Continuing care is important in the management of patients with substance use disorders. New SMART Phone communication technology provides a novel way to provide personalized continuing care support following alcohol treatment. Dr. Gustafson and colleagues at the University of Wisconsin have recently developed an addiction version of the Comprehensive Health Enhancement Support System (CHESS), a smart phone system that provides a range of functions that directly support patients. In randomized trials CHESS significantly improved: (a) quality of life and self-efficacy for women with breast cancer, (b) quality of life and costs of care in people with HIV, (c) asthma control for young children, and (d) quality of dying and survival length for lung cancer patients. Most important, findings from a recently completed NIAAA-funded study of an addiction version of CHESS (ACHESS) indicated that it produces better drinking outcomes than standard continuing care when provided to patients leaving inpatient treatment. The system's features include: Access to family, friends, and others in recovery access to discussion groups, other recovery supports, and web links tailored information on coping with stressors. Global Positioning System (GPS) alerts when patients approach risky geographic areas~ alerts/reminders of appointments~ ongoing mini assessments and check-ins (monitoring)~ and a panic button (patient or GPS activated). McKay and colleagues have also developed a telephone- based approach to continuing care, Telephone Monitoring and Counseling (TMC), which has demonstrated efficacy in two randomized trials with alcohol dependent patients. Although the ACHESS and TMC interventions use telephone technology, they have complementary strengths. ACHESS provides automated 24/7 re- co very support services and frequent assessment of symptoms and status, but does not involve regular con- tact with a counselor. TMC, on the other hand, provides regular and sustained contact with the same counselor, but does not provide ongoing support between calls. The future of continuing care for alcohol use disorders is likely to involve both automated mobile technology and counselor contact, but little is known about how best to integrate these services. To address this question, the study will feature a 2 x 2 design [ACHESS for 12 months (yes/no) x TMC for 12 months (yes/no)], in which 280 alcohol dependent patients in an intensive outpatient program (IOP) will be randomized to one of the four conditions and followed for 18 months. We will determine whether adding TMC to ACHESS produces fewer heavy drinking days than TMC or ACHESS alone, and test for TMC and ACHESS main effects. We will also conduct economic analyses, to determine the cost and cost-effectiveness of each intervention and their combination. Additional analyses will examine secondary outcomes, including a biological measure of alcohol use, and hypothesized moderation and mediation effects. The results of the study will yield important information on improving patient alcohol use outcomes by integrating mobile automated recovery support and counselor contact.

Public Health Relevance

This R01 seeks to determine whether combining an automated smart phone-based recovery support system with telephone continuing care sessions provided by a counselor improves outcomes over what can be achieved by either intervention alone. Analyses will also test the main effects of each intervention, examine secondary outcomes, and test for hypothesized moderation and mediation effects. Cost-effectiveness analyses will also be conducted. The findings will have major implications for policy decisions regarding efforts to improve the effectiveness and expand the availability of continuing care for alcohol use disorders.

National Institute of Health (NIH)
National Institute on Alcohol Abuse and Alcoholism (NIAAA)
Research Project (R01)
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Biomedical Research Review Subcommittee (AA)
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Falk, Daniel
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University of Pennsylvania
Schools of Medicine
United States
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