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ABSTRACT
Background: Smartphone applications can potentially provide recovery monitoring and support in real-time, real-life contexts. Study aims included determining feasibility of (a) adolescents completing ecological momentary assessments (EMAs) and utilizing phone-based ecological momentary interventions (EMIs); and (b) using EMA and EMI data to predict substance use in the subsequent week. Methods: Twenty-nine adolescents were recruited at discharge from residential treatment, regardless of their discharge status or length of stay. During the 6-week pilot, youth were prompted to complete an EMA at 6 random times per day and were provided access to a suite of recovery support EMI. Youth completed 87% of the 5580 EMAs. Based on use in the next 7 days, EMA observations were classified into 3 risk groups: “Current Use” in the past 30 minutes (3% of observations), “Unrecognized Risk” (42%), or “Recognized Risk” (55%). All youth had observations in 2 or more risk groups and 38% in all 3. Youth accessed an EMI on average 162 times each week. Results: Participants were 31% female, 48% African American, 21% Caucasian, 7% Hispanic, and 24% Mixed/Other; average age was 16.6 years. During the 90 days prior to entering treatment, youth reported using alcohol (38%), marijuana (41%), and other drugs (7%). When compared with the “Recognized Risk” group's use in the following week (31%), both the “Unrecognized Risk” (50%, odds ratio [OR] = 2.08) and “Current Use” (96%, OR = 50.30) groups reported significantly higher rates of use in the next week. When an EMI was accessed 2 or more times within the hour following an EMA, the rate of using during the next week was significantly lower than when EMIs were not accessed (32% vs. 43%, OR = 0.62). Conclusions: Results demonstrate the feasibility of using smartphones for recovery monitoring and support with adolescents, with potential to reduce use.
ACKNOWLEDGMENTS
The authors thank Dr. Dave Gustafson and his staff for adding our EMAs and additional EMIs to their existing Addiction Comprehensive Health Enhancement Support System (ACHESS) system and allowing us to use it as a platform for conducting the pilot study. We also thank Anthony Abrams for his work with the adolescents, Brittany Callahan and Belinda Willis for assistance with preparation of the manuscript; special appreciation also goes to the programs, staff, and adolescents who participated in the study and without whom this original research would not have been possible.
AUTHOR CONTRIBUTIONS
Drs. Dennis and Scott both (a) designed the study and ecological momentary assessment (EMA) and identified several of the EMIs for inclusion in this pilot; (b) trained the staff and oversaw implementation of the pilot study; and (c) led the analysis, interpretation, and writing-up of the results. Mr. Funk cleaned the data, conducted the analysis, and contributed to the write-up of the methods and results. Mrs. Nicholson led the adolescent recruitment, training, and day-to-day implementation and helped write the manuscript.
Funding
This work was supported by National Institute on Drug Abuse (NIDA) grants R37 DA11323 and R01 DA021174. The opinions here are those of the authors and do not reflect the positions of the funding agency or government.