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Apps represent pocket-sized support

May 08, 2018

People in recovery face a number of challenges, but staying sober after discharge from an inpatient treatment program obviously is one of the most difficult. Treatment centers have long struggled with maintaining patient engagement in aftercare services, however.

A new class of mobile apps aimed at substance use disorders might help change that. There have been addiction recovery apps on the market for several years, many of which were basic care trackers or simplified motivational tools. Newer apps now provide more advanced therapy resources and even provide incentives for aftercare program compliance.

According to Data Bridge Market Research, the global market for mobile medical apps is growing. To date, most of these software products have focused on things like fitness tracking, but treatment specific apps are also emerging in the field of “digital therapeutics.” Diabetics can monitor their blood sugar levels using mobile devices, for example.

In addiction treatment, these apps can provide quick connections with clinicians, sponsors and peers, as well as tools to help track and manage recovery progress.

“Most of our clients have a mobile phone, and everything they want is available at their fingertips, including the location of the nearest liquor store or their dealer,” says Chelsea Brigham, clinical outreach manager at Huntington Beach, Calif.-based Simple Recovery, which offers the WeConnect mobile app to its clients. “We want to make every possible recovery resource and their support system available to them that easily as well.”

Pear Therapeutics recently received FDA approval to market its Reset addiction treatment app as a way to improve clinical outcomes for certain patients and has fast-tracked the company’s Reset-O app for opioid addiction. The company has also developed apps for treating schizophrenia, post-traumatic stress and anxiety. The Reset app delivers computerized cognitive behavioral therapy activities and is prescribed by a clinician—hence the need for FDA approval.

Soberlink created a remote alcohol monitoring system that incorporates a cellular breathalyzer with facial recognition that sends real-time blood alcohol content results to the client's treatment provider or support team. The remote monitoring system is being used by Hazelden Betty Ford and Caron Treatment centers in their continued care programs.

In other examples, SoberTool tracks sober days and provides reminders. rTribe, developed by a group of people in recovery, also provides reminders and progress tracking capabilities, as well as ways to create prevention plans built around triggers. There are also a number of free 12-Step based apps and instant meeting finders.

The Hazelden Betty Ford Clinic now has its own app store, which includes tools from other treatment centers and third-party apps. Researchers at the Massachusetts Institute of Technology even came up with a mobile device called iHeal that monitors motion, skin temperature and heart rate to alert patients when they might be under relapse-triggering stress.

Monitoring progress

For treatment providers, these apps offer patients a way to stick with their aftercare plans, while also providing updates to counselors who otherwise might be in the dark as to their clients’ progress.

At Simple Recovery, the HIPAA-compliant WeConnect app is made available voluntarily to all clients upon admission.

“It provides continuing care access to clients, on a platform that makes sense,” Brigham says. “People can stay sober in the confines of treatment, but it is more challenging when they reintegrate into the larger community. They lose the accountability they had in treatment, and lose contact with peers and therapists. They don’t have the same support system.”

All clients and clinicians have access to the app. It includes a calendar that is populated with information from the client’s discharge plan. The app also includes geo-location technology, so it can track whether the client attended a meeting, for example, or kept an appointment.

“It tracks compliance, and if you stay at 70%, there are incentives available through the app,” Brigham says. “You earn points for completing activities, and once you get so many points you can get a gift card or earn other rewards.”

The app also includes an “S.O.S.” button to allow clients to reach out to sponsors, case managers or therapists if they have relapse or fear they might be on the verge of a setback. The tool is voluntary and provided free to the clients for a year. After the first year, they can opt in for a fee. Counselors have access to the data, and Simple Recovery has also implemented an education group in the clinical setting that is geared toward WeConnect users.

“We strongly encourage them to use it, but it’s not mandatory,” Brigham says. “In some cases, they say they don’t want to be tracked because they feel like someone is watching them, but that’s not how the app works. It’s not us watching them; it’s based around self-accountability.”

Improved abstinence through mobility

There isn’t much generally available data about how effective these apps are yet, but Pear Therapeutics has reported its own clinical trials—a prerequisite for receiving approval from the FDA in September 2017 to market it for alcohol, cocaine, marijuana and stimulant treatment.

The company provided data from a 12-week clinical trial involving 399 patients. According to the study, patients who used the Reset application showed abstinence adherence of 40.3% compared to the control group, which had an abstinence rate of just 17.6%. The Reset users earned financial incentives through the app, which could possibly have skewed the results, but the company has pointed out that such incentives are integral part of the solution.

As the program at Simple Recovery is less than a year old, Brigham says it’s too early to gauge results. The solution is generating data that the facility will eventually use to help measure its effectiveness at preventing relapses.

“As an industry, there really isn’t a lot of data on success rates,” Brigham says. “There’s a lot of negative news, and relapse rates are high. As a clinically driven treatment provider, we want to have statistics we can use to help improve what we do based on data. For clients who relapse while using the app, we want to look at the length of the relapse. If we know that a relapse is happening, this can potentially help us shorten the length of the relapse.”

According to Yuri Maricich, chief medical officer and head of clinical development at Pear Therapeutics, the Reset clinical trials showed that the more modules of the app the patient completed, the more likely they were to remain abstinent.

“Also, patients on Reset went to more face-to-face appointments,” he adds. Because clinicians can review each client’s self-assessments, they can potentially tailor the in-person sessions to be more effective.

Another product, A-CHESS, has undergone several clinical trials, including one in 2014 that showed a reduction of “risky drinking days” among those with alcohol use disorder undergoing treatment. A more recent study of 300 patients in residential treatment showed that the app could help improve the likelihood patient would continue methadone use. Another A-CHESS study that looked specifically at alcohol recidivism was scheduled to begin this year, sponsored by New York Presbyterian Hospital.

Multitude of apps

There are hundreds of different mobile apps for recovery that treatment centers could potentially offer, some free and others available for a subscription. The financial model for the more clinically focused apps like WeConnect and Reset typically rely on a mix of subscription fees or insurance coverage to pay for the service.

Treatment centers using WeConnect buy licenses for the application for counselors and patients. “It’s similar to software like Salesforce, in that we get a certain number of log-ins, and then for every log-in on top of that we pay a fee,” Brigham says. “They do a census based on how many clients we have. We’re also at a different price point because we are a smaller center.”

Last year, WeConnect was offering a price point of $98.55 per user for a year-long subscription. Individuals could sign up for $7.99 per month.

Simple Recovery has both private-pay and insurance-based clients. The WeConnect app is paid for as part of the facility’s general clinical services. The recovery group that is focused on WeConnect users is billed as part of the relapse prevention group.

Pear Therapeutics has taken the approach that a digital solution should be studied, tested and paid for the same way as any other form of treatment, officials say.

“It should be studied using a randomized clinical trial approach,” says Maricich. “We are working with traditional third-party payers and insurance companies to reimburse providers for the product using health economic outcomes data to demonstrate medical value.”

Patients receive a prescription for the app that includes an access code. Once logged on, patients complete therapeutic cognitive activities, including functional analysis activities, drug refusal skills, problem solving, etc. There are also fluency training quizzes, as well as a contingency management component that includes motivational incentives.

Reset-O functions the same way, but includes other features specifically for patients using medication-based therapies to treat opioid addiction.

“There is no cost to clinicians,” Maricich says. “We think of this as a specialty therapeutic product, and those products should be reimbursed for by payers. Patients should have access at no cost.”

Reset, WeConnect and most of the other treatment apps were designed to augment in-person therapies, but there are other models as well.

Ria Health has developed a solution for treating alcohol use disorders that is entirely mobile-based, with access to both a medical team and prescription medications. Annum Health offers a similar solution that is marketed as an alternative to traditional treatment.

Patients with severe substance use are unlikely to benefit from app-only treatment, of course –- even with GPS and other checks, it’s too easy to outfox a smartphone. But both Maricich and Brigham say that motivated clients already in treatment can benefit both from the organizational tools in these apps and the quick connection to support resources.  

There are likely more apps on the way, as well. Pear Therapeutics is one of nine companies taking part in an FDA pilot program aimed at helping the agency craft policies for regulating digital health technologies that claim to product clinical benefits. Other participants include Apple, Fitbit, Samsung, and Verily.

“Addiction is an isolating and lonely disease,” Brigham says. “Most recovery treatment centers are social model recovery systems. We realize that the idea that alumni can always come back in person is outdated and unrealistic.”

Brian Albright is a freelance writer based in Ohio.

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