How Patients Recovering From Alcoholism Use a Smartphone Intervention

Abstract

Objective Mobile technology has the potential to radically improve addiction treatment and continuing care by offering emotional and instrumental support anywhere and just in time. This is particularly important in addiction because timing is critical to preventing relapse. Although most experts consider alcoholism to be a chronic disease, providers do not typically offer ongoing support for relapse prevention after patients complete treatment, even though a central characteristic of alcoholism and other addictive behaviors is their chronically relapsing nature. A-CHESS is a smartphone-based system for preventing relapse to heavy drinking among people leaving active alcohol dependence treatment. A-CHESS is designed to improve competence, social relatedness, and motivation, the three tenets of Self-Determination Theory. This paper reports on the relative impact and use of A-CHESS four months after patients entered the study and discusses implications of the results on treating addiction and chronic diseases generally. Methods A total of 349 individuals with alcohol dependence leaving residential treatment were randomly assigned to either receive A-CHESS+Treatment as Usual or Treatment as Usual (standard aftercare). Patients came from two treatment agencies, one in the Midwest and one in the Northeast. Patients assigned to A-CHESS received a smartphone for 8 months and were followed for 12. The authors analyzed use patterns during the first 4 months of use by those receiving A-CHESS. Results Participants used A-CHESS heavily and sustained their use over time. Ninety-four percent of A-CHESS participants used the application during the first week after residential treatment. At week 16, almost 80% continued to access A-CHESS. Participants with alcohol and drug-dependence showed higher levels of system use than those with alcohol dependence only. Participants with a mental health diagnosis had slightly lower levels of use at the end of the intervention period (week 16), although more than 70% still accessed the system. Conclusions These findings illustrate that patients with alcohol dependence, alcohol and drug dependence, and mental health issues will use smartphone applications such as A-CHESS for ongoing support, resources and information, thus extending patient care if given the opportunity. Further analysis is needed to determine if sustained A-CHESS use improves outcomes.

Realising the technological promise of smartphones in addiction research and treatment: An ethical review

“…BinDhim et al, 2014;Borland et al, 2013;Bricker et al, 2014;Buller et al, 2014;Haug et al, 2014;Hertzberg et al, 2013;Kirchner et al, 2013;Meredith et al, 2014;V. Patel, Nowostawski, Thomson, Wilson, & Medlin, 2013;Ploderer et al, 2014;Reitzel et al, 2014; Whittaker, 2011) Alcohol 12 (34.3%) (Bendtsen & Bendtsen, 2014;Dulin et al, 2014;Gajecki et al, 2014;Gamito et al, 2014;Haug et al, 2014;Kauer, Reid, Sanci, & Patton, 2009;Matsumura, Yamakoshi, & Ida, 2009;McTavish et al, 2012;Renner, 2012;Yu et al, 2012) Heroin 2 (5.7%) Epstein et al, 2009) Cocaine 1 (2.9%) (Freedman, Lester, McNamara, Milby, & Schumacher, 2006) General 3 (8.6%) (Campling, 2011;Ingersoll et al, 2014; Bendtsen & Bendtsen, 2014;BinDhim et al, 2014;Borland et al, 2013;Bricker et al, 2014;Buller et al, 2014;Dulin et al, 2014;Hasin et al, 2014;Haug et al, 2014;Ingersoll et al, 2014;Ploderer et al, 2014;Renner, 2012;Whittaker, 2011;Yu et al, 2012) Relapse prevention 3 (8.6...…”

“…Articles not fulfilling these criteria were excluded (n = 22). Full-text analysis excluded a further 30 publications because they either did not fulfil the M a n u s c r i p t 6 inclusion criteria, provided only a case report or general review of the topic or re-published data McTavish, Chih, Shah, & Gustafson, 2012). Article reference lists were screened identifying one additional study .…”

“…Twenty apps provided users with an element of control over the utility of the app. For example, a number of apps sought to maintain user privacy by providing the participant with the ability to turn off alerts at certain times (Keoleian, Stalcup, Polcin, Brown, & Galloway, 2013;Kirchner et al, 2013;McTavish et al, 2012;. One application allowed the user to switch off location services when desired , potentially A c c e p t e d M a n u s c r i p t 8 reducing the amount of unnecessary data collected and the possibility of a third-party identifying the user through data profiling (Gasson et al, 2011).…”

“…Over half of the studies provided external support resources for participants, through either clinical treatment as part of the study Epstein et al, 2009;Ingersoll et al, 2014;McTavish et al, 2012), personal care or online interactive resources . However, almost half of the studies did not provide any resources or clinically relevant information for users.…”

“…A c c e p t e d M a n u s c r i p t 18 al., 2014; Haug et al, 2014;McTavish et al, 2012; M a n u s c r i p t M a n u s c r i p t 20 application was coded as NA for this ethical consideration as the users of the app were not being studied for their personal substance abuse (V. Patel et al, 2013).…”