Mobile Psychosocial Interventions for MMT Clients

This study will develop and implement a mobile technology-delivered psychosocial intervention
for opioid-dependent adults in methadone maintenance treatment (MMT). This novel therapeutic
system promises to be cost-effective and to enable the provision of flexible, on-demand
therapeutic support outside of the formal treatment setting. The specific aims of this
investigation are as follows: Aim 1: The investigators will develop a novel, interactive,
evidence-based psychosocial intervention delivered via mobile phones, designed to promote
skills acquisition and reduce illicit drug use. Specifically, our Mobile Therapeutic System
(MTS) will offer key elements of a psychosocial intervention for substance use disorders of
known efficacy (the Community Reinforcement Approach). Participants will be provided with
unlimited daily prompts to encourage use of the program and will be able to access the
application at any time and as much as they choose, within their natural environments. Our
iterative development process will include input from focus groups with clients in methadone
treatment (n=24), input from experts in the field, and feedback testing of a beta-version of
the mobile phone-based program with clients in methadone treatment (n=30). Aim 2: The
investigators will evaluate the efficacy of this mobile tool with participants entering MMT
during the first three months of their treatment (n=219). The investigators will evaluate the
relative preliminary efficacy of (1) standard treatment, (2) standard treatment plus MTS and
(3) a mobile-based control condition on the primary outcomes of retention and opioid use (via
urine toxicology) and secondary outcomes of other substance use (via urine toxicology and
self-report), readiness to change drug use behavior, coping skills, opioid craving, HIV risk
behavior, and psychosocial functioning during the 3-month intervention phase. Durability of
effects will be examined at 1 and 3 month follow-ups. Aim 3: The investigators will perform
an economic analysis of MTS in community-based MMT. The investigators will estimate the
incremental costs and the incremental cost-effectiveness ratio (ICER) of MTS relative to
standard care and the mobile control group. The primary ICER will be the incremental costs
per increased abstinence time (the clinical measure of effectiveness) and the secondary ICER
will be incremental costs per increased quality adjusted life year (QALY) (the economic
measure of effectiveness). Cost data will be vital to future translational projects to
disseminate effective mobile interventions in community systems. If results are promising,
this novel therapeutic tool may have a tremendous impact on improving access to and
effectiveness of substance abuse treatment in a variety of other populations (and could also
be adapted for an array of other behavioral health applications), while significantly
limiting costs.

Inclusion Criteria:

- client enrolled in the study site's methadone maintenance program

- within the first month of initiating methadone maintenance treatment

- 18 years of age or older

- sufficient English-language ability to participate in informed consent process,
complete study assessments and understand the text in mobile phone- delivered
interventions

Exclusion Criteria:

- entering treatment at the study site with the intention of receiving a
methadone-assisted withdrawal only

- evidence of an active psychiatric disorder requiring immediate intervention (e.g.,
suicidality, psychosis)

- evidence of significant mental illness that may preclude participation