This R01 proposal seeks to pair medication-assisted treatment (MAT) with an evidence-based, smartphone- delivered relapse prevention system (A-CHESS) to improve long-term recovery from opioid use disorders. Although MAT has been shown to be effective for opioid dependence, the high rate of relapse suggests that MAT is not enough. Long-term recovery remains a challenge. Our hope is that A-CHESS will help patients transfer the skills they learn in treatment into their daily lives after treatment and as a result, have greater success in sustained recovery. A-CHESS also will include tools for improving outcomes related the hepatitis C virus and HIV-infections that disproportionately affect opioid-dependent people. The project also seeks to understand which elements of treatment work for whom and why so that interventions, especially mobile health interventions, can be made more effective. The proposal builds upon evidence that A-CHESS improves outcomes among those suffering from alcohol and opioid use disorders. In one randomized trial, patients leaving residential treatment for alcohol use disorders who had A-CHESS had 57% fewer risky drinking days than those without it, an effect that was even greater among patients who had been opioid- as well as alcohol- dependent. In a pilot test, A-CHESS was bundled with MAT to treat transient veterans with documented alcohol use disorders and, anecdotally, high rates of other drug use. This test found that readmissions to residential detox decreased 71% for those with A-CHESS compared to those without it. This study proposes a randomized clinical trial of 24 months, with patients from 3 treatment agencies assigned either to MAT + A- CHESS or MAT alone. The primary aim of the project is to determine the difference between the two groups in opioid use days. Secondarily, we want to detect differences in quality of life; retention in treatment; unscheduled use of health services; and, for HCV and HIV, screening rates, risk behaviors, testing, and among those infected, treatment initiation. We will also test the 4 factors that we hypothesize mediate the relationship between the interventions and outcomes: the 3 constructs of self-determination theory-competence, relatedness, and intrinsic motivation-plus negative affect. We also seek to understand factors that affect the strength of the relationship between intervention and outcome, which we hypothesize are gender and-among those who have A-CHESS-communication style in discussion groups. Through qualitative research, we will explore (1) the differences between people who respond better to MAT + A-CHESS vs. those who do not, (2) the struggles in implementing and sustaining the interventions, and (3) the relationship between outcomes and using A-CHESS. The proposed project offers an innovative approach to a nearly intractable and increasingly common problem. The project is significant both for its potential to improve long-term treatment outcomes and to create and share new knowledge and understanding about factors that can be used to tailor future treatments for greater effectiveness and reach.

Public Health Relevance

Medication-assisted treatment is effective in helping people recover from opioid dependence, but usually not for the long term. This project pairs medication-assisted treatment with a proven relapse-prevention system delivered via smartphone. The goals are to improve patients' long-term recovery from opioid dependence, reduce the risk of infection from hepatitis C and HIV, and understand how medication-assisted treatment and mobile health interventions can be improved.

Agency
National Institute of Health (NIH)
Institute
National Institute on Drug Abuse (NIDA)
Type
Research Project (R01)
Project #
5R01DA040449-02
Application #
9099793
Study Section
Special Emphasis Panel (ZRG1)
Program Officer
Aklin, Will
Project Start
2015-07-01
Project End
2020-05-31
Budget Start
2016-06-01
Budget End
2017-05-31
Support Year
2
Fiscal Year
2016
Total Cost
Indirect Cost
Name
University of Wisconsin Madison
Department
Type
Biomed Engr/Col Engr/Engr Sta
DUNS #
161202122
City
Madison
State
WI
Country
United States
Zip Code
53715
Quanbeck, Andrew; Gustafson, David H; Marsch, Lisa A et al. (2018) Implementing a Mobile Health System to Integrate the Treatment of Addiction Into Primary Care: A Hybrid Implementation-Effectiveness Study. J Med Internet Res 20:e37
Kornfield, Rachel; Sarma, Prathusha K; Shah, Dhavan V et al. (2018) Detecting Recovery Problems Just in Time: Application of Automated Linguistic Analysis and Supervised Machine Learning to an Online Substance Abuse Forum. J Med Internet Res 20:e10136
Kornfield, Rachel; Toma, Catalina L; Shah, Dhavan V et al. (2018) What Do You Say Before You Relapse? How Language Use in a Peer-to-peer Online Discussion Forum Predicts Risky Drinking among Those in Recovery. Health Commun 33:1184-1193
Glass, Joseph E; McKay, James R; Gustafson, David H et al. (2017) Treatment seeking as a mechanism of change in a randomized controlled trial of a mobile health intervention to support recovery from alcohol use disorders. J Subst Abuse Treat 77:57-66
Kim, Eunkyung; Scheufele, Dietram A; Han, Jeong Yeob et al. (2017) Opinion Leaders in Online Cancer Support Groups: An Investigation of Their Antecedents and Consequences. Health Commun 32:142-151
Mares, Marie-Louise; Gustafson, David H; Glass, Joseph E et al. (2016) Implementing an mHealth system for substance use disorders in primary care: a mixed methods study of clinicians' initial expectations and first year experiences. BMC Med Inform Decis Mak 16:126
Johnson, Kimberly; Richards, Stephanie; Chih, Ming-Yuan et al. (2016) A Pilot Test of a Mobile App for Drug Court Participants. Subst Abuse 10:1-7
Mclaughlin, Bryan; Yang, JungHwan; Yoo, Woohyun et al. (2016) The Effects of Expressing Religious Support Online for Breast Cancer Patients. Health Commun 31:762-71
Quanbeck, Andrew; Brown, Randall T; E Zgierska, Aleksandra et al. (2016) Systems consultation: protocol for a novel implementation strategy designed to promote evidence-based practice in primary care. Health Res Policy Syst 14:8
Lord, Sarah; Moore, Sarah K; Ramsey, Alex et al. (2016) Implementation of a Substance Use Recovery Support Mobile Phone App in Community Settings: Qualitative Study of Clinician and Staff Perspectives of Facilitators and Barriers. JMIR Ment Health 3:e24

Showing the most recent 10 out of 16 publications