Sustaining recovery for people on opioid agonist treatment with conversational agents

使用对话代理维持阿片类激动剂治疗患者的康复

• 批准号: 10810952
• 负责人: TIMOTHY W. BICKMORE
• 金额: $ 31.61万
• 依托单位: BOSTON MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-09-30 至 2026-08-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10810952
• 关键词: Abstinence; Address; Adherence; Behavior; Buprenorphine; Capital; Caring; Cellular Phone; Clinic; Clinical Trials; Cognitive Therapy; Computers; Control Groups; Country; Data; Drops; Education; Effectiveness; Emotional; Emotions; Engineering; Enrollment; Exercise; Goals; Health; Health Personnel; Healthcare; Hybrids; Intervention; Intuition; Measures; Opioid; Outcome; Participant; Patients; Persons; Pharmaceutical Preparations; Pilot Projects; Process; Randomized; Randomized, Controlled Trials; Recovery; Recovery Support; Resources; Sampling; Social isolation; Stigmatization; Stress; Subgroup; System; Testing; Thinking; addiction; animation; arm; buprenorphine treatment; common treatment; comparison intervention; coping; dashboard; depressive symptoms; design; effectiveness study; emotion dysregulation; experience; follow-up; group intervention; high risk; implementation study; improved; individual patient; instrument; intervention effect; intervention participants; long term recovery; low health literacy; low socioeconomic status; medication for opioid use disorder; mindfulness; motivational enhancement therapy; opioid agonist therapy; opioid epidemic; opioid use; opioid use disorder; outreach; pilot test; pressure; primary outcome; racial minority population; recovery services; recruit; relapse prevention; relapse risk; smartphone application; social; social stigma; staff intervention; substance use; sustained recovery; therapy design; treatment as usual; treatment duration; treatment program; uptake; usability

PROJECT SUMMARY/ABSTRACT Almost half of all people receiving buprenorphine for opioid use disorder discontinue treatment within the first year, due to substance use and medication stigma and other recovery challenges such as stress, emotional dysregulation, and social isolation. We aim to improve retention in buprenorphine treatment through a smartphone-delivered, stigma-informed recovery support intervention. We propose to develop embodied conversational agents (ECA), i.e., animated computer agents that simulate natural and intuitive face-to-face conversations, proven successful in several clinical trials in assisting people with health-related challenges. Intervention participants will be engaged to interact with the ECA and maximize its uptake so that they can better cope with stigma, stay connected with recovery services and continue to receive buprenorphine. The ECA will deliver an acceptance-based intervention originating in cognitive-behavioral therapy, delivering a combination of didactic components, educational stories, experiential activities, motivational interviewing and mindfulness exercises to help participants overcome negative thoughts and emotions related to internalized substance use and intervention stigma. ECA activities will be based on our recently completed acceptance- based stigma intervention, shown to increase care engagement of people with opioid use disorder. In instances where participants experience a crisis with increased relapse risks, a clinic dashboard will generate staff alerts prompting clinician outreach. In year one, we will co-design and pilot-test the ECA system involving 10 OBAT patients. Guided by usability engineering and health stigma frameworks, we will design ECA activities and the clinic dashboard to help people on MOUD respond more effectively to manifestations of stigma and build recovery capital. In years 2 and 3, we will conduct a multi-arm 3:1 randomized, controlled pilot study, enrolling 100 people initiating buprenorphine treatment in three intervention subgroups of 25 participants each. Intervention group participants will be engaged in ECA use with different strategies to maximize uptake and compared to 25 control participants receiving usual care at the BMC office–based addiction treatment clinic. We will estimate the ECA’s effects for the primary outcome of retention in buprenorphine treatment 12 months post randomization, assessed for all intervention participants vs. control participants and pairwise for each of the three subgroups vs the control group separately. Similarly, we will assess the intervention’s effects on adherence to buprenorphine and opioid use at 6 and 12 months; and on changes in stigma and recovery capital scores (exploratory outcomes). This project will also test processes, instruments, and interactions between users, the system and the OBAT clinic, informing a subsequently planned R01 hybrid type implementation and effectiveness RCT. By addressing stigma and recovery challenges, this intervention can help improve buprenorphine treatment retention and support long-term recovery from opioid-use disorder.

项目摘要/摘要 在第一次接受OOid使用障碍治疗的所有接受丁丙诺啡的人中，几乎一半 一年，由于受试者的使用和药物污名和其他恢复挑战，例如压力，情感 失调和社会隔离。我们旨在通过 智能手机交付，污名化的恢复支持干预措施。我们建议发展体现 会话代理（ECA），即模拟自然和直观面对面的动画计算机代理 对话，在几项临床试验中成功地协助有与健康有关的挑战的人进行了成功。 干预参与者将与ECA互动并最大化其吸收，以便他们可以 更好地应对污名，与恢复服务保持联系并继续接受丁丙诺啡。 ECA将提供源自认知行为疗法的基于接受的干预措施，提供 教学成分，教育故事，专家活动，动机访谈和 正念练习以帮助参与者克服与内部化有关的负面思想和情绪 物质使用和干预污名。 ECA活动将基于我们最近完成的接受 - 基于污名干预，可增加阿片类药物使用障碍患者的护理参与。 参与者遇到带有后继风险的危机的实例，诊所仪表板将产生 员工警报促使临床外展。在第一年，我们将共同设计和试点测试涉及的ECA系统 10名OBAT患者。在可用性工程和健康污名框架的指导下，我们将设计ECA 活动和诊所仪表板，以帮助穆德的人们对表现的反应更有效 污名和建立恢复资本。在第2和3年中，我们将进行多臂3：1随机，受控的飞行员 研究，招募100人在三个干预子组中启动丁丙诺啡治疗的25名参与者 每个。干预小组参与者将与ECA一起使用不同的策略，以最大化吸收 并与25名在BMC办公室成瘾治疗的对照参与者相比 诊所。我们将估计ECA对丁丙诺啡治疗中保留的主要结果的影响12 随机化后的月份，对所有干预参与者与控制参与者进行评估，并对 三个亚组中的每个分别与对照组。同样，我们将评估干预的影响 遵守丁丙诺啡和6个月的阿片类药物使用；以及污名和恢复的变化 资本分数（探索结果）。该项目还将测试过程，工具和互动 在用户，系统和OBAT诊所之间，通知随后计划的R01混合动力类型 实施和有效性RCT。通过应对污名和恢复挑战，这种干预可以 有助于改善丁丙诺啡治疗保留率并支持阿片类药物疾病的长期恢复。