By: Felasfa Wodajo, MD & Perry Payne, MD/JD/MPP
The winning abstract was “Effects of a mHealth intervention for alcohol relapse prevention”, which presented results of an interactive and innovative smartphone based platform for helping patients with alcohol addiction remain clean.
A summary of the work was recently published on iMedicalApps.
The award was received by Fiona M. McTavish, MS, on behalf of her coauthors David H. Gustafson, PhD, Amy Atwood, PhD, Min-Yuan Chih, MHA, Dhavan Shah, PhD, Michael Boyle, MA and Michael Levy, PhD. In addition to the public announcement at the conference, the awardee receives a cash award.
The study tested the efficacy of A-CHESS, Alcohol – Comprehensive Health Enhancement Support System a platform designed to “radically improve addiction treatment and continuing care by offering emotional and instrumental support anywhere”.
A pilot study by many of the same team members had been presented at the 2011 Medicine 2.0 Congress and also had previously been published on iMedicalApps. The system utilizes many of the capabilities of modern smartphones to detect when patients may encounter challenging situations:
If A-CHESS detects, via GPS location, that a user is in a high-risk location (bar, liquor store, etc.), their cellphone will ring and they will receive a tailored set of recommended coping strategies.
Participants were from two treatment agencies, one in the Midwestern U.S. and the other in the Northeastern U.S. Participants had to be at least 18 years old and willing to be randomized. A total of 349 patients consented to participate in the randomized clinical study from February 2010 through June 2011.
Patients were randomized to one of two groups, a control group that received treatment as usual and a treatment group that received treatment as usual plus A-CHESS. Patients assigned to the A-CHESS group received a smartphone for 8 months. All patients took a pretest and answered survey questions via a telephone interview at 4, 8, and 12 months after leaving residential treatment. Patients in the A-CHESS group also had data about their use of A-CHESS automatically collected.
This video demonstrates how several A-CHESS features might support prevention of relapse.
For the 12-month intervention and follow-up period, patients in the A-CHESS group reported fewer risky drinking days (M = 1.386) than patients in the control group (M = 2.752), and the difference was significant [t(287.686) = 2.97, p = .003; d = .23]. A-CHESS patients reported fewer risky drinking days than control-group patients at all three time points; the differences were significant at months 4 (p = .020; d = .25) and 12 (p = .032; d = .24) but not month 8 (p = .096; d = .18).
The percentage of patients reporting total abstinence was greater for A-CHESS than control patients at all time points, with significant differences at months 8 (p = .038) and 12 (p = .014) but not at month 4 (p = .132).
This study shows the promise of using internet enabled, mobile devices to enhance behavioral change strategies. In the words of the authors,
This randomized trial demonstrates that technology such as A-CHESS can help provide continuing care to people struggling with alcohol use disorders and improve outcomes. Smartphones applications could be a practical and cost-effective way to provide continuing care. While further research needs to be done, (including cost benefits of such systems) this is an encouraging first step into using smartphones technology in alcohol treatment follow-up care
The types of behaviors attracting the most attention from mHealth researchers appear to relate to diet, addiction (tobacco, alcohol) and mental health. These results should be encouraging to patients and researchers.