The Recovery Line is a phone-based interactive voice response system to improve coping in individuals receiving methadone maintenance therapy who still use illicit substances.
The Recovery Line is a self-management intervention delivered over a telephone-based interactive voice response system. Users are asked to use the system daily and when starting the Recovery Line, users select a 2-hour window that they plan to call the Recovery Line each day, however participants are not required to call during this time. Informed by cognitive behavioral therapy approaches for substance use, Recovery Line included modules for self-monitoring, coping with cravings, identifying and avoiding risky situations, and managing mood and stress. Self-monitoring is addressed in a daily assessment that users complete to evaluate how they are doing, whether they have taken their methadone, and whether they have used any illicit drugs for that day. Learning modules describe different coping skills and assess user understanding with short assessments. Activity modules guide users to engage in different coping skills and present different role-play scenarios that give users the opportunity to select a response to a given scenario. Modules were designed to last 5-10 minutes and to be understandable at a 5th grade listening level.
Interactive voice response
Cognitive Behavioral Therapy (CBT)
Young Adults (18-30)
The Recovery Line: A pilot trial of automated, telephone-based treatment for continued drug use in methadone maintenance
Summary: Researchers recruited 36 individuals in methadone maintenance treatment who had reported using illicit drugs in the past 30 days to participate in a pilot trial evaluating the feasibility, acceptability, and initial efficacy of the Recovery Line. Participants were recruited through fliers, clinician-referral, and word-of-mouth. Participants assigned to the treatment as usual (TAU) group received methadone, a monthly individual therapy session, and access to 10+ weekly therapy groups. Participants assigned to the intervention group received TAU with 4 weeks of access to the Recovery Line. A research assistant called participants who did not use the Recovery Line weekly to recommend they use the system. Participants completed assessments of satisfaction with their methadone maintenance therapy, coping skill effectiveness, and self-reported substance use and provided urine samples for toxicology testing weekly. Recovery Line participants rated system interest, ease of use, and efficacy weekly on a 5-point Likert scale (not at all to extremely). Average ratings for system interest, ease of use, and perceived efficacy were 3.6, 4.8, and 3.7, respectively. Ratings did not change over the course of the study. On average, Recovery Line participants used the system on 9.9 days, made 14.2 calls, and spent a total of 121.9 minutes using the system. Most participants (61%) accessed modules in all 4 content domains. Outcomes did not differ between conditions, but Recovery Line participants were more likely to report abstinence from opioids and cocaine on days they accessed the program than days they did not.
Take Away: The Recovery Line was acceptable and usable and showed some preliminary promise for promoting abstinence on days that individuals use the system.
Customized recommendations and reminder text messages for automated, computer-based treatment during methadone
Summary: Researchers evaluated approaches to improve engagement with the Recovery Line in 2 trials. For both trials, researchers recruited individuals receiving methadone maintenance therapy who reported using illicit drugs at least 5 out of the last 30 days using fliers, clinician-referral, and word-of-mouth. Participants completed weekly assessments of substance use (Time Line Follow Back) and perceived coping skill effectiveness. Perceptions of the Recovery Line (interest, efficacy, ease of use) were assessed at the end of each trial. Participants also provided urine samples that were screened for illicit substances at the beginning and end of each trial.
Trial 1: Researchers randomized 60 participants to receive the Recovery Line with or without custom module recommendations after a 5-item assessment at the beginning of each call for 2 weeks. Participants who did not receive custom recommendations made more calls when they went on to complete a module after the assessment than participants who received custom recommendations. Participants who received custom recommendations rated the ease of use of the system higher than participants who did not. Frequency of illicit substance use and coping skill effectiveness improved from baseline to the end of the study for both groups.
Trial 2: Researchers randomized 67 participants to receive immediate (start of call window), short-latency (2 hours post call window), or long-latency (48 hours post call window) reminders to call the Recovery Line. Reminders included a mix of gain and loss-framed reminders. Reminder framing did not significantly affect likelihood of calling the system or call length after a reminder. Average weekly total call time and number of calls decreased significantly over the study period. Participants who received immediate or short-latency reminders made significantly longer calls in the first two weeks than participants who received long-latency reminders, though differences did not persist past week 2. Men who received immediate and short-latency reminders made more calls and spent more total time using the system than men who received long-latency reminders, though these relationships did not exist for women. Both groups significantly reduced substance use as measured by self-report and urine screens.
Take Away: Custom recommendations did not appear to improve engagement with the Recovery Line and may have made users less likely to complete modules after the initial assessment, though the recommendations may have made the system easier to use. Immediate and short latency reminders may promote engagement for male users.
A randomized clinical trial of the Recovery Line among methadone treatment patients with ongoing illicit use
Summary: Researchers recruited 82 individuals receiving methadone maintenance treatment who had reported illicit drug use or had a positive urine screen for illicit drugs in the past 14 days and randomly assigned them to receive treatment as usual (TAU) or TAU with access to the Recovery Line for 3 months. TAU involved methadone, 25+ weekly therapy groups with 1 required per month, psychiatric and medical care, and other optional services (e.g. pregnancy counseling, family meetings). Participants completed assessments of substance use, substance use-related problems, perceived effectiveness of coping skills, depression symptoms, and treatment attendance at baseline and monthly during the study period. Participants also provided urine samples that were screened for illicit substances at baseline and twice weekly during the study. Recovery Line participants completed assessments of perceived system interest, ease of use, and efficacy at study end. Recovery Line participants reported significantly more days of abstinence at months 1 and 3 than baseline. Attendance at clinic substance use treatment sessions and outside group sessions (e.g., AA or NA) was higher for Recovery Line participants than TAU-only participants. Recovery Line participants made an average of 10.6 calls and spent an average of 59.1 minutes total using the system. Making more calls to the Recovery Line and spending more time using the Recovery Line were significantly associated with higher rates of self-reported abstinence and negative urine screens. On average, Recovery Line participants rated perceived system interest, efficacy, and ease of use highly (4.2, 4.3, and 4.9, respectively).
Take Away: The Recovery Line may promote attendance at substance use treatment session, and there is also some evidence that the Recovery Line may promote abstinence from substance use (with greater use of the system, in particular).