How Smartphone Apps Have Changed the Road to Recovery
Is it possible that smart phone apps can assist in the treatment of people with substance use disorders and addictions? The current research suggests how this might happen.
The Rise of Smart Phones
Smart phones only made up 10% of cellular phones in the United States in 2008 (Entner, 2010) but smart phones currently outnumber personal computers (Gizmodo.com). The medical profession has been quite open to adapting technology for information and treatment purposes and especially the use of mobile technology for assisting in the daily routines of medical practice. Palm Pilot usage and other digital technologies have risen (and fallen) in medical treatment and scheduling (e.g., Vishwanath, Brodsky, & Shaha, 2009) and a number of smart phone applications are now available for both personal and professional use. Phone apps for private usage are numerous and range from simple medical advice apps, to virtual coaches that can provide instructions for practicing skills and reminders for taking medications, to phone apps that actually supply treatment recommendations for medical conditions.
Research on Phone App Use in Alcoholism Treatment
A recent study in the Journal of the American Medical Association reported an interesting study that looked at the effects of using a phone app known as A-CHESS (Addiction – Comprehensive Health Enhancement Support System) compared to standard treatment for alcohol use disorder (Gustafson, McTavish, Chih, et al., 2014). Three hundred and forty nine individuals who had met the DSM – IV criteria for alcohol dependence were randomly assigned to a treatment as usual group (a control group) and a smart phone app treatment group.
The residential treatment control condition consisted of group therapy that included psychoeducation, standard treatments for substance abuse such as motivational interviewing and cognitive behavioral therapy, as well as attendance at AA meetings and individual counseling. The group assigned to the smart phone application condition received the application for free. Each individual had a unique account. The A-CHESS application has a static component that allows for audio – guided therapies and treatments and a interactive feature that allows a GPS feature that could alert the person when they were in self – defined high risk situations (e.g., if someone was in a bar that they had frequented). The application would automatically notify the user and ask them if they wanted to be in the particular situation. Counselors in the A-CHESS condition also received weekly notifications of the person’s progress that included a brief alcohol monitoring index and participants in the phone app condition performed weekly self- assessments. The control group received the residential treatment for 12 months; the A-CHESS group received the smart phone app treatment for eight months and then residential treatment for a four-month follow-up period.
Over the course of the study those in the phone app group were more likely to report abstinence over most of the checkpoints in the study and reported less risky drinking days (defined as the number of days during which a patient’s drinking in a 2-hour period exceeded, for men, 4 standard drinks; and for women, 3 standard drinks). This study attempted to tie in the results with a psychological theory of motivation (self-determination theory). The findings of this study indicated that an increase in self-perceived competence may have been the result of the use of the smart phone app and this may have facilitated treatment.
Of course there are several limitations of the study. First, the participants in the smart phone app performed weekly self-assessments which itself can produce a treatment effect; those in the control group was not required to do this. Moreover, the smart phone group had more counselor contact than did the control group, which could account for the differences observed between the two groups.
Secondly, the study relied on self-report data which is known to be highly unreliable and did not use objective measures such as urine tests and so forth. Therefore, the claims made by the participants cannot be substantiated. This is a major issue with this particular study.
The control group in the study is not a real control group in the sense that no treatment is being given, which can be problematic for comparative purposes. The reason for this is that it is difficult to separate treatment effects that occur in both conditions and identify any treatment effect to the smart phone app group that can be attributed to that condition alone. Also there is a waxing and waning of the behaviors associated with addiction that occurs without any treatment that could just account for the changes observed in the treatment groups.
Finally, the participants in the study received the phone app for free and of course in the real world these services are actually relatively expensive which could lead to early termination or other issues.
However, the bottom line here is that the use of technology such as smart phone apps could contribute to treatment for individuals with addiction or related problems. Another very important consideration is that the study does not suggest that the use of smart phone apps alone can help with recovery. There is no evidence that the exclusive use of the smart phone app would be a preferred form of treatment for any individual with any substance use disorder or addiction issue. At present this technology is considered to be an adjunctive treatment at best.
Entner, R. (2010). Smartphones to overtake feature phones in U.S. by 2011. Retrieved from http://blog.nielsen.com/nielsenwire/consumer/smartphones-to-overtake-feature-phones-i n-u-s-by-2011
Gustafson, D. H., McTavish, F. M., Chih, M. Y., Atwood, A. K., Johnson, R. A., Boyle, M. G., … & Shah, D. (2014). A smartphone application to support recovery from alcoholism: a randomized clinical trial. JAMA psychiatry, 71(5), 566-572.
Vishwanath, A., Brodsky, L., & Shaha, S. (2009). Physician adoption of personal digital assistants (PDA): Testing its determinants within a structural equation model. Journal of Health Communication, 14, 77–95.
Dr. Hatfield is a clinical neuropsychologist with extensive experience assessing and treating neurological and psychiatric disorders. His areas of expertise include neurobiology, behavior, dementia, head injury, addiction, abnormal psychology, personality disorders, statistics, rehabilitation psychology and research methodology.