Effects of automated smartphone mobile recovery support and telephone continuing care in the treatment of alcohol use disorder: study protocol for a randomized controlled trial.
BACKGROUND
New smartphone communication technology provides a novel way to provide personalized continuing care support following alcohol treatment. One such system is the Addiction version of the Comprehensive Health Enhancement Support System (A-CHESS), which provides a range of automated functions that support patients. A-CHESS improved drinking outcomes over standard continuing care when provided to patients leaving inpatient treatment. Effective continuing care can also be delivered via telephone calls with a counselor. Telephone Monitoring and Counseling (TMC) has demonstrated efficacy in two randomized trials with alcohol-dependent patients. A-CHESS and TMC have complementary strengths. A-CHESS provides automated 24/7 recovery support services and frequent assessment of symptoms and status, but does not involve regular contact with a counselor. TMC provides regular and sustained contact with the same counselor, but no ongoing support between calls. The future of continuing care for alcohol use disorders is likely to involve automated mobile technology and counselor contact, but little is known about how best to integrate these services.


METHODS/DESIGN
To address this question, the study will feature a 2 × 2 design (A-CHESS for 12 months [yes/no] × TMC for 12 months [yes/no]), in which 280 alcohol-dependent patients in intensive outpatient programs (IOPs) will be randomized to one of the four conditions and followed for 18 months. We will determine whether adding TMC to A-CHESS produces fewer heavy drinking days than TMC or A-CHESS alone and test for TMC and A-CHESS main effects. We will determine the costs of each of the four conditions and the incremental cost-effectiveness of the three active conditions. Analyses will also examine secondary outcomes, including a biological measure of alcohol use, and hypothesized moderation and mediation effects.


DISCUSSION
The results of the study will yield important information on improving patient alcohol use outcomes by integrating mobile automated recovery support and counselor contact.


TRIAL REGISTRATION
ClinicalTrials.gov, NCT02681406 . Registered on 2 September 2016.
['McKay|James R|JR|', 'Gustafson|David H|DH|', 'Ivey|Megan|M|', 'McTavish|Fiona|F|', 'Pe-Romashko|Klaren|K|', 'Curtis|Brenda|B|', 'Oslin|David A|DA|', 'Polsky|Daniel|D|', 'Quanbeck|Andrew|A|', 'Lynch|Kevin G|KG|']
D000293:Adolescent D000328:Adult D000368:Aged D064829:Alcohol Abstinence D000428:Alcohol Drinking D000437:Alcoholism D001331:Automation D003266:Continuity of Patient Care D003376:Counseling D005260:Female D006297:Health Services Accessibility D006801:Humans D007398:Interpersonal Relations D008297:Male D008875:Middle Aged D015143:Philadelphia D011446:Prospective Studies D016032:Randomized Controlled Trials as Topic D012008:Recurrence D000068997:Smartphone D017216:Telemedicine D013689:Telephone D013997:Time Factors D016896:Treatment Outcome D055815:Young Adult
Smartphone Continuing care Alcohol use disorder A-CHESS Cost-effectiveness Alcohol use outcomes Automated recovery support Drug use outcomes Intervention costs Mobile health Telephone counseling