After discharge from in-patient care, users receive automated text messages supporting mental health and recovery from Alcohol Use Disorder (AUD) twice a week for three months.
Supportive text messages are targeted for individuals with depression and AUD who have recently finished in-patient treatment for comorbid depression and AUD. Over the course of three months, users receive two text messages a day, one in the morning and one in the evening. Messages are pulled from a pool of 180 pre-written messages to prevent repetition and all users receive the same messages. Text messages address stress, psychological well-being, abstinence from alcohol, cravings, medication adherence, and general support.
Principles of Dual Diagnosis Treatment
Young Adults (18-30)
Supportive text messaging for depression and comorbid alcohol use disorder: Single-blind randomised trial
Agyapong VIO, Ahern S, McLoughlin DM, Farren CK. Journal of Affective Disorders. 2012. 141: 168-176. doi: 10.1016/j.jad.2012.02.040
Summary: Researchers recruited 54 patients enrolled in an in-patient dual diagnosis treatment program for comorbid major depression and AUD or alcohol dependence alone. Participants were randomly assigned to an intervention group that received supportive text messages or to a control condition that received text messages every two weeks thanking them for participating in the study. Participants received messages on their own phone. Participants were not restricted from seeking outside follow-up care. Participants completed assessments of depression severity, past 90-day alcohol consumption, temptation to drink, confidence in abstaining, and overall functioning one week prior to discharge and 3 months post-discharge. Participants also completed an assessment of treatment satisfaction at follow-up. There were significant differences in depression severity between the intervention and control groups at post-discharge follow-up; depression severity was higher in the control group and the intervention group experienced greater reductions in depression severity relative to control. The intervention group reported significantly better functioning at follow-up and greater improvements in functioning than the control group. Researchers found that 17% of the variance in depression severity at three months and 20% of the variance in global functioning at three months was explained by supportive text-messaging, compared to baseline depression severity or global functioning scores (0.3% and 0.4%, respectively) or other covariates.
Take Away: Supportive text-messaging may be beneficial for improving depressive symptoms and overall functioning following discharge from in-patient treatment for comorbid depression and problematic alcohol use.
Six-months outcomes of a randomised trial of supportive text messaging for depression and comorbid alcohol use disorder
Agyapong VIO, McLoughlin DM, Farren CK. Journal of Affective Disorders. 2013. 151: 100-104. doi: 10.1016/j.jad.2013.05.058
Summary: Researchers analyzed 6-month outcomes for 48 participants. In addition to the assessments used at baseline and post-intervention, participants who had not maintained abstinence indicated when they first consumed alcohol after discharge from treatment and units of alcohol consumed each drinking day. There were no significant differences in depression severity, abstinence, functioning, temptation to drink, confidence in abstaining, or drinks consumed per drinking day between the intervention and control groups at 6 months following discharge. The intervention group reported significantly more days to first drink than the control group.
Take Away: The positive effects of supportive text messaging for individuals with comorbid depression and problematic alcohol use may not persist after text messages end.
Perceptions of patients with alcohol use disorder and comorbid depression about the usefulness of supportive text messages
Agyapong VIO, Milnes J, McLoughlin DM, Farren CK. Technology and Health Care. 2013. 151: 31-39. doi: 10.3233/THC-120707
Summary: Researchers analyzed responses to assessments of treatment satisfaction completed post-intervention by the intervention group (n=24). Treatment satisfaction assessments included questions about how often participants viewed the text messages, participant perspectives on frequency of messages, how helpful the intervention was, and whether participants would recommend the intervention to another patient with AUD and comorbid depression (on a 4 point Likert scale: certainly not – most certainly). Most participants (67%) reported always or often reading the text messages. Most participants (79%) reported being very satisfied or satisfied with the frequency of messages and that they preferred receiving messages twice daily. Three-quarters of participants reported that the messages made them feel supported by the research team. A majority of participants reported that the text messages always or often helped them remain abstinent (75%), but far fewer participants reported that the text messages always or often reminded them to take medication (17%). Participants reported that the text messages were most helpful for motivating recovery and preventing relapse. Most participants reported that they would “most certainly” recommend supportive text messages to another patient.
Take Away: Supportive text messages are most acceptable to participants as a motivational and relapse prevention tool.
Randomized controlled pilot trial of supportive text messages for patients with depression
Agyapong VIO, Juhás M, Ohinmaa A, et al. BMC Psychiatry. 2017. 17(286). doi: 10.1186/s12888-017-1448-2
Summary: Researchers adapted supportive text messaging to target depression without comorbid alcohol use disorder. Participants (N=73) were recruited using referral from psychiatrists and randomized to receive supportive text messaging twice a day or text messages thanking them for participating once every two weeks for a 90-day study period. Participants completed assessments of depression severity and overall health status at baseline and 3-month post intervention. Participants also reported health service utilization at 3 months. Controlling for baseline depression severity, depression severity was lower in the intervention group than the control group at 3 months. There was also significantly greater change in depression scores from baseline to 3 months in the intervention group relative to the control. When controlling for baseline health status, participants in the intervention group reported significantly higher self-rated health status at three months than control participants. The intervention group also experienced significantly greater improvement in self-rated health status between baseline and three months compared to control. There were no significant between-group differences in health service utilization.
Take Away: Twice daily supportive text messages for depression over 90 days may improve depression severity and overall health status.