Introduction

The
dangers and negative consequences of alcohol consumption have been an issue of
discussion for many years however the World Health Organization (WHO) estimated
that more than 75 million people alcohol use disorder worldwide over a 12-month
period and worldwide contributes to nearly 2 million deaths each year.1
Approximately 18% or 6 million of Canadians met the criteria for alcohol use
disorder.2 Alcohol use disorder is characterized by a problematic
pattern of alcohol use leading to clinically significant impairment or
distress, as manifested by multiple psychosocial, behavioural or physiologic
features.3 There is a higher rate of AUD in younger adults, where
16.2% of those between 18 to 29 years and 9.7% among those 30 to 44 years old
have been diagnosed – an age group more inclined to use technology.3

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Alcohol use disorder has
been found to be associated with higher rates of morbidity and mortality.3
Excessive alcohol consumption is the third leading preventable cause of death
in the US. Nearly 17,000 traffic fatalities in 2000 were related to alcohol use
accounting for 40% of all traffic fatalities.3 The lifetime rate of
suicide attempts was 7% in frequent alcohol users compared to 1% in the general
population.3

Not
only alcohol use disorder, but excessive alcohol use including underage
drinking and binge drinking (5 or more drinks on a single occasion for men, and
4 for women) can increase a person’s risk of developing serious health problems
as well as social manifestations.3 Examples include trauma or
injury, psychiatric conditions such as anxiety and depression, hypertension,
cardiovascular disease gastrointestinal symptoms, increased LFTs and liver
disease, bone marrow suppression and several malignancies including cancers of
the mouth, esophagus, liver and breast.3

There
are a variety of treatment options available for alcohol use disorder however
the condition is frequently untreated.1 The traditional goal of
treatment for alcohol use disorder was abstinence, however now a reduction in
heavy drinking has become accepted as an alternative treatment goal.1
A reduction in heavy drinking over abstinence may be more achievable for
patients who lack the readiness to quit.1 Treatment approaches vary
based on patient factors and preferences. Such treatment options include
medications, behavioural therapy, and mutual health groups.4

There are three
medications approved by the FDA to treat alcohol dependence: disulfiram,
naltrexone and acamprosate.4 In patients being treated with
medications, positive results were found when they were combined with
behavioural treatment.4 Maintaining contact with patients and
emphasizing adherence also appeared to be related to successful treatment with
medications.4

Behavioural
therapy includes cognitive behaviour therapy, contingency management,
motivational interviewing and other behavioural treatments.5
Cognitive behaviour therapy places emphasis on the development of skills that
can be used anticipate likely problems and enhancing patient’s self control by
helping them develop effective coping strategies.6 Contingency
management is based on the principles of reinforcement – it involves giving
patients tangible rewards to reinforce positive behaviours such as abstinence.5,6
Motivational interviewing is a patient-centered counseling method for
addressing the common problem of ambivalence about change. Motivational interviewing
is directive, with the goal of eliciting self-motivational statements and behavioural
change from the client.7 

Mutual
help groups (e.g. Alcoholics Anonymous) are the most commonly sought source of
help.5 A reason for their popularity is their inherent flexibility and
responsiveness and that they are more cost effective than formal treatment.5
Patients have the flexibility to attend as frequently and for as long as they
want without insurance. Studies on their effectiveness are difficult to conduct
but studies that follow patients during and after treatment have shown that
mutual help groups compare well to formal treatment.5 Their benefit
is thought to be due to the social network and support they receive for abstinence.5

Even
though all these treatment options are available, only 15 to 25% of those with
a drinking problem seek help.5 Many don’t seek help until forced to
do so by court, family member or employer.5 A person’s denial that
they have a drinking problem is not a primary reason for people not to seek
treatment. A possible reason people do not seek treatment earlier is that
alcohol problems and treatment remain stigmatized in society.5 Other
barriers to care include a belief that the problem is not serious enough to
warrant treatment, lack of insurance, worries about privacy and problems making
or keeping appointments keep them from treatment.5

In
this era of technology, it is not surprising that there are emerging
technologies for the treatment of alcohol use disorder. Early evidence has
shown that internet and computer based technologies improve access services and
promote treatment effectiveness.5 The internet provides patients
with the option of receiving treatment 24 hours a day, 7 days a week. This is
especially beneficial to those in rural settings and provides them with access
to much of the same care as those in urban settings. These resources are a cost-effective
way of engaging people in treatment and may be most useful for those interested
in self help. Alcohol Comprehensive Health Enhancement Support System (A-CHESS)
is a program which uses smartphones to provide patients with information,
adherence strategies, decision making tools, reminders and social support
services at their fingertips.5 This program is customizable to focus
on a patient’s needs and enhances their autonomy by providing tools that
provide resources to patients when needed.

The
purpose of this project is to further look into the emerging technologies
available for the treatment of alcohol use disorder – mainly mobile
applications for achieving/maintaining sobriety or a reduction in alcohol
consumption – and their apparent efficacy. There are a high proportion of
people with unhealthy alcohol use. This information can hopefully be used to
reach out to potential patients, especially those more hesitant to seek care, as
well as provide education to healthcare professionals who lack information in
this field with the overall goal of expanding treatment settings from primary
care offices to emergency departments, community centers and pharmacies.

Summary
of Proposed Methods

I.
The objectives

Majority of the
literature detailing treatment of alcohol use disorder has a main focus on
standard treatments such as medications, behavioural therapy and mutual help
groups as described above. Because these treatment options have been used for
many years, physicians tend to recommend them more often. In this era of technology,
individuals are becoming more and more self reliant on their mobile devices.
The main objective of this project is to provide information about current
mobile applications available, to determine the efficacy of these applications
developed for alcohol use disorder and their role in treatment. Through reading
patient reviews, I will determine what aspects of mobile applications enhance
patient usage, and which aspects compromise it. This research will hopefully
inform clinicians of the benefits of mobile applications in the treatment of alcohol
use disorder. Current therapies have their limitations – such as cost, side
effects to medications, inability to attend group meetings or the stigma
associated with alcohol use disorder – but mobile applications have the ability
to cover this gap in care. 

II.
Relevance

Clinical:

Treatment for alcohol use
disorder with medications, behavioural therapy, and treatment groups have their
limitations. Many individuals with alcohol use disorder also do not seek help –
with a main reason as stated being the stigma associated with alcohol use
disorder. As such, demonstrating value in these mobile applications can provide
individuals with treatment at the touch of their fingertips that doesn’t
require direct medical attention. It was found that 66-75% of risky drinkers
make positive changes on their own – mobile applications can help in this
population group. It should be noted that mobile applications are not designed
to replace medical care, but can be a facilitator to help those at lower risk
and used as an adjunct to other treatment options.

Community

Education regarding the
availability of these applications can be an essential tool in providing
assistance to treatment of alcohol use disorders. These applications can
provide 24/7 care to an individual struggling to overcome addiction and can be
essential in achieving abstinence or a reduction in alcohol consumption. This
is beneficial for maintaining relationships, employment and improve health outcomes.
Finding value and evidence in these applications can warrant physicians,
pharmacists and other health care professionals to advertise, and encourage the
use of these applications.

III.
How the objectives will be achieved/methods

To begin, a Google search
will be conducted to see available and variety of applications for alcohol use
disorder. Once the basis of the variety of applications is found, applications
will be searched on GooglePlay and the AppStore (Apple). From here,
descriptions of the applications can be found, including features as well as
patient reviews. Patient reviews can be used to determine the positive and
negative aspects of the applications – and be used to determine what works well
for patients who have used the apps. To determine which applications are most
used by the public, or gaining interest, a search on user forums such as Reddit
will be conducted. Finally, a literature search will be conducted to find any
information related to mobile applications and alcohol use disorder and the efficacy,
if any, associated with them.

IV.
Clear description of deliverables

By the end of this
project, I hope to achieve the following:

1.     
Gather information with regards to mobile
applications for alcohol use disorder through application description reviews
on GooglePlay and the AppStore.

2.     
Gather information about mobile
applications with regards to their scope, as well as the amount of applications
available through descriptions on GooglePlay and the AppStore.

3.     
Gather information on which mobile
applications are being used by the public through user forums such as Reddit.

4.     
Perform a literature review on the
efficacy of mobile applications for alcohol use disorder in achieving or
maintaining abstinence.

5.     
Perform a review of the application
reviews to determine positive and negative aspects of applications developed
for alcohol abuse.

6.     
Demonstrate the value of mobile
applications for use in alcohol use disorder or reduction in consumption of
alcohol

 

References

1.     
Johnson
BA. Pharmacotherapy for alcohol use disorder. In: Saitz R, ed. UpToDate. Waltham, MA.: UpToDate;
October 2017. www.uptodate.com: Accessed January
9, 2018.

2.      Statistics
Canada. Mental and substance use disorders in Canada.
http://www.statcan.gc.ca/pub/82-624-x/2013001/article/11855-eng.htm. Updated
November 27, 2015. Accessed January 9, 2018.

3.     
Tetrault
JM, O’Connor PG. Risky drinking and alcohol use disorder: Epidemiology,
pathogenesis, clinical manifestations, course, assessment and diagnosis. In:
Saitz R, ed. UpToDate. Waltham, MA.:
UpToDate; September 2017. www.uptodate.com: Accessed January
9, 2018.

4.     
National
Institute on Alcohol Abuse and Alcoholism. Exploring Treatment Options for
Alcohol Use Disorders. National Institute of Health.
https://pubs.niaaa.nih.gov/publications/AA81/AA81.htm. Published 2010. Accessed
January 9, 2018.

5.     
Carroll
KM, Onken LS. Behavioural Therapies for Drug Abuse. Am J Psychiatry. 2005;162(8):1452-1460. doi: 10.1176/appi.ajp.162.8.1452.

6.     
Adler
MW, Brady K, Brigham G, et al. Evidence-Based Approaches to Drug Addiction Treatment.
National Institute of Drug Abuse.
https://www.drugabuse.gov/publications/principles-drug-addiction-treatment/evidence-based-approaches-to-drug-addiction-treatment/behavioral-therapies.
Updated December 2012. Accessed January 9, 2018.

7.     
Center
for Substance Abuse Treatment. Enhancing Motivation for Change in Substance
Abuse Treatment. Rockville, MD: Substance Abuse and Mental Health
Administration; 1999. https://www.ncbi.nlm.nih.gov/books/NBK64967/. Accessed
January 9, 2018.

 

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