Table 1.

Behavior change techniques included in MODIA.

Technique	Representative examples
Action planning and mental contrasting	Envisioning how to act in high-risk situations Envisioning how to overcome obstacles
Avoidance	Reducing exposure to cues Reflecting on people, places, and things associated with prior opioid use Restructuring the social environment to support recovery
Behavioral substitution	Encouraging engagement in alternative behaviors in high-risk situations
Credible source	Explaining how specific claims and techniques have been validated in well-designed studies
Decisional balance exercises	Reflection of advantages and disadvantages of using opioids
Direct therapeutic advice	How to use simple therapeutic techniques
Functional analysis	Identifying individual antecedents and consequences of opioid use How to change sequences of triggers
Goal setting and progress review	Expression of commitment to abstinence Normalization and validation of relapse
Homework	To practice a variety of cognitive behavioral therapy techniques covered in each chat
Humor	“Bruce the parrot” verbalizing unhelpful thoughts to convey “cognitive defusion”
Mental imagery	Envisioning a “healthy future self” Guided meditation
Metaphors and images	Cravings as “ocean waves” Unhelpful thoughts as “leaves floating on a stream”
Problem solving	Teaching effective skills and general problem-solving strategies
Psychoeducation	Cognitive behavioral therapy techniques Basic neurobiological processes underlying opioid dependence Role of exercise, nutrition, and sleep hygiene in recovery
Reward	Praise for continued program engagement “Stars and crowns” (images) to reward progress
Simulated role-plays	Resisting social pressures to use drugs Assertive communication
Self-monitoring and feedback	Interactive self-report questionnaires
Self-talk	Teaching patients to practice internal monologue to support recovery
Storytelling	Presentation of fictional cases
Therapeutic writing	Writing about personally relevant issues
Validation	Patients are not judged for their behavior Patients’ efforts are recognized and valued