The Future is Now: Mobile Technology for Alcohol Use Disorder

The development and expansion of mobile technology – including text messaging and smartphone “apps” – has provided new ways to potentially help individuals with alcohol use disorder and other harmful drinking.

Are these interventions effective? Read more for an up-to-date review of the scientific evidence.

WHAT PROBLEM DOES THIS STUDY ADDRESS?

Strategies that use mobile text messaging (or short message service; SMS) and smart phone “apps” (e.g., on iPhones and Android devices) have become increasingly popular in the fight against alcohol use disorders and harmful drinking.

In the U.S., texting is the most popular form of communication for individuals under 50 & 80% of individuals in treatment for alcohol and other drug use disorder use text messages. Nearly 70% of U.S. adults own a smartphone, a figure growing with each year.

The ubiquity of mobile technology in day-to-day experience offers several advantages when it comes to addressing alcohol use disorder & harmful drinking:

They provide a way to build on gains made in outpatient or residential treatment where post-treatment professional resources may be limited (e.g., therapist availability)
Their content can be delivered consistently with tailoring to an individual’s unique needs
They can increase accessibility to help for individuals who are in areas where treatment is not as available (e.g., rural areas)
They offer help for individuals who do not want to seek face-to-face treatment due to the stigma of alcohol and other drug use disorders.

This study by Fowler and colleagues reviewed existing research on text message and smartphone app-based interventions for alcohol use disorder and other forms of hazardous drinking.

HOW WAS THIS STUDY CONDUCTED?

This systematic review of mobile technology interventions included articles from 2004 to 2015 that met these conditions:

All participants had to be 18 years or older
The individuals receiving the mobile technology intervention had to be compared to another group of individuals receiving a separate intervention or who were simply followed over time (i.e., control group)
The study had to measure at least one drinking outcome

Although studies where individuals were recruited from settings where they received face-to-face health care could be included, studies were excluded if the intervention itself included a face-to-face component.

WHAT DID THIS STUDY FIND?

Eight studies met the criteria for inclusion in the review. Of these eight studies, five found positive results in terms of better drinking outcomes for individuals who received the mobile technology intervention. It is worth nothing that for the three that did not have positive results, one study found somewhat better outcomes (that were not significant), one found increased motivation to quit or reduce drinking though no difference in terms of actual drinking, and one no positive effects whatsoever.

Studies included in this Review – with links to study abstracts below the table – the mobile technology intervention that was tested, the setting and population in which the interventions were tested, and whether the intervention had a positive effect on drinking outcomes.
Not included in the table is the amount of time each intervention lasted and their levels of intensity, which ranged from 4 days to 32 weeks, and from one weekly text message to between four and six text messages each day.

Links to studies: (Agyapong, 2012; Gonzalez, 2015; Gustafson, 2014; Mason, 2014; Suffoletto, 2012; Suffoletto, 2015; Weitzel, 2007; Witkiewitz, 2014)

Click here for a brief article on (Gustafson, 2014): Recovery & Continuing Care: There is an App For That

The Addiction-Comprehensive Health Enhancement Support System (A-CHESS) is a sophisticated “app” with several features:

monitoring and tracking options
access to cognitive-behavioral interventions
daily motivational quotes
“push” notification warnings when traveling nearby high-risk locations previously set up by the participant.

This intricate intervention helped reduce the number of risky drinking days & increase abstinence after residential treatment compared to the usual post-treatment care (i.e., continuing care) received by patients recruited from this treatment program.

WHY IS THIS STUDY IMPORTANT

The study provides an up-to-date review of the latest studies on mobile technology based interventions.

Because technology seemingly improves by the day, reviews like this are important so clinicians, clinical researchers, & policy makers can get a sense of the latest research in this dynamic area.

While they are certainly not cure-alls, this review suggests mobile technology is an important tool in a comprehensive approach to address alcohol use disorders and other harmful drinking in the United States.

LIMITATIONS

First, this was not a meta-analysis (i.e., an analysis of several analyses at the same time), so the results cannot speak to exactly how effective these interventions were when considered together (authors state the variability among the studies made it too difficult to perform this type of study).
Second, the review excluded interventions that combined face-to-face and mobile technology interventions. So these results do not generalize to individuals currently seeking face-to-face treatment. For example, Lisa Marsch and colleagues, among others, have shown that both web-based and mobile technology can be an effective addition to traditional face-to-face treatment.
Third, with one exception, the studies generally recruited individuals from health care and college settings. We still know very little about whether mobile technology interventions are helpful for individuals who want to access mobile interventions themselves – sometimes referred to as “self-management”. This could be a key strategy to get help to individuals who are resistant to accessing any form of treatment.
Finally, and perhaps most importantly, these mobile technology interventions are not freely available in iPhone and Google Play app stores – in other words, they are not widely available to the general public just yet. While there are dozens of apps available on these platforms, as of yet, they are generally untested and/or not grounded in scientific evidence.

NEXT STEPS

Given the growing body of data showing mobile technology interventions can be helpful for some, adding to the broader field of web-based interventions to help reduce drinking, next steps may be to investigate optimal strategies to roll out and engage individuals with these interventions.

One major barrier seems to be whether or not insurance companies will help reimburse for the time needed to introduce and engage individuals with these mobile technology interventions.

BOTTOM LINE

For individuals & families seeking recovery: Mobile technology interventions, such as text messaging and smartphone applications (“apps”) can be helpful tools in your efforts to reduce or quit drinking. At this time, however, they are not widely available in places where you might traditionally access apps. The majority of those have not been tested. If you are in treatment, we suggest consulting your provider about how you can incorporate mobile technology into your recovery plan.
For Scientists: The use of mobile technology represents a new strategy in the field of alcohol use disorder treatment and recovery. Unfortunately, many of these evidence-based interventions are not widely available to the individuals that need them. Research should focus on how to engage both individuals in health care settings as well as non-treatment seeking individuals in the community with mobile resources shown to be effective in clinical research, like the studies reviewed here. Furthermore, studies should help determine the best ways to integrate mobile technology into face-to-face treatment and continuing care.
For Policy makers: This review showed mobile technology can be used to improve individuals’ drinking outcomes. Policies and funding to help implement mobile technology interventions into both health care settings and the community at large may help reduce alcohol-related harm and hazards in communities.
For Treatment professionals and treatment systems: This review showed mobile technology can be a helpful tool for individuals with alcohol use disorder and other forms of harmful drinking. It excluded studies that have tested the addition of technology-based interventions to traditional face-to-face treatment. As such these findings may be less applicable to individuals in current treatment. That said, they have been tested as continuing care interventions to help extend treatment benefit. It is important to note that many of these interventions are proprietary, and require contracts with the developers to implement these interventions in your programs.

CITATIONS

Fowler, L. A., Holt, S. L., & Joshi, D. (2016). Mobile technology-based interventions for adult users of alcohol: A systematic review of the literature. Addictive Behaviors.