mobile health for alcohol use disorders in clinical practice

Conditions: Alcohol Drinking; Telemedicine

Summary: this study evaluates the impact on risky drinking days and quality of life for patients with alcohol use disorder among patients who use a mobile health smart phone application. a third of the participants will receive access to the smart phone app without any monitoring; a third of the participants will receive access to the smart phone app monitored by and connected with a peer mentor; a third will receive access to the smart phone app monitored by and connected with a health coach who works within a healthcare system.

patients in the trial will be given versions of an evidence-based mobile-health (mhealth) system (re-design based on a-chess) that is delivered using different implementation strategies according to study group. a-chess has more than 18 services designed to improve social relatedness, coping competence, and intrinsic motivation. the following describes key a-chess services that will be tested in the current study: * welcome message - patients write why they are choosing to reduce their drinking. * coping with cravings - the system automatically notifies nearby pre-approved friends, family, and peers, who can respond to a request for support. the patient can also be linked to positive activities, such as suggested games to download and play and audio/video-based relaxation recordings. * monitoring functionality- self-assessment measures, record of a-chess use, and prediction of the patient's likelihood of having a heavy drinking episode in the next week. a-chess sends patients with worrisome responses suggestions of coping skills, online peer support, healthy events, etc. with patient permission, a prediction of high-risk can be shared with others in a position to provide support. * triage and feedback functionality is designed to derail a setback in goal attainment, giving the patient 'just in time,' tailored support by linking patients to relevant a-chess resources or individuals (depending on group assignment). * the specialist report, harvests clinically relevant data from a-chess and presents it to a peer mentor (in the peer-supported group) or a health coach (in the clinically integrated group), at which point they may intervene with patients (e.g., through texting in a-chess). * facilitated discussion groups (in the clinically integrated group.) discussions are monitored daily by an a-chess coach. * library - information about healthy lifestyle choices, calendar of healthy events in the area, etc. * drink tracker and report feature - patients to self-monitor their drinking and each week see a summary of how they did the past week. * profiles about why patients want to reduce their drinking. all patients enrolled in the study will participate in a 3-month intervention period followed by a 9-month follow-up period, for a total of 12 months. all patient will undergo a 72-hour run-in period. after 72 hours, patients who remain in the study will be randomized to one of the following groups and receive the appropriate access to features. one group will operate independently; one group will have help from a peer-mentor; one group will be connected to a healthcare system by a health coach.

Eligibility criteria:
inclusion criteria: * are 21+ years old, * interested in learning about ways to reduce drinking, * willing to download and use a-chess, * lives in within the geographical boundaries of the uw health system * be able to understand and sign an electronic consent form in english, * own an apple or android smart phone, * meets the criteria for at risk drinking on the audit screening, * responds yes to at least one question on the alcohol use disorder (aud) diagnostic and statistical manual-5 survey, and * indicates in the past week they have had at least 7 drinks and 3 on a single day (women), or had at least 14 drinks and 4 on a single day (men). exclusion criteria: * has a severe alcohol use disorder (yes to 6+ items on the alcohol use disorder (aud) diagnostic and statistical manual-5) * have a current psychotic disorder * have an acute medical problem requiring immediate hospitalization * have a known terminal illness

Keywords: implementation alcohol drinking mhealth wellness