Ecological momentary assessments for self-monitoring and counseling to optimize methamphetamine treatment and sexual risk reduction outcomes among gay and bisexual men

Abstract

This pilot study evaluated the use of smartphone ecological momentary assessments (EMA) for self-monitoring to optimize treatment outcomes among gay and bisexual men enrolled in an outpatient methamphetamine abuse treatment service program. Participants (N = 34) received EMA prompts five times daily to self-monitor their methamphetamine use, cravings, sexual risk behaviors, and associated triggers and affect throughout the 8-week treatment program. Participants were randomized into either a self-directed condition with access to a web-based EMA response visualization dashboard (“EMA+Dashboard”; n = 16); or, a counselor-supported condition incorporating weekly, 30-minute, one-on-one counseling sessions to review and discuss the participant’s self-monitoring data on the dashboard (“EMA+Dashboard+Counselor”; n = 18). Pilot participants were compared with historical controls (n = 102) as the reference group in multiple regression analyses to assess the impact of the two study conditions on the treatment service program outcomes. Study participants with weekly counseling (EMA+Dashboard+Counselor) exhibited significantly greater reductions in the number of condomless anal intercourse episodes than historical controls (IRR = 0.02, 95% CI [0.00, 0.30]), whereas the reduction was of similar magnitude as controls in the EMA+Dashboard self-directed condition (IRR = 0.23, 95% CI [0.02, 3.56]). Treatment effects were not significant for comparisons between the two study conditions and historical controls for self-reported methamphetamine use (EMA+Dashboard: IRR = 1.06, 95% CI [0.32, 3.49]; EMA+Dashboard+Counselor: IRR = 0.46, 95% CI [0.14, 1.49]), number of male partners (EMA+Dashboard: IRR = 1.02, 95% CI [0.39, 2.61]; EMA+Dashboard+Counselor: IRR = 0.54, 95% CI [0.20, 1.45]), and the likelihood of providing a urine sample that tested positive for methamphetamine metabolites (EMA+Dashboard : OR = 1.00, 95% CI [0.79, 1.25]; EMA+Dashboard+Counselor: OR = 0.93, 95% CI [0.74, 1.16]). The pilot study provides preliminary evidence that the treatment outcome for condomless anal intercourse can be improved through a combination of smartphone- and counselor-assisted self-monitoring.

A scoping review of alcohol, tobacco, and other drug use treatment interventions for sexual and gender minority populations

“…Out of 28 methamphetamine use interventions, 13 focused on reducing use among current users or among those at risk for use (Carrico et al, 2018;Carrico, Gómez, et al, 2015;Landovitz, Fletcher, Shoptaw, & Reback, 2015;Reback, Fletcher, Shoptaw, & Mansergh, 2015;Reback, Fletcher, Swendeman, & Metzner, 2019;Reback et al, 2012;Reback & Shoptaw, 2014;Shoptaw, Landovitz, & Reback, 2017;Shoptaw et al, 2008;Wu et al, 2011;Zhang, Shoptaw, Reback, Yadav, & Nyamathi, 2018;Zule et al, 2012); 10 interventions focused on individuals who met criteria for methamphetamine use disorder (Coffin et al, 2018;Colfax et al, 2011;Das et al, 2010;Landovitz et al, 2012;Lea et al, 2017;McElhiney et al, 2009;Mimiaga, Pantalone, et al, 2019;Reback et al, 2010;Reback, Rünger, Fletcher, & Swendeman, 2018;Shoptaw et al, 2005). The other five studies evaluated interventions for individuals who used methamphetamine, regardless of whether they met criteria for methamphetamine use disorder (Burgess et al, 2018;A.…”

Technological Interventions for the Treatment of Substance Use Disorders

“…EMA has proven to be useful in the addiction field because substance use tends to be episodic and is associated with the individuals' mood and their environment ( Schulte et al., 2018 ; Shiffman et al., 2008 ). For example in a clinical setting, Reback et al. (2018) conducted a pilot study in which they recruited 34 treatment-seeking methamphetamine users who reported use in the previous 12 months.…”

Ecological Momentary Assessment and mHealth Interventions Among Men Who Have Sex With Men: Scoping Review (Preprint)

“…Of the 15 studies, 7 (47%) measured substance use status, including use of nicotine, alcohol, and other nonprescription drugs [9,11,24,27,29,33,34]. Of the 15 studies, 6 (40%) measured sexual behavior, especially, risky, unprotected sexual behavior defined by condomless sex or sex with partners who were of unknown HIV status [11,23,30,[32][33][34]. Of the 15 studies, 4 (27%) assessed the acceptability of EMAs implemented in an intervention by measuring response rates, completion rates, and study retention rates [9,25,26,31].…”