affect. This K23 Award would provide Dr. Langdon with a range of advanced skills designed to complement her prior training so that she may successfully transition into an independent scientist focused on addressing the public health burden of opioid use disorders through the development of effective, easily-disseminated, technology-augmented interventions.