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Abstract
Post-treatment relapse to uncontrolled alcohol use is common. Currently available communication technology can use existing models for relapse prevention to cost-effectively improve long-term relapse prevention. This paper describes: (1) research-based elements of alcohol consumption-related relapse prevention and how they can be encompassed in self-determination theory (SDT) and Marlatt's cognitive behavioral relapse prevention model, (2) how technology could help address the needs of people seeking recovery, (3) a technology-based prototype, organized around sexual transmitted disease and Marlatt's model, and (4) how we are testing a system based on the ideas in this article and related ethical and operational considerations.
THE AUTHORS
David H. Gustafson, PhD, is Research Professor of Industrial and Systems Engineering at the University of Wisconsin-Madison, and Director of one of the five National Cancer Institute-designated Centers of Excellence in Cancer Communications Research (chess.chsra.wisc.edu) and Director of the Network for the Improvement of Addiction Treatment funded by the Robert Wood Johnson Foundation and the federal government's Center for Substance Abuse Treatment (www.niatx.net). He is co-leading a Robert Wood Johnson Foundation national program to implement evidence-based practices in addiction treatment agencies and state governments (www.advancingrecovery.net). His research focuses on the use of systems engineering methods and models in individual and organizational change in healthcare.
Bret R. Shaw, PhD, is an Assistant Professor in the Department of Life Science Communication at the University of Wisconsin-Madison. His research focuses on how people with chronic health conditions benefit from online support and tailored information systems. He has published in a diverse range of journals, including Health Education Research, Health Communication, the Journal of Health Communication, CIN: Computers, Informatics and Nursing, American Behavioral Scientist, Information Technology and Behaviour, the International Journal of Medical Informatics, PsychoOncology, and the Journal of Computer-Mediated Communication and Patient Education and Counseling. He has received national and international media attention for the studies he has published.
Andrew Isham, MS, is a researcher at the Center for Health Enhancement Systems Studies. His focus is on the innovative adaptation of information technologies to support behavioral change in people with chronic health conditions. Andrew has played a substantial role in the Innovations for Recovery project, working with addiction and technology experts to design aftercare relapse prevention tools, and is now directing the development of those tools, to be delivered via smart phones and tested in Fall 2009. He is currently directing the development of a pediatric asthma care management system to be delivered via smart phones, which is currently being tested in an RCT.
Timothy B. Baker, PhD, is Professor of Medicine in the University of Wisconsin School of Medicine and Public Health. His principal research goals are to increase understanding of the motivational bases of addictive disorders and to develop and evaluate treatments for such disorders. He is also highly interested in developing and using technological advances to deliver effective treatments for addictive disorders and cancer. Dr. Baker has served as the Editor of the Journal of Abnormal Psychology, is the Principal Investigator of the University of Wisconsin Transdisciplinary Tobacco Use Research Center award (NIDA/NCI), has contributed chapters to multiple reports of the Surgeon General, and is the recipient of the James McKeen Cattell Award from the Association for Psychological Science.
Michael Boyle is President and CEO of Fayette Companies, a behavioral health organization located in Peoria, Illinois, and is Director of the Behavioral Health Recovery Management project. Mike was a member of the National Task Force on Co-Occurring Disorders, a founding member of the Network for the Improvement of Addiction Treatment (NIATx), and is on the editorial boards of Join Together's Treatment Practitioner's Research Bulletin and the National Addiction Technology Transfer Center's The Bridge. His current activities include integrating mental health, addiction and primary care services, implementing evidence-based clinical practices within recovery-oriented systems of care, and the development and use of electronic technologies to support behavioral health treatment and recovery. He also serves on a committee of the National Quality Forum charged with defining an episode of continuing care for a substance abuse treatment encounter.
Michael Levy, PhD, is a licensed psychologist and is the Director of Clinical Treatment Services at CAB Health and Recovery Services, an organization that offers a full continuum of care for individuals with substance use disorders. At CAB, his primary role is to oversee and improve the quality of treatment that is delivered across CAB's treatment continuum. Michael is also on the faculty at the Department of Psychiatry, Division on Addictions, Cambridge Health Alliance, Harvard Medical School, and has been the principal investigator of a number of federal grants funded through CSAT and the CDC. He has written numerous articles, book chapters, and given many workshops that focus on working with clients with substance use disorders and those with co-occurring disorders. In 2007, he has also published a book titled Take control of your drinking…and you may not need to quit, through Johns Hopkins University Press.
Notes
2 Treatment can be briefly and usefully defined as a planned, goal directed, temporally structured change process, of necessary quality, appropriateness, and conditions (endogenous and exogenous), which is bounded (culture, place, time, etc.) and can be categorized into professional-based, tradition-based, mutual-help based (AA, NA, etc.) and self-help (“natural recovery”) models. There are no unique models or techniques used with substance users—of whatever types and heterogeneities—which are also not used with non-substance users. In the West, with the relatively new ideology of “harm reduction” and the even newer quality of life (QOL) treatment-driven model, there are now a new set of goals, in addition to those derived from/associated with the older tradition of abstinence driven models. Treatment is implemented in a range of environments; ambulatory, within institutions which can include controlled environments. Editor's note.
3 The reader is referred to the “natural recovery” literature, which documents the cessation of substance use and misuse without tradition-based, professionally based or mutual-help-based (AA, NA, OA, etc.) planned interventions. Editor's note.
4 The reader is reminded that from a historical perspective, this point of view and diagnostic process is relatively new and is associated with the medicalization of a range of human behaviors (DSM-IVRev); prior to “substance use disorders,” such behaviors were moralized (sin), subsequently criminalized, and since the end of the 20th century categorized as chronic diseases. Editor's note.