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Oesterle TS, Karpyak VM, Coombes BJ, Athreya AP, Breitinger SA, Correa da Costa S, Dana Gerberi DJ. Systematic review: Wearable remote monitoring to detect nonalcohol/nonnicotine-related substance use disorder symptoms. Am J Addict 2022; 31:535-545. [PMID: 36062888 DOI: 10.1111/ajad.13341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 08/15/2022] [Accepted: 08/22/2022] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Substance use disorders (SUDs) are chronic relapsing diseases characterized by significant morbidity and mortality. Phenomenologically, patients with SUDs present with a repeating cycle of intoxication, withdrawal, and craving, significantly impacting their diagnosis and treatment. There is a need for better identification and monitoring of these disease states. Remote monitoring chronic illness with wearable devices offers a passive, unobtrusive, constant physiological data assessment. We evaluate the current evidence base for remote monitoring of nonalcohol, nonnicotine SUDs. METHODS We performed a systematic, comprehensive literature review and screened 1942 papers. RESULTS We found 15 studies that focused mainly on the intoxication stage of SUD. These studies used wearable sensors measuring several physiological parameters (ECG, HR, O2 , Accelerometer, EDA, temperature) and implemented study-specific algorithms to evaluate the data. DISCUSSION AND CONCLUSIONS Studies were extracted, organized, and analyzed based on the three SUD disease states. The sample sizes were relatively small, focused primarily on the intoxication stage, had low monitoring compliance, and required significant computational power preventing "real-time" results. Cardiovascular data was the most consistently valuable data in the predictive algorithms. This review demonstrates that there is currently insufficient evidence to support remote monitoring of SUDs through wearable devices. SCIENTIFIC SIGNIFICANCE This is the first systematic review to show the available data on wearable remote monitoring of SUD symptoms in each stage of the disease cycle. This clinically relevant approach demonstrates what we know and do not know about the remote monitoring of SUDs within disease states.
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Affiliation(s)
- Tyler S Oesterle
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota, USA
| | - Victor M Karpyak
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota, USA
| | - Brandon J Coombes
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota, USA
| | - Arjun P Athreya
- Department of Molecular Pharmacology and Experimental Therapeutics, Mayo Clinic, Rochester, Minnesota, USA
| | - Scott A Breitinger
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota, USA
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Zetterström A, Hämäläinen MD, Winkvist M, Söderquist M, Öhagen P, Andersson K, Nyberg F. The Clinical Course of Alcohol Use Disorder Depicted by Digital Biomarkers. Front Digit Health 2021; 3:732049. [PMID: 34950928 PMCID: PMC8688853 DOI: 10.3389/fdgth.2021.732049] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 11/15/2021] [Indexed: 11/13/2022] Open
Abstract
Aims: This study introduces new digital biomarkers to be used as precise, objective tools to measure and describe the clinical course of patients with alcohol use disorder (AUD).Methods: An algorithm is outlined for the calculation of a new digital biomarker, the recovery and exacerbation index (REI), which describes the current trend in a patient's clinical course of AUD. A threshold applied to the REI identifies the starting point and the length of an exacerbation event (EE). The disease patterns and periodicity are described by the number, length, and distance between EEs. The algorithms were tested on data from patients from previous clinical trials (n = 51) and clinical practice (n = 1,717).Results: Our study indicates that the digital biomarker-based description of the clinical course of AUD might be superior to the traditional self-reported relapse/remission concept and conventional biomarkers due to higher data quality (alcohol measured) and time resolution. We found that EEs and the REI introduce distinct tools to identify qualitative and quantitative differences in drinking patterns (drinks per drinking day, phosphatidyl ethanol levels, weekday and holiday patterns) and effect of treatment time.Conclusions: This study indicates that the disease state—level, trend and periodicity—can be mathematically described and visualized with digital biomarkers, thereby improving knowledge about the clinical course of AUD and enabling clinical decision-making and adaptive care. The algorithms provide a basis for machine-learning-driven research that might also be applied for other disorders where daily data are available from digital health systems.
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Affiliation(s)
| | | | | | | | - Patrik Öhagen
- Uppsala Clinical Research Center, Uppsala Science Park, Uppsala, Sweden
| | - Karl Andersson
- Rudbeck Laboratory, Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden
- Ridgeview Instruments AB, Vänge, Sweden
| | - Fred Nyberg
- Department of Pharmaceutical Biosciences, Uppsala University, Uppsala, Sweden
- Fred Nyberg
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Hämäläinen MD, Zetterström A, Winkvist M, Söderquist M, Öhagen P, Andersson K, Nyberg F. Breathalyser-Based eHealth Data Suggest That Self-Reporting of Abstinence Is a Poor Outcome Measure for Alcohol Use Disorder Clinical Trials. Alcohol Alcohol 2021; 55:237-245. [PMID: 32118260 DOI: 10.1093/alcalc/agaa004] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Revised: 01/07/2020] [Accepted: 01/20/2020] [Indexed: 11/12/2022] Open
Abstract
AIMS To evaluate the efficacy and monitoring capabilities of a breathalyser-based eHealth system for patients with alcohol use disorder (AUD) and to investigate the quality and validity of timeline follow-back (TLFB) as outcome measure in clinical trials and treatment. METHODS Patients (n = 115) were recruited to clinical trials from a 12-step aftercare programme (12S-ABS) and from hospital care with abstinence (HC-ABS) or controlled drinking (HC-CDR) as goal and randomly divided into an eHealth and a control group. The effect of the eHealth system was analysed with TLFB-derived primary outcomes-change in number of abstinent days (AbsDay) and heavy drinking days (HDDs) compared to baseline-and phosphatidyl ethanol (PEth) measurements. Validity and quality of TLFB were evaluated by comparison with breath alcohol content (BrAC) and eHealth digital biomarkers (DBs): Addiction Monitoring Index (AMI) and Maximum Time Between Tests (MTBT). TLFB reports were compared to eHealth data regarding reported abstinence. RESULTS The primary outcome (TLFB) showed no significant difference between eHealth and control groups, but PEth did show a significant difference especially at months 2 and 3. Self-reported daily abstinence suffered from severe quality issues: of the 28-day TLFB reports showing full abstinence eHealth data falsified 34% (BrAC measurements), 39% (MTBT), 54% (AMI) and 68% (BrAC/MTBT/AMI). 12S-ABS and HC-ABS patients showed severe under-reporting. CONCLUSIONS No effect of the eHealth system was measured with TLFB, but a small positive effect was measured with PEth. The eHealth system revealed severe quality problems with TLFB, especially regarding abstinence-should measurement-based eHealth data replace TLFB as outcome measure for AUD?
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Affiliation(s)
| | | | - Maria Winkvist
- Kontigo Care AB, Påvel Snickares Gränd 12, 753 20 Uppsala, Sweden
| | | | - Patrik Öhagen
- Uppsala Clinical Research Center, Dag Hammarskjölds väg 14 B, Uppsala Science Park, 751 83 Uppsala, Sweden
| | - Karl Andersson
- Department of Immunology, Genetics and Pathology, Rudbeck Laboratory, Uppsala University, 751 85 Uppsala, Sweden.,Ridgeview Instruments AB, Skillsta 4, 740 20 Vänge, Sweden
| | - Fred Nyberg
- Department of Pharmaceutical Biosciences, Uppsala University, Box 591, 751 24 Uppsala, Sweden
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Goldfine C, Lai JT, Lucey E, Newcomb M, Carreiro S. Wearable and Wireless mHealth Technologies for Substance Use Disorder. CURRENT ADDICTION REPORTS 2020; 7:291-300. [PMID: 33738178 DOI: 10.1007/s40429-020-00318-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Purpose of review The goal of this scoping review is to evaluate the advances in wearable and other wireless mobile health (mHealth) technologies in the treatment of substance use disorders. Recent findings There are a variety of wireless technologies under investigation for the treatment of substance use disorder. Wearable sensors are the most commonly used technology. They can be used to decrease heavy substance use, mitigate factors related to relapse, and monitor for overdose. New technologies pose distinct advantages over traditional therapies by increasing geographic availability and continuously providing feedback and monitoring while remaining relatively non-invasive. Summary Wearable and novel technologies are important to the evolving landscape of substance use treatment. As technologies continue to develop and show efficacy, they should be incorporated into multifactorial treatment plans.
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Affiliation(s)
- Charlotte Goldfine
- University of Massachusetts Medical School, Department of Emergency Medicine, Division of Medical Toxicology, Worcester, MA
| | - Jeffrey T Lai
- University of Massachusetts Medical School, Department of Emergency Medicine, Division of Medical Toxicology, Worcester, MA
| | - Evan Lucey
- University of Massachusetts Medical School, Department of Emergency Medicine, Division of Medical Toxicology, Worcester, MA
| | - Mark Newcomb
- University of Massachusetts Medical School, Department of Emergency Medicine, Division of Medical Toxicology, Worcester, MA
| | - Stephanie Carreiro
- University of Massachusetts Medical School, Department of Emergency Medicine, Division of Medical Toxicology, Worcester, MA
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Lin LA, Casteel D, Shigekawa E, Weyrich MS, Roby DH, McMenamin SB. Telemedicine-delivered treatment interventions for substance use disorders: A systematic review. J Subst Abuse Treat 2019; 101:38-49. [PMID: 31006553 DOI: 10.1016/j.jsat.2019.03.007] [Citation(s) in RCA: 160] [Impact Index Per Article: 32.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Revised: 03/04/2019] [Accepted: 03/20/2019] [Indexed: 10/27/2022]
Abstract
With increased negative impacts from opioid and other substance use disorders in the US, it is important for treatments to not only be effective, but also accessible to patients. Treatment delivery via telemedicine, specifically, the use of videoconferencing, which allows real time communication between a patient and a clinician at a distant site, has been shown to be an effective approach for increasing reach and access to treatments for mental health disorders and other chronic illnesses. This systematic review identified and summarized studies examining the effectiveness of telemedicine interventions to deliver treatment for patients with substance use disorders. Out of 841 manuscripts that met our search criteria, 13 studies met the inclusion criteria. Studies covered interventions for nicotine, alcohol and opioid use disorders. They varied widely in size, quality, and in the comparison groups examined. Studies examined both delivery of psychotherapy and medication treatments. Most studies suggested telemedicine interventions were associated with high patient satisfaction and are an effective alternative, especially when access to treatment is otherwise limited. However, there were substantial methodological limitations to the research conducted to date. Further studies are needed, including larger scale randomized studies that examine different models of telemedicine that can be integrated into existing healthcare delivery settings, to increase the use of effective treatments for patients with substance use disorders.
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Affiliation(s)
- Lewei Allison Lin
- Department of Psychiatry, University of Michigan, 2800 Plymouth Road, Ann Arbor, MI 48109, United States of America; VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, 2800 Plymouth Rd, Ann Arbor, MI 48109, United States of America.
| | - Danielle Casteel
- University of California San Diego, Health Services Research Center, Department of Family Medicine and Public Health, 9500 Gilman Drive, La Jolla, CA 92093, United States of America
| | - Erin Shigekawa
- California Health Benefits Review Program, University of California, Berkeley, CA 94720-3116, United States of America
| | - Meghan Soulsby Weyrich
- University of California, Davis, Center for Healthcare Policy and Research, 2103 Stockton Blvd, Sacramento, CA 95817, United States of America
| | - Dylan H Roby
- University of Maryland, College Park, School of Public Health, Department of Health Services Administration, 4200 Valley Dr, Suite 3310, College Park, MD 20742, United States of America
| | - Sara B McMenamin
- University of California, San Diego, School of Medicine, Department of Family Medicine and Public Health, 9500 Gilman Drive #0725, La Jolla, CA 92093-0725, United States of America
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Zetterström A, Hämäläinen MD, Karlberg E, Winkvist M, Söderquist M, Öhagen P, Andersson K, Nyberg F. Maximum Time Between Tests: A Digital Biomarker to Detect Therapy Compliance and Assess Schedule Quality in Measurement-Based eHealth Systems for Alcohol Use Disorder. Alcohol Alcohol 2018; 54:70-72. [DOI: 10.1093/alcalc/agy086] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Accepted: 11/13/2018] [Indexed: 11/14/2022] Open
Affiliation(s)
| | | | - Elin Karlberg
- Innovation Akademiska, Uppsala University Hospital, Uppsala, Sweden
| | - Maria Winkvist
- Kontigo Care AB, Påvel Snickares Gränd 12, Uppsala, Sweden
| | | | - Patrik Öhagen
- Uppsala Clinical Research Center, Dag Hammarskjölds väg 14 B, Uppsala Science Park, Uppsala, Sweden
| | - Karl Andersson
- Department of Immunology, Genetics and Pathology, Rudbeck Laboratory, Uppsala University, Uppsala, Sweden
- Ridgeview Instruments AB, Skillsta 4, Vänge, Sweden
| | - Fred Nyberg
- Department of Pharmaceutical Biosciences, Uppsala University, Uppsala, Sweden
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Tofighi B, Abrantes A, Stein MD. The Role of Technology-Based Interventions for Substance Use Disorders in Primary Care: A Review of the Literature. Med Clin North Am 2018; 102:715-731. [PMID: 29933825 PMCID: PMC6563611 DOI: 10.1016/j.mcna.2018.02.011] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
The burden of alcohol and drug use disorders (substance use disorders [SUDs]) has intensified efforts to expand access to cost-effective psychosocial interventions and pharmacotherapies. This article provides an overview of technology-based interventions (eg, computer-based and Web-based interventions, text messaging, interactive voice recognition, smartphone apps, and emerging technologies) that are extending the reach of effective addiction treatments both in substance use treatment and primary care settings. It discusses the efficacy of existing technology-based interventions for SUDs, prospects for emerging technologies, and special considerations when integrating technologies in primary care (eg, privacy and regulatory protocols) to enhance the management of SUDs.
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Affiliation(s)
- Babak Tofighi
- Department of Population Health, New York University School of Medicine, 227 East 30th Street 7th Floor, New York, NY 10016, USA; Division of General Internal Medicine, New York University School of Medicine, New York, NY 10016, USA.
| | - Ana Abrantes
- Butler Hospital, Department of Psychiatry and Human Behavior, Behavioral Medicine and Addictions Research, Butler, PA, USA; Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA
| | - Michael D Stein
- Department of Health Law, Policy, and Medicine, Boston University, Boston, MA 02118, USA
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Hämäläinen MD, Zetterström A, Winkvist M, Söderquist M, Karlberg E, Öhagen P, Andersson K, Nyberg F. Real-time Monitoring using a breathalyzer-based eHealth system can identify lapse/relapse patterns in alcohol use disorder Patients. Alcohol Alcohol 2018; 53:368-375. [DOI: 10.1093/alcalc/agy011] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Accepted: 02/09/2018] [Indexed: 11/14/2022] Open
Affiliation(s)
| | | | | | | | - Elin Karlberg
- Innovation Akademiska, Akademiska Sjukhuset, Uppsala, Sweden
| | - Patrik Öhagen
- Uppsala Clinical Research Center, Dag Hammarskjöldsväg 14 B, Uppsala Science Park, Uppsala, Sweden
| | - Karl Andersson
- Department of Immunology, Genetics and Pathology, Rudbeck Laboratory, Uppsala University, Uppsala, Sweden
- Ridgeview Instruments AB, Skillsta 4, Vänge, Sweden
| | - Fred Nyberg
- Department of Pharmaceutical Biosciences, Uppsala University, Box 591, Uppsala, Sweden
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Nehlin C, Carlsson K, Öster C. Patients' Experiences of Using a Cellular Photo Digital Breathalyzer for Treatment Purposes. J Addict Med 2017; 12:107-112. [PMID: 29176448 DOI: 10.1097/adm.0000000000000373] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES The field of eHealth systems is rapidly developing and is now expanding into alcohol treatment settings. Despite a growing public and professional interest, cellular photo digital breathalyzers (CPDBs) have not been investigated in a clinical context so far. In this study, we aimed to investigate the experiences of patients in alcohol treatment who had been using a CPDB-TripleA- for a minimum of three months. What are their personal experiences of using the CPDB? Do the patients think it supports them to change their drinking habits, and if so, in what way? METHODS A qualitative interview study with individuals who had been using the CPDB TripleA, for at least 3 months as complement to treatment (12-step program or hospital-based outpatient care). A thematic analysis with an inductive approach was used to identify, analyze, and interpret patterns within data. RESULTS In all, 12 interviews were conducted with 8 men and 4 women. Participants were generally enthusiastic about the CPDB and found it convenient and useful, even though it created a need for privacy when using the device. Although technical problems were substantial, participants were tolerant to those. The system was perceived to support self-control and to restore relations, but did not replace the need for close contact with caregivers. Self-motivation to change drinking habits was essential, and could not be reached by solely using the CPDB. CONCLUSIONS Participants perceived the CPDB as a convenient and useful tool that was supportive under the circumstances that it was used in a context that included personal contact with a caregiver; and the user felt more than just a minimum of motivation to reduce drinking. Technical stability needs to be achieved to secure long-term use.
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Affiliation(s)
- Christina Nehlin
- Uppsala University, Department of Neuroscience, Psychiatry and Uppsala University Hospital, Psychiatric Department, Sweden
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