Coronavirus (COVID-19) has disrupted the substance use disorder (SUD) treatment system, demanding an abrupt shift from in-person care to telehealth services. The transition to virtual care could permanently change SUD treatment delivery. This shift is coinciding with COVID-19-induced social isolation and anxiety, which could increase substance use and mental health disorder severity. A common refrain in the treatment and recovery field is that addiction is a disease of isolation; the cure is connection. To provide virtual treatment and the connection so essential to recovery, many SUD treatment centers are launching virtual services without a method for assessing how, where, and why virtual services are affecting their patients' quality of life and SUD recovery. The ACHESS smartphone app is currently being used at 40 Iowa treatment sites in the parent study, ?Test of a patient-centered e-health intervention in addiction treatment settings.? ACHESS offers a guide and a method for assessing use of virtual services and an unprecedented research opportunity. From 3/3/20 to 3/20/20, sign-ups for ACHESS in the parent study increased by 67% compared to the two prior weeks. Activity on the ACHESS app has nearly doubled in the same period! This supplement will address patient and organizational factors because of their integral roles in providing virtual care and adopting patient-centered technologies. The supplement will enhance ACHESS with new COVID-19 related features designed to help patients comply with social distancing guidelines, cope with unprecedented social isolation, and access virtual services and supports. The research will study how patients use ACHESS features, how organizations refer patients to the ACHESS, how they interact with patients in ACHESS, and the overall impact of the ACHESS features. The supplement's research aims are:
Aim 1 a: Refine ACHESS to provide information, support, and data on COVID-19, social distancing, adjusting to social isolation, and how to use virtual SUD services. Then, study how patients use existing ACHESS features before (for existing ACHESS services only), during, and after the announcement of social distancing guidelines.
Aim 1 b: Assess how the enhanced ACHESS APP affects anxiety, loneliness, and reported COVID-19 infections.
Aim 2 : Create ten case studies describing how agencies implemented and used COVID-19 enhanced ACHESS and how their patients used COVID-19 enhanced ACHESS. This supplement's projected outcomes will help us understand how to design virtual recovery systems to mitigate the effects of a pandemic and the resulting social isolation. The results will help design a virtual recovery system that can be used in future emergencies and to address the on-going challenges of social isolation in society post-COVID-19.
Project Summary/Relevance Mobile phone apps, such as ACHESS, offer continual addiction recovery support, expanding the availability of effective addiction care. Use of virtual systems of care and recovery has been limited until recently when the policies related to COVID-19 have provided an unprecedented opportunity to study use of virtual patient supports. The proposed research will test if ACHESS provided information, support, and data on COVID-19, social distancing, adjusting to social isolation, and how to use virtual SUD services can affect anxiety, loneliness, alcohol and drug use, as well as reported COVID-19 infections of ACHESS patients.
