Short CommunicationSmartphone-based support system (SoberDiary) coupled with a Bluetooth breathalyser for treatment-seeking alcohol-dependent patients
Introduction
Alcohol dependence (AD) has been characterised as a chronic disorder that presents an enduring vulnerability to relapse. Unfortunately, AD treatment is commonly delivered as a series of acute care sessions (Etheridge et al., 1995, McLellan et al., 2000), which means that individuals seeking treatment often face the challenge of maintaining sobriety upon returning to the same environment where they had struggled with alcohol dependence previous to seeking treatment. Studies have shown that 40%–60% of patients treated for alcohol problems relapse within 3 months, and this rate increases to 70%–80% within 12 months (Bradizza et al., 2006, McLellan et al., 2000, Witkiewitz and Marlatt, 2004).
Sustained care is generally more effective in achieving favorable outcomes (McKay, 2005, McLellan et al., 2005); however, this requires that patients have access to continuous monitoring and after-treatment care with minimal restrictions on the provision of services (Arria and McLellan, 2012, McLellan et al., 2000, White, 2007). Smartphones provide a ubiquitous service platform, which could be used to overcome access barriers to intervention services in the daily lives of patients (Gustafson et al., 2014).
Previous research on the use of mobile phones for AD treatment include telephone-based monitoring of medication adherence (Stoner & Hendershot, 2012), behavioural self-control training to withstand cravings (Yu et al., 2012), and video-recording breathalyser tests to measure breath alcohol content (BrAC) combined with contingency management procedures (Alessi & Petry, 2013). Two recent studies used, the Addiction-Comprehensive Health Enhancement Support System (A-CHESS) (Gustafson et al., 2014) and Location-Based Monitoring and Intervention for Alcohol Use Disorders (LBMI-A) (Dulin, Gonzalez, & Campbell, 2014) to monitor patients with AD. These two smartphone applications with composite functions have proven effective in reducing the incidence of hazardous drinking and promoting abstinence. This is achieved by providing multiple self-administered intervention modules designed specifically as a support mechanism for AD treatment. Alcohol monitoring in a clinical setting is important for early detection and deterrence of relapse. Thus, we surmise that integrating a smartphone application with devices for the continuous monitoring of alcohol intake could help to reinforce alcohol abstinence reliably and validly (Alessi & Petry, 2013). To the best of our knowledge, this is the first study to integrate a smartphone application with a Bluetooth breathalyser for AD treatment. The proposed smartphone system is called SoberDiary, comprising multiple function modules based on existing alcohol use disorder interventions and a Bluetooth breathalyser to enable the self-monitoring and self-management of drinking behaviour. The aim of this pilot study was to elucidate the potential benefits of using SoberDiary for a period of 12 weeks as a supplement to outpatient post-withdrawal treatment.
Section snippets
SoberDiary system overview
The SoberDiary system includes a portable Bluetooth breathalyser, phone application, and back-end server. The participants are expected to self-administer breath alcohol concentration (BrAC) tests using breathalysers and input real-time feedback into the phone app. The phone provides corresponding prompts in the form of feedback based on the test results and input data. The development of the SoberDiary was based on empirically supported psychosocial interventions for alcohol use disorder that
Results
This study recruited 38 participants (mean age: 42.2 ± 7.4). The HA and LA groups presented comparable baseline clinical and background characteristics, including drinking variables prior to treatment for alcohol withdrawal. One exception was that participants in the HA group were older (mean age: 44.7 ± 6.3 vs 39.6 ± 7.7, P = 0.03) and had a longer history of drinking alcohol (28.0 ± 10.4 vs 21.3 ± 7.6 years, P = 0.04). Each day, the participants took an average of 2.2 BrAC tests (HA vs LA group: 2.9 ± 0.1 vs
Discussion
This is the first study to investigate the advantages of a novel smartphone application (SoberDiary) coupled with a Bluetooth breathalyser for patients with AD. In conjunction with post-withdrawal outpatient treatment, it was found that better compliance in the use of SoberDiary was associated with better outcomes; i.e., drinking frequency, drinking amount, abstinence, anxiety and quality of life. These findings demonstrate the feasibility of using a smartphone-based support system to deliver
Role of funding sources
This study was funded by Ministry of Science and Technology (MOST 103–2628-B-532-001-MY3, 105-2633-E-002-001, and 105-2221-E-002-172) and Taipei City Government (TCH10401–62-040 and 10,501–62-040), and National Taiwan University (NTU-105R104045), Taiwan. The funders played no role in the study design, collection, analysis or interpretation of the data, writing the manuscript, or the decision to submit the paper for publication.
Contributors
CWY, YCC, CHL, MCH, and HHC developed the SoberDiary system. CWY, MCH, HHC designed the study. YCC conducted literature searches. CWY, YCC, and MCH enrolled the patients. YCC, CHC and PHK conducted the statistical analysis. CWY and MCH wrote the first draft of the manuscript and all authors contributed to and have approved the final manuscript.
Conflict of interest
All authors declare that they have no conflicts of interest.
Acknowledgements
The authors would like to thank Ms. Fan-Chi Yeh for the assistance on the statistical analysis.
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