Feasibility and acceptability of a novel digital therapeutic combining behavioral and pharmacological treatment for opioid use disorder.

Objective: Despite the worsening of the opioid epidemic, access to quality treatment for opioid use disorder (OUD) including buprenorphine remains a challenge. With the onset of the COVID-19 public health emergency, temporary regulatory changes and expanded reimbursement for telehealth services allowed for the rapid expansion of remote treatment for OUD and increased access to buprenorphine, but limited research exists to support this revolutionary shift in care delivery. This study evaluates the feasibility and acceptability of a novel digital therapeutic intervention for OUD combining buprenorphine and behavioral therapy. Methods: Adults (n = 27) with OUD received treatment with daily sublingual buprenorphine and psychosocial treatment delivered digitally via a smartphone app over 12 weeks. Participants were evaluated monthly for continued opioid use, medication adherence, anxiety and depression indicators, abstinence self-efficacy, craving, and overall well-being, as well as a one-time measure of treatment acceptability. Results: Participants reported increased opioid abstinence days from baseline (M = 8.2, SD = 8.6) to 12 weeks per 30 days (M = 24.9, SD = 10.1), t(20) = -6.5, p < .000, with strong medication adherence across study waves (96.2%). Anxiety and depression indicators, and opioid craving significantly decreased, and abstinence self-efficacy and overall well-being significantly increased following the intervention. Participants also demonstrated high rates of treatment engagement. Conclusions: As current public health emergency regulatory changes are reviewed for permanency, this feasibility and acceptability study of a novel digital therapeutic intervention for OUD including buprenorphine adds to the growing evidence that supports maintaining telehealth access for quality OUD treatment.

Implementing Suicide Risk Screening in a Virtual Addiction Clinic.

The purpose of this study was to describe the feasibility of implementing suicide risk screening in a virtual addiction clinic. Suicide risk screening was implemented in a virtual addiction clinic serving individuals with substance use disorders (SUD) using a quality improvement framework. One-hundred percent (252/252) of eligible patients enrolled in the clinic were screened for suicide risk (44% female; M[SD] age = 45.0[11.0] years, range = 21-68 years). Nineteen patients (8%) screened positive for suicide risk. After screening, no patients required emergency suicide interventions (100% non-acute positive). Notably, 74% (14/19) of those who screened positive did so by endorsing at least one past suicide attempt with no recent ideation. Suicide risk screening in virtual addiction clinics yields important clinical information for high-risk SUD populations without overburdening workflow with emergency services. Given the high proportion of non-acute positive screens based on suicide attempt histories with no recent ideation, clinicians may utilize information on suicide attempt history to facilitate further mental healthcare.

Feasibility and Preliminary Outcomes of a Mobile Intervention Combining Cognitive Behavioral Therapy, Virtual Coaching, and Nicotine Replacement Therapy for Nicotine Vaping Cessation.

Background: Despite research demonstrating that those who use e-cigarettes, also known as vaping, express an interest in quitting, evidence-based vaping cessation interventions are lacking. The purpose of this study was to examine the feasibility and preliminary outcomes of an mHealth vaping cessation intervention. Methods: Adults (N = 51) who were vaping nicotine were recruited online and enrolled in a 6-week mHealth intervention combining nicotine replacement therapy (NRT), self-guided cognitive behavioral therapy (CBT), and coaching support through telephone and asynchronous messaging. Feasibility and self-reported 7- and 30-day abstinence were assessed at baseline and 1-month postquit date. Results: The majority of participants completed treatment (45/51) and found the intervention helpful in supporting their vaping behavior change objectives. At 1-month postquit date, 48.9% (22/45) of study completers reported 7-day point prevalence abstinence and 28.8% (13/45) reported continuous 30-day abstinence. Conclusions: Findings provide preliminary support for an mHealth intervention approach to vaping cessation combining remote CBT-based coaching with NRT.

Feasibility, Acceptability, and Preliminary Outcomes of an Integrated Telemedicine Intervention Combining Naltrexone and Cognitive Behavioral Therapy for Alcohol Use Disorder.

Background: A small fraction of individuals in need of treatment for alcohol use disorders (AUDs) seek care, owing largely to barriers to accessing treatment. In the present pilot study, we examine the feasibility, acceptability, and preliminary outcomes of an m-health intervention combining cognitive behavioral therapy and pharmacotherapy for individuals with AUD. Methods: Adults with AUD (N = 26) recruited through online, social media-based advertising were enrolled in a 12-week, integrated telemedicine intervention combining psychosocial treatment with medical management: Quit Genius for AUD (QG-A). Feasibility, acceptability, perceived helpfulness, treatment engagement, retention, completion, and clinical outcomes including alcohol use and secondary mental health outcomes were assessed. Results: Participants found the QG-A intervention to be acceptable and helpful in facilitating action toward their therapeutic goals concerning alcohol use. Treatment completion, achieved by the majority (85%) of participants, was excellent. On average, participants reduced their past 30-day alcohol use from baseline (mean proportion of days of abstinent = 0.13) to follow-up (M = 0.59), t(19) = -4.97, p < 0.001, and consumed fewer drinks per drinking day from baseline (M = 6.7) to follow-up (M = 2.0), t(19) = 3.61, p < 0.001. Concurrently, reductions were observed in depressive (t[22] = 5.39, p < 0.001) and anxiety (t[22] = 2.87, p < 0.01) symptom severity, from the moderately severe range at baseline to the mild range at treatment-end, with increases in resilience (t[22] = -3.54, p < 0.001). Conclusions: Addressing AUDs using an integrated m-health intervention to deliver evidence-based psychosocial and pharmacological treatment is feasible and may produce improvements in both alcohol use and psychiatric symptoms.