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

The state of Rhode Island has been especially impacted by the opioid epidemic with rates of
overdose rising by 90% from 2011 to 2016. 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. 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 long-term career goal is to conduct clinical translational 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 the following domains: 1) treatment
development; 2) digital health interventions; 3) clinical trial methodology; and 4) general
professional development. These training objectives will be achieved through a combination of
didactic and applied activities, utilization of CTR service cores, as well as the application
of these skills in a Stage 1 pilot behavioral treatment development trial. Specific aims of
this research study include (1) the development, through formative evaluation, of an
interactive computer- and text message-delivered PFI, that incorporates DT skills training,
for persons actively seeking outpatient MAT (PFI-DT); and (2) pilot testing the feasibility,
acceptability, and preliminary efficacy of PFI-DT for increasing motivation, abstinence,
adherence, and retention to treatment compared to a health education comparison condition.
This work has the potential to address a Rhode Island Department of Health priority area -
opioid use and overdose.

Inclusion Criteria:

- age 18+ years of age; current DSM-5 Opioid Use Disorder; interest in engaging in MAT,
including the use of buprenorphine; and, access to cell phone with text message
capability

Exclusion Criteria:

- active suicidality and/or psychosis that would interfere with the ability to
participate in the intervention; not fluent in English; limited mental capacity or
inability to provide informed written consent