Abstract
BackgroundAdults who are homeless are more likely to have alcohol use disorders (AUDs) compared with domiciled adults. Although AUD treatments are commonly available, many factors (eg, transportation limitations and inability to schedule appointments) contribute to low treatment completion rates and low success rates of these interventions among adults experiencing homelessness. Most adults who are homeless own mobile phones; however, no interventions have been developed that use mobile devices to deliver and support AUD interventions for this population. Mobile phone–based AUD interventions may reduce barriers that have limited the use and utility of traditional interventions.ObjectiveThe aim of this study is to (1) identify variables (eg, affect, stress, geolocation, and cravings) that predict drinking among homeless adults (phase I), (2) develop a mobile intervention that utilizes an algorithm to identify moments of risk for drinking and deliver treatment messages that are tailored to the individual’s current needs in real time (phase II), and (3) pilot test the intervention app (phase III).MethodsIn phase I, adults experiencing homelessness with an AUD (N=80) will complete baseline, equipment, 2-week, and 4-week follow-up visits in person. Participants will be prompted to complete five daily ecological momentary assessments on a study-provided smartphone for 28 days. The smartphone app will collect GPS coordinates every 5 min for the entire 28-day study period. Participants will wear a transdermal alcohol sensor that will objectively measure alcohol use. In phase II, we will use phase I data to develop an algorithm that identifies moments of heightened risk for drinking and develop treatment messages that address risk factors for drinking. Phase III will pilot test the intervention in 40 adults experiencing homelessness with AUD.ResultsThis project was funded in June 2018. IRB approval was obtained in October 2018, and data collection for phase I began in February 2019. Phase III data collection is expected to conclude in 2020. To date, 80 participants have consented to the study, and data analysis for phase I will begin in early 2020.ConclusionsThis research will highlight intervention targets and develop a novel intervention for understudied and underserved adults experiencing homelessness with AUD.International Registered Report Identifier (IRRID)DERR1-10.2196/15610
Highlights
BackgroundAn estimated 6.2% of US adults will be homeless at some point in their lifetime [1]
IRB approval was obtained in October 2018, and data collection for phase I began in February 2019
80 participants have consented to the study, and data analysis for phase I will begin in early 2020
Summary
BackgroundAn estimated 6.2% of US adults will be homeless at some point in their lifetime [1]. Adults experiencing homelessness have higher rates of disease, greater risk of interpersonal violence, shorter life expectancies, and disproportionately higher health care utilization and costs compared with housed individuals [2,3,4,5]. One study found that alcohol was responsible for an estimated 17% of all deaths among homeless adults in Boston, a rate 6 to 10 times greater than in the general population [12]. In an analysis of 15 substance use disorder (SUD) treatment programs for homeless individuals funded by a National Institute on Alcohol Abuse and Alcoholism cooperative agreement [21], dropout rates ranged from 67% to 97.5%. Mobile phone–based AUD interventions may reduce barriers that have limited the use and utility of traditional interventions
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