Background
We estimated the efficacy of the Addiction-Comprehensive Health
Enhancement Support System (A-CHESS) in increasing the use of services for
addiction and examined the extent to which this use of services mediated the
effects of A-CHESS on risky drinking days and abstinence from drinking.
Methods
We conducted secondary data analyses of the A-CHESS randomized
controlled trial. Recruitment occurred in five residential treatment
programs operated by two addiction treatment organizations. Participants
were 349 adults with alcohol use disorders recruited two weeks before
discharge from residential treatment. We provided intervention arm
participants with a smartphone, the A-CHESS application, and an 8-month
service plan. Control arm participants received treatment as usual.
Telephone interviews at 4, 8, and 12-month follow-ups assessed past-month
risky drinking days, past-month abstinence, and post-discharge service
utilization (past-month outpatient addiction treatment and past-week mutual
help including Alcoholics Anonymous and Narcotics Anonymous). Using mixed
effects latent variable models, we estimated the indirect effects of A-CHESS
on drinking outcomes, as mediated by post-discharge service utilization.
Results
Approximately 50.5% of participants reported outpatient
addiction treatment and 75.5% reported mutual help at any follow-up
interview in the year following randomization. Assignment to the A-CHESS
intervention was associated with an increased odds of outpatient addiction
treatment across follow-ups, but not mutual help. This use of outpatient
addiction treatment mediated the effect of A-CHESS on risky drinking days,
but not abstinence. The effect of A-CHESS through outpatient addiction
treatment appeared to reduce the expected number of risky drinking days
across follow-ups by 11%.
Conclusions
The mobile health (mHealth) intervention promoted the use of
outpatient addiction treatment, which appeared to contribute to its efficacy
in reducing risky drinking. Future research should investigate how mHealth
interventions could link patients to needed treatment services and promote
the sustained use of these services.