PROJECT SUMMARY/ABSTRACT
Of the nearly 400,000 people with an opioid use disorder (OUD) who receive OUD treatment each year, 1
in 6 utilize
residential
services.
Community re-entry after residential OUD treatment is an especially vulnerable
time,
with
most people who return to use doing so in the 30 days following discharge. Posttraumatic stress
disorder (PTSD) is highly prevalent (>50%) among people in residential OUD treatment and linked to worse
opioid outcomes following treatment, including return to use during community re-entry. However, while PTSD
treatment
access
high-risk
the
they
access
individual
is safe/acceptable/efficacious for people with OUD,
return to use after residential OUD treatment happens so quickly, it is critical that patients have
to empirically-supported tools that deliver ongoing upport and resources for PTSD-OUD during this
transitional period. Rigorously-developed mobile ealth interventions that adapt provision of care to
individual offer a promising and innovative approach to continuing care after residential OUD treatment:
can be easily disseminated o people from a wide demographic (high scalability), ensuring equitable
to OUD care for our most marginalized populations; overcome many of the structural, social, and
barriers to traditional treatment; are cost-effective and sustainable; and provide personalized 24/7
OUD programs rarely provide PTSD treatment.
Because
s
h
t
care to people at their moments of greatest need while maintaining standardization and fidelity of treatment.
The proposed study will use a ground-up approach to rigorously develop and evaluate a mobile app with
both on-demand (24/7 PTSD-OUD resources) and automated (skills-based PTSD-OUD interventions) features
to reduce opioid use/harms during community re-entry of adults with co-morbid PTSD-OUD. Aim 1 will use
ecological momentary assessment (EMA) to identify tailoring
of
Aim
variables (i.e., states of high risk for occurrence
opioid use and related harms) for a just-in-time adaptive intervention (JITAI) component of the mobile app.
2 will experimental design to ruse a hybrid igorously develop and evaluate the mobile app. Specifically,
microrandomized trial (MRT) will evaluate the efficacyof intervention options (JITAI) vs. generic reminders to
access
resources
on the proximal occurrence of opioid use and harms, including optimization of decision rules
(e.g., when, whether) to alter dosage, type, and timing of JITAI intervention option delivery, and
controlled
secondary
Our final
community
Such
randomized
trail (RCT) will provide an initia l test of efficacy (primary outcomes: r eturn to opioid use and harms;
outcome: PTSD severity) and implementation outcomes of mobile app vs. treatment-as-usual.
product will be a highly scalable mobile app that provides access to 24/7 continuing care during
re-entry (on-demand resources), including in xact moments of need (skills-based interventions).
a clinical tool has strong potential to improve health and quality of life for individuals with PTSD-OUD.
e
