Contributions of mobile technologies to addiction research

The added value of a micro-level ecological approach when mapping self-regulatory control processes and externalizing symptoms during adolescence: a systematic review

Deficits in self-regulatory control (SRC) represent a core characteristic of externalizing (EXT) symptoms (e.g., rule-breaking behavior or aggressive behaviors) in adolescents. This review aims to specify the added value of ecologically valid assessments at a micro-level when examining the associations between SRC and EXT symptoms in adolescents. This systematic review was reported according to the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) 2020. The search strategy addressed the added value of (1) naturalistic assessment for the understanding of the relationship between (2) SRC and (3) EXT symptoms in (4) adolescents. We conducted comprehensive searches in bibliographic databases. An additional search was conducted in Google Scholar and supplementary studies were identified through backward and forward citation tracking. Twenty-four studies (n = 4071 adolescents) met the inclusion criteria. The methods used to assess naturalistic aspects included the experience sampling method (ecological momentary- or ambulatory assessment) and the time-course approach (i.e., real-time assessment of SRC processes referring to situations approximating real-life experience where SRC are to be engaged such as in frustrating situations). Micro-level ecological assessments, when mapping the intra-individual relationships between SRC processes and EXT symptoms over time in adolescents within their natural context (i.e., real world) of expression in real time, added a finer-grained observation alongside with a higher ecological validity. Micro-level approaches may enhance the understanding of the complex interplay between SRC and EXT symptoms in adolescence, especially in interventional studies, allowing for the acquisition of endpoints with a higher relevance for everyday functioning.

Detecting Prolonged Stress in Real Life Using Wearable Biosensors and Ecological Momentary Assessments: Naturalistic Experimental Study

BACKGROUND

Increasing efforts toward the prevention of stress-related mental disorders have created a need for unobtrusive real-life monitoring of stress-related symptoms. Wearable devices have emerged as a possible solution to aid in this process, but their use in real-life stress detection has not been systematically investigated.

OBJECTIVE

We aimed to determine the utility of ecological momentary assessments (EMA) and physiological arousal measured through wearable devices in detecting ecologically relevant stress states.

METHODS

Using EMA combined with wearable biosensors for ecological physiological assessments (EPA), we investigated the impact of an ecological stressor (ie, a high-stakes examination week) on physiological arousal and affect compared to a control week without examinations in first-year medical and biomedical science students (51/83, 61.4% female). We first used generalized linear mixed-effects models with maximal fitting approaches to investigate the impact of examination periods on subjective stress exposure, mood, and physiological arousal. We then used machine learning models to investigate whether we could use EMA, wearable biosensors, or the combination of both to classify momentary data (ie, beeps) as belonging to examination or control weeks. We tested both individualized models using a leave-one-beep-out approach and group-based models using a leave-one-subject-out approach.

RESULTS

During stressful high-stakes examination (versus control) weeks, participants reported increased negative affect and decreased positive affect. Intriguingly, physiological arousal decreased on average during the examination week. Time-resolved analyses revealed peaks in physiological arousal associated with both momentary self-reported stress exposure and self-reported positive affect. Mediation models revealed that the decreased physiological arousal in the examination week was mediated by lower positive affect during the same period. We then used machine learning to show that while individualized EMA outperformed EPA in its ability to classify beeps as originating from examinations or from control weeks (1603/4793, 33.45% and 1648/4565, 36.11% error rates, respectively), a combination of EMA and EPA yields optimal classification (1363/4565, 29.87% error rate). Finally, when comparing individualized models to group-based models, we found that the individualized models significantly outperformed the group-based models across all 3 inputs (EMA, EPA, and the combination).

CONCLUSIONS

This study underscores the potential of wearable biosensors for stress-related mental health monitoring. However, it emphasizes the necessity of psychological context in interpreting physiological arousal captured by these devices, as arousal can be related to both positive and negative contexts. Moreover, our findings support a personalized approach in which momentary stress is optimally detected when referenced against an individual's own data.

Use of Mobile Applications in Smoking, Alcohol and Substance Use Disorders

Currently, technology and mobile health applications are developing and being applied in different fields every day. Especially the use of mobile technology in many health fields offers various opportunities for the use of mobile applications in smoking, alcohol and substance use disorders, which is an important public mental health problem. The aim of this review study was to examine 16 mobile applications designed for the treatment and monitoring of smoking, alcohol and substance use. It was concluded that self-monitoring, notification and warning systems, location services, peer and expert support services were frequently used in the analyzed mobile applications. As a result of the studies, the use of mobile applications as a preventive intervention in the prevention of addiction and as an additional treatment option in addiction treatment is promising. However, this situation brings along various harms, risks and obstacles. This review of the relevant literature provides a critical update of mobile applications used in smoking, alcohol and substance use disorders. This review is expected to be an important guide for mental health professionals and mobile application designers working on addiction.

Beliefs, attitudes and experiences of virtual overdose monitoring services from the perspectives of people who use substances in Canada: a qualitative study

BACKGROUND

Solitary use of substances is a risk factor for substance use-related mortality. Novel e-health harm reduction interventions such as virtual overdose monitoring services (VOMS) have emerged in North America to improve access to emergency overdose support for people who use substances (PWUS). To date, little research has been published, and the perspectives of PWUS are needed to inform evaluation and policy efforts.

OBJECTIVE

To explore the beliefs, values and perceptions of PWUS around using and accessing VOMS in Canada.

METHODS

A qualitative study following grounded theory methodology was conducted. Using existing peer networks, purposive and snowball sampling was conducted to recruit PWUS (≥ 18 years) with previous experience with VOMS. Thematic analysis was used to analyze twenty-three interviews. Several methods were employed to enhance rigor, such as independent data coding and triangulation.

RESULTS

Twenty-three one-on-one telephone interviews of PWUS with previous experience with VOMS were completed and analyzed. The following themes emerged: (1) feelings of optimism around VOMS to save lives; (2) privacy/confidentiality was highly valued due to stigma and fear of arrest; (3) concerns with reliable cell phones negatively impacting VOMS uptake; (4) concerns around emergency response times, specifically in rural/remote communities; (5) desire for trusting relationships with VOMS operators; (6) importance of mental health supports and referrals to psychosocial services; and (7) possible limited uptake due to low public awareness of VOMS.

CONCLUSION

This qualitative study provided novel insights about the VOMS from the perspectives of PWUS. PWUS generally felt optimistic about the potential of VOMS as a suitable harm reduction intervention, but several potential barriers around accessing VOMS were identified that may limit uptake. Future research is warranted.

Systematic review: Wearable remote monitoring to detect nonalcohol/nonnicotine-related substance use disorder symptoms

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.

Bi+ adults' daily wellbeing: The roles of relationship status and partner gender

This study examined whether relationship involvement and partner gender were associated with between-person differences and within-person fluctuation in positive and negative affect and alcohol use among people who are attracted to more than one gender or regardless of gender (e.g., bisexual, pansexual, queer; bi+). 198 bi+ individuals (M age 26.97; 73.1% non-Latinx White) completed a 28-day diary study. Multilevel regression analyses modeled between-person differences in daily affect and alcohol use as a function of relationship status and partner gender. ANCOVAs were conducted to examine differences in within-person fluctuation. Results partially support past findings that relationship involvement may not confer benefits for bi+ people, and that mixed-gender partnerships could be particularly challenging. Future research directions are discussed.

The role of self-regulatory control processes in understanding aggressive ideations and behaviors: An experience sampling method study

INTRODUCTION

In this study, we aimed to examine the association between aggressive ideations and aggressive behaviors in everyday life, as well as the role of processes related to self-regulatory control (i.e., self-control, ego depletion, and emotional states), using experience sampling methods (ESM).

METHODS

A total of 62 male adolescents performed a baseline measure of aggression, violent ideations (trait level), and ESM assessments, including four measures per day during nine consecutive days.

RESULTS

At a state level, aggressive ideations were associated with higher negative emotions during the previous day as well as with lower self-control and stronger anger rumination at the moment. Aggressive behaviors were related to higher anger rumination at the moment and to the manifestation of higher intensity of aggressive ideations derived in the previous measure. Higher self-control was related to a lower probability of aggressive behavior.

DISCUSSION

This study highlights the temporal link between aggressive ideations and behaviors in everyday life as well as the role of self-control in understanding aggressivity in the lap of time. Furthermore, we observed that expressions of anger (i.e., reactivity, as well as rumination) were central in the understanding of aggressive ideations and behaviors in the everyday life (i.e., at within-person variability at the state level).

Scale-Up Study Protocol of the Implementation of a Mobile Health SBIRT Approach for Alcohol Use Reduction in Mozambique

BACKGROUND

Hazardous drinking imposes a major public health burden worldwide, especially in low-income countries such as Mozambique. Implementation of the Screening, Brief Intervention, Referral to Treatment (SBIRT) approach to address problem drinking is recommended. However, evidence regarding the best strategies to implement SBIRT at scale is needed.

METHODS

Guided by the Reach Effectiveness Adoption Implementation Maintenance model, the authors will conduct a 2-year, cluster-randomized, hybrid type-2 implementation-effectiveness trial in 12 districts in Mozambique evaluating implementation, clinical effectiveness, outcomes, and cost. Eight districts will be randomly assigned to a mobile application-based health SBIRT condition and four to SBIRT-Conventional Training and Supervision. Interventions will be delivered by clinic-based community health workers. The Consolidated Framework for Implementation Research will guide the authors' mixed-methods assessments throughout the study.

RESULTS

The study arm showing better cost-effectiveness will be scaled up in the other arms' districts. During this 12-month scale-up phase, Ministry of Health personnel will be charged with providing training, clinical activities, and supervision in all 12 districts without research team support. The SBIRT scale-up phase is critical to identify facilitators and barriers for tracking internal and external factors in clinics that continue using the superior arm and those that switch to it.

NEXT STEPS

In a multistep process with stakeholders from multiple sectors, outcomes and lessons learned from this study will inform the development of an implementation tool kit to guide SBIRT scale-up of community services addressing hazardous drinking in other low- and middle-income countries and low-resource settings in high-income countries.

Des repères pour la conception des apps ?

Objectif Proposer quelques repères pour faciliter le processus de création d’applications pour téléphones intelligents (apps) en santé mentale.

Méthode Présentation brève de l’intérêt potentiel des apps et proposition argumentée d’étapes clés pour la création des apps. L’article se base sur une revue narrative, un retour d’expérience et des discussions de groupes d’experts.

Résultats Les apps ont des caractéristiques ubiquitaires particulièrement intéressantes pour le domaine de la santé mentale. Potentiellement connectées à de multiples technologies, mobiles et disponibles en tout temps, elles permettent une grande flexibilité de conception. Afin d’augmenter les chances d’efficacité et de bonne dissémination d’une app donnée, certains principes pourraient guider de manière utile le travail de conception des apps : 9 repères sont proposés, en particulier une bonne intégration des utilisateurs finaux autour d’objectifs cibles bien définis durant tout le processus de création de tels outils.

Conclusion Les repères proposés pourraient faciliter le processus de création d’apps pour la santé mentale.

Developing an App to Screen for Dual Disorders: A Tool for Improving Treatment Services in Mexico

Background: Previous studies in Mexico undertaken at residential facilities for treating substance use disorders (SUDs) reported that the prevalence of Dual Disorders (DDs) is over 65%. DDs pose a major challenge for the Mexican health system, particularly for community-based residential care facilities for SUDs, due to the shortage of certified professionals to diagnose and treat these patients. Moreover, the lack of standardized algorithms for screening for and evaluating DDs to refer patients to specialized services (whether private or public) hinders timely care, delaying the start of integrated treatment. The use of new technologies provides a strategic opportunity for the timely detection of DDs through the development of standardized digital applications for the timely detection of DDs. Objective: To develop an app to screen for DDs, which will contribute to referral to specialized services in keeping with the level of severity of psychiatric and addictive symptomatology, and be suitable for use by community-based residential care facilities for SUDs. Method: The research project was implemented in two stages. Stage 1 involved obtaining the psychometric properties of the Dual Diagnosis Screening Interview (DDSI). Stage 2 consisted of two steps to test the Beta version of the app and the quality of version 1.0. Results: The DDS obtained sensitivity and specificity scores above 85%. The app and its algorithm to screen for and refer DDs proved to be efficient and easy to apply with satisfactory community acceptance. Conclusion: The app promises to be a useful screening tool at residential addiction treatment centers.

Point-of-Care Drug of Abuse Testing in the Opioid Epidemic

CONTEXT.—

The United States is experiencing an opioid overdose epidemic. Point-of-care (POC) drug of abuse testing is a useful tool to combat the intensified opioid epidemic.

OBJECTIVES.—

To review commercially available POC drug of abuse testing involving opioids, to review opportunities and challenges for POC opioid testing and emerging testing methods in research literature, and finally to summarize unmet clinical needs and future development prospects.

DATA SOURCES.—

The Google search engine was used to access information for commercial opioid POC devices and the Google Scholar search engine was used to access research literature published from 2000 to 2019 for opioid POC tests.

CONCLUSIONS.—

The opioid epidemic provides unprecedented opportunities for POC drug testing, with significant clinical needs. Compared with gold standard tests, limitations for commercially available opioid POC testing include lower analytical sensitivity, lower specificity, and cross-reactivity. In response to unmet clinical needs, novel methods have emerged in research literature, such as microfluidics and miniature mass spectrometry. Future prospects include the development of quantitative POC devices and smarter and real-time drug testing.

The utility of smartphone-based, ecological momentary assessment for depressive symptoms

BACKGROUND

Major Depressive Disorder (MDD) is a common and debilitating mood disorder. Individuals with MDD are often misdiagnosed or diagnosed in an untimely manner, exacerbating existing functional impairments. Ecological momentary assessment (EMA) involves the repeated sampling of an individual's symptoms within their natural environment and has been demonstrated to assist in illness assessment and characterization. Capturing data in this way would set the stage for improved treatment outcomes and serve as a complementary resource in the management and treatment of depressive symptoms.

METHODS

Online databases PubMed/MedLine and PsycINFO were searched using PRISMA guidelines and combinations of the following keywords: EMA, depression, smartphone app, diagnosing, symptoms, phone, app, ecological momentary assessment, momentary assessment, data mining, unobtrusive, passive data, GPS, sensor.

RESULTS

A total of nineteen original articles were identified using our search parameters and ten articles met the inclusion criteria for full-text review. Among the ten relevant studies, three studies evaluated feasibility, seven evaluated detection, and three evaluated treatment of MDD.

LIMITATIONS

Limitations include that the design of all of the studies included in this review are non-randomized. It should be noted that most of the studies included were pilot studies and/or exploratory trials lacking a control group.

CONCLUSIONS

Available evidence suggests that the use of passive smartphone-based applications may lead to improved management of depressive symptoms. This review aids the creation of new EMA applications, highlights the potential of EMA usage in clinical settings and drug development, emphasizes the importance for regulation of applications in the mental health field, and provides insight into future directions.

Review of Use of Asynchronous Technologies Incorporated in Mental Health Care

PURPOSE OF REVIEW

Mental health clinicians should understand how technologies augment, enhance, and provide alternate means for the delivery of mental healthcare. These technologies can be used asynchronously, in which the patient and the clinician need not be communicating at the same time. This contrasts with synchronous technologies, in which patient and clinician must communicate at the same time.

RECENT FINDINGS

The review is based on research literature and the authors' clinical and healthcare administration experiences. Asynchronous technologies can exist between a single clinician and a single patient, such as patient portal e-mail and messaging, in-app messaging, asynchronous telepsychiatry via store-and-forward video, and specialty patient-to-provider mobile apps. Asynchronous technologies have already been used in different countries with success, and can alleviate the psychiatric workforce shortage and improve barriers to access. Multiple studies referred to in this review demonstrate good retention and acceptability of asynchronous psychotherapy interventions by patients. Asynchronous technologies can alleviate access barriers, such as geographical, scheduling, administrative, and financial issues. It is important for clinicians to understand the efficacy, assess the ethics, and manage privacy and legal concerns that may arise from using asynchronous technologies.

Differing patterns of stress and craving across the day in moderate-heavy alcohol consumers during their typical drinking routine and an imposed period of alcohol abstinence

Background

Stress is a known factor related to alcohol use. However, how the relationship between alcohol craving and stress varies across the day is not fully understood. As craving is a consistent predictor of alcohol use disorder (AUD), understanding stress and craving patterns across the day in routine, non-dependent, moderate-heavy alcohol consumers may help in understanding those who may be vulnerable to transitioning into AUD.

Method

Moderate-heavy drinkers were recruited from the local community (n = 32) and assessed for fluctuations in craving and stress intensity across the day via Ecological Momentary Assessment (EMA) during 3 consecutive days of imposed alcohol abstinence (abstained trial) and their normal drinking routine (normal trial). A multilevel modeling statistical approach assessed differences in diurnal craving and stress patterns with the Alcohol Craving Experience Questionnaire (ACE) examined as a moderator.

Results

Immediately following alcohol consumption on normal trials, EMA craving levels were significantly reduced compared to pre-drinking levels. Moreover, the post-drinking craving levels were lower than on abstained trials. Higher ACE scores were associated with significantly higher EMA craving across the day and higher peaks at midday. Higher ACE scores were also associated with greater EMA stress across the day. Drinking relieved stress relative to abstained trials, but not in individuals with higher ACE scores. Higher stress was associated with greater EMA craving, which was stronger among those with higher ACE scores.

Conclusion

These findings suggest that ACE scores are important to understanding patterns of stress and craving experienced across the day in routine, non-dependent, moderate-heavy drinkers and may provide new insights for vulnerability to transitioning into AUD.

Mobile Phone Ownership Is Not a Serious Barrier to Participation in Studies: Descriptive Study

BACKGROUND

Rather than providing participants with study-specific data collection devices, their personal mobile phones are increasingly being used as a means for collecting geolocation and ecological momentary assessment (EMA) data in public health research.

OBJECTIVE

The purpose of this study was to (1) describe the sociodemographic characteristics of respondents to an online survey screener assessing eligibility to participate in a mixed methods study collecting geolocation and EMA data via the participants' personal mobile phones, and (2) examine how eligibility criteria requiring mobile phone ownership and an unlimited text messaging plan affected participant inclusion.

METHODS

Adult (≥18 years) daily smokers were recruited via public advertisements, free weekly newspapers, printed flyers, and word of mouth. An online survey screener was used as the initial method of determining eligibility for study participation. The survey screened for twenty-eight inclusion criteria grouped into three categories, which included (1) cell phone use, (2) tobacco use, and (3) additional criteria.

RESULTS

A total of 1003 individuals completed the online screener. Respondents were predominantly African American (605/1003, 60.3%) (60.4%), male (514/1003, 51.3%), and had a median age of 35 years (IQR 26-50). Nearly 50% (496/1003, 49.5%) were unemployed. Most smoked menthol cigarettes (699/1003, 69.7%), and had a median smoking history of 11 years (IQR 5-21). The majority owned a mobile phone (739/1003, 73.7%), could install apps (86.8%), used their mobile phone daily (89.5%), and had an unlimited text messaging plan (871/1003, 86.8%). Of those who completed the online screener, 302 were eligible to participate in the study; 163 were eligible after rescreening, and 117 were enrolled in the study. Compared to employed individuals, a significantly greater proportion of those who were unemployed were ineligible for the study based on mobile phone inclusion criteria (P<.001); yet, 46.4% (333/717) of the individuals who were unemployed met all mobile phone inclusion criteria.

CONCLUSIONS

Inclusion criteria requiring participants to use their personal mobile phones for data collection was not a major barrier to study participation for most respondents who completed the online screener, including those who were unemployed.

TRIAL REGISTRATION

ClinicalTrials.gov NCT02261363; https://clinicaltrials.gov/ct2/show/NCT02261363 (Archived by WebCite at http://www.webcitation.org/6wOmDluSt).

mHealth for the Detection and Intervention in Adolescent and Young Adult Substance Use Disorder

Purpose of review

The goal of this review is to highlight recent research in mHealth based approaches to the detection and treatment of substance use disorders in adolescents and young adults.

Recent findings

The main methods for mHealth based detection include mobile phone based self-report tools, GPS tracking, and wearable sensors. Wearables can be used to detect physiologic changes (e.g., heart rate, electrodermal activity) or biochemical contents of analytes (i.e. alcohol in sweat) with reasonable accuracy, but larger studies are needed. Detection methods have been combined with interventions based on mindfulness, education, incentives/goals and motivation. Few studies have focused specifically on the young adult population, although those that did indicate high rates of utilization and acceptance.

Summary

Research that explores the pairing of advanced detection methods such as wearables with real time intervention strategies is crucial to realizing the full potential of mHealth in this population.

Use of digital technology in addiction disorders

The expanding use of digital technology in mental health has widened the scope of emerging addiction interventions. This review focus on the use of technological advances in the field of addiction and mental health. We discuss about how these advances has been implemented in addiction treatment and research. Further, we also mention about the utilisation of these services in India.