Background Drug use disorder has high potential for relapse and imposes an enormous burden on public health in China. Since the promulgation of the Anti-drug law in 2008, community-based rehabilitation has become the primary approach to treat drug addiction. However, multiple problems occurred in the implementation process, leading to a low detoxification rate in the community. Mobile health (mHealth) serves as a promising tool to improve the effectiveness and efficiency of community-based rehabilitation. Community-based addiction rehabilitation electronic system (CAREs) is an interactive system for drug users and their assigned social workers. Objective The study aimed to examine the feasibility and preliminary efficacy of CAREs in community-based rehabilitation from the perspective of drug users and social workers in Shanghai, China. Methods In this pilot randomized controlled trial, 40 participants were recruited from the community in Shanghai from January to May 2019. Participants randomized to the intervention group (n=20) received CAREs + community-based rehabilitation, while participants in the control group (n=20) received community-based rehabilitation only for 6 months. CAREs provided education, assessment, and SOS (support) functions for drug users. The assigned social workers provided service and monitored drug use behavior as usual except that the social workers in the intervention group could access the webpage end to obtain drug users’ information and fit their routine workflow into CAREs. The primary outcome was the feasibility of CAREs, reflected in the overall proportion and frequency of CAREs features used in both app and webpage end. The secondary outcomes were the effectiveness of CAREs, including the percentage of drug-positive samples, longest period of abstinence, contact times with social workers, and the change of Addiction Severity Index (ASI) from baseline to the 6-month follow-up. Results The number of participants logged in to the app ranged from 7 to 20 per week, and CAREs had relatively high levels of continued patient use. Drug users preferred assessment and education features in the app end while their social workers showed high levels of use in urine results record and viewing assessment results on the webpage end. After the 6-month intervention, 3.3% (17/520) of samples in the intervention group and 7.5% (39/520) in the control group were drug-positive (F=4.358, P=.04). No significant differences were noted between the control and intervention groups in terms of longest duration of abstinence, number of contact times and ASI composite scores. Conclusions The study preliminarily demonstrated that with relatively good feasibility and acceptability, CAREs may improve the effectiveness and efficiency of the community-based rehabilitation, which provided instruction for further improvement of the system. Trial Registration ClinicalTrials.gov NCT03451344; https://clinicaltrials.gov/ct2/show/NCT03451344 International Registered Report Identifier (IRRID) RR2-10.3389/fpsyt.2018.00556

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Studies on recovery patterns and how baseline factors influence recovery consequences among heroin dependent patients have shown mixed results. This study is aimed at describing the gender differences in long-term recovery patterns and exploring the predictors of negative recovery consequences by gender among heroin dependent patients in Shanghai, China. At baseline, this study recruited 503 heroin dependent patients discharged from Shanghai compulsory rehabilitation facilities in 2007 and 2008. In this cohort study, the baseline data was then linked with participants’ 5-year follow-up data from official records. Generalized Estimating Equations (GEE) were used to compare males with females in terms of the presence of negative consequences (incarceration, or readmission to compulsory treatment, or both), in the subsequent 5-years after their discharge from compulsory treatment. Ordinary least squares (OLS) regression was used to explore factors associated to the time length of negative consequences in 5 years after the discharge for males and females separately. Our findings indicate that female heroin dependent patients tend to have less negative recovery outcomes than male patients. Male patients with a life-time history of poly drug use and female patients with borderline personality disorder are especially at risk of incarceration and readmission into compulsory treatment programs.

BACKGROUND Drug abuse has high potential to relapse and imposes an enormous burden on public health in China. Since the promulgation of the “Anti-drug law” in 2008, the community-based rehabilitation has become the primary approach to treat drug addiction. However, multi-faceted problems occurred in the implementation process, leading to low detoxification rate in the community. Mobile health (mHealth) serves as a promising tool to improve the effectiveness and efficiency of the community-based rehabilitation. Community-based addiction rehabilitation electronic system (CAREs) is an interactive system for drug users and their corresponding social workers. OBJECTIVE The study aimed to examine the feasibility and efficacy of integrated rehabilitation based on CAREs compared with the standard community-based rehabilitation from both the drug users and social workers perspective in Shanghai, China. METHODS In this pilot randomized controlled trial, 40 participants were recruited from the community in Shanghai from January to May 2019. Participants randomized to the intervention group (n=20) received integrated community rehabilitation based on CAREs, while participants in control group (n=20) received community-based rehabilitation alone for 6 months. Corresponding social workers provided service and monitored their drug use behavior as usual. The primary outcome was percentage of drug-positive samples which was submitted regularly once a week during the study course. The secondary outcome was longest period of abstinence and the change of Addiction Severity Index (ASI) from baseline in the 6th month. Usage of CAREs feature was also calculated. RESULTS After 6-month intervention, 3.3% samples in the intervention group and 7.5% in the control group were drug-positive (F = 4.358, P= .04). No significant differences between the control and intervention group in terms of longest duration of abstinence and ASI composite scores. Among the multiple features of CAREs, participants in intervention group accessed assessment and education features more frequently, while their corresponding social workers favored urine results record and viewing assessments results most. By using the CARES system, the patient's behavior and emotional state can be obtained by the social worker in a timely manner and get a timely response from the social worker. CONCLUSIONS The study preliminarily demonstrated that the feasibility and effectiveness of integrated community rehabilitation based on CAREs. CLINICALTRIAL ClinicalTrials.gov number: NCT03451344; https://clinicaltrials.gov/ct2/show/ NCT03451344 (Archived by WebCite at https://clinicaltrials.gov/ct2/show/ NCT03451344)