Academic journal article Alcohol Research

The Promises and Pitfalls of Digital Technology in Its Application to Alcohol Treatment

Academic journal article Alcohol Research

The Promises and Pitfalls of Digital Technology in Its Application to Alcohol Treatment

Article excerpt

Using methods like the Network for the Improvement of Addiction Treatment (NIATx) that identify the strengths and weaknesses of current treatment processes (Karlsson et al. 2010), treatment providers can identify the components of care in which DHTs may have the most and least impact, as well as the obstacles that arise when attempting DHT integration. This article's initial section will review some of the emerging trends and promises of DHTs inside and outside of alcohol treatment, including consumer-based DHTs, DHTs for treatment initiation and intake, DHTs to enhance alcohol treatment services and services for comorbid conditions, DHTs to extend care beyond the clinic and increase salience of the therapeutic environment, mobile assessment and just-in-time interventions, combining DHTs with in-person support, and finally DHT acceptability from the perspective of the client.

The Promise of DHTs

Direct-to-Consumer DHTs

Ample evidence shows that the majority of individuals who could benefit from alcohol treatment never seek care, suggesting a need to expand the reach and accessibility of treatment. Thus, the proliferation of DHTs that increase people's awareness of how much they drink or their relationship with drinking could meet this need. To date, the development and implementation of digital health services marketed directly to consumers has largely occurred outside of the traditional professional in-person treatment community. These technologies use both brief, one-time computer-based screening and brief interventions and multimodular long-term Internet programs (see table) (Brendryen et al. 2013; Carey et al. 2009; Cunningham et al. 2011; Hester et al. 2013). Such self-guided interventions have typically targeted a lower-severity population than those who tend to seek treatment for alcohol use disorders (AUDs), extending the reach of available options for individuals along the broader problem-drinking spectrum. The rise of mobile-phone applications has produced a large number of alcohol-specific mobile programs available directly to the consumer outside of care, ranging from blood alcohol content (BAC) calculators to coping-skills programs. However, almost no research exists to support the efficacy of these applications beyond their face validity (Cohn et al. 2011). For individuals in recovery, there also are numerous Web-based programs and mobile applications such as online video support meetings, 12-step meeting-finder apps, virtual sponsors, and recovery coaches (Cohn et al. 2011). These applications are designed to make the recovery process more efficient by enhancing what individuals are already doing, such as going to meetings or connecting with those in recovery.

Facilitating Treatment Initiation With DHTs

Although the actual integration of DHTs into alcohol treatment has been limited in comparison with the explosion of direct-to-consumer programs, DHTs specifically designed for implementation within traditional treatment are beginning to emerge (Carroll and Rounsaville 2010) in the research literature and offer significant promise to increase the efficiency and quality of care. In health care, and in other settings such as schools and workplaces, computer and mobile DHT screening and brief intervention programs have enhanced the ability to reach individuals opportunistically in those moments when they are motivated to seek more information about their drinking. For example, programs such as Hazelden, a large inpatient and outpatient treatment organization with centers in 5 states, include digital screeners on their Web sites to assist and engage individuals seeking services. Along similar lines, treatment program Web sites can include appointment schedulers for those who are reluctant to initiate help seeking with a phone call, as well as digital copies of all clinic forms (e.g., consent forms) to make the engagement process both more efficient and transparent. Ideally, these tools could be programmed to take into account a client's insurance, financial, and location constraints as well as his or her treatment preferences (Boudreaux et al. …

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