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

综合数字健康干预促进药物辅助治疗的参与和坚持

• 批准号: 10382299
• 负责人: Kirsten Johnson Langdon
• 金额: $ 17.17万
• 依托单位: RHODE ISLAND HOSPITAL
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-05-01 至 2024-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10382299
• 关键词: Abstinence; Address; Adherence; Affective; Affective Symptoms; Area; Behavior; Behavior Therapy; Behavioral; Buprenorphine; Car Phone; Cessation of life; Clinical Trials; Collaborations; Complement; Computers; Country; Development; Devices; Disadvantaged; Disease; Distress; Dropout; Emotional; Epidemic; Equilibrium; Evaluation; Feedback; Frequencies; Future; Goals; Health education; Individual; Informal Social Control; Injury; Intervention; K-Series Research Career Programs; Learning; Link; Maintenance; Mediation; Mentored Patient-Oriented Research Career Development Award; Mentors; Methodology; Methods; Modeling; Motivation; Nature; Negative Reinforcements; Opioid; Opioid agonist; Outpatients; Overdose; Participant; Patients; Persons; Pharmaceutical Preparations; Pharmacology; Pharmacotherapy; Phase; Population; Prevalence; Prognosis; Psychopathology; Public Health; Randomized; Randomized Controlled Trials; Recovery; Research; Risk Factors; Scientist; Structure; Substance Use Disorder; Technology; Testing; Text Messaging; Time; Training; Treatment outcome; United States; Work; anxiety symptoms; base; buprenorphine treatment; career; depressive symptoms; design; digital health; distress tolerance; efficacy testing; emotional distress; emotional symptom; experience; flexibility; high risk; illicit opioid; improved; improved outcome; indexing; innovation; medication administration; medication-assisted treatment; mobile computing; negative affect; negative mood; non-compliance; novel; opioid misuse; opioid use; opioid use disorder; opioid user; opioid withdrawal; patient oriented research; patient population; physical symptom; pilot test; prevent; programs; psychologic; recruit; research study; skills; skills training; substance use; substance use treatment; therapy design; therapy development; treatment comparison

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.

项目概要/摘要 阿片类药物的使用和相关疾病的流行率在美国已达到流行率。 药物辅助治疗（MAT），即药物治疗与行为疗法相结合， 与非法阿片类药物使用的显着减少有关。丁丙诺啡是一种部分阿片类激动剂 MAT 的药理选择越来越受欢迎，因为它的给药方式更加灵活 基于办公室的程序。尽管有很多优点，但近一半的参与者未能实现 丁丙诺啡稳定。遇险容忍度（DT），定义为感知或实际的处理能力 厌恶的身体或情绪状态，是与发展有关的跨诊断脆弱性因素 和维持物质使用。在药物滥用治疗期间以 DT 为目标可能会通过以下方式改善结果： 提高坚持目标导向活动（例如禁欲）的能力，即使在经历身体或 情绪困扰。个性化反馈干预（PFI）是一种有前途的方法，可以有效地 激励参与和坚持丁丙诺啡治疗，尤其是个人 其特点是DT低。这些干预措施通常很简短，针对具体情况进行定制，并且有可能 通过移动平台（例如计算机、短信）传递。兰登博士的职业目标是进行 以患者为中心的研究重点是新型数字健康干预措施的开发和评估 加强对 MAT 的参与和遵守。本报告提出的综合培训和研究计划 该应用程序将为兰登博士提供几个关键领域的高级培训，以提高她的能力 实现这一职业目标的研究计划。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）治疗方案开发； 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 通过教学和应用活动的结合以及这些技能的应用来实现 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 这项研究的主要内容包括（1）交互式计算机和文本的开发和完善 消息传递的 PFI，其中包含 DT 技能培训，面向积极寻求门诊 MAT 的人员（PFI- DT）； (2) 试点测试 PFI-DT 在提高动机、节制、坚持和保留方面的功效 治疗与健康教育比较条件进行比较； (3) 检查潜在机制 这可能是 PFI-DT 在改善结果方面的功效的基础，包括应激耐受性、自我 监管和负面影响。该 K23 奖项将为兰登博士提供一系列高级技能 旨在补充她之前的培训，以便她可以成功转型为一名独立科学家 重点是通过开发有效的、 易于传播、技术增强的干预措施。