A common perception many have about individuals in recovery is, “if they have enough willpower, they can do it.” But Fiona M. McTavish, MS, says she knows that people in recovery need more tangible recovery support. She is part of a team of researchers striving to provide individuals in recovery with more tools to help them succeed.
The A-CHESS (Addiction—Comprehensive Health Enhancement Support System), funded by the National Institute of Alcohol Abuse and Alcoholism (NIAAA), is a mobile-phone application designed to prevent relapse and offer support to alcohol- or drug-dependent individuals.
At the mHealth Summit (a meeting that brings together leaders in government, the private sector, industry, academia, providers and not-for-profit organizations to advance collaboration in the use of wireless technology to improve health outcomes in the United States and abroad) in early December, McTavish and her team received the iMedicalApps-mHealth Summit Research Award for their research on A-CHESS titled, “Effects of a mHealth intervention for alcohol relapse prevention.” McTavish accepted the award in Washington D.C. on behalf of her coauthors David H. Gustafson, PhD, Amy Atwood, PhD, Min-Yuan Chih, MHA, Dhavan Shah, PhD, Michael Boyle, MA and Michael Levy, PhD.
The A-CHESS program includes a variety of features. One that McTavish describes as “Facebook-like” makes it possible for participants to post notes to others dealing with addiction issues and provide/receive support. A panic button is available on the app for participants to use if they are struggling to stay clean and sober. When this button is pressed, a pre-typed message would be sent out to a group of people whom the participant had previously designated. In the study, two weeks before participants left residential treatment, they met with their counselor to be trained on the program and prepare for aspects such as this.
False alarms are not likely, McTavish explains, because after the panic button is pressed, a message comes up asking participants if they’re sure they want to send out a message. Should they say ‘yes,’ the message sent out would say, “[NAME] is struggling right now, please reach out to him/her.”
While the struggling person is waiting for a response, A-CHESS prompts a number of questions and tips on the system to help get him/her through the time. For example, if the person were really stressed, the program would walk the person through some of the skills that had been taught in treatment. The program also features lists such as “My top 10 reasons I decided I didn’t want to drink” to help participants in their struggling moments.
“One of the reasons may have been ‘I want to be a better mom’ or ‘I want to be there for my kid.’ So, those would pop up and remind the woman why she didn’t want to drink anymore,” explains McTavish.
The program also contains information about accomplishments of others who had been through addiction for motivational listening. McTavish says the research team also sent daily motivational thoughts that the participant could look at and hopefully draw inspiration from.
Additionally, the participants took the “Brief Alcohol Monitoring Survey” every week to help monitor their progress. It would assist them in recognizing their risk and protective factors, McTavish says.
This is another area where the counselor may get involved. If, for example, one of the risk factors for a person is that he/she is not attending meetings, a text or email would be sent to the counselor so the counselor could contact the individual to find out the reason for lack of attendance.
However, “if the counselor knew that the person was someone who never liked meetings, someone who just didn’t ‘fit there,’ then they could adjust it so they wouldn’t be told every time the person didn’t go to meetings because they were never going to go,” says McTavish.
The GPS tracking feature of A-CHESS helps participants stay away from places that were troublesome for them prior to treatment. If the person says Joe’s Bar had been the former preferred drinking location, that location would be entered into the phone and whenever the person went near that site, automatic warnings would be sent asking, “Is this where you want to be?”
In the randomized clinical trial conducted from February 2010 through June 2011, 349 adults were recruited from two treatment facilities—one in the Midwest and one in the Northeast—to participate in the study. Each of these individuals had just completed residential treatment for drug or alcohol abuse.
The 349 individuals were divided into two groups—a control group that received usual aftercare and an “A-CHESS group” that received usual care plus a smartphone with the A-CHESS program. The A-CHESS group had access to the mobile app for eight months. Both groups were surveyed after the intervention was over through 12 months to determine if the results lasted. Patients in the A-CHESS group also had data about their use of the application automatically collected.
The research team covered the expenses of phone and the service plan for the eight months while the research was being conducted. Their primary hypothesis, according to McTavish, was that risky drinking days would be reduced.
Bumps in the road