We're unable to sign you in at this time. Please try again in a few minutes.
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
Original Investigation |

A Smartphone Application to Support Recovery From Alcoholism:  A Randomized Clinical Trial

David H. Gustafson, PhD1; Fiona M. McTavish, MS1; Ming-Yuan Chih, PhD1; Amy K. Atwood, PhD1; Roberta A. Johnson, MA, MEd1; Michael G. Boyle, MA1; Michael S. Levy, PhD2; Hilary Driscoll, MA3; Steven M. Chisholm, MA4; Lisa Dillenburg, MSW1; Andrew Isham, MS1; Dhavan Shah, PhD5
[+] Author Affiliations
1Center for Health Enhancement Systems Studies, College of Engineering, University of Wisconsin–Madison
2North Shore Medical Center, Salem, Massachusetts
3Fayette Companies, Peoria, Illinois
4North Shore Community College, Lynn, Massachusetts
5Mass Communications Research Center, School of Journalism and Mass Communication, University of Wisconsin–Madison
JAMA Psychiatry. 2014;71(5):566-572. doi:10.1001/jamapsychiatry.2013.4642.
Text Size: A A A
Published online

Importance  Patients leaving residential treatment for alcohol use disorders are not typically offered evidence-based continuing care, although research suggests that continuing care is associated with better outcomes. A smartphone-based application could provide effective continuing care.

Objective  To determine whether patients leaving residential treatment for alcohol use disorders with a smartphone application to support recovery have fewer risky drinking days than control patients.

Design, Setting, and Participants  An unmasked randomized clinical trial involving 3 residential programs operated by 1 nonprofit treatment organization in the Midwestern United States and 2 residential programs operated by 1 nonprofit organization in the Northeastern United States. In total, 349 patients who met the criteria for DSM-IV alcohol dependence when they entered residential treatment were randomized to treatment as usual (n = 179) or treatment as usual plus a smartphone (n = 170) with the Addiction–Comprehensive Health Enhancement Support System (A-CHESS), an application designed to improve continuing care for alcohol use disorders.

Interventions  Treatment as usual varied across programs; none offered patients coordinated continuing care after discharge. A-CHESS provides monitoring, information, communication, and support services to patients, including ways for patients and counselors to stay in contact. The intervention and follow-up period lasted 8 and 4 months, respectively.

Main Outcomes and Measures  Risky drinking days—the number of days during which a patient’s drinking in a 2-hour period exceeded 4 standard drinks for men and 3 standard drinks for women, with standard drink defined as one that contains roughly 14 g of pure alcohol (12 oz of regular beer, 5 oz of wine, or 1.5 oz of distilled spirits). Patients were asked to report their risky drinking days in the previous 30 days on surveys taken 4, 8, and 12 months after discharge from residential treatment.

Results  For the 8 months of the intervention and 4 months of follow-up, patients in the A-CHESS group 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, 0.46-2.27; P = .003).

Conclusions and Relevance  The findings suggest that a multifeatured smartphone application may have significant benefit to patients in continuing care for alcohol use disorders.

Trial Registration  clinicaltrials.gov Identifier: NCT01003119

Figures in this Article

Sign in

Purchase Options

• Buy this article
• Subscribe to the journal


Place holder to copy figure label and caption
Participant Flow

A-CHESS indicates Addiction–Comprehensive Health Enhancement Support System; GPS, Global Positioning System.

Graphic Jump Location




Also Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
Please click the checkbox indicating that you have read the full article in order to submit your answers.
Your answers have been saved for later.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.
Submit a Comment


Some tools below are only available to our subscribers or users with an online account.

Web of Science® Times Cited: 5

Sign in

Purchase Options

• Buy this article
• Subscribe to the journal

Related Content

Customize your page view by dragging & repositioning the boxes below.

Articles Related By Topic
Related Collections
PubMed Articles

The Rational Clinical Examination: Evidence-Based Clinical Diagnosis
Alcohol Abuse

The Rational Clinical Examination: Evidence-Based Clinical Diagnosis
Original Article: A Primer on the Precision and Accuracy of the Clinical Examination