Patrick L. Dulin - US grants

DESCRIPTION (provided by applicant): This proposal is consistent with the research priorities of RFA-OD-09-004 (RC2), "Expanding and Personalizing Treatment Options for Alcohol Disorders". At present, a wide gap exists between the number of individuals needing alcohol abuse treatment and the number actually receiving it. Many factors account for this gap, including treatment availability and affordability, individuals wanting to independently solve their problems with alcohol, and stigma associated with receiving treatment. Due to their potential to circumvent these treatment barriers, technological innovations hold promise for increasing dramatically the number of individuals who receive treatment services. For example, recent research has indicated that readily- accessible web-based alcohol interventions are effective in reducing alcohol consumption among problem drinkers. However, such web-based interventions are limited to the extent that they are not sensitive to, or available within, the everyday environment in which drinking or relapse occurs. This lack of immediacy is particularly a concern as research has demonstrated consistently that cues, such as locations where an individual has previously drank, are strong triggers for continued alcohol use or relapse and that these cues often overwhelm an individual's rational decision-making abilities. To address these concerns and to make interventions more readily available and accessible, one approach is to use emerging technologies to develop a tool that helps to intervene in actual high-risk locations. The primary aim of this project is to develop such a tool, the Location-Based Monitoring and Intervention - Alcohol (LBMI-A), a system that utilizes recent advances in GPS-enabled smartphones. The LBMI-A will be programmed to alert users when they are entering their geographically defined high-risk areas for relapse and provide an immediate psychosocial intervention (e.g., by sending a text message to a support person and providing coping strategies). Other LMBI-A features will include assessment and feedback reports, alcohol use self- monitoring and feedback functions, and skills modules (e.g., coping skills). During Phases I and II of the proposed project, the initial technological and psychosocial intervention aspects of the LBMI-A will be developed. In Phase III, alcoholism treatment experts will test and review the LBMI-A and modifications will be made based on their recommendations. In Phase IV, a 6-week, randomized waitlist control pilot study will be performed with 60 young adults who demonstrate mild to moderate alcohol dependence. User- interface data will be gathered to examine how the LBMI-A is used by this population and pilot data will be gathered to examine its efficacy as an intervention tool. In Phase V, based on pilot data, the LBMI-A will be finalized and prepared for additional, rigorous testing for efficacy in future research. PUBLIC HEALTH RELEVANCE: Alcohol abuse and alcoholism are serious public health issues that have significant individual and society costs. It is estimated that over 80% of people who need alcohol treatment are unable to access it due to intractable treatment barriers. This project will lead to a technologically-based alcohol treatment system that can circumvent many of these barriers to treatment as well as provide interventions where they are needed most, namely, in real-world, high-risk environments. This treatment system holds the potential to revolutionize alcohol addiction treatment and to extend services to millions of individuals who otherwise would not obtain needed treatment.

PROJECT SUMMARY / ABSTRACT A wide gap exists between the number of individuals needing alcohol treatment and those actually receiving it. Many factors account for this gap, including stigma, treatment availability and affordability, and individuals wanting to solve their problems independently. Technologically-delivered interventions may dramatically increase the number of individuals who receive needed alcohol intervention services due to their ability to circumvent treatment barriers. Smartphones are the ideal devices to provide empirically-supported intervention assistance whenever and wherever it is needed. Our research team previously developed and tested a stand-alone, self-administered smartphone-based intervention system for alcohol use disorders that was based on empirically supported face-to-face treatments. This Location-Based Monitoring and Intervention for Alcohol Use Disorders (LBMI-A) system provided a progression through psychoeducational modules and in-the-moment interventions to reduce the likelihood of drinking. In a preliminary 6-week trial study, we contrasted the LBMI-A with a web-based intervention, the Drinker's Checkup (DCU) that was supplemented with bibliotherapy. While alcohol consumption was reduced by >50% in both interventions, only the LBMI-A produced a significant increase in percentage of days abstinent. Greater LBMI-A usage was associated with greater reductions in drinking. A revised and improved iPhone-based version, Step Away, has been developed and has been used by individuals downloading it from the iTunes App Store. Our Step Away usage data indicate that user engagement with modules that are not ?pushed? to the user is relatively low, which is a problem that many health apps experience. A new method of delivering Step Away through an artificially intelligent chatbot will be developed in this study that holds potential for providing enhanced user engagement and effectiveness as it can reach out through a text interface to introduce new intervention steps and respond to the user with Step Away's in-the-moment help with having a craving, experiencing distress or needing social support. It could serve as a personal assistant that guides a user through a process of changing their drinking. This project will focus on developing a Step Away chatbot during the first phase of the study. We will also enhance the existing Step Away app's user interface for optimal usability. The second phase will entail performing a pilot study to determine if the Step Away chatbot has enhanced user engagement, intervention fidelity and outcome efficacy in comparison to the Step Away app among a group of problem drinkers. A control condition will consist of a minimal intervention; an assessment-only app. Participants will be interviewed to determine their perceptions of both interventions with a view towards understanding barriers to user engagement. Finally, this project will set the stage for a further, large-scale evaluation of Step Away, the content of which will be determined by the outcome of the pilot study.