Treatment seeking as a mechanism of change in a randomized controlled trial of a mobile health intervention to support recovery from alcohol use disorders

Abstract

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.

Feasibility and Effects of Digital Interventions to Support People in Recovery From Substance Use Disorders: Systematic Review

“…It should be noted that the positive results in this paper could have simply reflected self-selection, with more motivated participants both accessing A-CHESS more frequently and having better outcomes. Finally, a fourth study found that the effects of A-CHESS on the risky drinking days outcome was mediated by participation in outpatient SUD treatment [ 75 ].…”

Intention to reduce drinking alcohol and preferred sources of support: An international cross-sectional study

“…Online support has been used to complement face to face treatment following residential programs in the US. Training was provided to patients before they left the facility and this additional online support meant they were more likely to seek additional face to face treatment once they had been discharged (Glass et al, 2017).…”

Feasibility and Effects of Digital Interventions to Support People in Recovery From Substance Use Disorders: Systematic Review (Preprint)

“…Finally, a forth study found that the effects of A-CHESS on the risky drinking days outcome was mediated by participation in outpatient SUD treatment (Glass et al, 2017).…”

“…Four of the papers on complex interventions also reported some information on effects on other outcomes than substance use. Gustafson [64] found that A-CHESS had no impact on negative consequences of drinking, Glass et al (2017) reported that A-CHESS increased participation in outpatient treatment following rehabilitation, Schaub [83] found that Can Reduce did not affect mental health measures, and Tait [84] found that the intervention they studied made no difference on psychological distress. On the other hand, Tait found that the intervention led to a significant reduction in days of general impairment.…”