Abstract
BackgroundNew smartphone communication technology provides a novel way to provide personalized continuing care support following alcohol treatment. One such system is the Addiction version of the Comprehensive Health Enhancement Support System (A-CHESS), which provides a range of automated functions that support patients. A-CHESS improved drinking outcomes over standard continuing care when provided to patients leaving inpatient treatment. Effective continuing care can also be delivered via telephone calls with a counselor. Telephone Monitoring and Counseling (TMC) has demonstrated efficacy in two randomized trials with alcohol-dependent patients. A-CHESS and TMC have complementary strengths. A-CHESS provides automated 24/7 recovery support services and frequent assessment of symptoms and status, but does not involve regular contact with a counselor. TMC provides regular and sustained contact with the same counselor, but no ongoing support between calls. The future of continuing care for alcohol use disorders is likely to involve automated mobile technology and counselor contact, but little is known about how best to integrate these services.Methods/DesignTo address this question, the study will feature a 2 × 2 design (A-CHESS for 12 months [yes/no] × TMC for 12 months [yes/no]), in which 280 alcohol-dependent patients in intensive outpatient programs (IOPs) will be randomized to one of the four conditions and followed for 18 months. We will determine whether adding TMC to A-CHESS produces fewer heavy drinking days than TMC or A-CHESS alone and test for TMC and A-CHESS main effects. We will determine the costs of each of the four conditions and the incremental cost-effectiveness of the three active conditions. Analyses will also examine secondary outcomes, including a biological measure of alcohol use, and hypothesized moderation and mediation effects.DiscussionThe results of the study will yield important information on improving patient alcohol use outcomes by integrating mobile automated recovery support and counselor contact.Trial registrationClinicalTrials.gov, NCT02681406. Registered on 2 September 2016.
Highlights
New smartphone communication technology provides a novel way to provide personalized continuing care support following alcohol treatment
Most positive factors associated with recovery, such as the development of supportive social networks, interests, and passions that reinforce abstinence, improved coping responses, employment, and other activities that provide a sense of worth and self-esteem, are slow to change and require ongoing support to prevent deterioration [1, 10, 11]
Aim The primary objective of the study is to test for main effects for Telephone Monitoring and Counseling (TMC) and A-Comprehensive Health Enhancement Support System (CHESS) and the combination of TMC + A-CHESS on the primary alcohol use outcome in Intensive outpatient program (IOP) participants with moderate-to-severe alcohol use disorder
Summary
New smartphone communication technology provides a novel way to provide personalized continuing care support following alcohol treatment. Most positive factors associated with recovery, such as the development of supportive social networks, interests, and passions that reinforce abstinence, improved coping responses, employment, and other activities that provide a sense of worth and self-esteem, are slow to change and require ongoing support to prevent deterioration [1, 10, 11]. These findings may explain why treatments derived from an acute care model are of limited effectiveness in the long-term management of alcohol dependence.
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