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Are we leveraging digital technology in addiction treatment?

May 12, 2016
by David H. Gustafson, PhD
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The Center for Health Enhancement Systems Studies at the University of Wisconsin-Madison, developed A-CHESS, a smartphone app for recovery support, based in part on the ideas that emerged from experts in diverse fields and people suffering from addiction or affected by it. In 2009, in a Behavioral Healthcare article, I talked about key ingredients that a technology-based addiction treatment system such as A-CHESS would need.

A lot of the identified, necessary ingredients weren’t yet available when we first started thinking about a mobile technology app to assist those in recovery. But mobile health has changed so fast that what was visionary a few years ago is considered outdated today. And new features have emerged that we couldn’t have imagined then. 

Today, A-CHESS continues to evolve as a smartphone app for recovery that provides nearly constant access to peer support, information, activities, counseling and other services. It has been proven to reduce risky drinking and improve abstinence.1

In any case, here’s an update of how close we are to our original vision, on a scale of 1 to 5, with 1 meaning we still have a long way to go, and 5 meaning, we’re there, but don’t unbuckle your seatbelt just yet.

Integrated systems and health records

Are We There Yet Score = 4

This is one place where we’re on the cusp of a big change. There now exist some electronic medical record systems that allow you to take data from a system like A-CHESS and enter it into an EHR, but that’s not true across the board.  In many cases, data can’t be entered into an EHR from an outside device.

A transition seems to be underway with systems such as Apple’s Health Net and its collaboration with Epic EHR systems, which is allowing one to integrate these systems together in ways we haven’t been able to in the past.  We’re pretty close to “there” with this one.

Wearable devices to capture moods, triggers and other risk factors for those with addiction

Are We There Yet Score = 3

There’s a lot of work being done on this. Many devices like FitBit and others that are more sophisticated have sensors that are collecting data. But few devices can collect all the information needed to establish a person’s mood. They collect some data, but not enough to have a major impact.  And very few of these systems on the market have been tested properly, so we don’t know how accurate they are.

Another factor to consider once the data is collected is how to integrate it to reach a conclusion on a person’s mood. For example, we can collect data on galvanic skin response and heart rate. But we are not sure yet how best to combine that information to reach a conclusion about stress level.

Another example: There are sensors that measure aspects of a person’s gait. Weaving back and forth could mean they’re under the influence or they might be having a stroke. For a sensor to really measure gait accurately to yield information about a condition or mood, a person would need to walk for five minutes in a confined location. Only then could the data be pulled together to reach any conclusions. So we have a ways to go to use these tools in the real world. Things look promising, but a lot more needs to happen.

Virtual experiences

Are We There Yet Score = 2

Virtual reality is being used today in some really interesting ways. The military is using it in some instances to help returning vets with PTSD. For example, the University of Southern California Institute for Creative Technologies creates a virtual city where patients are exposed to a sniper attack or experience an explosion.  There is evidence that these kinds of virtual reality tools can make a difference in terms of dealing with PTSD. Yet we don’t know how to use those tools to replicate, for example, verbal abuse that might lead to trauma or risk for substance abuse. On the other hand, virtual reality can be used to simulate the influence of some drugs. Virtual reality tools for dealing with addiction are limited, but the ones in development are promising.  

Treatment access and “one-stop shopping”

Are We There Yet Score = 4

There are automated programs for SBIRT, for teaching CBT, and for relapse prevention. A lot of improvements can still be made by integrating the monitoring devices, but there’s been a lot of progress in this area.

Networks enabling those with addiction to connect on digital platforms

Are We There Yet Score = 4.5

Things have come a long way in this area, with new options coming out regularly. You can now find platforms that are “walled gardens” that allow only a limited number of people to participate. This has been a popular feature of the A-CHESS app.  Then there are fully open programs that allow anybody to join. The challenge, of course, lies in ensuring privacy and honesty.

Tailored digital messaging to thwart risk for relapse

Are We There Yet Score = 3

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