Usefulness of Supportive Text Messages in the Treatment of Depressed Alcoholics
Condition: Depression; Alcohol Use Disorder
MeSH terms: Alcoholism; Depression
Study type: Interventional

Summary: 
      Background:

      There is abundant evidence that rates of comorbidity between substance use and depression are
      high (1, 2) and the risk of poor outcome is higher among individuals with the dual disorder
      compared with those with a single disorder (3, 4, 5, 6). Previous research has shown that
      about 50% of persons studied with severe mental illness and past substance abuse are likely
      to have a recurrence of substance abuse within 1 year of discharge from treatment (7).

      There is therefore a clear clinical challenge in treating patients with the dual disorder
      which may calls for further research and the possible introduction of new and innovative
      strategies including the use of mobile phone technology to provide increased support for
      patients with the dual diagnosis.

      There are established research evidence for using Short Message Service (SMS) text messages
      to remind patients of scheduled medical appointments (8,9,10,12, 13), coordinate medical
      staff,(14) deliver medical test results,(15,16) , promote smoking cessation ( 17), improve
      self-monitoring among the youth with type 1 diabetes( 18), promote weight loss among obese
      subjects (19 ) and monitor patient side effects following treatment(20).

      Relevance of the research:

      To date, after an extensive review of the literature using MEDLINE, Pub Med, ERIC, Web of
      Science, Science Direct and PsycINFO, no studies was found on the use of SMS text messages as
      an intervention to address abstinence amongst alcohol dependent subjects who are co-morbid
      for a depressive disorder. Thus, the investigators seek to determine if text messaging is a
      useful and effective strategy to help maintain abstinence, improve adherence with medication
      and ultimately promote mental stability in depressed patients discharged from an in-patient
      dual diagnosis programme. The investigators hypothesize that, daily supportive/reminder SMS
      text messages to depressed patients discharged from an in-patient dual diagnosis programme
      would increase alcohol abstinence rates , improve medication adherence rates and improve the
      overall mental well being of patients compared with those receiving treatment as usual.
    

Detailed description: 
      There is abundant evidence that rates of comorbidity between substance use and depression are
      high (1, 2). The risk of poor outcome is higher among individuals with both substance use and
      mood disorders compared with those that have a single disorder (3, 4, 5, 6). Previous
      research has shown that about 50% of persons studied with severe mental illness and past
      substance abuse are likely to have a recurrence of substance abuse within 1 year of discharge
      from treatment (7). In a study to evaluate the effectiveness of the dual diagnosis treatment
      programme established in St Patricks' Hospital in Dublin, it was discovered that 71.8% of
      patients achieved complete abstinence at 3 months and 55.8% at 6 months in the depression
      group(8).

      There is therefore a clear clinical challenge in treating patients with the dual disorder
      which calls for further research and the introduction of new and innovative strategies
      capable of improving upon abstinence rates among patients. Such strategies could include the
      use of mobile phone technology to provide increased support for patients with the dual
      diagnosis which may translate into increase abstinence rates over time.

      Significantly, mobile telephones are becoming integrated into virtually all aspects of
      society,(9,10,1112) and may provide an opportunity to improve health related behaviours , in
      particular through the use of Short Message Service (SMS) (13 ). In a randomized controlled
      trial to evaluate a text message-based intervention designed to help individuals lose or
      maintain weight over 4 months, the intervention group who received personalized SMS and MMS
      messages sent two to five times daily, printed materials, and brief monthly phone calls from
      a health counsellor lost more weight than the comparison group who only received only monthly
      printed materials (14). In another study, sending text messages to mobile phones increased
      the effectiveness of a smoking cessation intervention among college students (15). Similarly,
      in a program conducted among youth with type 1 diabetes (16), daily text messages were
      helpful for disease self-management, increased self-efficacy, and treatment adherence and
      achieved high satisfaction among participants. Again, weekly SMS self-monitoring of bulimic
      symptoms with automatic SMS feedback resulted in good monitoring adherence and acceptability
      in women aged 16 to 44 post-discharge from inpatient treatment (17). There are also
      established research evidence for using SMS to remind patients of scheduled medical
      appointments,(18,19,20,21, 22) coordinate medical staff,(23) deliver medical test
      results,(24,25,26) and monitor patient side effects following treatment(27).

      To date, after an extensive review of the literature using MEDLINE, Pub Med, ERIC, Web of
      Science, Science Direct and PsycINFO, no studies was found on the use of daily text messages
      delivered via mobile phone as an intervention to address abstinence amongst alcohol dependent
      subjects who are co-morbid for a depressive disorder. Thus, we seek to determine if text
      messaging is a useful and effective strategy to help maintain abstinence, improve adherence
      with medication and ultimately promote mental stability in depressed patients discharged from
      an in-patient dual diagnosis programme. We hypothesize that, daily supportive/reminder SMS
      text messages to depressed patients discharged from an in-patient dual diagnosis programme
      would increase alcohol abstinence rates , improve medication adherence rates and improve the
      overall mental well being of patients compared with those receiving treatment as usual.
      Patients receiving the text messages and phone calls would also report a favourable
      experience and an overall satisfaction with the system.
    

Intervention name(s): Supportive SMS text messages
Intervention type(s): Other
Intervention description(s): Patients in the intervention group would receive twice daily supportive SMS text messages for 3 months from the treating team which would encourage/motivate them to refrain from drinking alcohol and comply with their medication. They would also receive a fortnightly phone call from an unblinded member of the research/treating team which would only serve the purpose of confirming that they still uses the mobile phone and receive the text messages.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Outcomes Assessor)
Primary purpose: Treatment
Keywords: depression; alcohol dependency syndrome; dual diagnosis; SMS text messages