Effective medication-based treatment could prevent overdose deaths and help over 2 million Americans recover from opioid use disorder (OUD), but only a fraction access specialty treatment or receive an FDA-approved medication. Community Reinforcement and Family Training (CRAFT) works with family members to get treatment resistant individuals (Identified Persons; IPs) into treatment, and 68% of families coached in CRAFT achieve treatment entry for their IP; about twice as many as comparison groups. However, most addiction professionals (counselors) are not trained in CRAFT or deliver it with questionable fidelity. The goal of this project is to develop and evaluate the technical feasibility and commercial viability of a scalable digital counselor training program for CRAFT. The Counselor product would be tailored to prepare counselors to work with family members of individuals with OUD. It will allow counselors to deliver high-fidelity CRAFT and significantly benefit IPs and their families affected by OUD by addressing the critical barrier of access to a leading evidence-based approach to family involvement in addiction recovery. Current methods for training counselors and disseminating ESTs, including CRAFT, rely on brief online or in-person workshops. However, research shows this format is minimally effective in facilitating adoption and implementation of ESTs. A more efficacious model includes ongoing counselor training with feedback and coaching. This project will develop an enhanced training model for CRAFT and digitize it to maximize scalability. In this project, we will: Produce the digital counselor training prototype and coaching process, tailored to OUD - with stakeholder input (Aim 1); Conduct a pilot study of 3 levels of digital training (Level 1 -Digital tutorial only [T]; Level 2 -Tutorial & digital training materials for self-study [TM]; Level 3 – Tutorial, digital materials, feedback and coaching [TMC]) to establish feasibility, acceptability, and examine the effects of training on CRAFT knowledge, fidelity, and treatment entry and retention (Aim 2). Validation of feasibility and commercial merit in the Phase I pilot study will provide substantiation to advance to Phase II. In addition to optimizing the product based on Phase I learnings and stakeholder input, Phase II goals will include completing development of a supervised machine learning (SML) automated coding system that will score counselor-submitted digital audiotapes of CRAFT sessions and generate written feedback including suggestions for improvement. This will allow us to demonstrate digital training efficacy at scale and commercial readiness (Aim 3). We will conduct a fully-powered randomized control trial comparing all piloted outcomes for the 3 training level conditions (Aim 4). These studies form the basis to demonstrate commercial readiness and value to purchasers.

The goal of this project is to develop a scalable digital program to train behavioral addiction professionals (counselors) to high-fidelity levels in Community Reinforcement and Family Training (CRAFT) with the ultimate goal of increasing opioid use disorder (OUD) treatment entry rates. On average 68% of families coached in CRAFT achieve treatment entry for a loved one with OUD and this could help over 2 million Americans recover from OUD with effective treatment.