Developing a Smartphone Application to Support the Functional Needs of Veterans in Medication Treatment for Opioid Use Disorder

Va Connecticut Healthcare System, West Haven CT

Investigators

Abstract

The proposed Career Development Award (CDA2) would support Dr. Noah R. Wolkowicz, a Clinical Psychology postdoctoral fellow with the VISN 1 New England Mental Illness Research, Education, and Clinical Center (MIRECC), in his goal of becoming a Research Psychologist within the VA focused on developing technology-based interventions to support the psychosocial functioning of Veterans with addictive disorders. Opioid Use Disorder (OUD) is a chronic, relapsing condition that prompts a variety of functional problems (e.g., social disengagement, unemployment). Despite the efficacy of Medication treatment for Opioid Use Disorder (MOUD; buprenorphine, methadone), OUD’s impacts on optimal psychosocial functioning often extends beyond what is pragmatically feasible for resource-strained MOUD clinics. Further, implementation of treatments designed to improve psychosocial functioning, such as Acceptance and Commitment Therapy (ACT), are themselves resource intensive, potentially limiting use and efficacy. Thus, to provide a minimally burdensome alternative to support the psychosocial functioning of Veterans in MOUD, the proposed research will develop a tailored mobile app-based treatment: ACT to RECOVER (Realizing Empowerment through Commitment, Openness, and Valuing Experiences in Recovery). ACT to RECOVER will draw on the efficacy of ACT, an existing, evidence-based, and functionally oriented psychosocial treatment, to provide support for the pursuit of personally meaningful goals (e.g., reconnecting with family, job pursuit) alongside standard MOUD. Research aims and app creation will occur across 3 parallel Phases consisting of content development (Phase 1), iterative usability testing and app refinement (Phase 2), and a Stage 1b pilot Randomized Controlled Trial (RCT) to assess acceptability and feasibility of ACT to RECOVER and study procedures in preparation for a larger efficacy trial if indicated (Phase 3). In Phase 1, ACT to RECOVER content will be developed via consultation with ACT experts/project mentors, as well as qualitative input from VA MOUD Veterans and clinical providers. In Phase 2, the delivery mode and content of the ACT to RECOVER app will be iteratively assessed and refined across 3 small waves of Veteran participants. Finally, in Phase 3 we will examine the feasibility and acceptability of ACT to RECOVER versus a smartphone-based, symptom monitoring control condition through a Stage 1b pilot test. These aims will directly inform and support a subsequent RR&D Merit proposal to conduct a full-scale RCT of the resulting intervention and will also provide invaluable experience for the candidate’s intended long-term career path. The current proposal’s training aims are designed to prepare Dr. Wolkowicz as a leader in technology-supported psychosocial intervention development within VA by building skills in (a) iterative usability testing for technology-supported interventions, (b) ACT practice and intervention research, (c) clinical trials methodology, (d) advanced statistical techniques, and (e) immersion within VA addiction and technology leadership. Research and training aims will be met through mentor collaboration and consultation with field experts, alongside formal didactic experiences (e.g., Yale courses in clinical trials methodology). The current proposal will address a critical need to reduce harms to Veterans with OUD, aligned with VHA priorities, and provide invaluable protected time for mentorship and training to the applicant. Ultimately, the research and training outlined in the current proposal will position Dr. Wolkowicz to become a leading researcher in technology-supported treatments for Veterans with addictive disorders.