A-CHESS is a smartphone application designed to provide continuing care to patients with alcohol use disorders.
The A-CHESS smartphone application is an interactive program that provides information, adherence strategies, decision-making tools, and support services to patients with alcohol use disorders. The application focuses on helping patients develop and maintain motivation for abstinence, and connects patients with resources to cope with cravings, withdrawal symptoms, and high risk situations to avoid relapse. Components of the program align with self-determination theory, and assist patients in developing competence, autonomous motivation, and relatedness with others.
Alcohol use reduction and treatment retention
Young Adults (18-30)
Outpatient Substance Use Treatment
Community Health Center
Summary: In this randomized controlled trial of the smartphone application Addiction-Comprehensive Health Enhancement Support System (A-CHESS), patients in residential treatment for alcohol dependence received either usual continuing care services (n=179) or A-CHESS plus usual care (n=170). The A-CHESS group had access to a smartphone and the A-CHESS application for 8 months after release from the residential program. Participants were assessed through phone interviews at 4, 8, and 12 months post-discharge. At months 4 and 12, participants assigned to the A-CHESS group had fewer risky drinking days (1.38 days vs. 2.75 days). Over the entire follow-up period, the A-CHESS group also had higher odds of reporting abstinence from alcohol (OR=1.65, 95% CI=1.05-2.57).
Take Away: Compared to usual continuing care programs, adding the A-CHESS smartphone application improves drinking outcomes for adults with alcohol dependence.
Follow-Up of Previous Study:
How patients recovering from alcoholism use a smartphone intervention.
Summary: This article investigated the usage patterns of participants enrolled in the randomized controlled trial of A-CHESS. Researchers examined the utilization of A-CHESS by 170 participants with alcohol dependence. Results showed that 93.5% of participants accessed the A-CHESS application within 1 week of discharge from residential treatment. One month later, 78.2% of participants were still using the application. Participants accessed the relatedness components of the application most (e.g., discussions, messages). Fewest participants used services relating to competence (e.g., Instant Library, Weblinks). Participants with both an alcohol and drug use disorder used the A-CHESS program more than participants with only alcohol dependence. Presence of a co-occurring mental health disorder contributed to slightly lower use of the system at follow-up. Utilization rates from this A-CHESS study were also compared to utilization rates of the Asthma-CHESS and Survivor-CHESS programs.
Take Away: Patients with alcohol dependence will utilize a continuing care smartphone application. Rates of A-CHESS use were similar among patients with only alcohol dependence, patients with drug and alcohol dependence, and patients with co-occurring disorders.
Predictive modeling of addiction lapses in a mobile health application.
Summary: Data from the A-CHESS randomized controlled trial were used to develop a model for predicting relapse. Participants randomized to receive the A-CHESS intervention were given the Weekly Check-In survey every seven days. The Weekly Check-In is a 12-item survey adopted from the Brief Addiction Monitor (BAM). Items ask participants about their past week alcohol and drug use, relapse-related behaviors and cognitions, and protective behaviors and cognitions. These items were summed to obtain a total score. Over 8 months, 152 participants completed 2,640 Weekly Check-In surveys. Bayesian network modeling was used to create a predictive model estimating the chance of relapse. The resulting model accurately predicted the likelihood of relapse and had adequate sensitivity (75%) and specificity (88%). This model was programmed into the A-CHESS program, allowing the program to automatically contact participants and clinicians when the risk of relapse was high.
Take Away: The Weekly Check-In can be used to accurately estimate the risk of relapse for patients using the A-CHESS program. Results provide preliminary support for the potential to use ongoing data collection and modeling to develop alerts to proactively prevent relapse.
Efficacy and comparative effectiveness of telephone and smartphone remote continuing care interventions for alcohol use disorder: a randomized controlled trial
Summary: This article tested whether supplementing intensive outpatient programs (IOPs) with continuing care delivered via (1) telephone, (2) smartphone or (3) their combination improves outcomes relative to (4) IOP only. The study conducted a randomized controlled trial of four arms with follow-ups every 3 months for 18 months. 262 participants with alcohol use disorder were included in the study. At 12 months, results showed that the mean percentage of heavy drinking days was 10.29 in the control group, 5.41 in telephone monitoring/counseling, 6.80 in ACHESS smartphone app use, and 5.99 in combination of telephone monitoring/counseling and ACHESS. Differences between telephone monitoring/counseling, ACHESS, and combination of telephone monitoring/counseling and ACHESS are small and non-significant. The results were inconclusive on whether heavy drinking outcomes differed among the treatment groups at 18 months.
Take Away: A telephone-delivered intervention and a smartphone-delivered intervention, alone and in combination, provided effective remote continuing care for alcohol use disorder. The combination of both interventions was not superior to either alone and effects did not persist post-treatment.
Treatment seeking as a mechanism of change in a randomized controlled trial of a mobile health intervention to support recovery from alcohol use disorders
Glass, J. E., McKay, J. R., Gustafson, D. H., Kornfield, R., Rathouz, P. J., McTavish, F. M., Atwood, A. K., Isham, A., Quanbeck, A., & Shah, D. (2017). Journal of substance abuse treatment, 77, 57–66.
Summary: The study estimated the efficacy of the Addiction-Comprehensive Health Enhancement Support System (A-CHESS) in increasing the use of services for addiction and examined the extent to which this use of services mediated the effects of A-CHESS on risky drinking days and abstinence from drinking. 349 participants with alcohol use disorder from five residential treatment programs and are two weeks from discharge were recruited. Intervention arm participants received a smartphone, the A-CHESS app, and an 8-month service plan and the control arm received treatment as usual. The study conducted follow-ups at 4, 8, and 12 months. 50.5% of participants received outpatient addiction treatment and 75.5% reported mutual help at any follow-up interview in the year following randomization. The A-CHESS intervention was associated with an increased odds of outpatient addiction treatment across follow-ups, but not mutual help. The effect of A-CHESS through outpatient addiction treatment appeared to reduce the expected number of risky drinking days across follow-ups by 11%.
Take Away: The mobile health A-CHESS intervention promoted the use of outpatient addiction treatment, which appeared to contribute to its efficacy in reducing risky drinking.