“Ô DIDE” an application designed for patients suffering from co-occurring substance use and borderline personality disorder to facilitate the care observance (Preprint)
Authors: Salles Juliette , Stocker Antoine , Navarro Nicolas , Schmitt Laurent 
Published: September 2020

UNSTRUCTURED

Background: Substance Use Disorders (SUD) are frequently associated with other mental disorders, especially Borderline Personality Disorder, thus defining co-occurring substance use and mental disorders with borderline personality disorders (COD-BPD). Due to their personality disorder, patients with COD-BPD often present cognitive schemas that lead to care attrition and mistrust towards care. The comprehension of the construction and the treatment of those cognitive schemas were most notably modelized by the attachment theory that differentiates between a secure attachment style that is established through a sensitive, supportive, and caregiving environment and insecure attachment styles that are the result of an inconsistent, insensitive, or dismissive attachment figure. Considering this theory within SUD management, the goal of the care intervention is to help the patient to switch from an insecure to a secure attachment style in order to reduce the use of dysfunctional coping strategies involving substance use. Indeed, the establishment of a confident relation between the patient and the care team participate into building a secure attachment towards care that could secondly be generalized in other situations.
However, the development of a secure relationship in the care demands an important availability of the healthcare team, allowing for frequent interactions at all times, including at night and during days off, in order to build an adequate secure base. We consider that Electronic health (eHealth) and mobile health (mHealth) could also help achieve this goal by improving healthcare worker’s availability.
We thus designed an application for patients with COD-BPD that aims to help the caregivers maintaining a link with the patient in order to facilitate confidence in the relationship, help install a secure attachment and favorize care observance.
Methods : The application, called Ô DIDE for Digital Interaction for Detoxification Engagement, consists in i) a patient dedicated interface developed according to psychopathological considerations (attachment theory) as well as neurobiological findings (dedicated craving or relapse report system adapted to the alteration of the circadian rhythm, implementation of rewards and motivational messages to reinforce the reward system and the use of declarative memory systems by creating content related to the care), ii) a clinician dedicated interface which has been designed as a decision-making support system for care.
Results: The application is currently under development, and is scheduled for the end of 2020. We will be using patients’ feedback during development to ensure the final product is as close as possible to their needs and to maximize their engagement. After the development we will evaluate the application effect on care by using a single case experimental design (SCED) method. We will use a multiple baseline design and will monitor various aspects of the use of the application (e.g. connections, report of relapses, communication with the healthcare team).
Conclusion: We designed an application by using pathopsychological as well as neurobiological models and by including patients’ feedback throughout the development process. We intend to evaluate the use of this application by using the SCED method.