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 4 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 whether sustained A-CHESS use improves outcomes. This clinical trial is registered at www.clinicaltrials.gov as trial #NCT01003119.

Keywords:

• alcohol dependence
• e-health
• smartphones
• system use analysis
• self determination theory
• cognitive-behavioral relapse prevention

ACKNOWLEDGMENTS

This research is being supported by a grant from the National Institute of Alcohol Abuse and Alcoholism (Grant number: R01 AA017192).