A four-month pilot study is testing the use of a smartphone with 30 offenders in the Ayer Concord drug court program in Massachusetts. Early trials have found that the phone can help people stay in recovery.

The smartphone application is called Addiction-CHESS (A-CHESS) and was developed by researchers at the University of Wisconsin-Madison. Created by the University’s Center for Health Enhancement Systems Studies (CHESS), which houses NIATx (formerly the Network for the Improvement of Addiction Treatment, now devoted to improving addiction and mental health treatment), the A-CHESS project is currently in clinical trials funded by a $2.8 million grant from the National Institute on Alcohol Abuse and Alcoholism (NIAAA). The drug court pilot is funded by the Center for Substance Abuse Treatment (CSAT) of the Substance Abuse and Mental Health Services Administration (SAMHSA).

“Our early evidence in the clinical trials indicate that this does reduce heavy drinking days,” said NIATx deputy director Kim Johnson in an interview last week. The application should be used in conjunction with a treatment program, but no decision has been made yet about whether to market it directly to consumers, said Johnson. “I lean toward limiting this to providers,” she told ADAW. “The interaction with the therapist is a big part of what makes this useful.” The counselor providing the support is the counselor who treated the patient. “In the clinical trial, this was conceptualized to be for someone who is in treatment, or is just leaving treatment,” said Johnson. “If it were to be used instead of treatment, I’d want to test for that first, to see if it works.”

Drug court

A-CHESS gives the patient 24-hour access to support from a counselor, and also other applications that support recovery, via an Android (Google-made smartphone). It includes a “panic button” that can be programmed to give whatever response the user wants — for example, a direct text to the counselor, or a recording of the user’s child saying “Daddy, please come home,” or playing a song. The GPS can be programmed to give a certain response, as well, whenever the user gets near a bar that he used to get drunk at, for example. A-CHESS also allows for real-time video counseling.

It was CSAT — the funder — that was interested in having the product tested with a drug court, said Johnson. The researchers at the Center will measure how the participants use A-CHESS over the four-month period, which features they use most, and how their substance abuse compares to that of other drug court participants. The researchers will also ask participants, substance abuse counselors, judges, and drug court administrators for feedback.

Johnson is concerned that the drug courts will view the application as monitoring the offenders. “This is not a monitoring tool,” she said. “The therapist only sees what the person wants them to see.” In this pilot, the drug court isn’t requiring that information be shared with the court. Only the researchers will have access to it, and they obtained a federal certificate of confidentiality that protects the information, said Johnson.

“Our primary hypothesis is that A-CHESS will improve competence and autonomy, which are important to help individuals succeed in drug court treatment,” said David H. Gustafson, principal investigator for the A-CHESS study.

A-CHESS is not for sale yet, and the clinical trial is mainly for advocacy purposes. The A-CHESS doesn’t have to be approved by the Food and Drug Administration (FDA), at least not at this point, said Johnson. “But there are a lot of conversations about these medical devices, and the FDA is looking at these as possible medical devices,” she said. “There’s a lot of development work being done in this arena, whether for phones or computers.”

The application includes a weekly assessment — the Brief Assessment of Mood — which includes 20 questions. If the responses reach a threshold that is of concern, the counselor gets the information immediately, said Johnson.

Marketability questions

It’s too soon to say how counselors or treatment programs could be reimbursed for the treatment services provided via A-CHESS, said Johnson. But she said that the Centers for Medicaid and Medicare Services, as well as private insurance companies, are interested in technological solutions to treating chronic disease. “Someone with a chronic disease is dealing with it all the time, but the treatment provider is with that person only briefly,” she said.

The Center is already working with Kaiser Permanente on a similar product for breast cancer patients. “They are interested in this because clinical outcomes are improved if there’s an interaction piece with physicians or care providers,” she said. “And it potentially lowers the cost of care, which is why insurers are interested.”

The market price for A-CHESS hasn’t been determined yet, but it would be a minor part of the total expense, said Johnson. The phones themselves are less than $200 each. It’s possible that A-CHESS will be developed for other smartphones such as the Blackberry and iPhone, she said.

The main expense would be the monthly service. For the pilot and the clinical trials, unlimited service is being purchased. But many patients only buy service by the minutes – the “pay as you go” plan – and don’t have unlimited service. “We need to look at this in terms of feasibility and marketability,” said Johnson.

Treatment providers shouldn’t worry about being replaced by smart-phones, said Johnson. “We know there are 2.5 million people who come to treatment, and 20 million who need it.” There are computerized versions of cognitive behavioral therapy, and they are effective, “because the computer never wanders off course,” said Johnson. “Some people say the counselor is what keeps people in treatment, and is the only way to keep people engaged in their change process. But is it always necessary for a change process to have that human interaction?” That’s what the pilot, and the clinical trials, are designed to explore. Stay tuned for updates.