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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.
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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

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

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