Impact of Residential Substance Abuse Treatment on Affect and Personality-Related Variables Across Inner-city Substance Abusers

Substance abuse treatment outcome studies have shown positive effects for a large number of drug users with regard to reduction in substance use and criminal activity, as well as improvement of general well-being. However, high rates of relapse following treatment have compelled researchers to elucidate the individual difference factors that change among those who receive substance abuse treatment. Affect- (depressive and anxiety symptoms) and disinhibition-related variables (impulsivity, risk taking) may be of particular relevance. These factors are related to the development and maintenance of substance use and distinguish between substance users with and without Axis I and II disorders that may interfere with treatment success, such as depression, anxiety disorders, or antisocial personality disorder. Consequently, these factors may be considered important treatment targets. However, there currently is a dearth of research focused on understanding whether these variables are affected by standard substance use treatments, and more specifically, which variables may change throughout the course of substance use treatment. Given that many of these variables are considered to be enduring aspects of an individual's personality, the extent to which they are malleable by treatment is an important consideration. Moreover, to enhance the generalizability of these findings, it is important to understand the extent to which changes occur in more standard substance use treatments as opposed to more elaborate and targeted treatments that rarely are disseminated in real world treatment settings. Therefore, the purpose of the current study was to examine the effect of a residential substance use treatment program on particular affect- (e.g., depressive and anxiety symptoms, stress reactivity) and disinhibition-related variables (e.g., risk taking). A sample of 81 inner-city substance abusers were assessed on self-reported and behavioral measures of the above affect- and disinhibition-related variables that have previously found to be implicated in substance use over a 30-day course of treatment. A residential treatment program provides an optimal setting for evaluating changes as behavioral confounds (i.e., substance use) can be controlled, and the natural changes during abstinence can be measured with both reliability and validity. A significant pre-post treatment decrease was found on scores of risk taking, as indexed by the Balloon Analogue Risk Task (BART); levels of depressive symptomatology and stress reactivity also evidenced a significant pre-post decrease. These data are discussed with respect to implications for understanding the factors that underlie mechanisms of change during treatment, thereby informing substance abuse prevention and treatment programs

Workshop on the Development and Evaluation of Digital Therapeutics for Health Behavior Change: Science, Methods, and Projects

The health care field has integrated advances into digital technology at an accelerating pace to improve health behavior, health care delivery, and cost-effectiveness of care. The realm of behavioral science has embraced this evolution of digital health, allowing for an exciting roadmap for advancing care by addressing the many challenges to the field via technological innovations. Digital therapeutics offer the potential to extend the reach of effective interventions at reduced cost and patient burden and to increase the potency of existing interventions. Intervention models have included the use of digital tools as supplements to standard care models, as tools that can replace a portion of treatment as usual, or as stand-alone tools accessed outside of care settings or direct to the consumer. To advance the potential public health impact of this promising line of research, multiple areas warrant further development and investigation. The Center for Technology and Behavioral Health (CTBH), a P30 Center of Excellence supported by the National Institute on Drug Abuse at the National Institutes of Health, is an interdisciplinary research center at Dartmouth College focused on the goal of harnessing existing and emerging technologies to effectively develop and deliver evidence-based interventions for substance use and co-occurring disorders. The CTBH launched a series of workshops to encourage and expand multidisciplinary collaborations among Dartmouth scientists and international CTBH affiliates engaged in research related to digital technology and behavioral health (eg, addiction science, behavioral health intervention, technology development, computer science and engineering, digital security, health economics, and implementation science). This paper summarizes a workshop conducted on the Development and Evaluation of Digital Therapeutics for Behavior Change, which addressed (1) principles of behavior change, (2) methods of identifying and testing the underlying mechanisms of behavior change, (3) conceptual frameworks for optimizing applications for mental health and addictive behavior, and (4) the diversity of experimental methods and designs that are essential to the successful development and testing of digital therapeutics. Examples were presented of ongoing CTBH projects focused on identifying and improving the measurement of health behavior change mechanisms and the development and evaluation of digital therapeutics. In summary, the workshop showcased the myriad research targets that will be instrumental in promoting and accelerating progress in the field of digital health and health behavior change and illustrated how the CTBH provides a model of multidisciplinary leadership and collaboration that can facilitate innovative, science-based efforts to address the health behavior challenges afflicting our communities