Using smartphones to decrease substance use via self-monitoring and recovery support: study protocol for a randomized control trial

Christy K Scott, Michael L Dennis, David H Gustafson, Christy K Scott, Michael L Dennis, David H Gustafson

Abstract

Background: Alcohol abuse, other substance use disorders, and risk behaviors associated with the human immunodeficiency virus (HIV) represent three of the top 10 modifiable causes of mortality in the US. Despite evidence that continuing care is effective in sustaining recovery from substance use disorders and associated behaviors, patients rarely receive it. Smartphone applications (apps) have been effective in delivering continuing care to patients almost anywhere and anytime. This study tests the effectiveness of two components of such apps: ongoing self-monitoring through Ecological Momentary Assessments (EMAs) and immediate recovery support through Ecological Momentary Interventions (EMIs).

Methods/design: The target population, adults enrolled in substance use disorder treatment (n = 400), are being recruited from treatment centers in Chicago and randomly assigned to one of four conditions upon discharge in a 2 × 2 factorial design. Participants receive (1) EMAs only, (2) EMIs only, (3) combined EMAs + EMIs, or (4) a control condition without EMA or EMI for 6 months. People in the experimental conditions receive smartphones with the apps (EMA and/or EMI) specific to their condition. Phones alert participants in the EMA and EMA + EMI conditions at five random times per day and present participants with questions about people, places, activities, and feelings that they experienced in the past 30 min and whether these factors make them want to use substances, support their recovery, or have no impact. Those in the EMI and EMA + EMI conditions have continual access to a suite of support services. In the EMA + EMI condition, participants are prompted to use the EMI(s) when responses to the EMA(s) indicate risk. All groups have access to recovery support as usual. The primary outcome is days of abstinence from alcohol and other drugs. Secondary outcomes are number of HIV risk behaviors and whether abstinence mediates the effects of EMA, EMI, or EMA + EMI on HIV risk behaviors.

Discussion: This project will enable the field to learn more about the effects of EMAs and EMIs on substance use disorders and HIV risk behaviors, an understanding that could potentially make treatment and recovery more effective and more widely accessible.

Trial registration: ClinicalTrials.gov, ID: NCT02132481 . Registered on 5 May 2014.

Keywords: Ecological momentary assessment; Ecological momentary intervention; Recovery support; Smartphone; Substance use disorder; Technology; eHealth; mHealth.

Conflict of interest statement

Ethics approval and consent to participate

Participation was voluntary. The study received approval from the Chestnut Health Systems’ Institutional Review Board (IRB Study No. 1091-0114) and is registered at Clinical Trials.gov (NCT02132481). Chestnut’s IRB acted as a Centralized Ethics Committee for the two substance use treatment agencies from which participants were recruited. The study complies with the relevant Standard Protocol Items: Recommendations for Interventional Trials (SPIRIT) and World Health Organization (WHO) Checklist (see Additional file 1).

Consent for publication

Informed written consent was received for publication of the manuscript and figures. The Consent Form is held by the authors and their institution and is available for review by the Editor-in-Chief.

Competing interests

Author Dr. Gustafson has a shareholder interest in CHESS Mobile Health, a small business that develops web-based health care technology for patients and family members. This relationship is extensively managed by the authors and the University of Wisconsin. All other authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Consolidated Standards of Reporting Trials (CONSORT) diagram of participant flow
Fig. 2
Fig. 2
Study schedule of enrolment, intervention, and assessments

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