We The Village Family Support Study

Substance-Related Disorders Clinical Trial

Official title:

SBIR Phase 1: Scalable Digital Delivery of Evidence-based Training for Family to Maximize Treatment Admission Rates of Opioid Use Disorder in Loved Ones-- We The Village Family Support Study

Clinical Trial Details — Status: Completed

Administrative data

• NCT number: NCT04250077
• Other study ID #: Protocol 1906
• Status: Completed
• Phase: N/A
• Start date: January 9, 2020
• Est. completion date: June 30, 2020

Study information

• Verified date: November 2021
• Source: We The Village, Inc.
• Contact: n/a
• Is FDA regulated: No
• Study type: Interventional

Clinical Trial Summary

The United States is in the midst of an opioid crisis. Over-prescription of opioid analgesic pain relievers contributed to a rapid escalation of use and misuse of these substances across the country. In 2016, more than 2.6 million Americans were diagnosed with opioid use disorder (OUD) and more than 42,000 have died of overdose involving opioids. This death rate is more than any year on record and has quadrupled since 1999 (1,2). Leveraging the potential of available data bases and health IT technologies may help to combat opioid crisis by targeting various aspects of the problem ranging from the prevention of opioid misuse to OUD treatment. NIH through NIDA solicits the research and development of data-driven solutions and services that focus on issues related to opioid use prevention, opioid use, opioid overdose prevention or OUD treatment.

In this project, We The Village, Inc. will address a need to prepare Concerned Significant Others (CSOs) to best use their influence over the trajectory of a loved one's OUD. CSOs are motivated to help, make majority of treatment decisions and payments and have influence over treatment entry and thus, impact the trajectory of an OUD. The project goal is to develop digital delivery of Community Reinforcement And Family Training (CRAFT) methodology, an empirical family behavioral intervention to improve outcomes around treatment entry, family functioning and substance use.

Description:

The primary objective of the proposed Phase I work is to determine the feasibility of delivering Community Reinforcement And Family Training (CRAFT) principles via scalable digital coaching methods and determine its efficacy based on measured outcomes.

Technical Objectives 1. Modify the WTV platform to produce a CRAFT-informed automated prototype and protocol for live coaching.

Technical Objectives 2. Test prototype usability and reliability to deliver the protocol, and make any refinements needed.

Technical Objectives 3. Demonstrate prototype efficacy. Testing three digital scenarios: A. Automated CRAFT, B. CRAFT Coach, C. Peer support, the current WTV platform interaction.

As a result, when tested at baseline versus post-intervention, CRAFT conditions (Coach and Automated) are expected to achieve better outcomes than the peer condition in a) treatment entry, b) Concerned Significant Others (CSO) health and wellbeing, c) CSO and identified patient relationship, d) CRAFT adeptness.

Results will substantiate the case for Phase II roll out of the platform at scale, plus commercialization and dissemination through an existing and growing network of partners.

Recruitment information / eligibility

• Status: Completed
• Enrollment: 45
• Est. completion date: June 30, 2020
• Est. primary completion date: June 30, 2020
• Accepts healthy volunteers: Accepts Healthy Volunteers
• Gender: All
• Age group: 19 Years and older

Eligibility

Inclusion Criteria:

• Identify as a concerned significant other (CSO) of a loved one with an OUP

• Be 19 years or older

• No substance use disorder

• Has concern about the opioid use of a loved one (IP)

• Plans to be in close contact (phone/face-to-face) with the IP

• The IP is not currently receiving treatment, or the IP is in treatment, but the CSO perceives the IP may benefit from additional treatment (e.g., receiving MAT but the IP may benefit from attending outpatient services, or in residential treatment, but will need to enter outpatient treatment upon discharge).

Exclusion Criteria:

• Does not agree to sign the consent form

• Is not English-speaking

• Is not able to understand the consent form

• Does not have personal access to a smart phone with data or a computer with internet to be able to access the digital platform for the study conditions, quizzes, questionnaires, and follow-up communication

• Reports that they have a drug abuse problem or a history of drug abuse or dependence and that they have not been in recovery for at least 2 years

• Resides outside the United States

Related Conditions & MeSH terms

• Community Reinforcement And Family Training
• Family Health
• Substance-Related Disorders

Intervention

Behavioral:
• Community Reinforcement And Family Training (CRAFT)
Community Reinforcement Approach and Family Training (CRAFT) is a scientifically based intervention designed to help concerned significant others (CSOs) to engage treatment-refusing substance abusers into treatment. This new intervention method was developed with the belief that the CSO can play a powerful role in helping to engage the substance user in treatment. It is often the substance user who reports that family pressure or influence is the reason sought treatment. CSOs benefit by becoming more independent and reducing their depression, anxiety and anger symptoms even if their loved one does not enter treatment. CRAFT uses a positive approach versus confrontation, emphasizing learning new skills to cope with old problems. Some components include: how to stay safe, outlining the context in which substance abusing behavior occurs, teaching CSOs how to use positive reinforcers (rewards) and how to let the substance user suffer the natural consequences for their using behavior.
• We The Village Peer Community Forum
An online peer support forum with other CSOs. Members of the forum post questions or comments to weekly peer-led discussions and receive responses and feedback from other CSO forum members. Members typically express concerns regarding their IP's wellbeing and ask other members to share any strategies they have employed when dealing with their IPs. Interactions typically, are based either in 12-Step strategies members have learned (usually through Al-Anon or Nar-Anon Family Groups or Family Training Workshops provided by treatment programs) or in CRAFT skills learned (usually from treatment programs or other We The Village members). A staff member from We The Village monitors forum interactions to ensure members are interacting respectfully.

Locations

Country	Name	City	State
United States	We the Village, Inc.	New York	New York

Sponsors (2)

Lead Sponsor	Collaborator
We The Village, Inc.	Public Health Management Corporation

Country where clinical trial is conducted

United States, 

References & Publications (40)

Benishek, L. A., Dugosh, K. L., Faranda-Diedrich, T. M., & Kirby, K. C. (2006). Development of the significant other survey: An interview for family members of substance users. American Journal of Family Therapy, 34(1), 33-46.

Bischof G, Iwen J, Freyer-Adam J, Rumpf HJ. Efficacy of the Community Reinforcement and Family Training for concerned significant others of treatment-refusing individuals with alcohol dependence: A randomized controlled trial. Drug Alcohol Depend. 2016 Jun 1;163:179-85. doi: 10.1016/j.drugalcdep.2016.04.015. Epub 2016 Apr 19. — View Citation

Bresani, E., Kirby, K.C., Meyers, R.J., Case, T., Miller, T.G., Festinger, D.S., Serna, B., & Grasso, S. (2016). The parent's modular toolkit: Development of an online CRAFT program for parents of emerging adults with SUD. Drug and Alcohol Dependence, 156, e27-e28

Brigham GS, Slesnick N, Winhusen TM, Lewis DF, Guo X, Somoza E. A randomized pilot clinical trial to evaluate the efficacy of Community Reinforcement and Family Training for Treatment Retention (CRAFT-T) for improving outcomes for patients completing opioid detoxification. Drug Alcohol Depend. 2014 May 1;138:240-3. doi: 10.1016/j.drugalcdep.2014.02.013. Epub 2014 Feb 23. — View Citation

Center for Behavioral Health Statistics and Quality. (2017.) National Survey on Drug Use and Health: Detailed tables. Rockville, MD: Substance Abuse and Mental Health Services Administration; 2018.

Centers for Disease Control (CDC) Multiple Cause of Death 1999-2017 on CDC Wide-ranging Online Data for Epidemiologic Research (CDC WONDER). Atlanta, GA: CDC, National Center for Health Statistics. 2018. Available at http://wonder.cdc.gov.

Ghertner, R., & Groves, L. (2018). The opioid crisis and economic opportunity: geographic and economic trends. ASPE Research Brief, 1-22.

Hartley, J. (1998). Learning and studying: A research perspective. Florence, KY: Taylor & Frances/Routledge.

Hudson CR, Kirby KC, Firely ML, Festinger DS, Marlowe DB. Social adjustment of family members and significant others (FSOs) of drug users. J Subst Abuse Treat. 2002 Oct;23(3):171-81. — View Citation

Keane H. Facing addiction in America: The Surgeon General's Report on Alcohol, Drugs, and Health U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES, OFFICE OF THE SURGEON GENERAL Washington, DC, USA: U.S. Department of Health and Human Services, 2016 382 pp. online (grey literature): https://addiction.surgeongeneral.gov/. Drug Alcohol Rev. 2018 Feb;37(2):282-283. doi: 10.1111/dar.12578. — View Citation

Kirby KC, Benishek LA, Kerwin ME, Dugosh KL, Carpenedo CM, Bresani E, Haugh JA, Washio Y, Meyers RJ. Analyzing components of Community Reinforcement and Family Training (CRAFT): Is treatment entry training sufficient? Psychol Addict Behav. 2017 Nov;31(7):818-827. doi: 10.1037/adb0000306. Epub 2017 Aug 24. — View Citation

Kirby KC, Dugosh KL, Benishek LA, Harrington VM. The Significant Other Checklist: measuring the problems experienced by family members of drug users. Addict Behav. 2005 Jan;30(1):29-47. — View Citation

Kirby KC, Marlowe DB, Festinger DS, Garvey KA, La Monaca V. Community reinforcement training for family and significant others of drug abusers: a unilateral intervention to increase treatment entry of drug users. Drug Alcohol Depend. 1999 Aug 2;56(1):85-96. — View Citation

Kirby, K.C., Meyers, K., Carpenedo, C.M., Bresani, E., Dugosh, K.L., Zentgraf, K., & Zaslav, D. (2016). Randomized, controlled trial of CRAFT for parents of treatment-resistant adolescents and young adults: Interim results. Drug and Alcohol Dependence, 156, e112

Lovett, L. (2018) Senate passes bill to address opioid crisis, expands telemedicine scope. Mobihealthnews. https://www.mobihealthnews.com/content/senate-passes-bill-address-opioid-crisis-expands-telemedicine- scope?mc_cid=f7c67890d1&mc_eid=3bfb3dd1e7

Marlowe DB, Kirby KC, Bonieskie LM, Glass DJ, Dodds LD, Husband SD, Platt JJ, Festinger DS. Assessment of coercive and noncoercive pressures to enter drug abuse treatment. Drug Alcohol Depend. 1996 Oct;42(2):77-84. — View Citation

McLellan, A. Thomas Wolfe, B. L., & Meyers, R. J. (2004). Community reinforcement and family training: Getting loved ones sober. In The counselor publication of the National Association of Alcoholism and Drug Abuse Counselors, Vol. 5, No. 3 (pp. 57-60).

Meyers RJ, Miller WR, Smith JE, Tonigan JS. A randomized trial of two methods for engaging treatment-refusing drug users through concerned significant others. J Consult Clin Psychol. 2002 Oct;70(5):1182-5. — View Citation

Meyers, R. J. (2008). Providing a CRAFT book - Get your loved one sober - resulted in treatment entry in greater proportions than seen in twelve-step facilitation control groups. Unpublished raw data.

Miller WR, Meyers RJ, Tonigan JS. Engaging the unmotivated in treatment for alcohol problems: a comparison of three strategies for intervention through family members. J Consult Clin Psychol. 1999 Oct;67(5):688-97. — View Citation

Osilla KC, Kennedy DP, Hunter SB, Maksabedian E. Feasibility of a computer-assisted social network motivational interviewing intervention for substance use and HIV risk behaviors for housing first residents. Addict Sci Clin Pract. 2016 Sep 7;11(1):14. doi: 10.1186/s13722-016-0061-x. — View Citation

Ray GT, Mertens JR, Weisner C. Family members of people with alcohol or drug dependence: health problems and medical cost compared to family members of people with diabetes and asthma. Addiction. 2009 Feb;104(2):203-14. doi: 10.1111/j.1360-0443.2008.02447.x. — View Citation

Ray GT, Mertens JR, Weisner C. The excess medical cost and health problems of family members of persons diagnosed with alcohol or drug problems. Med Care. 2007 Feb;45(2):116-22. — View Citation

Rhoades H, La Motte-Kerr W, Duan L, Woo D, Rice E, Henwood B, Harris T, Wenzel SL. Social networks and substance use after transitioning into permanentsupportive housing. Drug Alcohol Depend. 2018 Oct 1;191:63-69. doi: 10.1016/j.drugalcdep.2018.06.027. Epub 2018 Jul 29. — View Citation

Roozen HG, Boulogne JJ, van Tulder MW, van den Brink W, De Jong CA, Kerkhof AJ. A systematic review of the effectiveness of the community reinforcement approach in alcohol, cocaine and opioid addiction. Drug Alcohol Depend. 2004 Apr 9;74(1):1-13. Review. — View Citation

Roozen HG, de Waart R, van der Kroft P. Community reinforcement and family training: an effective option to engage treatment-resistant substance-abusing individuals in treatment. Addiction. 2010 Oct;105(10):1729-38. doi: 10.1111/j.1360-0443.2010.03016.x. Review. Erratum in: Addiction. 2010 Nov;105(11):2040. — View Citation

Rounsaville, B. J., Carroll, K. M., & Onken, L. S. (2001). A stage model of behavioral therapies research: Getting started and moving on from stage I. Clinical Psychology: Science and Practice, 8(2), 133-142.

Scholl L, Seth P, Kariisa M, Wilson N, Baldwin G. Drug and Opioid-Involved Overdose Deaths - United States, 2013-2017. MMWR Morb Mortal Wkly Rep. 2018 Jan 4;67(5152):1419-1427. doi: 10.15585/mmwr.mm675152e1. — View Citation

Singer, N. (2018) New York Times. Take This App and Call Me in the Morning (March 18) https://www.nytimes.com/2018/03/18/technology/take-this-app-and-call-me-in-the-morning.html

Sisson RW, Azrin NH. Family-member involvement to initiate and promote treatment of problem drinkers. J Behav Ther Exp Psychiatry. 1986 Mar;17(1):15-21. — View Citation

Slesnick N, Meyers RJ, Meade M, Segelken DH. Bleak and hopeless no more. Engagement Of reluctant substance-abusing runaway youth and their families. J Subst Abuse Treat. 2000 Oct;19(3):215-22. — View Citation

Smyth BP, Barry J, Keenan E, Ducray K. Lapse and relapse following inpatient treatment of opiate dependence. Ir Med J. 2010 Jun;103(6):176-9. — View Citation

Stanton MD. Getting reluctant substance abusers to engage in treatment/self-help: a review of outcomes and clinical options. J Marital Fam Ther. 2004 Apr;30(2):165-82. Review. — View Citation

Thomas, E. J., & Santa, C. A. (1982). Unilateral family therapy for alcohol abuse: A working conception. American Journal of Family Therapy, 10(3), 45-58.

Thomas, E. J., & Yoshioka, M. R. (1989). Spouse interventive confrontations in unilateral family therapy for alcohol abuse. Social Casework, 70, 340-347.

Trudeau JV, Deitz DK, Cook RF. Utilization and cost of behavioral health services: employee characteristics and workplace health promotion. J Behav Health Serv Res. 2002 Feb;29(1):61-74. — View Citation

van Dommelen-Gonzalez E, Deardorff J, Herd D, Minnis AM. Homies with aspirations and positive peer network ties: associations with reduced frequent substance use among gang-affiliated Latino youth. J Urban Health. 2015 Apr;92(2):322-37. doi: 10.1007/s11524-014-9922-3. — View Citation

Ventura AS, Bagley SM. To Improve Substance Use Disorder Prevention, Treatment and Recovery: Engage the Family. J Addict Med. 2017 Sep/Oct;11(5):339-341. doi: 10.1097/ADM.0000000000000331. — View Citation

Vice Chairman's Staff of the Joint Economic Committee. (2017). The Numbers Behind the Opioid Crisis: https://www.lee.senate.gov/public/_cache/files/b54a2abb-978d-4bbb-a868-531cdfaeae7a/the-numbers- behind-the-opioid-crisis-final.pdf 2.

Wogan, J.B., (2017). Governing States and Localities. Health and Human Services. For Opioids' Youngest Victims, Is Help Too Little, Too Late? http://www.governing.com/topics/health-human-services/gov-opioid-epidemic- child-welfare.html

* Note: There are 40 references in all — Click here to view all references

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	Treatment Entry: IP Treatment Status	Participants reported whether their loved one had attended any treatment for their opioid problem since the last assessment by answering 8 questions regarding participation in treatment (e.g., detox, any treatment, new treatment, MAT, new MAT, counseling, support group, and other group). Reports of new treatment, new MAT, and treatment at the follow-up assessment which were not reported at baseline were categorized as treatment entry. In addition, entry into WTV recovery coaching, WTV family coaching, or reports of treatment entry to WTV staff were categorized as treatment entry. Outcome was the proportion of participants reporting that their loved one entered new treatment.	3-month post study
Secondary	Relationship Happiness: Relationship Happiness Scale	Global score from the 10-item scale was calculated by adding scores (1-10) from 10 items. Minimum possible score was 10 and maximum was 100. Higher scores reflect greater Relationship Happiness.	3-month post study
Secondary	CSO Health and Wellbeing: Profile of Mood State (POMS) - Short Form	Total mood disturbance (TMD) score calculated by adding scores (1-5) from the tension (6 items), depression (8 items), anger (7 items), fatigue (5 items), and confusion (5 items) subscales, then subtracting the score form the vigor (6 items) subscale. Minimum TMD possible score was 1 and maximum was 149. Higher scores reflect greater mood disturbance.	3-month post study
Secondary	CSO Health and Wellbeing: SF-12 Physical Health Subscale	The 7-item scale was transformed so that is had a mean of 50 and a s.d. of 10 in the general US population. Scores above and below 50 are above and below the average with each point representing a difference of 1/10th of a standard deviation.	3-month post study
Secondary	CSO Health and Wellbeing: SF-12 Mental Health Subscale	The 5-item scale was transformed so that is had a mean of 50 and a s.d. of 10 in the general US population. Scores above and below 50 are above and below the average with each point representing a difference of 1/10th of a standard deviation.	3-month post study
Secondary	CSO Health and Wellbeing: SAS-SR Work Subscale	Social Adjustment Scale, Self-Report. Standardized scale to assess individual's level of satisfaction in their role performance over the past two weeks key life areas. We used subscales representing the work, housework, and school areas of functioning. Each subscale consisted of 6 items scored on a 1-5 scale. A subscale adjustment score was obtained by summing the scores of all the items and dividing by the number of items actually answered. Thus, each subscale summary score had a minimum score of 1 and a maximum score of 5. Lower scores indicate higher satisfaction in their role performance.	3-month post study
Secondary	CRAFT Knowledge: CRAFT Knowledge Scale	Knowledge score calculated by adding the number of correct multiple-choice answers to 10 scenarios. Minimum score was 0 and maximum was 10. Higher scores reflect greater knowledge.	3-month post study
Secondary	MAT	Participants reported whether their loved one had attended any treatment for their opioid problem since the last assessment by answering 8 questions regarding participation in treatment. Reports of new MAT and MAT at the follow-up assessment which was not reported at baseline were categorized as new MAT. In addition, reports of MAT entry to WTV staff were included. Outcome was the proportion of participants reporting that their loved one entered MAT. This differs from Outcome Measure 1 in that Outcome Measure 1 included drug-free and medication-assisted treatments of any type, while this measure included only MAT.	3-month post study