Mobile Apps to Reduce Tobacco, Alcohol, and Illicit Drug Use: Systematic Review of the First Decade

Evaluation of iSTART: A Novel Substance Use Prevention Web-App Designed for Diverse College Students

There is little research assessing substance use prevention programs designed for first generation, working, and ethnic minority college students. This study assessed the effectiveness of a multi-substance web-app prevention program implemented at a Hispanic Serving Institution in southern California. Participants (N = 1066) were randomly assigned to either a control, comparison, or 5 module web-app condition. Surveys assessing substance specific knowledge, perceived health risks, normative peer use, and past 30-day alcohol, cannabis, nicotine, and illicit drug use were administered at baseline, exit, and 90-day follow-up. At exit and 90-day follow up, students assigned to the web-app had significantly greater gains in substance specific knowledge, more accurate perceptions of campus peers' substance use, and the health risks associated with substance use than comparison or control group students. Moreover, web-app students had lower incidence rates of alcohol, cannabis, nicotine, and illicit drug use at exit with effects evident at 90-day follow up for alcohol, cannabis, and illicit drug use but not nicotine use. Given young adults preference for web-based technology, our findings underscore the benefits of developing, adopting, and implementing culturally sensitive substance use prevention programming using mHealth technology among diverse college populations.

Determining the Acceptability of Targeted Apps for High-Risk Alcohol Consumption in Nurses: A Qualitative Study

AIM

To determine the acceptability of targeted apps and provide recommendations for the implementation of and app addressing high risk alcohol use to nurses.

DESIGN

A qualitative descriptive study design, using the Behavioural Change Wheel implementation framework.

METHODS

Semi-structured interviews with 42 Australian nurses were subject to structural coding using the Capability, Opportunity, and Motivation (COM-B) model linked to the Behaviour Change Wheel. Qualitative data has been reported using the COREQ framework.

RESULTS

Most participants agreed that targeted apps would appeal to nurses, provided specific design considerations were included. These considerations related to privacy and confidentiality, strategies to target the app to nurses across wide age and experience ranges and identified the need for a considered campaign to both launch the app and position it with existing interventions for high-risk alcohol use.

CONCLUSIONS

Our findings indicate that a targeted app to reduce high-risk alcohol consumption could be acceptable to nurses, however the needs to include specific components suitable for nurses. We recommend further research into specific components of a targeted app, leading to a co-design process where nurses can determine app components and function.Summary of relevanceHigh-risk alcohol consumption has been shown to be an issue amongst nurses.Targeted apps have been shown to have an effect in addressing high-risk alcohol consumption among specific groups.However, consideration for privacy of data provided to the app must be considered, especially given the link between disciplinary action, loss of role identity, and nurse suicide.This paper indicates that nurses would accept a targeted app, subject to specific design considerations, particularly related to confidentiality.

App-Based Coaching to Prevent Addictive Behaviors in Vocational School Students: A Cluster Randomized Trial

PURPOSE

This two-arm cluster randomized controlled trial evaluated the effectiveness of an app-based addiction prevention program in German vocational school students.

METHODS

Schools from 5 German federal states were recruited. No eligibility criteria for classes were applied; enrollment decisions were made by school heads or teachers. Students were eligible if aged at least 16 years and possessing a smartphone (participation rate: 46.7%). Classes were randomly allocated to intervention or control within blocks of 4, stratified by school. Intervention classes received app-based coaching for 16 weeks. Control classes received health information and could access the coaching after 12 months. Both groups were assessed at baseline, 6 months, 6 and 12 months (follow-up rates: 35.8% and 34.9%). Primary outcomes were changes in alcohol, tobacco, cannabis consumption, and problematic Internet use at the individual level. Participants were blinded to group allocation until providing informed consent; the primary outcome analyst was also blinded. Generalized linear models with multiple imputation were used across all time points.

RESULTS

Intention-to-treat analyses of 1,266 intervention and 1,279 control participants from 162 classes each showed small but significant effects on social competence (b = 0.075, confidence interval [CI] 0.027, 0.123; d6-months = 0.10; d12-months = 0.19), stress (b = -0.02, [CI -0.03, -0.01]; d6-months = -0.10; d12-months = -0.20), problematic Internet use (b = -0.058, [CI -0.098, -0.019]; d6-months = -0.08; d12-months = -0.17), and tobacco consumption (b = -0.031, [CI -0.053, -0.009]).

DISCUSSION

App-based programs can reduce addictive behaviors and enhance life skills among vocational students, fostering broader mental health benefits.

The role and reach of alcohol reduction apps

Although apps are widely available and have several advantages as a tool to support alcohol reduction and recovery, little is known about how individuals are using them. In 2024, we conducted an exploratory sequential mixed-methods study that coupled in-depth interviews with 22 app users and a nationally representative survey of 2002 adults. We explored experiences with and perceptions of alcohol reduction apps. Approximately 6% of US adults in the sample reported using alcohol reduction apps, and for most, it was the only support to address problematic drinking. In interviews, some users viewed apps as an alternative to traditional services and a way to independently address alcohol use; however, apps were seen as disconnected from care even by those who also used other supports. App users accessed a variety of features, with the most common being motivational content, tracking alcohol consumption, and educational content. Findings suggest that there are opportunities to not only introduce apps to individuals receiving healthcare services or participating in mutual support groups, but to reference and embed them in those settings. New approaches to regulation and reimbursement may support adoption as well as integration into healthcare services.

Mobile app measuring sleep and behaviors: A trial in adolescents with addiction

INTRODUCTION

The smartphones generalisation allows the development of attractive "real-life" monitoring tools for care and research enabling the measurement of addictive behaviours and comorbidities such as sleep disorders. The study objective was to assess the interest of a mobile app collecting such information among adolescents with addictive behaviours in order to enhance the availability of behavioural data in consultation.

METHODS

An open label randomised pilot study was held along two parallel arms. The patients randomised to the intervention group (n=18) used a mobile app to provide daily data for 15 days relating to their sleep and their behaviour (addictive behaviours with or without substances). The patients in the control group (n=18) used a paper diary allowing the collection of the same data, only the medium differed.

RESULTS

The patients' median age was 16 years [15.0-16.5]. A median of 67% and 10% of the expected information was completed respectively in the intervention and control groups during the 15 days of follow-up and could be used in consultation (P=0.08). The patient's knowledge, attitudes, intentions to change, behaviour change and seeking help related to the use of the diaries appeared higher in the intervention group (20.5/30) than in the control group (11/20).

CONCLUSION

This study described the high patient compliance with the data collection by means of the app. The diary app seems to have been more impactful for patients than the paper diary. This app could represent an important tool to improve the therapeutic alliance and care due to a better knowledge of the behaviours on the part of the clinician but also a better awareness of the patients themselves.

Evaluating the Impact of a Game (Inner Dragon) on User Engagement Within a Leading Smartphone App for Smoking Cessation: Randomized Controlled Trial

BACKGROUND

Smartphone apps are a convenient, low-cost approach to delivering smoking cessation support to large numbers of individuals. Yet, the apps are susceptible to low rates of user engagement and retention.

OBJECTIVE

This study aims to test the effects of a new game module (called Inner Dragon) integrated into Smoke Free (23 Limited), a leading smoking cessation app with established efficacy. The primary outcomes measured user engagement with the app.

METHODS

A 2-arm, parallel-group, randomized controlled trial was conducted in the United States with an 8-week follow-up. Adult individuals who smoked ≥1 cigarettes daily and planned to quit smoking within 7 days were recruited and randomized (N=500), with equal allocation. Both groups received free access to the original Smoke Free app with "core" features of its smoking cessation program (eg, a diary and craving log). The treated group received additional access to the integrated Inner Dragon game that incorporated several game mechanics designed to increase user engagement. User engagement outcomes were the number of unique app sessions, average minutes per session, days with a session, and program adherence. Self-reported and verified smoking abstinence and app satisfaction were also assessed. The main analysis estimated the intention-to-treat effect of access to Inner Dragon on each outcome. Further analyses assessed effect modification by participant characteristics and the association of intensity of game use with program adherence and abstinence.

RESULTS

Overall, user engagement was greater for treated versus control participants: they had 5.3 more sessions of Smoke Free (mean 29.6, SD 36.5 sessions vs mean 24.3, SD 37.9 sessions; P=.06), 0.8 more minutes per session (mean 6.9, SD 5.4 min vs mean 6.1, SD 5.2 min; P=.047), and 3.4 more days with a session (mean 14.3, SD 15.3 days vs mean 11.9, SD 14.3 days; P=.03). Program adherence, based on the number of times core features of the original Smoke Free app were used, was higher for treated versus control participants (mean 29.4, SD 41.3 times vs mean 22.6, SD 35.6 times; P=.03). Self-reported 7-day and 30-day point-prevalence abstinence and verified 7-day point-prevalence abstinence at 8 weeks did not significantly differ by study group. The mean repeated 1-day prevalence of quitting was higher among the treated group versus the control group (mean 17.3%, SD 25.6 vs mean 12.4%, SD 21.3; P=.01). App satisfaction and the motivation to (stay) quit did not differ by study group. Higher intensity of game use was associated with increased program adherence and self-reported abstinence.

CONCLUSIONS

Findings suggest that the Inner Dragon game increased user engagement and program adherence. Additional refinements to the game design may clarify whether the game increases abstinence rates. Overall, it is feasible to deploy games and gamification to enhance user engagement in existing smoking cessation interventions.

TRIAL REGISTRATION

ClinicalTrials.gov NCT05227027; https://clinicaltrials.gov/study/NCT05227027.

Effectiveness of mobile phone applications for tobacco cessation: An umbrella review

BACKGROUND

Mobile Health (mHealth), leveraging nearly 4.5 billion people actively use mobile phone and internet, can be crucial in promoting tobacco cessation. This umbrella review aimed to assess the effectiveness of mobile phone applications in achieving this outcome.

METHODS

Searches were conducted in databases like Medline, EMBASE, PubMed Central, ScienceDirect, Google Scholar, and Cochrane library from their inception till June 2022, without language restriction. Quality assessment was carried out using the AMSTAR-2 tool. The narrative synthesis findings were presented in terms of the overall effect size reported by the individual systematic review along with the heterogeneity measures and risk of bias assessment findings.

RESULTS

We included 11 reviews, most of which had critical weaknesses in certain domains. Among these, three reviews conducted meta-analyses providing pooled estimates, but the effect sizes were non-significant and imprecise, indicating that mobile phone applications did not have a significant effect on tobacco cessation. Only three reviews concluded a promising role for mobile phone applications in tobacco cessation, particularly when these applications were based on theoretical constructs or combined with face-to-face interventions.

CONCLUSION

Our review indicates that mobile phone applications could play a promising role in tobacco cessation. However, using a single mobile phone application without any theoretical construct may not sufficiently drive behavioural change to reduce tobacco usage.

Alcohol Feedback, Reflection, and Morning Evaluation (A-FRAME): Refining and testing feasibility and acceptability of a smartphone-delivered alcohol intervention for heavy-drinking young adults

BACKGROUND

Young adults drink heavily and experience negative alcohol consequences. To capitalize on mornings after drinking as an optimal time to intervene, we developed a novel, theory-based personalized feedback intervention (PFI) called Alcohol Feedback, Reflection, and Morning Evaluation (A-FRAME), to reduce heavy drinking. An initial prototype was refined via feedback from college students who drink heavily. The goal of the present study was to conduct an open trial to establish feasibility and acceptability of the refined PFI.

METHODS

The refined PFI was delivered for 4 weeks to 18 heavy-drinking young adults (Mage = 22.61, 44% women, 66.7% White, 27.8% Black, 16.7% Asian, 5.6% Native American/Alaskan Indian, 22.2% Hispanic/Latino). Participants completed a goal-setting procedure, followed by 28 daily surveys. Surveys indicating prior-day drinking were followed by the option to view personalized feedback (e.g., goal attainment, blood alcohol concentration [BAC], peer norms, protective behaviors). Aggregated feedback was also delivered at the 14- and 28-day marks. Participants completed a post-test acceptability survey and individual interviews to inform further refinement.

RESULTS

The response rate to daily surveys was 93.8% and all participants completed study procedures, demonstrating feasibility. Daily feedback was reviewed about half (45.5%) of the time it was offered (i.e., following drinking days). Biweekly feedback was viewed 50% and 56% of the time at 14- and 28-day marks, respectively. Other benchmarks for acceptability were supported by survey and interview results.

CONCLUSIONS

Open trial results support the feasibility and acceptability of this theory-based intervention for heavy-drinking young adults. A planned randomized controlled trial will evaluate efficacy.

Effect of a Smartphone App (S-Check) on Actual and Intended Help-Seeking and Motivation to Change Methamphetamine Use Among Adult Consumers of Methamphetamine in Australia: Randomized Waitlist-Controlled Trial

BACKGROUND

Interventions are required that address delays in treatment-seeking and low treatment coverage among people consuming methamphetamine.

OBJECTIVE

We aim to determine whether a self-administered smartphone-based intervention, the "S-Check app" can increase help-seeking and motivation to change methamphetamine use, and determine factors associated with app engagement.

METHODS

This study is a randomized, 28-day waitlist-controlled trial. Consenting adults residing in Australia who reported using methamphetamine at least once in the last month were eligible to download the app for free from Android or iOS app stores. Those randomized to the intervention group had immediate access to the S-Check app, the control group was wait-listed for 28 days before gaining access, and then all had access until day 56. Actual help-seeking and intention to seek help were assessed by the modified Actual Help Seeking Questionnaire (mAHSQ), modified General Help Seeking Questionnaire, and motivation to change methamphetamine use by the modified readiness ruler. χ2 comparisons of the proportion of positive responses to the mAHSQ, modified General Help Seeking Questionnaire, and modified readiness ruler were conducted between the 2 groups. Logistic regression models compared the odds of actual help-seeking, intention to seek help, and motivation to change at day 28 between the 2 groups. Secondary outcomes were the most commonly accessed features of the app, methamphetamine use, feasibility and acceptability of the app, and associations between S-Check app engagement and participant demographic and methamphetamine use characteristics.

RESULTS

In total, 560 participants downloaded the app; 259 (46.3%) completed eConsent and baseline; and 84 (32.4%) provided data on day 28. Participants in the immediate access group were more likely to seek professional help (mAHSQ) at day 28 than those in the control group (n=15, 45.5% vs n=12, 23.5%; χ21=4.42, P=.04). There was no significant difference in the odds of actual help-seeking, intention to seek help, or motivation to change methamphetamine use between the 2 groups on the primary logistic regression analyses, while in the ancillary analyses, the imputed data set showed a significant difference in the odds of seeking professional help between participants in the immediate access group compared to the waitlist control group (adjusted odds ratio 2.64, 95% CI 1.19-5.83, P=.02). For participants not seeking help at baseline, each minute in the app increased the likelihood of seeking professional help by day 28 by 8% (ratio 1.08, 95% CI 1.02-1.22, P=.04). Among the intervention group, a 10-minute increase in app engagement time was associated with a decrease in days of methamphetamine use by 0.4 days (regression coefficient [β] -0.04, P=.02).

CONCLUSIONS

The S-Check app is a feasible low-resource self-administered intervention for adults in Australia who consume methamphetamine. Study attrition was high and, while common in mobile health interventions, warrants larger studies of the S-Check app.

TRIAL REGISTRATION

Australian New Zealand Clinical Trials Registry ACTRN12619000534189; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=377288&isReview=true.

Mobile Health Interventions for Substance Use Disorders

Substance use disorders (SUDs) have an enormous negative impact on individuals, families, and society as a whole. Most individuals with SUDs do not receive treatment because of the limited availability of treatment providers, costs, inflexible work schedules, required treatment-related time commitments, and other hurdles. A paradigm shift in the provision of SUD treatments is currently underway. Indeed, with rapid technological advances, novel mobile health (mHealth) interventions can now be downloaded and accessed by those that need them anytime and anywhere. Nevertheless, the development and evaluation process for mHealth interventions for SUDs is still in its infancy. This review provides a critical appraisal of the significant literature in the field of mHealth interventions for SUDs with a particular emphasis on interventions for understudied and underserved populations. We also discuss the mHealth intervention development process, intervention optimization, and important remaining questions.

Therapeutic Content of Mobile Phone Applications for Substance Use Disorders: An Umbrella Review

Mobile phone applications (MPAs) for substance use disorder (SUD) treatment are increasingly used by patients. Although pilot studies have shown promising results, multiple previous systematic reviews noted insufficient evidence for MPA use in SUD treatment-many of the previously published reviews evaluated different trials. Subsequently, we aimed to conduct an umbrella review of previously published reviews investigating the efficacy of MPAs for SUD treatment, excluding nicotine/tobacco because umbrella reviews have been done in this population and the nicotine/tobacco MPA approach often differs from SUD-focused MPAs. No previous reviews have included a statistical meta-analysis of clinical trials to quantify an estimated overall effect. Seven reviews met inclusion criteria, and 17 unique studies with available data were taken from those reviews for the meta-analysis. Overall, reviews reported a lack of evidence for recommending MPAs for SUD treatment. However, MPA-delivered recovery support services, cognitive behavioral therapy, and contingency management were identified across multiple reviews as having promising evidence for SUD treatment. Hedges g effect size for an MPA reduction in substance use-related outcomes relative to the control arm was insignificant (0.137; 95% CI, -0.056 to 0.330; P=.16). In subgroup analysis, contingency management (1.29; 95% CI, 1.088-1.482; τ 2=0; k=2) and cognitive behavioral therapy (0.02; 95% CI, 0.001-0.030; τ 2=0; k=2) were significant. Although contingency management's effect was large, both trials were small (samples of 40 and 30). This review includes an adapted framework for the American Psychiatric Association's MPA guidelines that clinicians can implement to review MPAs critically with patients.

Evaluating the effectiveness of a mobile app-based self-guided psychological interventions to reduce relapse in substance use disorder: protocol for a randomized controlled trial

Background

Substance Use Disorder (SUD) persists as a significant public health challenge worldwide, with an estimated prevalence of approximately 10-15% across the global populace. This condition is characterized by a notably high risk of lapses and relapses, even subsequent to treatment interventions. Mobile health interventions, owing to their widespread accessibility, emerge as a promising approach to diminish the risk of relapse post-treatment and to broaden the scope of care, especially in regions with a scarcity of trained medical professionals.

Method

This study is designed to assess the effectiveness of mobile interventions in mitigating cravings and preventing lapses among individuals diagnosed with SUD. Employing a two-armed, randomized controlled trial framework, the study will evaluate a self-administered psychological intervention delivered through a mobile application, Nałogometr 2.0. Over a period of three months, participants will engage with intervention modules that primarily incorporate mindfulness techniques and Cognitive Behavioral Therapy (CBT) principles. Ecological Momentary Assessment (EMA) will be utilized to gather longitudinal data on a range of variables that are indicative of craving intensity and the risk of lapse. In addition to this, a monthly-administered battery of questionnaires will be employed to gauge the severity of substance dependence, as well as to measure levels of anxiety, depression, and overall life satisfaction.

Results

Results will be submitted for publication in peer-reviewed journals.

Clinical trial registration

https://clinicaltrials.gov/, identifier [NCT05730504].

Development and Evaluation of a Digital App for Patient Self-Management of Opioid Use Disorder: Usability, Acceptability, and Utility Study

BACKGROUND

Self-management of opioid use disorder (OUD) is an important component of treatment. Many patients receiving opioid agonist treatment in methadone maintenance treatment settings benefit from counseling treatments to help them improve their recovery skills but have insufficient access to these treatments between clinic appointments. In addition, many addiction medicine clinicians treating patients with OUD in a general medical clinic setting do not have consistent access to counseling referrals for their patients. This can lead to decreases in both treatment retention and overall progress in the patient's recovery from substance misuse. Digital apps may help to bridge this gap by coaching, supporting, and reinforcing behavioral change that is initiated and directed by their psychosocial and medical providers.

OBJECTIVE

This study aimed to conduct an acceptability, usability, and utility pilot study of the KIOS app to address these clinical needs.

METHODS

We developed a unique, patient-centered computational software system (KIOS; Biomedical Development Corporation) to assist in managing OUD in an outpatient, methadone maintenance clinic setting. KIOS tracks interacting self-reported symptoms (craving, depressed mood, anxiety, irritability, pain, agitation or restlessness, difficulty sleeping, absenteeism, difficulty with usual activities, and conflicts with others) to determine changes in both the trajectory and severity of symptom patterns over time. KIOS then applies a proprietary algorithm to assess the individual's patterns of symptom interaction in accordance with models previously established by OUD experts. After this analysis, KIOS provides specific behavioral advice addressing the individual's changing trajectory of symptoms to help the person self-manage their symptoms. The KIOS software also provides analytics on the self-reported data that can be used by patients, clinicians, and researchers to track outcomes.

RESULTS

In a 4-week acceptability, usability (mean System Usability Scale-Modified score 89.5, SD 9.2, maximum of 10.0), and utility (mean KIOS utility questionnaire score 6.32, SD 0.25, maximum of 7.0) pilot study of 15 methadone-maintained participants with OUD, user experience, usability, and software-generated advice received high and positive assessment scores. The KIOS clinical variables closely correlated with craving self-report measures. Therefore, managing these variables with advice generated by the KIOS software could have an impact on craving and ultimately substance use.

CONCLUSIONS

KIOS tracks key clinical variables and generates advice specifically relevant to the patient's current and changing clinical state. Patients in this pilot study assigned high positive values to the KIOS user experience, ease of use, and the appropriateness, relevance, and usefulness of the specific behavioral guidance they received to match their evolving experiences. KIOS may therefore be useful to augment in-person treatment of opioid agonist patients and help fill treatment gaps that currently exist in the continuum of care. A National Institute on Drug Abuse-funded randomized controlled trial of KIOS to augment in-person treatment of patients with OUD is currently being conducted.

Digital interventions targeting excessive substance use and substance use disorders: a comprehensive and systematic scoping review and bibliometric analysis

Addictive substances are prevalent world-wide, and their use presents a substantial and persistent public health problem. A wide range of digital interventions to decrease use and negative consequences thereof have been explored, differing in approach, theoretical grounding, use of specific technologies, and more. The current study was designed to comprehensively map the recent (2015-2022) extant literature in a systematic manner, and to identify neglected and emerging knowledge gaps. Four major databases (Medline, Web of Science Core Collection, and PsychInfo) were searched using database-specific search strategies, combining terms related to clinical presentation (alcohol, tobacco or other drug use), technology and aim. After deduplication, the remaining n=13,917 unique studies published were manually screened in two stages, leaving a final n=3,056 studies, the abstracts of which were subjected to a tailored coding scheme. Findings revealed an accelerating rate of publications in this field, with randomized trials being the most common study type. Several meta-analyses on the topic have now been published, revealing promising and robust effects. Digital interventions are being offered on numerous levels, from targeted prevention to specialized clinics. Detailed coding was at times made difficult by inconsistent use of specific terms, which has important implications for future meta-analyses. Moreover, we identify several gaps in the extant literature - few health economic assessments, unclear descriptions of interventions, weak meta-analytic support for some type of interventions, and limited research on many target groups, settings and new interventions like video calls, chatbots and artificial intelligence - that we argue are important to address in future research.

"Simply complicated": Uncovering the processes of lifestyle behavior change among college and university students with access to a digital multiple lifestyle intervention

Background

One approach to promoting healthy lifestyle behaviors is to target students with digital interventions. One of these is the digital intervention Buddy. This study aimed to understand why college and university students' chose to participate in a digital multiple lifestyle behavior intervention trial (Buddy), and their subsequent experiences of the behavior-change process.

Methods

College and university students taking part in a trial of the Buddy intervention were individually interviewed after completing the 4-month intervention. Participants were guided to narrate their experiences and actions that followed signing up. Altogether, 50 interviews were conducted via telephone. The verbatim transcribed texts were analyzed qualitatively.

Results

The analysis generated seven personas, which illustrated the students' different levels of engagement with the intervention and the behavior-change process. These were: the Occupied, the Kickstarter, the Aimless, the Reflective, the Goal-oriented, the Compliant, and the Personally developed. Buddy worked best for students who had clear ideas about what they wanted to change and why, and who were aware of their needs, and those who could translate information and reflection into action and had the mental and physical energy needed to make changes.

Conclusions

The progress of behavior change depends on the interaction between the digital mode of delivery, the intervention materials of Buddy, the individual's expectations, needs, and skills, and their current life situation. This suggests that designing lifestyle interventions could benefit from more often considering the various personas' different intentions, knowledge, and contexts. By doing so, interventions are likely to emerge that can better match different needs in the target population.

Optimizing Digital Tools for the Field of Substance Use and Substance Use Disorders: Backcasting Exercise

BACKGROUND

Substance use trends are complex; they often rapidly evolve and necessitate an intersectional approach in research, service, and policy making. Current and emerging digital tools related to substance use are promising but also create a range of challenges and opportunities.

OBJECTIVE

This paper reports on a backcasting exercise aimed at the development of a roadmap that identifies values, challenges, facilitators, and milestones to achieve optimal use of digital tools in the substance use field by 2030.

METHODS

A backcasting exercise method was adopted, wherein the core elements are identifying key values, challenges, facilitators, milestones, cornerstones and a current, desired, and future scenario. A structured approach was used by means of (1) an Open Science Framework page as a web-based collaborative working space and (2) key stakeholders' collaborative engagement during the 2022 Lisbon Addiction Conference.

RESULTS

The identified key values were digital rights, evidence-based tools, user-friendliness, accessibility and availability, and person-centeredness. The key challenges identified were ethical funding, regulations, commercialization, best practice models, digital literacy, and access or reach. The key facilitators identified were scientific research, interoperable infrastructure and a culture of innovation, expertise, ethical funding, user-friendly designs, and digital rights and regulations. A range of milestones were identified. The overarching identified cornerstones consisted of creating ethical frameworks, increasing access to digital tools, and continuous trend analysis.

CONCLUSIONS

The use of digital tools in the field of substance use is linked to a range of risks and opportunities that need to be managed. The current trajectories of the use of such tools are heavily influenced by large multinational for-profit companies with relatively little involvement of key stakeholders such as people who use drugs, service providers, and researchers. The current funding models are problematic and lack the necessary flexibility associated with best practice business approaches such as lean and agile principles to design and execute customer discovery methods. Accessibility and availability, digital rights, user-friendly design, and person-focused approaches should be at the forefront in the further development of digital tools. Global legislative and technical infrastructures by means of a global action plan and strategy are necessary and should include ethical frameworks, accessibility of digital tools for substance use, and continuous trend analysis as cornerstones.

Evaluating the effectiveness of mobile app-based self-guided psychological intervention to reduce craving and lapse risk in problematic substance use and behaviors: Protocol for a randomized control trial in the general population

Background

The prevalence of substance and behavioral addiction is estimated between 10 and 15% of the global population and remains a severe public health concern. Moreover, addiction treatment has several barriers, such as a lack of access to professional treatment or stigmatization. Mobile health interventions emerge as a promising solution.

Methods

This two-armed randomized controlled trial (RCT) aims to assess the efficacy of a mobile app-based self-guided psychological intervention delivered via a smartphone app (Nałogometr) in reducing craving and lapse risk in problematic behaviors and substance use compared to a control condition. Participant recruitment and data collection will start in June 2022 and end in September 2022. Due to the nature of the study, i.e., a nationwide study of problematic substance use and behaviors, we will aim to recruit all individuals willing to participate. The four-week intervention condition includes short-term and long-term modules based mainly on mindfulness and cognitive behavioral therapy. Longitudinal data on several variables related to craving and lapse risk are collected daily using ecological momentary assessment (EMA). The primary outcomes of interest will be the self-reported number of lapses and craving level in daily EMA. Moreover, a questionnaire battery assessment is administered at baseline in the first week following onboarding, after five weeks, and after six months. The secondary outcome measures will include the severity of problematic substance use or behaviors, anxiety and depression, and life satisfaction.

Results

Results will be submitted for publication in peer-reviewed journals.

Clinical trial registration

[https://clinicaltrials.gov/], identifier [NCT054 34,429].

Testing a Digital Health App for Patients With Alcohol-Associated Liver Disease: Mixed Methods Usability Study

BACKGROUND

Alcohol-associated liver disease (ALD) is increasingly common and associated with serious and costly health consequences. Cessation of drinking can improve ALD morbidity and mortality; however, support for cessation is not routinely offered to those diagnosed with ALD, and continued drinking or resumption of drinking after diagnosis is common. Mobile health (mHealth) has the potential to offer convenient and scalable support for alcohol cessation to those diagnosed with ALD, but mHealth interventions for alcohol cessation have not been designed for or evaluated in a population with ALD.

OBJECTIVE

This study aims to understand how individuals with ALD would perceive and use an mHealth tool for alcohol cessation and to gather their perspectives on potential refinements to the tool that would allow it to better meet their needs.

METHODS

We interviewed 11 individuals who attended clinic visits related to their ALD to elicit their needs related to support for alcohol cessation and views on how mHealth could be applied. After completing initial interviews (pre), participants were provided with access to an mHealth app designed for alcohol cessation, which they used for 1 month. Afterward, they were interviewed again (post) to give feedback on their experiences, including aspects of the app that met their needs and potential refinements. We applied a mixed methods approach, including a qualitative analysis to identify major themes from the interview transcripts and descriptive analyses of use of the app over 1 month.

RESULTS

First, we found that a diagnosis of ALD is perceived as a motivator to quit drinking but that patients had difficulty processing the overwhelming amount of information about ALD they received and finding resources for cessation of alcohol use. Second, we found that the app was perceived as usable and useful for supporting drinking recovery, with patients responding favorably to the self-tracking and motivational components of the app. Finally, patients identified areas in which the app could be adapted to meet the needs of patients with ALD, such as providing information on the medical implications of an ALD diagnosis and how to care for their liver as well as connecting individuals with ALD to one another via a peer-to-peer support forum. Rates of app use were high and sustained across the entire study, with participants using the app a little more than half the days during the study on average and with 100% (11/11) of participants logging in each week.

CONCLUSIONS

Our results highlight the need for convenient access to resources for alcohol cessation after ALD diagnosis and support the potential of an mHealth approach to integrate recovery support into care for ALD. Our findings also highlight the ways the alcohol cessation app should be modified to address ALD-specific concerns.

Ecological momentary interventions for smoking cessation: a systematic review and meta-analysis

BACKGROUND AND OBJECTIVES

Tobacco use is an important cause of preventable mortality and morbidity worldwide. Only 7% of smokers successfully quit annually, despite numerous evidence-based smoking cessation treatments. An important reason for failure is barriers to accessing appropriate smoking cessation interventions, which can be minimized by technology-delivered interventions, such as ecological momentary interventions. Ecological momentary interventions provide the right type and intensity of treatment in real time, based on ecological momentary assessments of relevant variables. The aim of this review was to assess the effectiveness of ecological momentary interventions in smoking cessation.

METHODS

We searched MEDLINE, Scopus, CENTRAL, psychINFO, and ProQuest without applying any filters on 19 September, 2022. One author screened search results for obvious irrelevant and duplicate studies. The remaining studies were independently reviewed by two authors to exclude irrelevant studies, and then they extracted data from the included studies. We collated study findings, transformed data into a common rubric, and calculated a weighted treatment effect across studies using Review Manager 5.

FINDINGS

We analyzed 10 studies with a total of 2391 participants. Assessment methods included exhaled CO analyzers, bidirectional SMS, data input in apps, and hand movement detection. Interventions were based on acceptance and commitment therapy and cognitive behavioral therapy. Smoking abstinence was significantly higher in participants of intervention groups compared to control groups (RR = 1.24; 95% CI 1.07-1.44, P = 0.004; I2 = 0%).

CONCLUSION

Ecological momentary intervention is a novel area of research in behavioral science. The results of this systematic review based on the available literature suggest that these interventions could be beneficial for smoking cessation.

Effective Behavior Change Techniques in Digital Health Interventions for the Prevention or Management of Noncommunicable Diseases: An Umbrella Review

BACKGROUND

Despite an abundance of digital health interventions (DHIs) targeting the prevention and management of noncommunicable diseases (NCDs), it is unclear what specific components make a DHI effective.

PURPOSE

This narrative umbrella review aimed to identify the most effective behavior change techniques (BCTs) in DHIs that address the prevention or management of NCDs.

METHODS

Five electronic databases were searched for articles published in English between January 2007 and December 2022. Studies were included if they were systematic reviews or meta-analyses of DHIs targeting the modification of one or more NCD-related risk factors in adults. BCTs were coded using the Behavior Change Technique Taxonomy v1. Study quality was assessed using AMSTAR 2.

RESULTS

Eighty-five articles, spanning 12 health domains and comprising over 865,000 individual participants, were included in the review. We found evidence that DHIs are effective in improving health outcomes for patients with cardiovascular disease, cancer, type 2 diabetes, and asthma, and health-related behaviors including physical activity, sedentary behavior, diet, weight management, medication adherence, and abstinence from substance use. There was strong evidence to suggest that credible source, social support, prompts and cues, graded tasks, goals and planning, feedback and monitoring, human coaching and personalization components increase the effectiveness of DHIs targeting the prevention and management of NCDs.

CONCLUSIONS

This review identifies the most common and effective BCTs used in DHIs, which warrant prioritization for integration into future interventions. These findings are critical for the future development and upscaling of DHIs and should inform best practice guidelines.

A Digital Counselor-Delivered Intervention for Substance Use Among People With HIV: Development and Usability Study

BACKGROUND

Substance use disorders are prevalent and undertreated among people with HIV. Computer-delivered interventions (CDIs) show promise in expanding reach, delivering evidence-based care, and offering anonymity. Use in HIV clinic settings may overcome access barriers. Incorporating digital counselors may increase CDI engagement, and thereby improve health outcomes.

OBJECTIVE

We aim to develop and pilot a digital counselor-delivered brief intervention for people with HIV who use drugs, called "C-Raven," which is theory grounded and uses evidence-based practices for behavior change.

METHODS

Intervention mapping was used to develop the CDI including a review of the behavior change research in substance use, HIV, and digital counselors. We conducted in-depth interviews applying the situated-information, motivation, and behavior skills model and culturally adapting the content for local use with people with HIV. With a user interaction designer, we created various digital counselors and CDI interfaces. Finally, a mixed methods approach using in-depth interviews and quantitative assessments was used to assess the usability, acceptability, and cultural relevance of the intervention content and the digital counselor.

RESULTS

Participants found CDI easy to use, useful, relevant, and motivating. A consistent suggestion was to provide more information about the negative impacts of drug use and the interaction of drug use with HIV. Participants also reported that they learned new information about drug use and its health effects. The CDI was delivered by a "Raven," digital counselor, programmed to interact in a motivational interviewing style. The Raven was perceived to be nonjudgmental, understanding, and emotionally responsive. The appearance and images in the intervention were perceived as relevant and acceptable. Participants noted that they could be more truthful with a digital counselor, however, it was not unanimously endorsed as a replacement for a human counselor. The C-Raven Satisfaction Scale showed that all participants rated their satisfaction at either a 4 (n=2) or a 5 (n=8) on a 5-point Likert scale and all endorsed using the C-Raven program again.

CONCLUSIONS

CDIs show promise in extending access to care and improving health outcomes but their development necessarily requires integration from multiple disciplines including behavioral medicine and computer science. We developed a cross-platform compatible CDI led by a digital counselor that interacts in a motivational interviewing style and (1) uses evidence-based behavioral change methods, (2) is culturally adapted to people with HIV who use drugs, (3) has an engaging and interactive user interface, and (4) presents personalized content based on participants' ongoing responses to a series of menu-driven conversations. To advance the continued development of this and other CDIs, we recommend expanded testing, standardized measures to evaluate user experience, integration with clinician-delivered substance use treatment, and if effective, implementation into HIV clinical care.

Digital interventions to moderate alcohol consumption in young people: a Cancer Prevention Europe overview of systematic reviews

Background

Strategies to reduce alcohol consumption would contribute to substantial health benefits in the population, including reducing cancer risk. The increasing accessibility and applicability of digital technologies make these powerful tools suitable to facilitate changes in behaviour in young people which could then translate into both immediate and long-term improvements to public health.

Objective

We conducted a review of systematic reviews to assess the available evidence on digital interventions aimed at reducing alcohol consumption in sub-populations of young people [school-aged children, college/university students, young adults only (over 18 years) and both adolescent and young adults (<25 years)].

Methods

Searches were conducted across relevant databases including KSR Evidence, Cochrane Database of Systematic Reviews (CDSR) and Database of Abstracts of Reviews of Effects (DARE). Records were independently screened by title and abstract and those that met inclusion criteria were obtained for full text screening by two reviewers. Risk of bias (RoB) was assessed with the ROBIS checklist. We employed a narrative analysis.

Results

Twenty-seven systematic reviews were included that addressed relevant interventions in one or more of the sub-populations, but those reviews were mostly assessed as low quality. Definitions of "digital intervention" greatly varied across systematic reviews. Available evidence was limited both by sub-population and type of intervention. No reviews reported cancer incidence or influence on cancer related outcomes. In school-aged children eHealth multiple health behaviour change interventions delivered through a variety of digital methods were not effective in preventing or reducing alcohol consumption with no effect on the prevalence of alcohol use [Odds Ratio (OR) = 1.13, 95% CI: 0.95-1.36, review rated low RoB, minimal heterogeneity]. While in adolescents and/or young adults who were identified as risky drinkers, the use of computer or mobile device-based interventions resulted in reduced alcohol consumption when comparing the digital intervention with no/minimal intervention (-13.4 g/week, 95% CI: -19.3 to -7.6, review rated low RoB, moderate to substantial heterogeneity).In University/College students, a range of E-interventions reduced the number of drinks consumed per week compared to assessment only controls although the overall effect was small [standardised mean difference (SMD): -0.15, 95% CI: -0.21 to -0.09]. Web-based personalised feedback interventions demonstrated a small to medium effect on alcohol consumption (SMD: -0.19, 95% CI: -0.27 to -0.11) (review rated high RoB, minimal heterogeneity). In risky drinkers, stand-alone Computerized interventions reduced short (SMD: -0.17, 95% CI: -0.27 to -0.08) and long term (SMD: -0.17, 95% CI: -0.30 to -0.04) alcohol consumption compared to no intervention, while a small effect (SMD: -0.15, 95% CI: -0.25 to -0.06) in favour of computerised assessment and feedback vs. assessment only was observed. No short-term (SMD: -0.10, 95% CI: -0.30 to 0.11) or long-term effect (SMD: -0.11, 95% CI: -0.53 to 0.32) was demonstrated for computerised brief interventions when compared to counsellor based interventions (review rated low RoB, minimal to considerable heterogeneity). In young adults and adolescents, SMS-based interventions did not significantly reduce the quantity of drinks per occasion from baseline (SMD: 0.28, 95% CI: -0.02 to 0.58) or the average number of standard glasses per week (SMD: -0.05, 95% CI: -0.15 to 0.05) but increased the risk of binge drinking episodes (OR = 2.45, 95% CI: 1.32-4.53, review rated high RoB; minimal to substantial heterogeneity). For all results, interpretation has limitations in terms of risk of bias and heterogeneity.

Conclusions

Limited evidence suggests some potential for digital interventions, particularly those with feedback, in reducing alcohol consumption in certain sub-populations of younger people. However, this effect is often small, inconsistent or diminishes when only methodologically robust evidence is considered. There is no systematic review evidence that digital interventions reduce cancer incidence through alcohol moderation in young people. To reduce alcohol consumption, a major cancer risk factor, further methodologically robust research is warranted to explore the full potential of digital interventions and to form the basis of evidence based public health initiatives.

The Craving-Manager smartphone app designed to diagnose substance use/addictive disorders, and manage craving and individual predictors of relapse: a study protocol for a multicenter randomized controlled trial

Background

The rate of individuals with addiction who are currently treated are low, and this can be explained by barriers such as stigma, desire to cope alone, and difficulty to access treatment. These barriers could be overcome by mobile technologies. EMI (Ecological Momentary Intervention) is a treatment procedure characterized by the delivery of interventions (messages on smartphones) to people in their daily lives. EMI presents opportunities for treatments to be available to people during times and in situations when they are most needed. Craving is a strong predictor of relapse and a key target for addiction treatment. Studies using Ecological Momentary Assessment (EMA) method have revealed that, in daily life, person-specific cues could precipitate craving, that in turn, is associated with a higher probability to report substance use and relapse in the following hours. Assessment and management of these specific situations in daily life could help to decrease addictive use and avoid relapse. The Craving-Manager smartphone app has been designed to diagnose addictive disorders, and assess and manage craving as well as individual predictors of use/relapse. It delivers specific and individualized interventions (counseling messages) composed of evidence-based addiction treatments approaches (cognitive behavioral therapy and mindfulness). The Craving-Manager app can be used for any addiction (substance or behavior). The objective of this protocol is to evaluate the efficacy of the Craving-Manager app in decreasing use (of primary substance(s)/addictive behavior(s)) over 4 weeks, among individuals on a waiting list for outpatient addiction treatment.

Methods/design

This multicenter double-blind randomized controlled trial (RCT) will compare two parallel groups: experimental group (full interventional version of the app, 4 weeks, EMA + EMI), versus control group (restricted version of the app, 4 weeks, only EMA). Two hundred and seventy-four participants will be recruited in 6 addiction treatment centers in France.

Discussion

This RCT will provide indication on how the Craving-Manager app will reduce addictive use (e.g., better craving management, better stimulus control) in both substance and behavioral addictions. If its efficacy is confirmed, the app could offer the possibility of an easy to use and personalized intervention accessible to the greatest number of individuals with addiction.

Clinical Trial Registration

ClinicalTrials.gov: NCT04732676.

Identifying Desired Features That Would Be Acceptable and Helpful in a Wrist-Worn Biosensor-Based Alcohol Intervention: Interview Study Among Adults Who Drink Heavily

BACKGROUND

Alcohol misuse is highly prevalent in the United States and results in a huge financial and public health burden. Current alcohol reduction treatments are underused, and there is a critical need for innovation in the field. Transdermal alcohol biosensors measure alcohol use passively and continuously and may be helpful tools in alcohol interventions. To date, however, alcohol biosensors have not been widely used to directly intervene on alcohol use. There is a new wrist-worn biosensor that could be used to help people reduce their drinking, although it is unclear how best to incorporate such a device into an alcohol intervention.

OBJECTIVE

We aimed to identify desired features that would be acceptable and helpful in a wrist-worn biosensor-based alcohol intervention for adults who drink heavily.

METHODS

Participants were recruited through an alcohol contingency management study, a contact registry, and participant referral. To qualify, participants had to be aged at least 40 years, report drinking at least twice per week, and indicate interest in reducing their drinking. We conducted a semistructured interview with each participant via Zoom (Zoom Video Communications, Inc). The interview guide addressed general thoughts on the wrist-worn biosensor, how participants thought a wrist-worn biosensor could be used to help people quit or reduce drinking, types of information that participants would want to receive from the biosensor, how they would want to receive this information, and how they thought this information could be used to change their behavior. Interviews were transcribed verbatim and analyzed using thematic analysis.

RESULTS

The sample comprised 20 adults (mean age 55.1, SD 6.1 years; 11/20, 55%, women; and 17/20, 85%, Black). Of the 20 participants, 9 (45%) had previous experience with the Secure Continuous Remote Alcohol Monitor continuous alcohol monitoring ankle biosensor from participating in an alcohol contingency management study. The desirable features could be grouped into 5 main themes: features that would influence willingness to use the biosensor (it should look attractive and be both comfortable to wear and accessible), personalized messaging (personalized biosensor-based prompts and feedback could be helpful), preference for time wearing the biosensor (for some, just wearing the biosensor could have an intervention effect), sharing data with others (this was appealing to many but not to all), and mental health support (many felt that mental health support could be incorporated into the biosensor).

CONCLUSIONS

Five main themes that would maximize interest in using a wrist-worn biosensor for alcohol intervention were identified. Taken together, the identified themes could inform the development of a just-in-time adaptive intervention that uses a wrist-worn biosensor to help adults who drink heavily reduce their alcohol use.

Digital interventions for opioid use disorder treatment: A systematic review of randomized controlled trials

INTRODUCTION

Opioid use disorders are associated with a high burden of disease and treatment gap. Digital interventions can be used to provide psycho-social treatment for opioid use disorders, as an alternative to or together with face-to-face interventions. This review aimed to assess the application and effectiveness of digital interventions to treat opioid use disorder globally.

METHODS

The study team searched four electronic databases (PubMed, Psych INFO, Web of Science and Cochrane Central register of controlled trials). The inclusion criteria were: randomized controlled trials, assessment for opioid use before and at least once following intervention, and use of digital interventions. The primary outcomes were opioid use and/or retention in treatment, with data being summarized in tables and a narrative review presented.

RESULTS

The initial database search yielded 3542 articles, of which this review includes 20. Nineteen were conducted among adults in the United States. The digital interventions used included web-based, computer-based, telephone calls, video conferencing, automated self-management system, mobile applications and text messaging. They were based on therapeutic education systems, community reinforcement approaches, cognitive behavior therapy, relapse prevention, brief interventions, supportive counselling and motivational interviewing. The studies had mixed findings; of the 20 studies, 10 had statistically significant differences between the treatment groups for opioid abstinence, and four had significant differences for treatment retention. Comparisons were difficult due to varying methodologies. Participants rated the interventions as acceptable and reported high rates of satisfaction.

CONCLUSION

The use of digital interventions for opioid use disorder treatment was acceptable, with varying levels of effectiveness for improving outcomes, which is influenced by participant and intervention delivery factors. Further studies in different parts of the world should compare these findings, specifically in low- and middle-income countries.

Reducing craving and lapse risk in alcohol and stimulants dependence using mobile app involving ecological momentary assessment and self-guided psychological interventions: Protocol for a randomized controlled trial

Background

The prevalence of alcohol consumption in Poland is estimated to be as high as 80% of the adult population. The use of stimulants is the second most common reason for seeking addiction treatment. However, treatment outcomes remain unsatisfactory, as 40-85% of individuals who complete various treatment programs relapse and fall back into addiction within 2 years following program completion.

Methods

The 13-armed randomized controlled trial aimed to assess the effectiveness of a mobile app-based self-guided psychological intervention delivered via a smartphone app (Nałogometr) in reducing craving and lapse risk in problematic alcohol or stimulants use. Participant recruitment and data collection will be performed from June 2022 to September 2022. The 4-week mobile intervention program will include short-term and long-term intervention modules based mainly on mindfulness and cognitive-behavioral therapy. Intervention effectiveness assessment will include Ecological Momentary Assessment. That is, we will collect longitudinal data on a set of characteristics of day-to-day functioning. The primary outcomes will include a self-reported number of lapses and addiction craving level. In contrast, the secondary outcomes will be the severity of problematic substance use, anxiety and depression scores, and life satisfaction scores.

Conclusion

This study will establish how mobile app-based self-guided psychological interventions can help reduce craving and lapse risk in alcohol and stimulant dependence. If successful, this randomized controlled trial (RCT) may provide an innovative, easily available, and cost-effective mHealth approach for craving and lapse risk in substance addictions.

Clinical trial registration

[https://clinicaltrials.gov/], identifier [NCT054 34429].

Exploring the Black Box of an mHealth Intervention (LIFE4YOUth): A Qualitative Process and Outcome Evaluation of End-User Engagement

The effectiveness of mHealth interventions rely on whether the content successfully activate mechanisms necessary for behavior change. These mechanisms may be affected by end-users' experience of the intervention content. The aim of this study was to explore how the content of a novel mHealth intervention (LIFE4YOUth) was understood, interpreted, and applied by high school students, and the consequences of engaging with the content. Qualitative content analysis was used inductively and deductively to analyze interview data (n = 16) based on think-aloud techniques with Swedish high school students aged 16-19 years. Theoretical constructs from social cognitive theory framed the deductive analysis. The analysis resulted in four categories which describe central activities of intervention engagement among end-users: defining, considering, centralizing, and personalizing. End-users engaged in these activities to different degrees as illustrated by four typologies: Literal, Vague, Rigid, and Creative engagement. Most informants knew about the risks and benefits of health behaviors, but engagement with intervention content generally increased informants' awareness. In conclusion, this study provides in-depth knowledge on the cognitive process when engaging with mHealth content and suggests that deliberate and flexible engagement most likely deepens end-users' understanding of why and how health behavior change can be managed.

Practical Technology for Expanding and Improving Substance Use Disorder Treatment: Telehealth, Remote Monitoring, and Digital Health Interventions

The US opioid crisis and the COVID-19 pandemic have sparked innovation in substance use disorder (SUD) treatment such that telehealth, remote monitoring, and digital health interventions are increasingly feasible and effective. These technologies can increase SUD treatment access and acceptability, even for nontreatment seeking, remote, and underserved populations, and can be used to reduce health disparities. Overall, digital tools will likely overcome many barriers to delivery of evidence-based behavioral treatments such as cognitive behavioral therapy and contingency management, that, along with appropriate medications, constitute the foundation of treatment of SUDs.

The current evidence for substance use disorder apps

PURPOSE OF REVIEW

New mHealth (smartphone) apps for substance use disorders (SUD) are emerging at an accelerated rate, with consumer choice typically guided by app-store user ratings rather than their effectiveness. The expansive reach, low-cost and accessibility of mHealth apps have driven their popularity and appeal as alternatives to traditional treatment; as such, rigorously establishing their effectiveness is of paramount importance.

RECENT FINDINGS

Several systematic reviews conclude that the evidence-base for mHealth SUD apps is weak, inconclusive and hampered by substantial heterogeneity in study designs. However, there have been a number of interesting and novel developments in this area in recent years, which have not been synthesised to date.

SUMMARY

Most mHealth apps deliver either multiple-component behaviour change techniques, discrete psychological interventions or cognitive training interventions, or are designed to act as adjuncts to facilitate the delivery of clinical or continuing care. There are promising signals of their feasibility, acceptability and preliminary effectiveness in numerous open-label pilot studies of mHealth apps targeting alcohol and smoking. However, only a handful of sufficiently-powered, well-designed randomised controlled trials have been conducted to date with mixed findings. Furthermore, there has been limited recent attention on mHealth apps aiming to improve outcomes for individuals using other drugs.

An Innovative Approach to Delivering a Family-Based Intervention to Address Parental Alcohol Misuse: Qualitative Findings from a Pilot Project

Within child welfare systems, the issue of parental alcohol misuse (PAM) and the responsibility for supporting children affected by PAM impacts on multiple health and social care services. An innovation pilot project (IPP) was set up to reduce the fragmentation between services and to help identify children affected by PAM. The current study presents findings regarding the IPP, examining its implementation, the service delivery, and the perceived impact for family members. Qualitative data were collected from 41 participants. This included interviews with alcohol-misusing parents (n = 13), affected adult family members (n = 5), and children affected by PAM (n = 9). Two focus groups and three one-to-one interviews were conducted with project workers (n = 7) and multi-agency service managers (n = 7). Data were analysed thematically relating to three main themes: (1) innovation in team composition and multi-disciplinary team working, (2) innovative ways of working, and (3) the benefits of a whole-family approach. The findings highlighted the importance of time for the team to 'bed in' and come together under one structure, a focus and oversight on whole-family care, and the importance of offering early, targeted, and flexible interventions to prevent crisis points and manage the consequences of PAM. Consideration will need to be given to joint commissioning to strengthen family-focused support.

Exploring Whether Addictions Counselors Recommend That Their Patients Use Websites, Smartphone Apps, or Other Digital Health Tools to Help Them in Their Recovery: Web-Based Survey

Background

Hundreds of smartphone apps or websites claiming to help those with addictions are available, but few have been tested for efficacy in changing clinically relevant addictions outcomes. Although most of these products are designed for self-facilitation by users struggling with addictions, counselors and other addictions treatment providers will likely play a critical role in facilitating adoption by integrating their use into counseling or recommending them to their patients. Yet, few studies have explored the practices of addictions counselors in using or recommending addictions-focused digital health tools in their work.

Objective

The aim of this study was to understand whether addiction counselors are recommending that their patients use addictions-focused apps to help them in their recovery, and the factors that affect their desire to do so.

Methods

Licensed addiction counselors practicing in the United States (N=112) were recruited from professional and scientific organizations of alcohol or drug counselors to complete a web-based survey.

Results

In total, 74% (83/112) of counselors had recommended that their patients use a website or smartphone app to assist them in recovery, and those that had done so reported recommending an app with an average of 54% of their patients. The most commonly recommended app or website was SMARTRecovery.org (9%), I am Sober (8%), In the Rooms (7%), Insight Timer (4%), Calm (4%), Sober Tool (4%), Recovery Box (3%), and Sober Grid (3%). The most important reason that counselors recommended the websites or apps was that colleagues or patients told them they found it helpful (55%), followed by their workplaces recommending it (20%) and professional organizations recommending it (10%). Counselors’ intentions to recommend a hypothetical app were strongest for apps that had been tested in rigorous, scientific studies that showed they helped users stay sober or reduce their substance use; 94% (105/112) reported that they would “definitely” or “probably” use such an app.

Conclusions

Most addictions counselors surveyed are already recommending that their patients use apps or websites to help them in their recovery, despite the paucity of available products that have evidence supporting their efficacy for addictions outcomes. One way that product developers could increase adoption among addictions treatment providers is to make efficacy testing a priority and to disseminate results through professional organizations and clinics.

mHealth Technologies for Managing Problematic Pornography Use: A Content Analysis (Preprint)

Background

Several mobile apps are currently available that purportedly help with managing pornography addiction. However, the utility of these apps is unclear, given the lack of literature on the effectiveness of mobile health solutions for problematic pornography use. Little is also known about the content, structure, and features of these apps.

Objective

This study aims to characterize the purpose, content, and popularity of mobile apps that claim to manage pornography addiction.

Methods

The phrase “pornography addiction” was entered as a search term in the app stores of the two major mobile phone platforms (Android and iOS). App features were categorized according to a coding scheme that contained 16 categories. Apps were included in the analysis if they were described as helpful for reducing pornography use, and data were extracted from the store descriptions of the apps. Metrics such as number of user ratings, mean rating score, and number of installations were analyzed on a per-feature basis.

Results

In total, 170 apps from both app stores met the inclusion criteria. The five most common and popular features, both in terms of number of apps with each feature and minimum possible number of installations, were the ability to track the time since last relapse (apps with feature=72/170, 42.4%; minimum possible number of installations=6,388,000), tutorials and coaching (apps with feature=63/170, 37.1%; minimum possible number of installations=9,286,505), access to accountability partners or communities (apps with feature=51/170, 30%; minimum possible number of installations=5,544,500), content blocking or content monitoring (apps with feature=46/170, 27.1%; minimum possible number of installations=17,883,000), and a reward system for progress (apps with feature=34/170, 20%; minimum possible number of installations=4,425,300). Of these features, content-blocking apps had the highest minimum possible number of installations. Content blocking was also the most detected feature combination in a combinatorial analysis (with 28 apps having only this feature), but it also had the lowest mean consumer satisfaction rating (4.04) and second-lowest median rating (4.00) out of 5 stars. None of the apps reviewed contained references to literature that provided direct evidence for the app’s efficacy or safety.

Conclusions

There are several apps with the potential to provide low- or zero-cost real-time interventions for people struggling to manage problematic pornography use. Popular app features include blockers of pornographic content, behavior monitoring, and tutorials that instruct users how to eliminate pornography use. However, there is currently no empirical evidence to support the effectiveness and safety of these apps. Further research is required to be able to provide recommendations about which apps (and app features) are safe for public consumption.

Digital Health Interventions for Delivery of Mental Health Care: Systematic and Comprehensive Meta-Review

BACKGROUND

The COVID-19 pandemic has shifted mental health care delivery to digital platforms, videoconferencing, and other mobile communications. However, existing reviews of digital health interventions are narrow in scope and focus on a limited number of mental health conditions.

OBJECTIVE

To address this gap, we conducted a comprehensive systematic meta-review of the literature to assess the state of digital health interventions for the treatment of mental health conditions.

METHODS

We searched MEDLINE for secondary literature published between 2010 and 2021 on the use, efficacy, and appropriateness of digital health interventions for the delivery of mental health care.

RESULTS

Of the 3022 records identified, 466 proceeded to full-text review and 304 met the criteria for inclusion in this study. A majority (52%) of research involved the treatment of substance use disorders, 29% focused on mood, anxiety, and traumatic stress disorders, and >5% for each remaining mental health conditions. Synchronous and asynchronous communication, computerized therapy, and cognitive training appear to be effective but require further examination in understudied mental health conditions. Similarly, virtual reality, mobile apps, social media platforms, and web-based forums are novel technologies that have the potential to improve mental health but require higher quality evidence.

CONCLUSIONS

Digital health interventions offer promise in the treatment of mental health conditions. In the context of the COVID-19 pandemic, digital health interventions provide a safer alternative to face-to-face treatment. However, further research on the applications of digital interventions in understudied mental health conditions is needed. Additionally, evidence is needed on the effectiveness and appropriateness of digital health tools for patients who are marginalized and may lack access to digital health interventions.

Excessive alcohol consumption and binge drinking in college students

Background

Binge drinking (BD) refers to a pattern of alcohol consumption characterized by the consumption of large amounts of alcohol in a short period of time followed by periods of abstinence. This drinking pattern is prevalent worldwide, mainly among young people. Excessive alcohol consumption is the spectrum of consumption patterns that may have or have had health consequences, and includes the concepts of risky alcohol use, harmful alcohol use and alcohol dependence according to Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV), the latter two are currently grouped into alcohol use disorder (AUD) according to the fifth edition of the DSM (DSM-5). Due to the high prevalence of BD among young people, especially university students, as well as the important consequences of its practice, a study was conducted to evaluate excessive alcohol consumption and its relationship with the practice of BD in university students.

Methods

A cross-sectional study was conducted among students (aged 18-30 years) enrolled in the academic year 2018-2019 at the Faculty of Nursing at a university in northern Spain. Data collection included sociodemographic information, and alcohol use information, collected using a semi-structured questionnaire. To measure the excessive alcohol consumption, this study used the Alcohol Use Disorders Identification Test (AUDIT).

Results

A total of 142 participants were included, of which 88.03% were women. Up to 38.03% were classified as BD. Up to 14.77% of non-BD participants and 66.67% of BD participants were classified as risky drinkers (AUDIT Total geq 8 in men or geq 6 in women) (p < 0.001). Up to 3.41% of the non-BD and 24.07% of the BD were drinkers with harmful alcohol use and probable alcohol dependence (AUDIT Total geq 13) (p < 0.001). A total of 5.68% of non-BD and 42.59% of BD were AUD drinkers (AUDIT Total geq 9 in males or geq 8 in females) (p < 0.001). In addition, statistically significant differences were found between the BD and non-BD groups in the responses to each of the AUDIT items, as well as in the total score and also in the scores of the three domains of the questionnaire.

Conclusions

Excessive alcohol consumption is frequent among university students, especially among those who practice BD.

Preliminary Effectiveness of a Remotely Monitored Blood Alcohol Concentration Device as Treatment Modality: Protocol for a Randomized Controlled Trial

Background

Alcohol use disorder is a chronic disorder with a high likelihood of relapse. The consistent monitoring of blood alcohol concentration through breathalyzers is critical to identifying relapse or misuse. Smartphone apps as a replacement of or in conjunction with breathalyzers have shown limited effectiveness. Yet, there has been little research that has effectively utilized wireless or Wi-Fi–enabled breathalyzers that can accurately, securely, and reliably measure blood alcohol concentration.

Objective

The purpose of this study is to evaluate the impact of a wireless blood alcohol concentration device in collaboration with long-term treatment on dropout rates, psychological distress, treatment motivation, quality of life, and need for higher levels of follow-up care for patients with alcohol use disorder.

Methods

The randomized clinical trial will include two arms, access to the wireless breathalyzer versus no access to the breathalyzer, while both groups have access to treatment. Evaluation will last 3 months with a 6-week follow-up, during which each participant will be interviewed at admission, 1 month in, 2 months in, 3 months in, and follow-up. Individuals will be recruited online through a secure telehealth meeting invitation. Outcomes will focus on the impact of the wireless breathalyzer within the alcohol use disorder population, and the combined effect on psychological distress, treatment motivation, and quality of life. In addition, we intend to investigate the impact of the breathalyzer on dropout rates and participants’ need for higher levels of follow-up care and treatment.

Results

The recruitment of this study started in July 2020 and will run until 2022.

Conclusions

This information will be important to develop cost-effective treatments for alcohol dependence. Ongoing monitoring allows treatment providers to take an individualized disease management approach and facilitates timely intervention by the treatment provider.

Trial Registration

ClinicalTrials.gov NCT04380116; http://clinicaltrials.gov/ct2/show/NCT04380116

International Registered Report Identifier (IRRID)

DERR1-10.2196/30186

Preliminary efficacy of a digital therapeutics smartphone application for methamphetamine use disorder: An experimental study

Methamphetamine is the most widely used illicit drug in China. Treating methamphetamine use disorder (MUD) is challenging due to the lack of effective pharmacotherapies. This study is an experimental study to investigate the efficacy of smartphone-based digital therapeutics in treating MUD at the community level. One hundred participants were recruited and randomized into a digital therapeutics (DTx) group (n = 52) and a treatment as usual (TAU) group (n = 48). The DTx group used a smartphone application to deliver cognitive behavioral therapy, approach bias modification, cognitive training, and contingency management for 8 weeks. The TAU group received counseling from social workers and professional psychotherapists. Cue-induced craving, cognitive functions, PHQ9, and GAD7 were measured at baseline and post-intervention. Wilcoxon tests were performed with bootstrap and multiply imputation to estimate the treatment effect size. The DTx group showed a significant reduction in drug craving [Wilcoxon effect size = -0.267, 95% CI = (-0.435, -0.099), p = 0.002] and a significant improvement in cognitive function [Wilcoxon effect size = 0.220, 95% CI = (0.009, 0.432), p = 0.041]. The DTx group had overall 1, 8, and 24-week attritions of 8%, 11.5%, and 38.5%, respectively. The study shows that Digital therapeutics is feasible and potentially beneficial as a complement to community substance use treatment programs.

Opportunities to Integrate Mobile App-Based Interventions Into Mental Health and Substance Use Disorder Treatment Services in the Wake of COVID-19

The COVID-19 pandemic has heightened concerns about the impact of depression, anxiety, alcohol, and drug use on public health. Mobile apps to address these problems were increasingly popular even before the pandemic, and may help reach people who otherwise have limited treatment access. In this review, we describe pandemic-related substance use and mental health problems, the growing evidence for mobile app efficacy, how health systems can integrate apps into patient care, and future research directions. If equity in access and effective implementation can be addressed, mobile apps are likely to play an important role in mental health and substance use disorder treatment.

Feasibility of a Mobile Health App for Routine Outcome Monitoring and Feedback in SMART Recovery Mutual Support Groups: Stage 1 Mixed Methods Pilot Study

Background

Mutual support groups are an important source of long-term help for people impacted by addictive behaviors. Routine outcome monitoring (ROM) and feedback are yet to be implemented in these settings. SMART Recovery mutual support groups focus on self-empowerment and use evidence-based techniques (eg, motivational and behavioral strategies). Trained facilitators lead all SMART Recovery groups, providing an opportunity to implement ROM.

Objective

The aim of this stage 1 pilot study is to explore the feasibility, acceptability, and preliminary outcomes of a novel, purpose-built mobile health ROM and feedback app (SMART Track) in mutual support groups coordinated by SMART Recovery Australia (SRAU) over 8 weeks.

Methods

SMART Track was developed during phase 1 of this study using participatory design methods and an iterative development process. During phase 2, 72 SRAU group participants were recruited to a nonrandomized, prospective, single-arm trial of the SMART Track app. Four modes of data collection were used: ROM data directly entered by participants into the app; app data analytics captured by Amplitude Analytics (number of visits, number of unique users, visit duration, time of visit, and user retention); baseline, 2-, and 8-week follow-up assessments conducted through telephone; and qualitative telephone interviews with a convenience sample of study participants (20/72, 28%) and facilitators (n=8).

Results

Of the 72 study participants, 68 (94%) created a SMART Track account, 64 (88%) used SMART Track at least once, and 42 (58%) used the app for more than 5 weeks. During week 1, 83% (60/72) of participants entered ROM data for one or more outcomes, decreasing to 31% (22/72) by the end of 8 weeks. The two main screens designed to provide personal feedback data (Urges screen and Overall Progress screen) were the most frequently visited sections of the app. Qualitative feedback from participants and facilitators supported the acceptability of SMART Track and the need for improved integration into the SRAU groups. Participants reported significant reductions between the baseline and 8- week scores on the Severity of Dependence Scale (mean difference 1.93, SD 3.02; 95% CI 1.12-2.73) and the Kessler Psychological Distress Scale-10 (mean difference 3.96, SD 8.31; 95% CI 1.75-6.17), but no change on the Substance Use Recovery Evaluator (mean difference 0.11, SD 7.97; 95% CI –2.02 to 2.24) was reported.

Conclusions

Findings support the feasibility, acceptability, and utility of SMART Track. Given that sustained engagement with mobile health apps is notoriously difficult to achieve, our findings are promising. SMART Track offers a potential solution for ROM and personal feedback, particularly for people with substance use disorders who attend mutual support groups.

Trial Registration

Australian New Zealand Clinical Trials Registry ACTRN12619000686101; https://anzctr.org.au/Trial/Registration/TrialReview.aspx?id=377336

International Registered Report Identifier (IRRID)

RR2-10.2196/15113

The growing field of digital psychiatry: current evidence and the future of apps, social media, chatbots, and virtual reality

As the COVID-19 pandemic has largely increased the utilization of telehealth, mobile mental health technologies - such as smartphone apps, vir-tual reality, chatbots, and social media - have also gained attention. These digital health technologies offer the potential of accessible and scalable interventions that can augment traditional care. In this paper, we provide a comprehensive update on the overall field of digital psychiatry, covering three areas. First, we outline the relevance of recent technological advances to mental health research and care, by detailing how smartphones, social media, artificial intelligence and virtual reality present new opportunities for "digital phenotyping" and remote intervention. Second, we review the current evidence for the use of these new technological approaches across different mental health contexts, covering their emerging efficacy in self-management of psychological well-being and early intervention, along with more nascent research supporting their use in clinical management of long-term psychiatric conditions - including major depression; anxiety, bipolar and psychotic disorders; and eating and substance use disorders - as well as in child and adolescent mental health care. Third, we discuss the most pressing challenges and opportunities towards real-world implementation, using the Integrated Promoting Action on Research Implementation in Health Services (i-PARIHS) framework to explain how the innovations themselves, the recipients of these innovations, and the context surrounding innovations all must be considered to facilitate their adoption and use in mental health care systems. We conclude that the new technological capabilities of smartphones, artificial intelligence, social media and virtual reality are already changing mental health care in unforeseen and exciting ways, each accompanied by an early but promising evidence base. We point out that further efforts towards strengthening implementation are needed, and detail the key issues at the patient, provider and policy levels which must now be addressed for digital health technologies to truly improve mental health research and treatment in the future.

Mobile Mental Health Apps from the National Center for PTSD: Digital Self-Management Tools for Co-Occurring Disorders

Mobile mental health apps can help bridge gaps in access to care for those with substance use disorders and dual diagnoses. The authors describe a portfolio of free, publicly available mobile mental health apps developed by the National Center for PTSD. The authors also demonstrate how this suite of primarily non-substance use disorder-specific mobile mental health apps may support the active ingredients of substance use disorder treatment or be used for self-management of substance use disorder and related issues. The potential advantages of these apps, as well as limitations and considerations for future app development, are discussed.

IMPROVE 1.0: Individual Monitoring of Psoriasis Activity by Regular Online App Questionnaires and Outpatient Visits

Smartphone apps gain more and more importance in supporting management of chronic diseases. Psoriasis is a highly prevalent, lifelong chronic inflammatory skin disease with a high impact on patient's quality of life. Disease management includes regular topical and systemic treatment of skin lesions as well as co-treatment of metabolic and psychologic disorders. In this study, we investigated the potential of a new smartphone app (IMPROVE 1.0) for individual monitoring of disease activity and disease influencing factors. Twelve out of 50 psoriasis patients asked for study participation performed self-assessment of psoriasis severity, life quality, and stress scores using the app over a period of 1 year. Every 2 months, study participants were carefully examined by a dermatologist in order to control the quality of app-reported data. We found that psoriasis severity and life quality values as entered in the app closely correlate to physician's examination. Furthermore, we detected strong correlations of disease activity with life quality and psoriasis serum biomarker. Temporal relations between psoriasis aggravation and previous changes of lifestyle factors, such as increased stress levels, were observed in individual patients, indicating a high potential for preventive interventions in future psoriasis apps. The vast majority of study participants evaluated IMPROVE 1.0 app positively and wish to include the app into their daily life. Hence, we demonstrate that smartphone apps are a useful tool to raise self-awareness for the dimensions of complex diseases and fully integrate psoriasis patients into individual disease management. These data are important to develop more advanced digital tools supporting the management of chronic diseases in the future.