A smartphone application to support recovery from alcoholism: a randomized clinical trial

JAMA Psychiatry. 2014 May;71(5):566-72. doi: 10.1001/jamapsychiatry.2013.4642.


Importance: Patients leaving residential treatment for alcohol use disorders are not typically offered evidence-based continuing care, although research suggests that continuing care is associated with better outcomes. A smartphone-based application could provide effective continuing care.

Objective: To determine whether patients leaving residential treatment for alcohol use disorders with a smartphone application to support recovery have fewer risky drinking days than control patients.

Design, setting, and participants: An unmasked randomized clinical trial involving 3 residential programs operated by 1 nonprofit treatment organization in the Midwestern United States and 2 residential programs operated by 1 nonprofit organization in the Northeastern United States. In total, 349 patients who met the criteria for DSM-IV alcohol dependence when they entered residential treatment were randomized to treatment as usual (n = 179) or treatment as usual plus a smartphone (n = 170) with the Addiction-Comprehensive Health Enhancement Support System (A-CHESS), an application designed to improve continuing care for alcohol use disorders.

Interventions: Treatment as usual varied across programs; none offered patients coordinated continuing care after discharge. A-CHESS provides monitoring, information, communication, and support services to patients, including ways for patients and counselors to stay in contact. The intervention and follow-up period lasted 8 and 4 months, respectively.

Main outcomes and measures: Risky drinking days--the number of days during which a patient's drinking in a 2-hour period exceeded 4 standard drinks for men and 3 standard drinks for women, with standard drink defined as one that contains roughly 14 g of pure alcohol (12 oz of regular beer, 5 oz of wine, or 1.5 oz of distilled spirits). Patients were asked to report their risky drinking days in the previous 30 days on surveys taken 4, 8, and 12 months after discharge from residential treatment.

Results: For the 8 months of the intervention and 4 months of follow-up, patients in the A-CHESS group reported significantly fewer risky drinking days than did patients in the control group, with a mean of 1.39 vs 2.75 days (mean difference, 1.37; 95% CI, 0.46-2.27; P = .003).

Conclusions and relevance: The findings suggest that a multifeatured smartphone application may have significant benefit to patients in continuing care for alcohol use disorders.

Trial registration: clinicaltrials.gov Identifier: NCT01003119.

Publication types

  • Multicenter Study
  • Randomized Controlled Trial
  • Research Support, N.I.H., Extramural

MeSH terms

  • Adult
  • Aftercare
  • Alcoholism / prevention & control
  • Alcoholism / psychology
  • Alcoholism / rehabilitation*
  • Case Management
  • Cell Phone*
  • Cognitive Behavioral Therapy
  • Female
  • Humans
  • Male
  • Middle Aged
  • Midwestern United States
  • Motivational Interviewing
  • Patient Compliance / psychology
  • Patient Education as Topic
  • Personal Autonomy
  • Psychotherapy, Group
  • Secondary Prevention
  • Software*
  • Substance Abuse Treatment Centers
  • Temperance / psychology
  • Therapy, Computer-Assisted*

Associated data

  • ClinicalTrials.gov/NCT01003119