(Source: iStock Photo)
Maybe AA should add smartphones as a thirteenth step to overcoming alcoholism and addiction

If you think about this one, it sort of makes sense -- in an era where many of us would rather give up sex than our cell phones, if our beloved devices discourage us from our addictions and bad habits, we just might listen.  And research now supports that suspicion.
I. A Digital Tool to Combat Alcoholism
Researchers at the University of Wisconsin in Madison's Center for Health Enhancement Systems Studies (CHESS) have completed a study on 271 adults recovering from alcoholism.  The researchers developed an app called A-CHESS that was intended to support sobriety.  Participants were selected at several treatment centers in the midwest and northeast.  The participants used A-CHESS to help them in their path to sobriety and reported their results for a full year.
The app features several useful features designed to try to discourage relapses.
It is GPS-enabled and can sound a warning noise if you get too close to a bar.  Likewise it has a panic button that the user can press if they're thinking about drinking or buying alcohol.  The button contacts the user's closest peers and medical professionals who can reach out and discourage the person from relapsing.  While the patient is waiting for a response, it offers them links to potentially helpful materials such as tutorials on relaxation exercises.

A-CHESS panic button

Even if the user attempts to undermine the app, it has ways of trying to reach out to them and bring them back from the brink.  For example, it sends the user periodic text messages and voicemails asking how they're doing.  The user must respond and the responses are screened by the outpatient treatment center's medical staff who look for signs of trouble.  If they suspect something is amiss they can then reach out to the patient.
II. Patients Embrace the App
CHESS Director David Gustafson was the lead author of the study on A-CHESS and one of its chief developers.  He said the results were impressive and his team plans to make the app available commercially in the near future on a variety of platforms.  But don't take his word for it, he says:

We've been told [by patients] that makes a big difference.

Indeed, one criticism of the study is precisely that -- it involved self-reporting.  As the fiction "Dr. House" famously said, "I don't ask why patients lie, I just assume they all do."

But many of A-CHESS's users who participated in the study have turned into evangelists for the app.  Mark Wiitala, 32, says the app helped save his life.  He remarks to the Associated Press:

It's an absolutely amazing tool.

He said that the app's best feature was the panic button, which allowed peers at his treatment program in Middlesex County, Mass. to quickly and discretely send him support and encouragement when he was feeling down.

This emotional support may have helped the app in one of its biggest successes -- preventing risky drinking days in the app test group, versus the control group that only received traditional treatment.

III. Impressive Results

A study, published in the prestigious Journal of the American Medical Association Psychiatry (JAMA) describes:

Risky drinking days—the number of days during which a patient’s drinking in a 2-hour period exceeded 4 standard drinks for men and 3 standard drinks for women, with standard drink defined as one that contains roughly 14 g of pure alcohol (12 oz of regular beer, 5 oz of wine, or 1.5 oz of distilled spirits).
For the 8 months of the intervention and 4 months of follow-up, patients in the A-CHESS group reported significantly fewer risky drinking days than did patients in the control group, with a mean of 1.39 vs 2.75 days (mean difference, 1.37; 95% CI, 0.46-2.27; P = .003).

The study adds some insight into the treated population writing:

Most patients were white (80.2%), male (60.7%), and unemployed (78.5%); most used or abused drugs in addition to alcohol (62.5%). Mean (SD) patient age was 38 (10) years (median, 39 years).

The study showed that patients were using the app quite frequently -- with the most used feature being the peer support "panic button":

During the 8-month intervention period, patients randomized to the A-CHESS group used the system, on average, 41.1% of days (mean number of days of use, 100.2; median, 103.0) and viewed a mean number of 1967 pages (median, 1745 pages). Of the 170 patients who received A-CHESS, 122 (71.8%) pressed the panic button at least once.

Patients using A-CHES showed a higher sobriety rate and a lower incidence of risky drinking. [Image Source: Vanguardia]

And in addition to reducing the overall drinking days the app seemed to have a lasting impact on sobriety rates.  Sobriety rates among the A-CHESS users continued to go up over the 12-month treatment program, reaching 78.7 percent by 12 months.  By contrast, the control group saw sobriety rates slowly decline, falling to 65.5 percent by 12 months.  Among A-CHESS users 51.9 percent -- roughly half -- were continuously sober at each of the reporting periods (4, 8, and 12 months), while only 39.6 percent for the control group.
In other words, the smartphone app didn't "cure" alcoholism and addiction, but it did provide enough support to allow roughly an additional 1 out of every 10 patients to stay sober.
IV. Deployment Expands
Alcoholism is a massive problem in the U.S.  An estimated 18 million adult Americans -- roughly 1 in 13 people -- are estimated to be chronic alcoholics.  Many more Americans exhibit occasional risky drinking behavior that could evolve into alcoholism.  Studies have suggested alcohol is the most dangerous drug -- more dangerous than crack cocaine or heroine -- given how socially accepted and easy to obtain is, and how much problems it causes.
At the same time it is a problem intimately tied to emotional and mental health issues, a key reason why a solution like A-CHESS that features digital real-time communication features as a means of social support may be a crucial difference maker.
Dr. Gail Basch, director of the addiction medicine program at Rush University Medical Center in Chicago was not affiliated with the study, but is excited at its premise and promise.  She comments to the AP:

There is increasing excitement regarding technology-based tools in substance use treatment, prevention and education.  A stand-alone mobile app may not be the answer, but one can see how it could fit in nicely.  A real-time tool, as well as reminders throughout the day, could be very helpful for a recovering brain.

The A-CHESS app won an award late last year.  The center reports:

The winner of the iMedicalApps-mHealth Summit Research Awardwas announced during the recently concluded mHealth Summit, held December 3-5, 2012 in Washington DC.

CHESS has been testing the A-CHESS software at a number of locations since the study and adding new features.  Among its latest additions have been vibration and other features to assist deaf users.  Its been testing those at Arapahoe House, a treatment center in Colorado which specializes in providing support for deaf patients with addiction issues.
James Ness, 40, a deaf patient who uses American Sign Language told the Denver Post is helping him avoid places like bars and parties that would get him in trouble. 

James Ness using A-CHESS
James Ness, a deaf recovering alcoholic uses the A-CHESS app. [Image Sources: The Denver Post]

And while he's avoiding his old drinking buddies to a degree, he says he's encouraging them to get the app and seek treatment. He comments:

I'm here for a drinking problem, not to socialize with the wrong friends.  I'm going to go for it.

Part of what seems to make the technology so well liked by patients is that it provides them with many forms of support, while not policing them too stringently.  While it does play a little bit of "bad cop" at times via the text message and voicemail inquiries, it stops short of very intrusive features such as GPS tracking that might dissuade users.  The developers were pleasantly surprised to see many users wanted to keep using the app and its features even after the study period was over.
CHESS is also carrying out a follow-up study with the ATARI (Appalachian Assisted Therapy and Recovery Innovation), using A-CHESS to treat patients in West Virginia.

By the looks of it, it's well on its way to being able to make the treatment app commercially available across the country.

Sources: JAMA Psychiatry, CHESS on YouTube, AP, Denver Post

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