Support for Alcoholism After Rehab? There's an App for That

A smartphone application may be effective in helping alcohol-dependent patients remain abstinent following a stint in a residential rehab facility, new research shows.

Results from a randomized trial show that individuals with alcohol use disorder treated in various residential programs for a year were significantly more likely to refrain from drinking after they left these facilities if they used the app, known as the Addiction–Comprehensive Health Enhancement Support System (A-CHESS), compared with their counterparts who did not use it but received usual follow-up care.

"Actually, it's not really an app, that's a misleading term because an app is typically one small thing," David H. Gustafson, PhD, director of the Center for Health Enhancement Systems Studies at the University of Wisconsin, in Madison, told Medcscape Medical News.

"This is 17 different services. It does operate on a smartphone, but it has many more things involved in it than a typical app would have, so we just call it a computerized system," Dr. Gustafson explained.

The study was published online March 26 in JAMA Psychiatry.

Improving Coping Competence

The investigators studied 349 patients with alcohol use disorder who were leaving 1 of 3 residential programs operated by 1 nonprofit treatment organization in the Midwestern United States and 2 residential programs that were also operated by a nonprofit organization in the Northeastern United States.

They randomly assigned 179 patients to receive treatment as usual for 12 months, and 170 patients to receive treatment as usual plus a smartphone containing A-CHESS for 8 months, followed by treatment as usual for another 4 months.

All patients met Diagnostic and Statistical Manual of Mental Disorders, 4th Edition (DSM-IV) criteria for alcohol dependence. Most (80.2%) where white, male (60.7%), and unemployed (78.5%). Most (62.5%) used or abused drugs in addition to alcohol.

The mean (standard deviation) age of the patients was 38 years, and the median age was 39 years.

A-CHESS utilized the Global Positioning System (GPS), which would alert patients that they were near a high-risk location, such as a bar, and ask whether they wanted to be there.

It also contained a discussion board and texting features, a panic button in case the patient felt a need to contact 2 support contacts, and other features.

Recipients of A-CHESS were taught how to use it 2 weeks before they were discharged from the residential facility.

"The system tries to improve a person's coping competence, improves their social relatedness, so they feel like they are not going through this alone, that there are other people who experience the same things they are, and it also gives them resources to improve their own motivation, to make sure their desire is coming from them and not from somebody else telling them to reduce their drinking," Dr. Gustafson said.

A service that was used the most was a kind of "wild garden" where people could talk confidentially, privately, and anonymously to other people who were going through a similar time of abstinence from alcohol, he added.

The study participants were asked to report their risky drinking days during the previous 30 days on surveys taken 4, 8, and 12 months after discharge from residential treatment.

Risky drinking days were deemed to be the number of days during which a person's drinking in a 2-hour period exceeded 4 standard drinks for men and 3 standard drinks for women.

A standard drink was defined as 14 g of pure alcohol, and could be 12 ounces of regular beer, 5 ounces of wine, or 1.5 ounces of distilled spirits.

The study found that use of A-CHESS significantly reduced the consumption of alcohol.

Patients in the A-CHESS group reported significantly fewer risky drinking days, with a mean of 1.39 days, than did patients in the control group, who reported a mean of 2.75 risky drinking days (mean difference, 1.37; 95% confidence interval, 0.46 - 2.27; P = .003).

Promising Findings

Commenting on this study for Medscape Medical News, George F. Koob, PhD, director of the National Institute on Alcohol Abuse and Alcoholism (NIAAA), at the National Institutes of Health (NIH), Bethesda, Maryland, said the evidence from the study that smartphones could be useful in recovery from alcoholism was promising.

"This study is important in that it provides promising evidence for the efficacy of mobile phone–based technologies to enhance continued recovery among individuals receiving treatment for alcohol use disorder," Dr. Koob, who was not part of the study, said.

Videos describing A-CHESS are available online.

The study was sponsored by the NIAAA. Dr. Gustafson and Dr. Koop report no relevant financial relationships.

JAMA Psychiatry. Published online March 26, 2014. Abstract

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Cite this: Support for Alcoholism After Rehab? There's an App for That - Medscape - Mar 27, 2014.