The Treatment Section continues its long-term projects to improve treatment for substance dependence through behavioral, pharmacologic, and combined behavioral and pharmacologic interventions. We collaborated on a human laboratory study of sustained opioid blockade a depot formulation of naltrexone (Bigelow et al., 2012). The rationale for depot naltrexone is that outpatient adherence to prescribed opioid antagonists is notoriously low. Presumably this reflects deterioration of patients resolve to remain opioid-abstinenta resolve that the patient must reassert each day by taking naltrexone orally. A slow-release depot formulation requires only that the patient make a one-time commitment to remain on naltrexone for several weeks. In the laboratory study, we showed that a new formulation of depot naltrexone either completely or substantially blocked the agonist effects of high, clinically relevant doses of hydromorphone for 28 days. The availability of this depot formulation provides a good pharmacological option for relapse prevention in opioid addiction. A far broader spectrum of problems in addiction can be treated with contingency management, a behavioral intervention in which incentives are used to increase the frequency of desirable behaviors, such as drug abstinence or medication adherence. A major challenge associated with contingency management is its likely prohibitive cost and staff/resource intensity, especially when the reinforcement follows an escalating schedule (i.e., when each consecutive occurrence of the desired behavior is reinforced more than the lastan especially effective treatment). One of the major implementation challenges for community clinics is keeping track of each patients prior earnings so that current earnings can be calculated on the spot. To address this and related challenges, in collaboration with the Biomedical Informatics Section of the NIDA IRP, we developed a software application, Motivational Incentives Implementation Software (MIIS), for abstinence reinforcement. This year, we completed a project field-testing the softwares usability and robustness under conditions simulating those of a community treatment program with little technology infrastructure or staff expertise. MIIS is now being distributed to community treatment programs to promote technology transfer and increase community use of evidence-based treatments for addiction. We are also completing a manuscript so that this work will appear in a peer-reviewed journal. In further technology-development work, we are exploring the use of handheld electronic devices for treatment delivery in patients daily environments. We have just begun pilot testing of an mHealth (mobile-health) intervention in which educational videos on HIV-risk reduction are presented to participants on handheld electronic devices in their daily environments. This on the spot approach to delivery of healthcare knowledge may enable faster and more complete integration of such knowledge into participants daily behaviors. In related work, we are developing Geographical Momentary Assessment, a descriptive approach to better measure and understand the relationships among mood, drug use, and environmental exposure to psychosocial stressors. We remain committed to transforming description into intervention. For example, we have shown that electronic-diary studies can provide amazing insight into the daily lives of substance abusers during treatment and data that are sensitive to behavioral changes during even brief periods of abstinence. The technologies that enable us to collect data on drug use, craving, and stress in the field may also be used for delivery of treatment in the field, perhaps in response to the patients own self-reported behaviors or previously identified triggers.
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