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Miguel AQ, Smith CL, Rodin NM, Johnson RK, McDonell MG, McPherson SM. Automated Reinforcement Management System: Feasibility study findings of an app-based contingency management treatment for alcohol use disorder. DRUG AND ALCOHOL DEPENDENCE REPORTS 2023; 6:100140. [PMID: 36994367 PMCID: PMC10040325 DOI: 10.1016/j.dadr.2023.100140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 01/26/2023] [Accepted: 01/30/2023] [Indexed: 02/04/2023]
Abstract
Alcohol Use Disorder (AUD) is the most prevalent substance use disorder in the United States and is directly related to 5% of all annually reported deaths worldwide. Contingency Management (CM) is among the most effective interventions for AUD, with recent technological advancements allowing CM to be provided remotely. Objective: To evaluate the feasibility and acceptability of a mobile Automated Reinforcement Management System (ARMS) designed to provide CM for AUD remotely. Methods: Twelve participants with mild or moderate AUD were exposed to ARMS in a A-B-A within-subject experimental design where they were required to submit three breathalyzer samples per day. During the B phase participants could earned rewards with monetary value for submitting negative samples. Feasibility was determined by the proportion of samples submitted and retention in the study and acceptability was based on participants self-reported experience. Results: The mean number of samples submitted per day was 2.02 out of 3. The proportion of samples submitted in each phase was 81.5%, 69.4% and 49.4%, respectively. Participants were retained for a mean of 7.5 (SD=1.1) out of 8 weeks with 10 participants (83.3%) completing the study. All participants found the app easy to use and stated it helped them reduce their alcohol use. Eleven (91.7%) would recommend the app as an adjunct to AUD treatment. Preliminary indicators of efficacy are also presented. Conclusions: ARMS has shown to be feasible and well accepted. If shown effective, ARMS can serve as an adjunctive treatment for AUD.
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Affiliation(s)
- André Q. Miguel
- Elson S Floyd College of Medicine, Washington State University, Spokane, WA, United States
- Analytics and PsychoPharmacology Laboratory, Spokane, WA, United States
- Program of Excellence in Addictions Research, Spokane, WA, United States
- Corresponding author.
| | - Crystal L. Smith
- Elson S Floyd College of Medicine, Washington State University, Spokane, WA, United States
- Analytics and PsychoPharmacology Laboratory, Spokane, WA, United States
- Program of Excellence in Addictions Research, Spokane, WA, United States
| | - Nicole M. Rodin
- College of Pharmacy and Pharmaceutical Sciences, Washington State University, Spokane, WA, United States
- Analytics and PsychoPharmacology Laboratory, Spokane, WA, United States
- Program of Excellence in Addictions Research, Spokane, WA, United States
| | | | - Michael G. McDonell
- Elson S Floyd College of Medicine, Washington State University, Spokane, WA, United States
- Analytics and PsychoPharmacology Laboratory, Spokane, WA, United States
- Program of Excellence in Addictions Research, Spokane, WA, United States
| | - Sterling M. McPherson
- Elson S Floyd College of Medicine, Washington State University, Spokane, WA, United States
- Analytics and PsychoPharmacology Laboratory, Spokane, WA, United States
- Program of Excellence in Addictions Research, Spokane, WA, United States
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Proctor SL, Rigg KK, Tien AY. Acceptability and Usability of a Reward-Based Mobile App for Opioid Treatment Settings: Mixed Methods Pilot Study. JMIR Form Res 2022; 6:e37474. [PMID: 36197705 PMCID: PMC9582914 DOI: 10.2196/37474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 07/30/2022] [Accepted: 09/12/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Contingency management is an evidence-based yet underutilized approach for opioid use disorder (OUD). Reasons for limited adoption in real-world practice include ethical, moral, and philosophical concerns regarding use of monetary incentives, and lack of technological innovation. In light of surging opioid overdose deaths, there is a need for development of technology-enabled solutions leveraging the power of contingency management in a way that is viewed by both patients and providers as acceptable and feasible. OBJECTIVE This mixed methods pilot study sought to determine the perceived acceptability and usability of PROCare Recovery, a reward-based, technology-enabled recovery monitoring smartphone app designed to automate contingency management by immediately delivering micropayments to patients for achieving recovery goals via smart debit card with blocking capabilities. METHODS Participants included patients receiving buprenorphine for OUD (n=10) and licensed prescribers (n=5). Qualitative interviews were conducted by 2 PhD-level researchers via video conferencing to explore a priori hypotheses. Thematic analysis of interviews was conducted and synthesized into major themes. RESULTS Participants were overwhelmingly in favor of microrewards (eg, US $1) to incentivize treatment participation (up to US $150 monthly). Participants reported high acceptability of the planned debit card spending restrictions (blocking cash withdrawals and purchases at bars or liquor stores, casinos or online gambling). Quantitative data revealed a high level of perceived usability of the PROCare Recovery app. CONCLUSIONS Patients and providers alike appear receptive to microfinancial incentives in standard OUD treatment practices. Further pilot testing of PROCare is underway to determine acceptability, feasibility, and preliminary effectiveness in a rigorous randomized controlled trial.
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Affiliation(s)
- Steven L Proctor
- PRO Health Group, Miami Beach, FL, United States
- Thriving Mind South Florida, Miami, FL, United States
- Department of Psychiatry and Behavioral Health, Herbert Wertheim College of Medicine, Florida International University, Miami, FL, United States
| | - Khary K Rigg
- Department of Mental Health Law and Policy, University of South Florida, Tampa, FL, United States
| | - Allen Y Tien
- Medical Decision Logic, Inc, Baltimore, MD, United States
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Smith CL, Rodin NM, Hwang JY, Miguel AQC, Johnson K, McDonell MG, McPherson SM. Automated Reinforcement Management System (ARMS): focused phase I provider feedback. Addict Sci Clin Pract 2022; 17:20. [PMID: 35346358 PMCID: PMC8962143 DOI: 10.1186/s13722-022-00301-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Accepted: 03/07/2022] [Indexed: 12/02/2022] Open
Abstract
Background Alcohol use increases risk for morbidity and mortality and is associated with over 3 million annual deaths worldwide. Contingency Management (CM) is one of the most effective interventions for substance use disorders, and has recently been coupled with technologies to promote novel treatments for alcohol use disorders (AUD). Leveraging these technological advances, we are developing the Automated Reinforcement Management System (ARMS), an integrated CM system designed to enable CM treatment as a component of a digital therapeutic or adjunct therapy remotely to anyone with a smartphone. Objective To collect detailed provider feedback on ARMS and determine the need for modifications to make the system most feasible, acceptable, and useful to providers. Methods Seven providers completed one-hour structured interviews/focus groups wherein we described the ARMS system and its application to clinical care. Providers viewed screen shots of the ARMS provider facing and patient facing systems. Providers gave feedback on their current AUD treatment practices, preferences for the functionality and appearance of the system, preferences for receipt of information on their patients, why they and their patients would or would not use the system, suggestions for improvement, and the proposed intervention overall. To analyze the qualitative data gathered, we used a qualitative descriptive approach with content analysis methods. Results The overarching theme of Individualized Treatment emerged throughout the interviews. This sentiment supports use of ARMS, as it is intended to supplement provider communication and intervention as an adjunctive and customizable tool with the ability to reach rural patients, not a stand-alone option. Themes of Accountability and Objective Assessment arose during discussions of why people would use the system. Themes within provider obstacles included, Information Overload and Clinical Relevance, and in patient obstacles, Sustained Engagement and Security Concerns. Two themes emerged regarding suggestions for improvement: Increasing Accessibility and Bi-directional Communication. Discussion Themes from provider input are being used to modify ARMS to make it more user friendly, time saving, and relevant to treatment of AUD. If successful, ARMS will provide effective, individualized-digital therapeutic for those needing adjunctive treatment or those living in rural remote areas needing better connected care.
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Affiliation(s)
- Crystal L Smith
- Elson S. Floyd College of Medicine, Washington State University, PO Box 1495, Spokane, WA, 99210-1495, USA. .,Analytics and PsychoPharmacology Laboratory (APPL), Spokane, WA, USA. .,Program of Excellence in Addiction Research (PEAR), Washington State University, Spokane, WA, USA.
| | - Nicole M Rodin
- Elson S. Floyd College of Medicine, Washington State University, PO Box 1495, Spokane, WA, 99210-1495, USA.,Analytics and PsychoPharmacology Laboratory (APPL), Spokane, WA, USA.,College of Pharmacy and Pharmaceutical Sciences, Washington State University, Spokane, WA, USA
| | - Julie Y Hwang
- Elson S. Floyd College of Medicine, Washington State University, PO Box 1495, Spokane, WA, 99210-1495, USA.,Analytics and PsychoPharmacology Laboratory (APPL), Spokane, WA, USA.,Program of Excellence in Addiction Research (PEAR), Washington State University, Spokane, WA, USA
| | - André Q C Miguel
- Elson S. Floyd College of Medicine, Washington State University, PO Box 1495, Spokane, WA, 99210-1495, USA.,Analytics and PsychoPharmacology Laboratory (APPL), Spokane, WA, USA.,Program of Excellence in Addiction Research (PEAR), Washington State University, Spokane, WA, USA
| | - Kim Johnson
- Managed Health Connections, Spokane, WA, USA
| | - Michael G McDonell
- Elson S. Floyd College of Medicine, Washington State University, PO Box 1495, Spokane, WA, 99210-1495, USA.,Program of Excellence in Addiction Research (PEAR), Washington State University, Spokane, WA, USA.,Behavioral Health Innovations, Washington State University, Spokane, WA, USA
| | - Sterling M McPherson
- Elson S. Floyd College of Medicine, Washington State University, PO Box 1495, Spokane, WA, 99210-1495, USA.,Analytics and PsychoPharmacology Laboratory (APPL), Spokane, WA, USA.,Program of Excellence in Addiction Research (PEAR), Washington State University, Spokane, WA, USA
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