CASA-CHESS Relapse Prevention App: Addressing the Gap in Substance Use Services for Latinx Spanish-Speaking Communities

Background: Latinx individuals with substance use disorders (SUDs) lack adequate access to culturally relevant recovery support services and communities. To address this need, we adapted the Addiction-Comprehensive Health Enhancement Support System (A-CHESS; Gustafson et al., 2014) smartphone application for Latinx Spanish-speakers in recovery for SUDs (CASA-CHESS relapse prevention tool; Muroff et al., 2017, 2019). This study examines the CASA-CHESS app usage as well as substance use and service utilization outcomes for participants using CASA-CHESS.

Methods: Spanish-speaking Latinx adult clients enrolled in integrated substance use, mental health, and primary care services at a community outpatient clinic were recruited to participate in this study. Participants received a smartphone with the CASA-CHESS app. App usage data (e.g., app features utilized) was collected for each unique participant and stored on a secure server. Participants completed interviews at baseline and 6-months assessing substance use, mental health, service utilization, and social supports.

Results: Forty-six participants have enrolled in the study and completed their 6-month follow-up assessment (85% follow-up rate). Participants were approximately 44 years old, 100% identified as Hispanic/Latinx (mostly Puerto Rican).  Approximately 77% were male, 60% had less than a high school education, 57% had never been married, 39% were unemployed, 62% were homeless, and 82% had been in jail at least once. All participants speak Spanish well or very well and 35% also speak English well or very well. Participants had sought treatment for alcohol, heroin, and/or cocaine disorders. At 6 months, 86.7% endorsed the smartphone had "quite a lot" of impact on their mental health and recovery. About 74% actively used CASA-CHESS for 4 or more months while about 26% discontinued using the app prior to 4 months. The 5 most commonly utilized CASA-CHESS features included the discussion board, weekly surveys, daily check-ins, messaging, and medication reminders/surveys. About 87% strongly agreed that they felt connected to their case manager through CASA-CHESS. From baseline to 6-month follow-up, substance use remained relatively stable and statistically significant increases in service utilization (e.g., case management (t(45))=9.26, p<.0001), individual counseling (t(45))=2.64, p<.02)) were observed.

Conclusions and Implications: Results suggest that Latinx Spanish-speaking clients with SUD receiving behavioral health services will utilize  the CASA-CHESS app for a sustained period and may benefit from it (e.g., increased service utilization). Results inform how technology may be used to deepen supportive networks within this population. Social workers play key roles in providing culturally and linguistically appropriate services and in the development and application of technology to support SUD recovery.