Elsevier

Addictive Behaviors

Volume 65, February 2017, Pages 174-178
Addictive Behaviors

Short Communication
Smartphone-based support system (SoberDiary) coupled with a Bluetooth breathalyser for treatment-seeking alcohol-dependent patients

https://doi.org/10.1016/j.addbeh.2016.10.017Get rights and content

Highlights

  • Relapse prevention is a clinical challenge in the management of alcohol dependence.

  • A support system in place enabling continuous self-monitoring may be beneficial.

  • We developed a smartphone application (SoberDiary) coupled with a breathalyser.

  • We examined the benefits of SoberDiary in assisting patients with recovery.

  • Increased SoberDiary compliance is associated with better clinical outcomes.

Abstract

Background

Relapse prevention in patients with alcohol dependence (AD) has long been a clinical challenge. It is vital to provide services with minial restrictions for patients to have access to continuous after-treatment care. The study was aimed to examine the benefits of a smartphone application (SoberDiary) coupled to a Bluetooth breathalyser to assist patients recovering from alcohol dependence (AD).

Methods

This study recruited 38 patients that fulfilled the DSM-IV-TR criteria for AD and who were undergoing an outpatient maintenance program for abstinence. The participants were provided a breathalyser and smartphone-equipped SoberDiary and followed for 12 weeks. The participants were divided into highly adherent (HA) and less adherent (LA) groups according to the medium number of reward points they were awarded for using the SoberDiary system throughout the follow-up period based on the average amount of time spent on using the application, the number of function modules they accessed, and the number of BrAC tests they completed each day.

Results

19 of the patients were classified as HA and 19 patients were classified as LA group. Members of the HA group recorded fewer drinking days and drinks consumed per week, a higher cumulative number of abstinence days, a higher abstinence rate, less pronounced anxiety, and superior quality of life.

Conclusions

The proposed smartphone-assisted support system coupled with a Bluetooth breathalyser might be a feasible supplement to conventional treatment for AD. Higher SoberDiary compliance appears to be associated with better clinical outcomes.

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.

References (21)

There are more references available in the full text version of this article.

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