Using Mobile Phone Technology to Assess Substance Use Outcomes and Promote Recovery

The Addiction Comprehensive Support System (ACHESS) is a novel, promising application that delivers both ecological momentary assessments and ecological momentary interventions to help individuals self-monitor and reduce substance use relapse (Gustafson et al, 2014). Despite the promise of ACHESS, the application has not been tested with a diverse sample of individuals from an urban setting who may have different risk profiles. In addition, there is limited knowledge on how best to use and integrate a program like ACHESS in clinical practice. This paper reports the feasibility and acceptability of an evidence-based smartphone application, ACHESS, over a 3-month period with 38 individuals receiving substance use outpatient treatment services at a non-profit licensed clinic in New York City.

We used a mixed-methods design to pilot test the ACHESS program with 38 individuals receiving outpatient treatment over a 3-month period. This analysis focuses only on the feasibility and acceptability data. During the post-intervention interview, we asked participants open-ended questions to explore the barriers and facilitators to using ACHESS. In addition, we administered weekly ecological momentary surveys to assess substance use and health and mental health wellbeing. We also used descriptive statistics to examine feasibility data on study recruitment and retention. We report feedback on application use and provider-related challenges around implementation.

All 38 participants who enrolled had access to a smartphone with a data plan. Participants with smartphones from the Federal Lifeline Assistance program had limited data plans and experienced challenges with installing the application and registering for an account. Pilot results suggest that more than 80% of participants engaged with the application, with varying levels and types of use. The most frequently used aspects of the application were the discussion boards, followed by appointment reminders, daily check-ins, weekly surveys, and substance use resources. Participants self-reported improvements in supportive relationships and maintaining sobriety or reductions in substance use. While some participants described the application as being helpful and easy to use, others reported challenges to using it, such as registering for an account, setting up a password, loading content, and difficulties connecting with others using the app. These differences appeared to be related to participant age and experience with technology, as well as the type of smartphone and data plan. Provider-related challenges to implementation included onboarding and registering participants, the time required to engage participants in the application, keeping participants engaged in the application, and integrating the application into routine services.

With hands-on support and encouragement, ACHESS is a potentially useful application to support the recovery of people receiving substance use treatment services. Greater attention to how ACHESS and other digital health smartphone applications can be integrated into routine care is an important consideration for future evaluations.