IntroductionThedangers and negative consequences of alcohol consumption have been an issue ofdiscussion for many years however the World Health Organization (WHO) estimatedthat more than 75 million people alcohol use disorder worldwide over a 12-monthperiod and worldwide contributes to nearly 2 million deaths each year.1Approximately 18% or 6 million of Canadians met the criteria for alcohol usedisorder.
2 Alcohol use disorder is characterized by a problematicpattern of alcohol use leading to clinically significant impairment ordistress, as manifested by multiple psychosocial, behavioural or physiologicfeatures.3 There is a higher rate of AUD in younger adults, where16.2% of those between 18 to 29 years and 9.7% among those 30 to 44 years oldhave been diagnosed – an age group more inclined to use technology.3Alcohol use disorder hasbeen found to be associated with higher rates of morbidity and mortality.3Excessive alcohol consumption is the third leading preventable cause of deathin the US. Nearly 17,000 traffic fatalities in 2000 were related to alcohol useaccounting for 40% of all traffic fatalities.
3 The lifetime rate ofsuicide attempts was 7% in frequent alcohol users compared to 1% in the generalpopulation.3Notonly alcohol use disorder, but excessive alcohol use including underagedrinking and binge drinking (5 or more drinks on a single occasion for men, and4 for women) can increase a person’s risk of developing serious health problemsas well as social manifestations.3 Examples include trauma orinjury, psychiatric conditions such as anxiety and depression, hypertension,cardiovascular disease gastrointestinal symptoms, increased LFTs and liverdisease, bone marrow suppression and several malignancies including cancers ofthe mouth, esophagus, liver and breast.3Thereare a variety of treatment options available for alcohol use disorder howeverthe condition is frequently untreated.
1 The traditional goal oftreatment for alcohol use disorder was abstinence, however now a reduction inheavy drinking has become accepted as an alternative treatment goal.1A reduction in heavy drinking over abstinence may be more achievable forpatients who lack the readiness to quit.1 Treatment approaches varybased on patient factors and preferences. Such treatment options includemedications, behavioural therapy, and mutual health groups.4There are threemedications approved by the FDA to treat alcohol dependence: disulfiram,naltrexone and acamprosate.
4 In patients being treated withmedications, positive results were found when they were combined withbehavioural treatment.4 Maintaining contact with patients andemphasizing adherence also appeared to be related to successful treatment withmedications.4 Behaviouraltherapy includes cognitive behaviour therapy, contingency management,motivational interviewing and other behavioural treatments.5Cognitive behaviour therapy places emphasis on the development of skills thatcan be used anticipate likely problems and enhancing patient’s self control byhelping them develop effective coping strategies.6 Contingencymanagement is based on the principles of reinforcement – it involves givingpatients tangible rewards to reinforce positive behaviours such as abstinence.5,6Motivational interviewing is a patient-centered counseling method foraddressing the common problem of ambivalence about change. Motivational interviewingis directive, with the goal of eliciting self-motivational statements and behaviouralchange from the client.
7 Mutualhelp groups (e.g. Alcoholics Anonymous) are the most commonly sought source ofhelp.5 A reason for their popularity is their inherent flexibility andresponsiveness and that they are more cost effective than formal treatment.5Patients have the flexibility to attend as frequently and for as long as theywant without insurance. Studies on their effectiveness are difficult to conductbut studies that follow patients during and after treatment have shown thatmutual help groups compare well to formal treatment.5 Their benefitis thought to be due to the social network and support they receive for abstinence.
5Eventhough all these treatment options are available, only 15 to 25% of those witha drinking problem seek help.5 Many don’t seek help until forced todo so by court, family member or employer.5 A person’s denial thatthey have a drinking problem is not a primary reason for people not to seektreatment. A possible reason people do not seek treatment earlier is thatalcohol problems and treatment remain stigmatized in society.5 Otherbarriers to care include a belief that the problem is not serious enough towarrant treatment, lack of insurance, worries about privacy and problems makingor keeping appointments keep them from treatment.5 Inthis era of technology, it is not surprising that there are emergingtechnologies for the treatment of alcohol use disorder.
Early evidence hasshown that internet and computer based technologies improve access services andpromote treatment effectiveness.5 The internet provides patientswith the option of receiving treatment 24 hours a day, 7 days a week. This isespecially beneficial to those in rural settings and provides them with accessto much of the same care as those in urban settings. These resources are a cost-effectiveway of engaging people in treatment and may be most useful for those interestedin 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 supportservices at their fingertips.
5 This program is customizable to focuson a patient’s needs and enhances their autonomy by providing tools thatprovide resources to patients when needed. Thepurpose of this project is to further look into the emerging technologiesavailable for the treatment of alcohol use disorder – mainly mobileapplications for achieving/maintaining sobriety or a reduction in alcoholconsumption – and their apparent efficacy. There are a high proportion ofpeople with unhealthy alcohol use. This information can hopefully be used toreach out to potential patients, especially those more hesitant to seek care, aswell as provide education to healthcare professionals who lack information inthis field with the overall goal of expanding treatment settings from primarycare offices to emergency departments, community centers and pharmacies.
Summaryof Proposed MethodsI.The objectivesMajority of theliterature detailing treatment of alcohol use disorder has a main focus onstandard treatments such as medications, behavioural therapy and mutual helpgroups as described above. Because these treatment options have been used formany 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 currentmobile applications available, to determine the efficacy of these applicationsdeveloped for alcohol use disorder and their role in treatment.
Through readingpatient reviews, I will determine what aspects of mobile applications enhancepatient usage, and which aspects compromise it. This research will hopefullyinform clinicians of the benefits of mobile applications in the treatment of alcoholuse disorder. Current therapies have their limitations – such as cost, sideeffects to medications, inability to attend group meetings or the stigmaassociated with alcohol use disorder – but mobile applications have the abilityto cover this gap in care. II.Relevance Clinical:Treatment for alcohol usedisorder with medications, behavioural therapy, and treatment groups have theirlimitations. Many individuals with alcohol use disorder also do not seek help –with a main reason as stated being the stigma associated with alcohol usedisorder. As such, demonstrating value in these mobile applications can provideindividuals with treatment at the touch of their fingertips that doesn’trequire direct medical attention. It was found that 66-75% of risky drinkersmake positive changes on their own – mobile applications can help in thispopulation group.
It should be noted that mobile applications are not designedto replace medical care, but can be a facilitator to help those at lower riskand used as an adjunct to other treatment options. CommunityEducation regarding theavailability of these applications can be an essential tool in providingassistance to treatment of alcohol use disorders. These applications canprovide 24/7 care to an individual struggling to overcome addiction and can beessential in achieving abstinence or a reduction in alcohol consumption. Thisis 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 theuse of these applications. III.
How the objectives will be achieved/methodsTo begin, a Google searchwill be conducted to see available and variety of applications for alcohol usedisorder. Once the basis of the variety of applications is found, applicationswill be searched on GooglePlay and the AppStore (Apple). From here,descriptions of the applications can be found, including features as well aspatient reviews. Patient reviews can be used to determine the positive andnegative aspects of the applications – and be used to determine what works wellfor patients who have used the apps. To determine which applications are mostused by the public, or gaining interest, a search on user forums such as Redditwill be conducted.
Finally, a literature search will be conducted to find anyinformation 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 thisproject, I hope to achieve the following:1. Gather information with regards to mobileapplications for alcohol use disorder through application description reviewson GooglePlay and the AppStore.
2. Gather information about mobileapplications with regards to their scope, as well as the amount of applicationsavailable through descriptions on GooglePlay and the AppStore. 3.
Gather information on which mobileapplications are being used by the public through user forums such as Reddit. 4. Perform a literature review on theefficacy of mobile applications for alcohol use disorder in achieving ormaintaining abstinence.5. Perform a review of the applicationreviews to determine positive and negative aspects of applications developedfor alcohol abuse.
6. Demonstrate the value of mobileapplications for use in alcohol use disorder or reduction in consumption ofalcohol References1. JohnsonBA. Pharmacotherapy for alcohol use disorder. In: Saitz R, ed.
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