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

项目摘要/摘要 在美国，阿片类药物的使用和相关疾病的流行率已经达到了流行率。 药物辅助治疗(MAT)，是药物治疗与行为治疗相结合的使用， 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，就是其中之一 MAT的药理选择越来越受欢迎，因为它的给药方式更灵活 基于Office的程序。尽管它有许多优势，但近一半的参与者在实现 丁丙诺啡稳定。痛苦容忍度(DT)，定义为感知或实际的处理能力 厌恶的身体或情绪状态，是在发育过程中涉及的跨诊断易感性因素 和维持物质使用。在药物使用治疗期间靶向DT可能通过以下方式改善结果 提高坚持目标导向的活动(例如，禁欲)的能力，即使在经历身体或 精神上的痛苦。个性化反馈干预(PFI)代表了一种很有前途的有效方法 鼓励参与和坚持丁丙诺啡治疗，特别是在个人中 以DT低为特征的。这些干预措施一般都是简短的、个别定制的，并有可能 通过移动平台(例如，计算机、文本消息)交付。兰登博士的职业目标是 以患者为中心的研究侧重于开发和评估新的数字健康干预措施，以 提高对MAT的参与度和忠诚度。本文件中提出的综合培训和研究计划 应用程序将为兰登博士提供几个关键领域的高级培训，以增强她的能力 针对这一职业目标的研究计划。在她的导师的合作下，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)治疗发展；3)数字健康 干预措施；4)临床试验方法学；5)专业发展。这些培训目标将是 通过教学活动和应用活动的结合以及在 阶段1行为治疗发展试验。学习的目标领域与具体目标直接相关 这项研究研究的主要内容包括：(1)开发和完善交互式计算机和文本 消息传递的PFI，包含DT技能培训，适用于积极寻求门诊MAT的人(PFI- DT)；(2)初步测试PFI-DT在提高动机、禁欲、依从性和对 治疗与健康教育条件的比较；以及，(3)潜在机制的检查 这可能是PFI-DT在改善结果方面的有效性的基础，包括对痛苦的耐受，自我 监管和负面影响。这项K23奖将为兰登博士提供一系列高级技能 旨在补充她之前的训练，以便她可以成功地过渡到一名独立的科学家 重点解决阿片类药物使用障碍的公共卫生负担， 易于传播、技术强化的干预措施。

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.