Blog | Thursday, March 27, 2014

QD: News Every Day--Smartphone app may support post-treatment recovery for alcohol misuse

A smartphone application appears to help patients with alcohol use disorder reduce risky drinking days compared to patients who received usual care after leaving treatment in a residential program, a study found

Researchers randomized 349 patients with alcohol dependence leaving 3 residential programs to treatment as usual (n=179) for a year or treatment plus the app (n=170) with the Addiction-Comprehensive Health Enhancement Support System (A-CHESS) application. The application featured audio-guided relaxation and alerts if patients neared a high-risk location, such as a bar they used to frequent.

Results appeared online March 26 at JAMA Psychiatry.

Patients who used the smartphone application reported fewer risky drinking days (defined as when a patient’s drinking in a 2-hour period exceeded 4 standard drinks for men and 3 for women) compared with controls. Specifically, for the 8 months of the intervention and 4 months of follow-up, patients using the app reported significantly fewer risky drinking days than did patients in the control group, with a mean of 1.39 vs 2.75 days (mean difference, 1.37; 95% CI, 0.46 to 2.27; P=0.003).

Patients using the smartphone application also had a higher likelihood of consistent abstinence from alcohol (51.9%vs 39.6%; P=0.03), with significant differences at months 8 (P=0.04) and 12 (P=0.02) but not at month 4 (P=0.13). App users were also more likely than control patients to report abstinence at all 3 time points (P=0.03). However, there was no difference in the negative consequences of drinking.

Of the 170 patients who received the app, 122 (71.8%) pressed a “panic button” feature at least once. To rule out accidental activations, researchers reported that 98 patients who pressed the panic button navigated the app to at least 1 subsequent page in the feature.

As for real-world use, while 170 patients were randomized to receive the smartphones with app and a data package to support it, there were actually 286 smartphones given out during the study. Of the 116 smartphones that were replaced, 56 did not work properly, 20 were stolen, 18 were damaged by patients, and 22 were lost.

“Whether smartphones will be practical as continuing care of AUDs (alcohol use disorders) depends in part on the cost and whether it will be reimbursed,” the authors wrote. “In this study, 8months of A-CHESS cost about $597 per patient, based on 1 hour per month of counselor time at $90 per hour divided by 50 patients, 1 hour per month for system administrator time at $50 per hour divided by 170 patients, $60 per month for each data plan, and $100 to buy each smartphone. The cost of interventions such as A-CHESS will decrease dramatically as more people have smartphones and data plans of their own, although low-income patients may be less likely to have them.”