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Can new technologies prevent relapse?

June 1, 2006
by BRET R. SHAW, PHD
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“Body monitoring” technologies hold promise for helping people in recovery

Relapse following treatment for drug and alcohol addiction is common. Indeed, relapse rates for addictive diseases usually are in the range of 50 to 90%.1,2 Fortunately, research indicates that many of these relapses are predictable and ultimately preventable if people in recovery are provided the proper support and tools.

Researchers from a new initiative called Innovations for Recovery at the University of Wisconsin–Madison are exploring how technology can improve addiction treatment outcomes. One of the areas researchers are examining is how body-monitoring instruments can be used to prevent relapse.

“New applications for body-monitoring technology could proactively prevent relapse rather than just stop it once it has already begun,” says David Gustafson, PhD, professor of engineering at UW–Madison and the leader of Innovations for Recovery, which is funded by the Robert Wood Johnson Foundation. “One of our goals is to identify promising body-monitoring technologies that assess appropriate physiological measures so we can more effectively provide people the support they need to stay clean.”

Wearable Biomonitoring Instruments

Body-monitoring technology could be used to detect when someone is experiencing anxiety or stress related to a specific situation that could lead to relapse.

“We know that stress is the most accurate predictor of relapse, and relapse is often preceded by stressful episodes characterized by feelings of strong negative moods,” says Timothy Baker, PhD, professor of psychology at UW–Madison. “This suggests that autonomic nervous or somatic system activity associated with stress and distress can be used to detect such stressful episodes, which is important since laboratory research shows that individuals may actually be unaware of when they are becoming stressed or experiencing negative moods.”

Indicators of stress, such as heightened skin conductance of electric current and increased heart rate, pulse, and muscle tension, usually accompany higher states of arousal, and these physiologic indicators can be measured by wearable technology available today. Such products offer different measurement capabilities and come in forms such as shirts with integrated sensors, removable patches, or sensors that attach to fingers. BodyMedia (www.bodymedia.com) is one of the leaders in creating easy-to-wear monitors that collect the physiologic information needed to measure arousal and incorporate integrated wireless data transmission and Web-based interfaces for interpreting results.

Consider the following scenario of how such wearable technologies might be used to improve addiction treatment and recovery:

A husband (in recovery from alcoholism) and his wife attend a party. The couple begins to argue, and the physiologic sensors the man is wearing record a spike in arousal. An application sends a message to his mobile phone asking if he needs any support. Likewise, the sudden increase in stress triggers text messages to be sent to the mobile phones of people in his support network, such as a peer sponsor and a therapist, who immediately call him to make sure he is managing the stress appropriately (i.e., not drinking).

Biomonitoring devices have some limitations despite their many possibilities. First, the most fully featured devices can be relatively costly. Although costs can be expected to decrease over time, the current instruments also are not specific enough to maximize their use for people in recovery; they indicate general arousal rather than specific emotional states such as anxiety or depression. An elevated heart or pulse rate or drop in the resistance of skin to the passage of electric current can be associated with emotional or physiologic arousal but does not indicate whether the arousal is positive or negative. A person may be aroused because he is craving alcohol or drugs—or because he is flirting or watching his favorite football team score a touchdown.

Despite these shortcomings, general arousal data could be used to trigger automatic “check-ins” to confirm if a person is doing okay or to cross-check physiologic data against his schedule to objectively discuss routines or situations that may relate to negative arousal and increased likelihood of relapse.

Embedded Microchip Sensors

Another type of body-monitoring device that offers the potential to prevent relapse involves microchip sensors (with wireless capabilities) implanted in the body. Embedded sensors could assess rising cortisol levels that indicate cumulative stress over a person's day rather than immediate stress that comes from a moment of high risk for relapse. Research indicates that a pattern of gradually rising distress levels is a significant predictor of relapse. This suggests that information on gradually emerging stress levels may be useful in the timing of interventions.

“If a pattern of escalating stress could be short-circuited, this might give people in recovery the resilience to resist addictive impulses as they arise,” says Dr. Baker. Rising stress levels, measured by the implanted microchips and transmitted to reporting devices such as computers and phones, could alert the person in recovery that he should implement some healthy stress-management strategies such as exercise or meditation, or inform treatment providers and peer sponsors that additional support may be needed.

Microchips could be designed to trigger the release of implanted pharmaceutical agents to reduce cravings for alcohol or other drugs when overall daily stress levels surpass a given threshold.

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