Predictive modeling of addiction lapses in a mobile health application

Background for Real-Time Monitoring and Intervention Related to Alcohol Use

Real-time assessment, known as ecological momentary assessment (EMA), and real-time intervention (ecological momentary intervention [EMI]) can significantly extend the reach and impact of interventions to help individuals reduce their drinking behavior. For EMA, the user provides information on the variable of interest (e.g., drinking or craving) via a mobile device.This data reporting can occur either at pre-specified times or in certain high-risk situations.The primary benefits of EMA include external validity, minimized recall bias, and the ability to capture dynamic patterns in human behavior. EMI refers to interventions that are delivered via mobile devices at the time when the user needs it (i.e., in a high-risk situation). Key constructs of EMI are what interventions are delivered and when they are delivered.The timing of the EMI often is determined by the user's EMA reports. Both EMA and EMI have been studied in people with alcohol use disorders. EMA and EMI often are used in conjunction with each other because EMA can help inform the optimal timing of EMI and help tailor its content. Further development of high-impact, algorithm-driven, technology-mediated real-time intervention may help reduce drinking and promote positive health behavior change.

The Promises and Pitfalls of Digital Technology in Its Application to Alcohol Treatment

Individuals seeking to change their alcohol use form a heterogeneous group with varied treatment goals-including moderation and abstinence-that therefore requires flexible treatment options. The availability of alcohol in the United States, and the pervasive social pressure to drink, warrant treatments that support individuals outside the treatment environment and that foster coping and self-regulation in the face of these demands. Emerging digital technologies show promise for helping both to hone therapies to clients' individual needs and to support clients in settings beyond the clinic. In the broader health care arena, digital health technologies (DHTs) are transforming how health professionals assess, prevent, and treat both physical and mental health problems. DHTs include assessments and interventions delivered via computer, Internet, mobile phone, and wireless or wearable device technologies. The emerging literature examining within-treatment and mobile DHTs highlights an opportunity to create personalized alcohol treatments for every person seeking care. Despite the promises DHTs may hold, however, there still are many potential risks to using them and a number of challenges regarding how to integrate them into treatment successfully. This article will review the current and potential advantages of DHTs in alcohol treatment and the technological, personal, organizational, and systemic limitations of integrating various technology-based assessment and intervention programs into care.

Ecological Momentary Assessment and Alcohol Use Disorder Treatment

The ability to capture real-time data on human behavior inexpensively, efficiently, and accurately holds promise to transform and broaden our understanding of many areas of health science. One approach to acquiring this type of real-time data is ecological momentary assessment (EMA).This method has been used to collect data in many domains of addiction research, including research on the treatment of alcohol use disorders (AUDs). Empirical evidence supports the hypothesis that use of EMA can improve the quality of AUD treatment research when compared with standard assessment methods because it provides more accurate reporting, allows investigators to examine the dynamic unfolding of the behavior change process at an individual level, and can be used to augment and improve clinical assessment and treatment. Overall, the existing literature provides strong support for the advantages of EMA when combined with standard assessment of addictive behaviors in general. Nevertheless, use of EMA in AUD treatment research thus far has been limited, especially in the area of research on mechanisms of behavior change. Existing research indicates, however, that EMA can be used to deliver tailored feed- back as a novel and potentially transformative approach to improving AUD treatment. This research area clearly warrants additional future efforts.

Mobile Delivery of Treatment for Alcohol Use Disorders: A Review of the Literature

Several systems for treating alcohol-use disorders (AUDs) exist that operate on mobile phones. These systems are categorized into four groups: text-messaging monitoring and reminder systems, text-messaging intervention systems, comprehensive recovery management systems, and game-based systems. Text-messaging monitoring and reminder systems deliver reminders and prompt reporting of alcohol consumption, enabling continuous monitoring of alcohol use. Text-messaging intervention systems additionally deliver text messages designed to promote abstinence and recovery. Comprehensive recovery management systems use the capabilities of smart-phones to provide a variety of tools and services that can be tailored to individuals, including in-the-moment assessments and access to peer discussion groups. Game-based systems engage the user using video games. Although many commercial applications for treatment of AUDs exist, few (if any) have empirical evidence of effectiveness. The available evidence suggests that although texting-based applications may have beneficial effects, they are probably insufficient as interventions for AUDs. Comprehensive recovery management systems have the strongest theoretical base and have yielded the strongest and longest-lasting effects, but challenges remain, including cost, understanding which features account for effects, and keeping up with technological advances.