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Abstract

Objective:

Medication for opioid use disorder (MOUD) improves treatment retention and reduces illicit opioid use. A-CHESS is an evidence-based smartphone intervention shown to improve addiction-related behaviors. The authors tested the efficacy of MOUD alone versus MOUD plus A-CHESS to determine whether the combination further improved outcomes.

Methods:

In an unblinded parallel-group randomized controlled trial, 414 participants recruited from outpatient programs were assigned in a 1:1 ratio to receive either MOUD alone or MOUD+A-CHESS for 16 months and were followed for an additional 8 months. All participants were on methadone, buprenorphine, or injectable naltrexone. The primary outcome was abstinence from illicit opioid use; secondary outcomes were treatment retention, health services use, other substance use, and quality of life; moderators were MOUD type, gender, withdrawal symptom severity, pain severity, and loneliness. Data sources were surveys comprising multiple validated scales, as well as urine screens, every 4 months.

Results:

There was no difference in abstinence between participants in the MOUD+A-CHESS and MOUD-alone arms across time (odds ratio=1.10, 95% CI=0.90–1.33). However, abstinence was moderated by withdrawal symptom severity (odds ratio=0.95, 95% CI=0.91–1.00) and MOUD type (odds ratio=0.57, 95% CI=0.34–0.97). Among participants without withdrawal symptoms, abstinence rates were higher over time for those in the MOUD+A-CHESS arm than for those in the MOUD-alone arm (odds ratio=1.30, 95% CI=1.01–1.67). Among participants taking methadone, those in the MOUD+A-CHESS arm were more likely to be abstinent over time (b=0.28, SE=0.09) than those in the MOUD-alone arm (b=0.06, SE=0.08), although the two groups did not differ significantly from each other (∆b=0.22, SE=0.11). MOUD+A-CHESS was also associated with greater meeting attendance (odds ratio=1.25, 95% CI=1.05–1.49) and decreased emergency department and urgent care use (odds ratio=0.88, 95% CI=0.78–0.99).

Conclusions:

Overall, MOUD+A-CHESS did not improve abstinence relative to MOUD alone. However, MOUD+A-CHESS may provide benefits for subsets of patients and may impact treatment utilization.

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Information & Authors

Information

Published In

Go to American Journal of Psychiatry
Go to American Journal of Psychiatry
American Journal of Psychiatry
Pages: 115 - 124
PubMed: 37789744

History

Received: 18 January 2023
Revision received: 14 June 2023
Accepted: 30 June 2023
Published online: 4 October 2023
Published in print: February 01, 2024

Keywords

  1. mHealth
  2. Opioid Use Disorder
  3. Medications for Opioid Use Disorder
  4. Methadone
  5. Buprenorphine
  6. Substance-Related and Addictive Disorders

Authors

Details

David H. Gustafson, Sr., Ph.D.
Center for Health Enhancement Systems Studies (D.H. Gustafson Sr., Landucci, Vjorn, Johnston, Pe-Romashko, D.H. Gustafson Jr.), Department of Industrial and Systems Engineering, College of Engineering (D.H. Gustafson Sr.), School of Nursing (Gicquelais), Department of Counseling Psychology, School of Education (Goldberg), Center for Healthy Minds (Goldberg), Department of Psychology, College of Letters and Science (Curtin), and School of Journalism and Mass Communication (Shah), University of Wisconsin–Madison; Department of Psychiatry and Human Behavior, Alpert Medical School, Brown University, Providence, R.I. (Bailey); Stanley Street Treatment and Resources (SSTAR), Fall River, Mass. (Bailey).
Gina Landucci, B.S.
Center for Health Enhancement Systems Studies (D.H. Gustafson Sr., Landucci, Vjorn, Johnston, Pe-Romashko, D.H. Gustafson Jr.), Department of Industrial and Systems Engineering, College of Engineering (D.H. Gustafson Sr.), School of Nursing (Gicquelais), Department of Counseling Psychology, School of Education (Goldberg), Center for Healthy Minds (Goldberg), Department of Psychology, College of Letters and Science (Curtin), and School of Journalism and Mass Communication (Shah), University of Wisconsin–Madison; Department of Psychiatry and Human Behavior, Alpert Medical School, Brown University, Providence, R.I. (Bailey); Stanley Street Treatment and Resources (SSTAR), Fall River, Mass. (Bailey).
Olivia J. Vjorn, M.S.
Center for Health Enhancement Systems Studies (D.H. Gustafson Sr., Landucci, Vjorn, Johnston, Pe-Romashko, D.H. Gustafson Jr.), Department of Industrial and Systems Engineering, College of Engineering (D.H. Gustafson Sr.), School of Nursing (Gicquelais), Department of Counseling Psychology, School of Education (Goldberg), Center for Healthy Minds (Goldberg), Department of Psychology, College of Letters and Science (Curtin), and School of Journalism and Mass Communication (Shah), University of Wisconsin–Madison; Department of Psychiatry and Human Behavior, Alpert Medical School, Brown University, Providence, R.I. (Bailey); Stanley Street Treatment and Resources (SSTAR), Fall River, Mass. (Bailey).
Rachel E. Gicquelais, Ph.D., M.P.H.
Center for Health Enhancement Systems Studies (D.H. Gustafson Sr., Landucci, Vjorn, Johnston, Pe-Romashko, D.H. Gustafson Jr.), Department of Industrial and Systems Engineering, College of Engineering (D.H. Gustafson Sr.), School of Nursing (Gicquelais), Department of Counseling Psychology, School of Education (Goldberg), Center for Healthy Minds (Goldberg), Department of Psychology, College of Letters and Science (Curtin), and School of Journalism and Mass Communication (Shah), University of Wisconsin–Madison; Department of Psychiatry and Human Behavior, Alpert Medical School, Brown University, Providence, R.I. (Bailey); Stanley Street Treatment and Resources (SSTAR), Fall River, Mass. (Bailey).
Simon B. Goldberg, Ph.D.
Center for Health Enhancement Systems Studies (D.H. Gustafson Sr., Landucci, Vjorn, Johnston, Pe-Romashko, D.H. Gustafson Jr.), Department of Industrial and Systems Engineering, College of Engineering (D.H. Gustafson Sr.), School of Nursing (Gicquelais), Department of Counseling Psychology, School of Education (Goldberg), Center for Healthy Minds (Goldberg), Department of Psychology, College of Letters and Science (Curtin), and School of Journalism and Mass Communication (Shah), University of Wisconsin–Madison; Department of Psychiatry and Human Behavior, Alpert Medical School, Brown University, Providence, R.I. (Bailey); Stanley Street Treatment and Resources (SSTAR), Fall River, Mass. (Bailey).
Darcie C. Johnston, M.L.I.S. [email protected]
Center for Health Enhancement Systems Studies (D.H. Gustafson Sr., Landucci, Vjorn, Johnston, Pe-Romashko, D.H. Gustafson Jr.), Department of Industrial and Systems Engineering, College of Engineering (D.H. Gustafson Sr.), School of Nursing (Gicquelais), Department of Counseling Psychology, School of Education (Goldberg), Center for Healthy Minds (Goldberg), Department of Psychology, College of Letters and Science (Curtin), and School of Journalism and Mass Communication (Shah), University of Wisconsin–Madison; Department of Psychiatry and Human Behavior, Alpert Medical School, Brown University, Providence, R.I. (Bailey); Stanley Street Treatment and Resources (SSTAR), Fall River, Mass. (Bailey).
John J. Curtin, Ph.D.
Center for Health Enhancement Systems Studies (D.H. Gustafson Sr., Landucci, Vjorn, Johnston, Pe-Romashko, D.H. Gustafson Jr.), Department of Industrial and Systems Engineering, College of Engineering (D.H. Gustafson Sr.), School of Nursing (Gicquelais), Department of Counseling Psychology, School of Education (Goldberg), Center for Healthy Minds (Goldberg), Department of Psychology, College of Letters and Science (Curtin), and School of Journalism and Mass Communication (Shah), University of Wisconsin–Madison; Department of Psychiatry and Human Behavior, Alpert Medical School, Brown University, Providence, R.I. (Bailey); Stanley Street Treatment and Resources (SSTAR), Fall River, Mass. (Bailey).
Genie L. Bailey, M.D.
Center for Health Enhancement Systems Studies (D.H. Gustafson Sr., Landucci, Vjorn, Johnston, Pe-Romashko, D.H. Gustafson Jr.), Department of Industrial and Systems Engineering, College of Engineering (D.H. Gustafson Sr.), School of Nursing (Gicquelais), Department of Counseling Psychology, School of Education (Goldberg), Center for Healthy Minds (Goldberg), Department of Psychology, College of Letters and Science (Curtin), and School of Journalism and Mass Communication (Shah), University of Wisconsin–Madison; Department of Psychiatry and Human Behavior, Alpert Medical School, Brown University, Providence, R.I. (Bailey); Stanley Street Treatment and Resources (SSTAR), Fall River, Mass. (Bailey).
Dhavan V. Shah, Ph.D.
Center for Health Enhancement Systems Studies (D.H. Gustafson Sr., Landucci, Vjorn, Johnston, Pe-Romashko, D.H. Gustafson Jr.), Department of Industrial and Systems Engineering, College of Engineering (D.H. Gustafson Sr.), School of Nursing (Gicquelais), Department of Counseling Psychology, School of Education (Goldberg), Center for Healthy Minds (Goldberg), Department of Psychology, College of Letters and Science (Curtin), and School of Journalism and Mass Communication (Shah), University of Wisconsin–Madison; Department of Psychiatry and Human Behavior, Alpert Medical School, Brown University, Providence, R.I. (Bailey); Stanley Street Treatment and Resources (SSTAR), Fall River, Mass. (Bailey).
Klaren Pe-Romashko, M.S.
Center for Health Enhancement Systems Studies (D.H. Gustafson Sr., Landucci, Vjorn, Johnston, Pe-Romashko, D.H. Gustafson Jr.), Department of Industrial and Systems Engineering, College of Engineering (D.H. Gustafson Sr.), School of Nursing (Gicquelais), Department of Counseling Psychology, School of Education (Goldberg), Center for Healthy Minds (Goldberg), Department of Psychology, College of Letters and Science (Curtin), and School of Journalism and Mass Communication (Shah), University of Wisconsin–Madison; Department of Psychiatry and Human Behavior, Alpert Medical School, Brown University, Providence, R.I. (Bailey); Stanley Street Treatment and Resources (SSTAR), Fall River, Mass. (Bailey).
David H. Gustafson, Jr., M.S.
Center for Health Enhancement Systems Studies (D.H. Gustafson Sr., Landucci, Vjorn, Johnston, Pe-Romashko, D.H. Gustafson Jr.), Department of Industrial and Systems Engineering, College of Engineering (D.H. Gustafson Sr.), School of Nursing (Gicquelais), Department of Counseling Psychology, School of Education (Goldberg), Center for Healthy Minds (Goldberg), Department of Psychology, College of Letters and Science (Curtin), and School of Journalism and Mass Communication (Shah), University of Wisconsin–Madison; Department of Psychiatry and Human Behavior, Alpert Medical School, Brown University, Providence, R.I. (Bailey); Stanley Street Treatment and Resources (SSTAR), Fall River, Mass. (Bailey).

Notes

Send correspondence to Ms. Johnston ([email protected]).

Competing Interests

Dr. Gustafson has served as a consultant for Dartmouth-Hitchcock Medical Center (on matters of quality improvement), and he is a shareholder in CHESS Health. The other authors report no financial relationships with commercial interests.

Funding Information

Supported by NIDA grant 1R01DA040449. Dr. Goldberg was supported by the National Center for Complementary and Integrative Health (grant K23AT010879).

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