{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,1]],"date-time":"2026-08-01T00:43:38Z","timestamp":1785545018431,"version":"3.56.0"},"reference-count":59,"publisher":"JMIR Publications Inc.","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JMIR Form Res"],"abstract":"Abstract<\/jats:title>\n \n Background<\/jats:title>\n Young adults, defined as individuals between the ages of 18 and 29 years, drop out of opioid use disorder (OUD) treatment more often than older adults. Premature treatment drop-out substantially increases fatal overdose risk. Self-monitoring through text messaging has been researched extensively among people with OUD to identify drop-out risk factors. Self-monitoring could potentially improve methadone treatment engagement among young adults, who are a population that is both hard to reach and more likely to use technology compared to older adults. Self-monitoring can increase risk factor awareness and help patients and counselors develop targeted coping strategies and treatment plans. However, embedding a discussion of risk factor information into existing counseling sessions has been limited and may offer a promising opportunity to improve engagement among young adults.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n This pilot proof-of-concept study examined the implementation of self-monitoring intervention, AWARE (Awareness and Response to the Environment), designed to bring attention to treatment drop-out risk factors among young adults and create discussion about risk factors with their existing treatment counselor.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n In this formative research, a convenience sample (N=8) of young adults (n=3, 38%) in methadone treatment, their counselors (n=3, 38%), and clinic leadership (n=2, 25%) were recruited from an opioid treatment program after referral from treatment staff. Participants were interviewed to obtain feedback as AWARE was developed. In semistructured interviews, perspectives regarding barriers to treatment for young adults and AWARE utility were obtained. Concurrently, 3 dyads of young adults (n=3, 38%) and counselors (n=3, 38%) piloted the intervention daily for 4 weeks.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n The 3 consented young adults with OUD participants (n=2, 67% female; n=2, 67% Latino\/a) were sent daily surveys for 28 days (53% overall completion rate). Young adults and counselors found AWARE relevant to their treatment experience and acceptable to complete over 4 weeks. The most reported daily stressors included concerns about the health and well-being of a family member, challenges with staying organized, and feeling overwhelmed by responsibilities without adequate support. In qualitative interviews, counselors and clinic leadership reported that AWARE presented a relevant, new way to engage young adults daily, in addition to weekly counseling sessions. Young adults felt that prompts sent by AWARE offered a type of social support they lacked, like \u201csomeone checking in on them.\u201d<\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n Overall, young adult and counselor participants were able to engage in AWARE in a busy clinic environment, and participants and clinic leadership found it valuable. By addressing common stressors and providing a sense of social connection, AWARE may help fill a gap in support between counseling sessions. However, the study was limited by the small number of young adults engaging in methadone treatment. Further research is needed to refine the measures and methods of AWARE and evaluate its effectiveness.<\/jats:p>\n <\/jats:sec>","DOI":"10.2196\/67401","type":"journal-article","created":{"date-parts":[[2025,9,5]],"date-time":"2025-09-05T07:45:07Z","timestamp":1757058307000},"page":"e67401-e67401","source":"Crossref","is-referenced-by-count":1,"title":["The Development of a Patient-Centered Digital Health Care Technology for Young Adults in Opioid Use Disorder Treatment: Qualitative Study"],"prefix":"10.2196","volume":"9","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3941-947X","authenticated-orcid":false,"given":"Karen","family":"Alexander","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-5948-1531","authenticated-orcid":false,"given":"Madison","family":"Scialanca","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1010","published-online":{"date-parts":[[2025,9,23]]},"reference":[{"issue":"2","key":"R1","doi-asserted-by":"publisher","first-page":"89","DOI":"10.21106\/ijma.284","article-title":"Opioid epidemic in the United States: empirical trends, and a literature review of social determinants and epidemiological, pain management, and treatment patterns","volume":"8","author":"Singh","journal-title":"Int J MCH AIDS"},{"issue":"2","key":"R2","doi-asserted-by":"publisher","first-page":"151","DOI":"10.1111\/ajad.12998","article-title":"Predictors of medication utilization for opioid use disorder among medicaid-insured HIV patients in New York","volume":"29","author":"Choi","journal-title":"Am J Addict"},{"issue":"8","key":"R3","doi-asserted-by":"publisher","first-page":"747","DOI":"10.1001\/jamapediatrics.2017.0745","article-title":"Trends in receipt of buprenorphine and naltrexone for opioid use disorder among adolescents and young adults, 2001-2014","volume":"171","author":"Hadland","journal-title":"JAMA Pediatr"},{"key":"R4","doi-asserted-by":"publisher","DOI":"10.1016\/j.josat.2023.209020","article-title":"The interaction of race and age in methadone treatment retention outcomes: a single-center analysis","volume":"148","author":"Alexander","journal-title":"J Subst Use Addict Treat"},{"issue":"2","key":"R5","doi-asserted-by":"publisher","first-page":"93","DOI":"10.1097\/ADM.0000000000000193","article-title":"A systematic review on the use of psychosocial interventions in conjunction with medications for the treatment of opioid addiction","volume":"10","author":"Dugosh","journal-title":"J Addict Med"},{"key":"R6","doi-asserted-by":"publisher","DOI":"10.1016\/j.jsat.2021.108329","article-title":"Who stays in medication treatment for opioid use disorder? A national study of outpatient specialty treatment settings","volume":"126","author":"Krawczyk","journal-title":"J Subst Abuse Treat"},{"key":"R7","doi-asserted-by":"publisher","DOI":"10.1016\/j.addbeh.2019.01.023","article-title":"Perceived need and availability of psychosocial interventions across buprenorphine prescriber specialties","volume":"93","author":"Lin","journal-title":"Addict Behav"},{"issue":"1","key":"R8","doi-asserted-by":"publisher","DOI":"10.1186\/s13011-018-0173-2","article-title":"Effects of behavioural activation on substance use and depression: a systematic review","volume":"13","author":"Mart\u00ednez-Vispo","journal-title":"Subst Abuse Treat Prev Policy"},{"issue":"1","key":"R9","doi-asserted-by":"publisher","first-page":"122","DOI":"10.1007\/s40429-020-00351-7","article-title":"Ambulatory assessment methods to examine momentary state-based predictors of opioid use behaviors","volume":"8","author":"Burgess-Hull","journal-title":"Curr Addict Rep"},{"issue":"4","key":"R10","doi-asserted-by":"publisher","first-page":"370","DOI":"10.1176\/appi.focus.20180017","article-title":"Use of ecological momentary assessment and intervention in treatment with adults","volume":"16","author":"McDevitt-Murphy","journal-title":"Focus (Am Psychiatr Publ)"},{"key":"R11","doi-asserted-by":"publisher","DOI":"10.1146\/annurev.clinpsy.3.022806.091415","article-title":"Ecological momentary assessment","volume":"4","author":"Shiffman","journal-title":"Annu Rev Clin Psychol"},{"issue":"3","key":"R12","doi-asserted-by":"publisher","first-page":"366","DOI":"10.1007\/s40429-023-00492-5","article-title":"The use of ecological momentary assessment methods with people receiving medication for opioid use disorder: a systematic review","volume":"10","author":"Alexander","journal-title":"Curr Addict Rep"},{"key":"R13","doi-asserted-by":"publisher","DOI":"10.1016\/j.addbeh.2018.01.009","article-title":"Real-time assessment of alcohol craving and naltrexone treatment responsiveness in a randomized clinical trial","volume":"83","author":"Miranda","journal-title":"Addict Behav"},{"key":"R14","doi-asserted-by":"publisher","DOI":"10.1016\/j.drugalcdep.2021.108884","article-title":"Longitudinal patterns of momentary stress during outpatient opioid agonist treatment: a growth-mixture-model approach to classifying patients","volume":"226","author":"Burgess-Hull","journal-title":"Drug Alcohol Depend"},{"issue":"2-3","key":"R15","doi-asserted-by":"publisher","first-page":"118","DOI":"10.1016\/j.drugalcdep.2010.12.027","article-title":"Within-day temporal patterns of smoking, withdrawal symptoms, and craving","volume":"117","author":"Chandra","journal-title":"Drug Alcohol Depend"},{"issue":"1-2","key":"R16","doi-asserted-by":"publisher","first-page":"29","DOI":"10.1016\/j.drugalcdep.2012.12.025","article-title":"Sex differences in cocaine\/heroin users: drug-use triggers and craving in daily life","volume":"132","author":"Kennedy","journal-title":"Drug Alcohol Depend"},{"issue":"6","key":"R17","doi-asserted-by":"publisher","first-page":"1513","DOI":"10.1007\/s00213-021-05782-2","article-title":"Beyond abstinence and relapse II: momentary relationships between stress, craving, and lapse within clusters of patients with similar patterns of drug use","volume":"238","author":"Panlilio","journal-title":"Psychopharmacology (Berl)"},{"key":"R18","doi-asserted-by":"publisher","DOI":"10.1016\/j.drugalcdep.2018.08.023","article-title":"End-of-day reports of daily hassles and stress in men and women with opioid-use disorder: relationship to momentary reports of opioid and cocaine use and stress","volume":"193","author":"Preston","journal-title":"Drug Alcohol Depend"},{"issue":"5","key":"R19","doi-asserted-by":"publisher","first-page":"512","DOI":"10.1080\/00952990.2018.1454934","article-title":"Sex differences in daily life stress and craving in opioid-dependent patients","volume":"44","author":"Moran","journal-title":"Am J Drug Alcohol Abuse"},{"key":"R20","doi-asserted-by":"publisher","DOI":"10.1016\/j.drugalcdep.2019.05.026","article-title":"Stress, craving and mood as predictors of early dropout from opioid agonist therapy","volume":"202","author":"Panlilio","journal-title":"Drug Alcohol Depend"},{"key":"R21","doi-asserted-by":"publisher","DOI":"10.1186\/1747-597X-6-17","article-title":"Relapse prevention for addictive behaviors","volume":"6","author":"Hendershot","journal-title":"Subst Abuse Treat Prev Policy"},{"issue":"2","key":"R22","first-page":"151","volume":"23","author":"Larimer","journal-title":"Alcohol Res Health"},{"issue":"2","key":"R23","doi-asserted-by":"publisher","first-page":"147","DOI":"10.1037\/0033-295x.97.2.147","article-title":"A cognitive model of drug urges and drug-use behavior: role of automatic and nonautomatic processes","volume":"97","author":"Tiffany","journal-title":"Psychol Rev"},{"issue":"1","key":"R24","doi-asserted-by":"publisher","first-page":"23","DOI":"10.1146\/annurev.ps.44.020193.000323","article-title":"Mechanisms of self-regulation: a systems view","volume":"44","author":"Karoly","journal-title":"Annu Rev Psychol"},{"issue":"5","key":"R25","doi-asserted-by":"publisher","first-page":"e281","DOI":"10.1097\/ADM.0000000000001161","article-title":"Integrating text messaging in a low threshold telebuprenorphine program for New York City residents with opioid use disorder during COVID-19: a pilot randomized controlled trial","volume":"17","author":"Tofighi","journal-title":"J Addict Med"},{"key":"R26","doi-asserted-by":"publisher","DOI":"10.1177\/20552076241258400","article-title":"Feasibility and acceptability of a novel digital therapeutic combining behavioral and pharmacological treatment for opioid use disorder","volume":"10","author":"Monico","journal-title":"Digit Health"},{"issue":"1","key":"R27","doi-asserted-by":"publisher","first-page":"43","DOI":"10.1016\/j.jsat.2013.08.012","article-title":"Web-based behavioral treatment for substance use disorders as a partial replacement of standard methadone maintenance treatment","volume":"46","author":"Marsch","journal-title":"J Subst Abuse Treat"},{"key":"R28","doi-asserted-by":"publisher","DOI":"10.1016\/j.drugalcdep.2024.111268","article-title":"A randomized clinical trial to assess feasibility, acceptability and preliminary effects of telehealth-delivered cognitive-behavioral therapy for perceived social isolation among individuals with opioid use disorders","volume":"258","author":"Ashrafioun","journal-title":"Drug Alcohol Depend"},{"issue":"4","key":"R29","doi-asserted-by":"publisher","first-page":"436","DOI":"10.1176\/appi.ajp.2013.13070987","article-title":"Computer-assisted delivery of cognitive-behavioral therapy: efficacy and durability of CBT4CBT among cocaine-dependent individuals maintained on methadone","volume":"171","author":"Carroll","journal-title":"Am J Psychiatry"},{"key":"R30","doi-asserted-by":"publisher","DOI":"10.1016\/j.jsat.2018.06.001","article-title":"Developing an opioid use disorder treatment cascade: a review of quality measures","volume":"91","author":"Williams","journal-title":"J Subst Abuse Treat"},{"issue":"11","key":"R31","doi-asserted-by":"publisher","first-page":"1178","DOI":"10.1037\/hea0000387","article-title":"The impact of changing attitudes, norms, and self-efficacy on health-related intentions and behavior: a meta-analysis","volume":"35","author":"Sheeran","journal-title":"Health Psychol"},{"issue":"5","key":"R32","doi-asserted-by":"publisher","first-page":"735","DOI":"10.15288\/jsad.2009.70.735","article-title":"Craving and self-efficacy in the first five weeks of methadone maintenance therapy: a daily process study","volume":"70","author":"Barta","journal-title":"J Stud Alcohol Drugs"},{"issue":"4","key":"R33","doi-asserted-by":"publisher","first-page":"512","DOI":"10.1080\/08897077.2021.1874595","article-title":"The use and impact of self-monitoring on substance use outcomes: a descriptive systematic review","volume":"42","author":"Gass","journal-title":"Subst Abus"},{"issue":"1","key":"R34","doi-asserted-by":"publisher","first-page":"S80","DOI":"10.1097\/QAI.0000000000000570","article-title":"Smartphone self-monitoring to support self-management among people living with HIV: perceived benefits and theory of change from a mixed-methods randomized pilot study","volume":"69 Suppl 1","author":"Swendeman","journal-title":"J Acquir Immune Defic Syndr"},{"issue":"1","key":"R35","doi-asserted-by":"publisher","DOI":"10.1186\/s13011-020-0254-x","article-title":"\u201cBecoming myself\u201d: how participants in a longitudinal substance use disorder recovery study experienced receiving continuous feedback on their results","volume":"15","author":"Svendsen","journal-title":"Subst Abuse Treat Prev Policy"},{"key":"R36","doi-asserted-by":"publisher","DOI":"10.1016\/s0895-4356(01)00457-7","article-title":"Treatment adherence in chronic disease","volume":"54 Suppl 1","author":"Dunbar-Jacob","journal-title":"J Clin Epidemiol"},{"issue":"2","key":"R37","doi-asserted-by":"publisher","first-page":"267","DOI":"10.1037\/0022-3514.56.2.267","article-title":"Assessing coping strategies: a theoretically based approach","volume":"56","author":"Carver","journal-title":"J Pers Soc Psychol"},{"issue":"5","key":"R38","doi-asserted-by":"publisher","first-page":"751","DOI":"10.1111\/add.13502","article-title":"Making the hard work of recovery more attractive for those with substance use disorders","volume":"112","author":"McKay","journal-title":"Addiction"},{"key":"R39","doi-asserted-by":"crossref","unstructured":"Carroll KM . Therapy Manuals for Drug Addiction, Manual 1: A Cognitive-Behavioral Approach: Treating Cocaine Addiction. National Institute on Drug Abuse; 1998:55-65.","DOI":"10.1037\/e597502007-001"},{"issue":"9","key":"R40","doi-asserted-by":"publisher","first-page":"2713","DOI":"10.1007\/s00213-018-4966-9","article-title":"Before and after: craving, mood, and background stress in the hours surrounding drug use and stressful events in patients with opioid-use disorder","volume":"235","author":"Preston","journal-title":"Psychopharmacology (Berl)"},{"issue":"17","key":"R41","doi-asserted-by":"publisher","first-page":"2631","DOI":"10.1007\/s00213-017-4663-0","article-title":"Context and craving during stressful events in the daily lives of drug-dependent patients","volume":"234","author":"Preston","journal-title":"Psychopharmacology (Berl)"},{"issue":"1","key":"R42","doi-asserted-by":"publisher","first-page":"29","DOI":"10.1007\/s00213-011-2183-x","article-title":"Stress in the daily lives of cocaine and heroin users: relationship to mood, craving, relapse triggers, and cocaine use","volume":"218","author":"Preston","journal-title":"Psychopharmacology (Berl)"},{"issue":"5","key":"R43","doi-asserted-by":"publisher","first-page":"502","DOI":"10.1080\/00952990.2018.1454933","article-title":"Using ecological momentary assessment to examine the relationship between craving and affect with opioid use in a clinical trial of clonidine as an adjunct medication to buprenorphine treatment","volume":"44","author":"Kowalczyk","journal-title":"Am J Drug Alcohol Abuse"},{"issue":"1","key":"R44","doi-asserted-by":"publisher","first-page":"63","DOI":"10.1097\/FBP.0000000000000268","article-title":"Aripiprazole for cocaine abstinence: a randomized-controlled trial with ecological momentary assessment","volume":"28","author":"Moran","journal-title":"Behav Pharmacol"},{"issue":"2","key":"R45","doi-asserted-by":"publisher","first-page":"291","DOI":"10.1007\/s00213-009-1655-8","article-title":"Cocaine craving and use during daily life","volume":"207","author":"Preston","journal-title":"Psychopharmacology (Berl)"},{"issue":"7","key":"R46","doi-asserted-by":"publisher","first-page":"579","DOI":"10.1097\/FBP.0000000000000250","article-title":"Real-time assessment of alcohol drinking and drug use in opioid-dependent polydrug users","volume":"27","author":"Preston","journal-title":"Behav Pharmacol"},{"issue":"1","key":"R47","doi-asserted-by":"publisher","DOI":"10.1177\/1609406917712131","article-title":"Rapid and Rigorous Qualitative Data Analysis: The \u201cRADaR\u201d technique for applied research","volume":"16","author":"Watkins","journal-title":"Int J Qual Methods"},{"key":"R48","doi-asserted-by":"publisher","DOI":"10.1016\/j.drugalcdep.2015.12.021","article-title":"Opioid substitution therapy: lowering the treatment thresholds","volume":"161","author":"Kourounis","journal-title":"Drug Alcohol Depend"},{"issue":"3","key":"R49","doi-asserted-by":"publisher","first-page":"454","DOI":"10.1111\/add.13622","article-title":"Patient-centered methadone treatment: a randomized clinical trial","volume":"112","author":"Schwartz","journal-title":"Addiction"},{"issue":"1","key":"R50","doi-asserted-by":"publisher","DOI":"10.1186\/s13722-021-00249-3","article-title":"Receipt of medications for opioid use disorder among youth engaged in primary care: data from 6 health systems","volume":"16","author":"Bagley","journal-title":"Addict Sci Clin Pract"},{"issue":"2","key":"R51","doi-asserted-by":"publisher","first-page":"143","DOI":"10.1080\/00952990.2017.1399403","article-title":"Medication-assisted treatment for youth with opioid use disorder: current dilemmas and remaining questions","volume":"44","author":"Chang","journal-title":"Am J Drug Alcohol Abuse"},{"issue":"6","key":"R52","doi-asserted-by":"publisher","first-page":"778","DOI":"10.1016\/j.jadohealth.2020.07.038","article-title":"Young adults have worse outcomes than older adults: secondary analysis of a medication trial for opioid use disorder","volume":"67","author":"Fishman","journal-title":"J Adolesc Health"},{"issue":"2","key":"R53","doi-asserted-by":"publisher","first-page":"115","DOI":"10.1176\/appi.ajp.20230055","article-title":"Effects of bundling medication for opioid use disorder with an mHealth intervention targeting addiction: a randomized clinical trial","volume":"181","author":"Gustafson","journal-title":"Am J Psychiatry"},{"key":"R54","doi-asserted-by":"publisher","DOI":"10.2196\/48068","article-title":"Development and evaluation of a digital app for patient self-management of opioid use disorder: usability, acceptability, and utility study","volume":"8","author":"King","journal-title":"JMIR Form Res"},{"issue":"6","key":"R55","doi-asserted-by":"publisher","DOI":"10.2196\/15752","article-title":"Technologies for opioid use disorder management: mobile app search and scoping review","volume":"8","author":"Nuamah","journal-title":"JMIR Mhealth Uhealth"},{"issue":"3","key":"R56","doi-asserted-by":"publisher","first-page":"202","DOI":"10.1016\/j.jsat.2014.04.006","article-title":"Emerging adult age status predicts poor buprenorphine treatment retention","volume":"47","author":"Schuman-Olivier","journal-title":"J Subst Abuse Treat"},{"issue":"2","key":"R57","doi-asserted-by":"publisher","first-page":"212","DOI":"10.1037\/neu0000510","article-title":"Executive function, impulsivity, and risky behaviors in young adults","volume":"33","author":"Reynolds","journal-title":"Neuropsychology"},{"issue":"16","key":"R58","doi-asserted-by":"publisher","DOI":"10.3390\/ijerph20166571","article-title":"Association of loneliness and mindfulness in substance use treatment retention","volume":"20","author":"Herczyk","journal-title":"Int J Environ Res Public Health"},{"key":"R59","doi-asserted-by":"publisher","DOI":"10.1016\/j.jsat.2018.06.005","article-title":"Ecological momentary assessments for self-monitoring and counseling to optimize methamphetamine treatment and sexual risk reduction outcomes among gay and bisexual men","volume":"92","author":"Reback","journal-title":"J Subst Abuse Treat"}],"container-title":["JMIR Formative Research"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/formative.jmir.org\/2025\/1\/e67401","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,31]],"date-time":"2026-07-31T22:27:59Z","timestamp":1785536879000},"score":1,"resource":{"primary":{"URL":"https:\/\/formative.jmir.org\/2025\/1\/e67401"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,9,23]]},"references-count":59,"URL":"https:\/\/doi.org\/10.2196\/67401","relation":{},"ISSN":["2561-326X"],"issn-type":[{"value":"2561-326X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,9,23]]},"article-number":"v9i2e67401"}}