Customized recommendations and reminder text messages for automated, computer-based treatment during methadone.

Abstract

The Recovery Line is an automated, computer-based intervention based on Cognitive Behavioral Therapy designed to provide real-time assistance by phone for patients in methadone maintenance. Preliminary efficacy findings were promising, however, as with other computer-based systems for substance use disorder, patient system use was less than recommended. Development and evaluation of system functions to increase patient engagement and use is needed. Thus, we conducted two randomized trials to evaluate system functions designed to increase patient use of the Recovery Line among methadone-maintained patients with continued illicit drug use. In Trial 1 (n = 60), patients received customized, system use recommendations or no recommendations on each Recovery Line call. Ratings of system usability were higher for customized recommendations, but number of calls and total call time did not differ by condition. Trial 2 evaluated characteristics of reminder messages (message frame and reminder latency). Participants (N = 67) received gain- and loss-frame reminder messages, and were randomly assigned to immediate, short, or long term message latency. Although message framing had no effect, gender interacted with latency condition such that females did not differ by message latency, while males had significantly greater total contact time in the short latency conditions. Number of calls differed by condition over time such that the shorter latencies led to greater calls initially, but dissipated over time. Overall the study indicates that computer-based self-management systems can be adapted to increase patient engagement and use.

A randomized clinical trial of the Recovery Line among methadone treatment patients with ongoing illicit drug use

“…Despite the limited use of the Recovery Line, there was a group difference between the conditions, suggesting that the ability to access the system, that is, the patient knowing that the system is a resource that they could access if needed, may provide benefit. Some of the informal qualitative interviews that we conducted at the end of this study and other studies of the Recovery Line (Moore et al, 2017;Moore et al, 2013), are consistent with this hypothesis. Several patients noted that they had thought of calling the Recovery Line on a number of occasions, and although they chose not to, the fact that the system was available when needed helped them make the choice to abstain.…”

“…For those assigned to RL+TAU, satisfaction with the RL was examined at the 12-week follow-up with an assessment used in our prior studies (Moore et al, 2017;Moore et al, 2013). Ease of use, interest, and perceived efficacy were assessed using 5-point Likert scales.…”

“…is a password-protected, automated, computerbased, Interactive Voice Response (IVR) system providing Cognitive Behavioral Therapy (CBT) based modules (Moore et al, 2017;Moore et al, 2013;Rogers et al, 2017). The line was intended to be used by patients within their own environment to provide immediate assistance, training, and support for improved coping.…”

“…The orientation included step-by-step instructions of how to utilize the system, introduction to the concepts of CBT, a recommendation to call the system daily, a written manual and an identification card that included the patient's ID, password and number to access the system. Positively-framed reminder text messages (see Table 1) were sent to the patients based on pre-identified call window established with the research assistants during orientation (Moore et al, 2017). Text messages were sent in unicode electronic format and were limited to 128 characters.…”

“…Patients received one of 30 randomized text messages four hours after their call window if the patient did not contact the system within the last 24 hours. Moore et al (Moore et al, 2017) demonstrated that the short-term latencies increased call frequency.…”