Abstract
BackgroundAlcohol abuse, other substance use disorders, and risk behaviors associated with the human immunodeficiency virus (HIV) represent three of the top 10 modifiable causes of mortality in the US. Despite evidence that continuing care is effective in sustaining recovery from substance use disorders and associated behaviors, patients rarely receive it. Smartphone applications (apps) have been effective in delivering continuing care to patients almost anywhere and anytime. This study tests the effectiveness of two components of such apps: ongoing self-monitoring through Ecological Momentary Assessments (EMAs) and immediate recovery support through Ecological Momentary Interventions (EMIs).Methods/designThe target population, adults enrolled in substance use disorder treatment (n = 400), are being recruited from treatment centers in Chicago and randomly assigned to one of four conditions upon discharge in a 2 × 2 factorial design. Participants receive (1) EMAs only, (2) EMIs only, (3) combined EMAs + EMIs, or (4) a control condition without EMA or EMI for 6 months. People in the experimental conditions receive smartphones with the apps (EMA and/or EMI) specific to their condition. Phones alert participants in the EMA and EMA + EMI conditions at five random times per day and present participants with questions about people, places, activities, and feelings that they experienced in the past 30 min and whether these factors make them want to use substances, support their recovery, or have no impact. Those in the EMI and EMA + EMI conditions have continual access to a suite of support services. In the EMA + EMI condition, participants are prompted to use the EMI(s) when responses to the EMA(s) indicate risk. All groups have access to recovery support as usual. The primary outcome is days of abstinence from alcohol and other drugs. Secondary outcomes are number of HIV risk behaviors and whether abstinence mediates the effects of EMA, EMI, or EMA + EMI on HIV risk behaviors.DiscussionThis project will enable the field to learn more about the effects of EMAs and EMIs on substance use disorders and HIV risk behaviors, an understanding that could potentially make treatment and recovery more effective and more widely accessible.Trial registrationClinicalTrials.gov, ID: NCT02132481. Registered on 5 May 2014.
Highlights
Alcohol abuse, other substance use disorders, and risk behaviors associated with the human immunodeficiency virus (HIV) represent three of the top 10 modifiable causes of mortality in the US
This project will enable the field to learn more about the effects of Ecological Momentary Assessment (EMA) and Ecological Momentary Intervention (EMI) on substance use disorders and HIV risk behaviors, an understanding that could potentially make treatment and recovery more effective and more widely accessible
We found that participants could learn to operate the phone and complete EMAs one week and integrate EMIs the week, but doing all the training at once was too much
Summary
Contribution to science and practice This study will inform the field about whether smartphone EMAs have an independent effect on addiction recovery It will assess whether EMAs can help patients to monitor multiple risk factors such as people, places, activities, and feelings. Frequent and regular EMA monitoring of risk of relapse mitigates the biases resulting from retrospective reporting and will likely enhance our understanding of the proximal antecedents of relapse and improve the timeliness and appropriateness of interventions This information may lead to improved treatment and recovery interventions for people with substance use disorders. To better understand for whom the intervention is working, we will examine whether participant characteristics (including gender, race, age, and familiarity with smartphones), pretreatment days of abstinence and HIV risk behavior, and pre-enrollment treatment experiences moderate any of the observed effects in the combined model using a multigroup MSEM with mixed effects in MPlus.
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