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Around in 1 in 4 patients with alcohol use disorders remain abstinent in the first year after treatment. Also, the provision of continuous care for alcohol and substance use disorders is associated with improved treatment outcomes.
However, patients after receiving treatment for the alcohol use disorder are not typically offered aftercare with continuous monitoring. 
A few reasons for this lack of support is because the treatment system is labour intensive, unstable and financially overburdened.
Technology can help bridge this treatment gap and offer innovative ways of providing continuous care to individuals recovering from alcohol addiction.
Researchers from the University of Wisconsin-Madison conducted a study to investigate the utility of a smartphone application, A-CHESS (Alcohol – Comprehensive Health Enhancement Support System) to support alcoholism recovery.
This study was supported by the National Institute on Alcohol Abuse and Alcoholism.
A-CHESS provides emotional and instrumental support at any given time and place. The app is designed on the concept of self-determination theory that comprises of three basic needs to fuel an individual’s ability to adapt and recover:
- Being perceived as competent
- Feeling related to others
- Feeling internally motivated and not coerced in one’s action
The application had multiple features and services such as:
- Discussion groups for support from other individuals who are recovering
- Personal stories of successful recovery
- Access to experts to ask personal questions
- Computerized cognitive behavioural therapy to reduce stress
- Notification about healthy drug and alcohol-free events taking place in the city
- GPS technology to track and identify high-risk locations where the patient traditionally obtained or consumed alcohol earlier
- Sobriety counter
- Panic button in case of emergency or relapse
- Weekly Check-in to provide counsellors feedback or regular updates on patient’s progress
How was the study conducted?
The primary outcome was to measure whether patients using A-CHESS would have fewer risky drinking days.
349 patients with the alcohol use disorder were involved in the study.
They had enrolled for alcohol addiction treatment (residential programs), one organized by non-profit in Midwestern US and 2 programs organized in Northeastern US.
All patients were above 18 years of age.
The programs conducted in the Midwestern US comprised cognitive behavioural therapy, motivational interviewing and psychoeducation.
The programs in the North-eastern US involved CBT, psychoeducation, case management services, supportive individual counselling and 3 community AA meetings per week.
The patients were assigned to either a control group or treatment group. The control group received usual treatment for 12 months.
The A-CHESS group received treatment as usual and also a smartphone with A-CHESS app for 8 months and usual treatment during the 4 months follow up.
Each patient using A-CHESS had a unique account. Data such as when the patient accessed A-CHESS, service selected, duration of service use, pages viewed and messages sent or received, was recorded.
With the patient’s permission, counsellors could access the information about patient’s A-CHESS use.
Counsellors were asked to treat patients in the A-CHESS group just as they would treat any other patient. That involved responding to requests to referral or information as requested by patients but not providing counselling.
Every week patients using A-CHESS were asked to complete a survey Brief Alcohol Monitoring (BAM) Index. It considered several parameters such as sleep quality, recent substance use, lifestyle balance.
With the patient’s permission, A-CHESS automatically notified counsellors if the BAM score exceeded a preset threshold or was not completed that week.
Researchers conducted a survey (over a call) at 4, 8 and 12 months after discharge to assess the impact of A-CHESS use on parameters such as risky drinking days, quality of life, treatments or services used.
Risky drinking days were defined as days on which a patient’s drinking in a 2-hour period exceeded, for men, 4 standard drinks and for women, 3 standard drinks.
For abstinence, patients reported whether they had a drink in the last 30 days.
Negative consequences of drinking were assessed via The Short Inventory of Problems – Revised (SIP-R).
What were the results of the study?
61% of the study population were males and the mean patient age was 38 years. During the 8 month period, patients in the A-CHESS group used the app for 40% of the days.
More than 90% of patients used A-CHESS during months 1-4. 58% used the application during the last week of the 8 month period.
71% (122) of the patients in the A-CHESS group pressed the panic attack button at least once.
However patients could have pressed the button by mistake, so intended use was defined as going beyond the panic button main page to at least one other page. 98 individuals did this.
Patients in the A-CHESS group reported fewer risky drinking days compared to those in the control group at month 4 but not month 8.
The number of risky drinking days was significantly predicted by number of pages viewed in the app and by the number of days used.
The results on A-CHESS use and the risky drinking days was significant for month 4 and 12 but not month 8.
The odds of reporting abstinence in the last 30 days were higher in the A-CHESS group compared to the control group at month 8 and 12.
A-CHESS patients were more likely to report abstinence than the control group at all three points: 4, 8 and 12 months.
No significant differences in any of the negative consequences of drinking were observed between both groups.
Overall patients who received treatment as usual plus A-CHESS reported a lower average number of risky drinking days compared to those who received usual treatment only.
The likelihood of consistent abstinence was higher in the A-CHESS group (51.9%) than the control group (39.6%).
However, there was no difference in the negative consequences of drinking.
This is perhaps the first study that has assessed the potential effectiveness of mobile technology to support alcohol addiction recovery.
Rates of participation in A-CHESS program was higher compared to the participation for usual aftercare programs for alcohol use disorder.
There were a few limitations to the study such as more counsellor contact for A-CHESS group than control group, only self-report, no urine testing, abstinence record for only last 30 days which could misrepresent patient’s drinking behaviour, lack of diverse study populations.
Since most patients have smartphones and data plans the cost of A-CHESS based intervention would decrease.
Researchers highlighted that if their results were confirmed by other studies, smartphone applications could serve to be one of the most effective methods of providing aftercare and support during alcoholism recovery.
Read Full Text at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4016167/
Reference: Gustafson, David H. et al. “A Smartphone Application to Support Recovery from Alcoholism: A Randomized Controlled Trial.” JAMA psychiatry 71.5 (2014): 566–572. PMC. Web. 1 Aug. 2018.