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Utilizing Smartphone Technologies in Recovery Services

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Currently, there is a lack of people receiving treatment for alcohol and substance related issues. In the United States, only one in fourteen people with alcohol problems seek treatment, compared to one in three in Canada (Cunningham, Kypri, & McCambridge, 2011). The most common reasons for this phenomena are due to stigma, embarrassment, the desire to handle own problems, and difficulty in accessing treatment—lack of transportation or lack of service providers—especially in rural areas. For these reasons, emerging technologies have created opportunities for at-risk populations to seek treatment online rather than face-to-face interactions. In addition, these technologies have the potential to contribute to the evidence-based research movement (Cunningham et al., 2011).

 

 
In today’s globalized world, people are finding innovative and creative ways to benefit from the growing amount of available technology. In addiction treatment, using smartphone technology as an aid in recovery is becoming increasingly popular (Marsch, 2012). As of 2013, 61 percent of the United States population reported owning a smartphone (Stern, 2013), and ownership is robust across most demographic groups (Smith, 2014). This paper provides information on current smartphone technologies and how they might benefit clinical activities throughout the addiction treatment field.

 

 
Utilization of Smartphones in Recovery Services  

 

 
There is current research on the utilization of smartphone applications in recovery services for drug and alcohol abuse. Due to the boom in technology within the past decades, the internet has made it easier to find resources for those struggling with addiction. Developers have created mobile applications (apps) that facilitate recovery. These applications include a variety of tools to help those recovering from using alcohol and other drugs. One such application is called Alcoholics Anonymous’ (AA) Speakers to Go, which has over five hundred recordings of AA speakers from the Speakers Collection. Other applications that agencies can utilize in recovery services include AA Steps Away, which is a directory of meetings in the United States, Canada, and abroad; and AA Companion, which has a sobriety calculator, daily meditations, and the AA Big Book digital reader. Another application, called iHeal, involves users wearing a wrist sensor to keep track of cravings and triggers by mapping indicators of the sympathetic nervous system. Additionally, iPromises is another application that provides users access to sponsors, visual journals, and calendars to keep track of progress and meetings. Finally, Afternoon Affirmation is an app that offers inspirational quotes, photos, and videos every day at 1:00 pm (Peters, 2014a). 

 

 
Agencies and services should be aware that there are recovery applications for many ages. Teenagers who own smartphones can also benefit from recovery and preventative applications. One application, Drinking Mirror, is mainly used for entertainment and educational purposes for teenagers. Drinking Mirror provides a visual outcome of alcohol consumption. This involves the users taking a picture of themselves with their smartphone and then providing the number of alcoholic drinks consumed per day. As a result they will see a display reflecting what they could look like after a decade of drinking at their current rate (Cornerstone Recovery Center, 2013). 

 

 
One application is known as A Day at a Time, which provides access to the digital AA Big Book along with daily meditations, an abstinence tracking system, and other resources. Another application on the market is called My Ongoing Recovery Experience (MORE) “Field Guide to Life.” This application is part of a web-based recovery program that guides users in early recovery for a year. Finally, Mindfulness Meditation is an application that helps users set a daily time to meditate and relax (Ianculescu, 2014).  

 

 
For agencies to utilize these applications they should be aware of what types of operating systems (iOS, Android, etc.) their client’s smartphone uses. Once they are aware of the type of operating system that their clients use, they can direct their client to the correct application store. Increasingly, however, mobile applications are being made to function cross-platform, meaning they can be accessed by users regardless of their phone’s operating system. As previously mentioned, different smartphones have different application stores. If a client reports having an Android smartphone then their application store will be called the Google Play Store and will already be installed on their phone. Once they open the store they can search for the application in the search bar (Google Play, 2014). 

 

 
In 2012, researchers investigated how many smartphone applications were available for addiction recovery on Android’s application store, Google Play, and found eighty-seven. These applications were reviewed by the researchers for their content and treatment models. It was discovered that many of the applications had common factors. The majority of the applications had an educational piece to them, to inform the user and help increase their knowledge about addiction and addictive substances. In addition to the information piece, the applications typically also involved motivational strategies to increase the user’s motivation to remain free of the addictive substance. The applications also involved inspirational messages and access to social support groups (Savic, Best, Rodda, & Lubman, 2013).

 

 
In addition to analyzing the content of the applications on Google Play, the researchers also reviewed user comments. Savic and colleagues reported that many of the users who commented on the recovery applications had positive remarks, stating that that their experiences with recovery-based applications were informative, inspirational, and helpful (2013).  

 

 
The costs of applications vary. In 2012, when the recovery applications were analyzed on Google Play, about one-third of the recovery applications were available for free. The mean cost of a recovery application was $2.31 with the most expensive application costing $10.40. (Savic et al., 2013). 

 

 
Currently, there is a limited amount of research focused on the impacts of smartphones in recovery services. Although there is a lack of research, there is a growing amount of applications becoming available on smartphone application stores. As a clinician, it would be beneficial to download the application and familiarize oneself with it. As a result, the client can be presented with a general overview of what the different applications have to offer. As more research becomes available, it is likely that an increased amount of applications will be clinically tested in order to better understand their impacts. 

 

 
Current Research on Recovery Outcomes  

 

 
Current studies present a limited amount of evidence based research on the outcomes of recovery based smartphone applications. Geospatial technology has made it relevant for scientists to keep track of sobriety and relapse of users on smartphone apps (Stahler, Mennis, & Baron, 2013). Ecological momentary assessment (EMA) along with geospatial data is used in smartphones to keep track of the location of the user and monitor movements, evaluating how the environment can impact the user (Stahler et al., 2013). Applications such as the Body Awareness Research Network (BARN) have shown positive outcomes with asthma control, smoking cessations, alcoholism, people infected with HIV, and people who are economically and socially disadvantaged (Gustafson et al., 2011a). 

 

 
Through cognitive behavioral therapy (CBT), mindfulness has been helpful to sobriety in becoming aware of one’s distressing thoughts, emotions, and actions that could lead to relapse (Appel & Kim-Appel, 2009). Smartphone technology can improve the outcome of mindfulness in helping the user monitor their sobriety. Other measures such as the addiction severity index (ASI), WHO quality of life instrument, electronic health records (EHR), and treatment effectiveness assessment (TEA) represent traditional ways of assessing clients on their recovery (Ling, Farabee, Liepa, & Wu, 2014). Smartphone applications can contribute to these assessments by making it easier on the client and the medical professionals to monitor and track recovery.  

 

 
Tested Models of Technology in Addiction Services  

 

 
Just as there are numerous smartphone operating systems, there are also numerous models of technology in addiction treatment. Not all of the models of technology in addiction treatment yield the same results. The concept of using smartphone technology as a tool in addiction recovery is a relatively new idea; as a result, almost all of the applications have not been clinically tested. A research team from the University of Wisconsin-Madison has begun to shift the expectations of technology used in recovery. Beginning six years ago, an application to aid a person in recovery has been designed and developed. The application is referred to as Addiction-Comprehensive Health Enhancement Support System (A-CHESS). This is a cutting edge technology because it is the first of its kind to be clinically tested. This smartphone application uses an array of techniques to reduce a person’s likelihood to drink (University of Wisconsin-Madison, 2014). 

 

 
The application reduces a person’s risk of drinking by implementing relaxation techniques, daily messages of inspiration and support, and helpful reminders and tips. In addition to these techniques, A-CHESS also has a weekly assessment tool to track the progress of the person in recovery. The assessment survey is taken by the participant and as a result their counselor is able to assess their risk of relapse. Finally, A-CHESS also has a GPS tracking system to monitor the location of the recovering person. This is helpful because the person in recovery preprograms trigger spots for drinking. This could include their favorite bar or club. If the person gets within a certain distance of their trigger spot they will have individualized tools to help them avoid the trigger location. This could include personalized messages or reminders. There is even an option to add a self-made video journal that begins playing if the person is too close to the trigger spot. The video journal is typically the person in recovery reminding themselves why recovery is so important to their well-being (University of Wisconsin-Madison, 2014).

 

 
A-CHESS was the first of its kind to undergo a randomized clinical trial. It is important to mention that this mobile application is not currently available for public download. Agencies have used A-CHESS and persons in recovery have voluntarily agreed to try the application. The clinical trial set out to test drinking levels as well as risky drinking. Risky drinking is considered more than three drinks for women and more than four drinks for men in a two-hour time period (Gustafson et al., 2014).

 

 
The clinical study was made up of 349 participants who were in recovery from addiction problems. All participants received some level of treatment services. There were two distinct groups in the study; one group received a smartphone after treatment with the application and the other group received no smartphone or application. Throughout the study the researchers gathered self-reported data related to how many times the participants engaged in drinking and risky drinking. After the study concluded, there was a one-year follow up. It was reported that those who had access to the A-CHESS app averaged one day of risky drinking that month. The control group who did not have access to the application reported an average of three days of risky drinking that month. Interestingly, over half (52 percent) of the participants with access to A-CHESS reported that they had completely abstained from alcohol for the past year. In comparison, 40 percent of those without the application reported that they had maintained complete sobriety for the entire year (Gustafson et al., 2014). 

 

 
Benefits and Barriers to Recovery  

 

 
Nancy Barnett, an associate professor at Brown University Center for Alcohol and Addiction Studies, stated that an app cannot replace a face-to-face meeting (Peters, 2014b). On the other hand, smartphone apps are certainly seen as helpful in addiction recovery. Supporters of smartphone apps who are in recovery state that smartphone apps can be used as an adjunct to treatment or by itself in therapy (Vimont, 2011). Other benefits include cost-effectiveness, reaching new target audiences, creating access to places with limited resources such as prisons and schools, and increasing availability of resources when clinicians are not available (Vimont, 2011).

 

 
Although many recovery programs are utilizing smartphone technology as a tool in the aid of addiction there are specific barriers that need to be addressed. The first and most overt barrier is that not everyone who needs treatment owns a smartphone. As previously stated, about 61 percent of the adult population owns a smartphone (Stern, 2013). The remaining 40 percent of the population are largely unable to benefit from smartphone applications. Reasons for not owning a smartphone vary; some individuals may not own a smartphone because of a lack of funds to pay for the phone and maintain the monthly payments.

 

 
Another barrier is that smartphone technology can be hard to learn to use for many individuals. Many people who do not own new technology report apprehension because of the difficulty of learning how to use technology.  In addition, some people may have difficulty reading or perceive barriers that make reading a screen impossible (Smith, 2014). Another consideration about the use of smartphones in recovery is confidentiality concerns. When using technology in any health care setting, there is risk of private and confidential information being less secure (Gill, Kamath, & Gill, 2012). 

 

 
Another limitation to smartphone applications in recovery services is that the majority of applications are specifically tailored to the continuing treatment of alcoholism. Very few applications currently on the market focus on other drug use or other types of addictions such as a gambling addiction (Savic et al., 2013).

 

 
Conclusion  

 

 
Future research should include more clinically tested trials of smartphone applications. Since only one major smartphone application, A-CHESS, has implemented a clinical trial, much is still unknown about the impacts of applications in recovery. When more research tests the effectiveness of applications for recovery, it may be possible to overcome some of the previously discussed barriers. The barriers include a lack of funds for recovering persons to afford smartphones, a lack of funds for monthly payments, issues with privacy and security, and a lack of knowledge on how to use smartphones. With additional research supporting the positive impacts of smartphone technologies on addiction, there may be increased funding opportunities in this area. With increased funding available for mobile technologies, agencies may be able to further support addiction recovery by providing clients in need with smartphone-based resources. 

 

 
Resources  

 

 
The following technology-based interventions are free of charge and accessible through the internet (Cunningham et al., 2011):

 

 
  • http://rethinkingdrinking.niaaa.nih.gov
  • www.CheckYourDrinking.net
  • www.AlcoholScreening.org
  • www.DrinkersCheckup.com
  • www.CheckYourDrinkingU.net
  • www.eChug.com
  • http://aa-intergroup.org
  • http://www.moderation.org
  • www.AlcoholHelpCenter.net
  • www.DownYourDrinking.org.uk

 

 
 

 

 
 
References  

 

Appel, J., & Kim-Appel, D. (2009). Mindfulness: Implications for substance abuse and addiction. International Journal of Mental Health & Addiction, 7(4), 506–12.
 
Chambers, B. (2011). Drug court tests recovery app for smartphones. Retrieved from http://www.drugfree.org/join-together/drugs/mass-drug-court-tests

Cornerstone Recovery Center. (2013). Addiction recovery has gone mobile. Retrieved from http://cornerstonerecoverycenter.com/cornerstone-recovery-center/addiction-recovery-has-gone-mobile/

Cunningham, J. A., Kypri, K., & McCambridge, J. (2011). The use of emerging technologies in alcohol treatment. Alcohol Research & Health, 33(4), 320–6.

Gill, P. S., Kamath, A., & Gill, T. S. (2012). Distraction: An assessment of smartphone usage in health care work settings. Risk Management and Healthcare Policy, 5, 105–14. 
 
Google Play. (2014). Apps. Retrieved from https://play.google.com/store/apps
 
Gustafson, D. H., Boyle, M. G., Shaw, B. R., Isham, A., McTavish, F., Richards, S., . . . Johnson, K. (2011a). An e-health solution for people with alcohol problems. Alcohol Research & Health, 33(4), 327–37.
 
Gustafson, D. H., Shaw, B. R., Isham, A., Baker, T., Boyle, M. G., & Levy, M. (2011b). Explicating an evidence-based, theoretically informed, mobile technology-based system to improve outcomes for people in recovery for alcohol dependence. Substance Use & Misuse, 46(1), 96–111.
 
Gustafson, D. H., McTavish, F. M., Chih, M. Y., Atwood, A. K., Johnson, R. A., Boyle, M. G., . . . Shah, D. (2014). A smartphone application to support recovery from alcoholism: A randomized clinical trial. JAMA Psychiatry, 71(5), 566–72. 
 
Hall, S. P. & Anderson, E. (2009).  Operating systems for mobile computing. Journal of Computing Sciences in Colleges, 25(2), 64–71.
 
Ianculescu, O. (2014). Nine addiction recovery apps. Retrieved from http://www.castlecraig.co.uk/blog/10/2013/9-addiction-recovery-apps
 
Ling, W., Farabee, D., Liepa, D., & Wu, L. T. (2012). The Treatment Effectiveness Assessment (TEA): An efficient, patient-centered instrument for evaluating progress in recovery from addiction. Substance Abuse & Rehabilitation, 3(1), 129–36.
 
Marsch, L. A. (2012). Leveraging technology to enhance addiction treatment and recovery. Journal of Addictive Diseases, 31(3), 313–8.
 
Peters, S. (2014a). Recovery: There’s an app for that. Retrieved from http://www.thefix.com/content/technology-and-addiction
 
Peters, S. (2014b). Can recovery apps ever replace face-to-face addiction treatment? Huffington Post. Retrieved from http://www.huffingtonpost.com/2014/02/21/recovery-apps-addiction-treatment_n_4831756.html

Savic, M., Best, D., Rodda, S., & Lubman, D. I. (2013). Exploring the focus and experiences of Smartphone applications for addiction recovery. Journal of Addictive Diseases, 32(3), 310–9.

Smith, A. (2014). Attitudes, impacts, and barriers to adoption. Retrieved from http://www.pewinternet.org/2014/04/03/attitudes-impacts-and-barriers-to-adoption/
 
Stahler, G. J., Mennis, J., & Baron, D. A. (2013). Geospatial technology and the “exposome”: New perspectives on addiction. American Journal of Public Health, 103(8), 1354–6. 
 
Stern, J. (2013). More than half of Americans own smartphones. Retrieved from http://abcnews.go.com/blogs/technology/2013/06/more-than-half-of-americans-ownsmartphones/
 
University of Wisconsin-Madison. (2014). Addiction CHESS project: Developing and testing a computer-based alcohol use disorder recovery system. Retrieved from http://chess.wisc.edu/chess/projects/AddictionChess.aspx
 
Vimont, C. (2011). Technology shows promise in substance use prevention and treatment. Retrieved from https://www.drugfree.org/join-together/addiction/technology-shows-promise-in-substance-use-prevention-and-treatment
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