Addiction treatment providers go mobile

Addiction treatment providers go mobile

ADDICTION TREATMENT experts say
there’s a huge need to expand high-qual-
ity outpatient care, including medica-tion-assisted treatment, to Americans with opioid and other substance use disorders. After inpatient care, however, patients often can’t access or don’t stay connected to outpatient therapy, which contributes to a very high relapse rate. There are also too few outpatient centers offering medication-assisted treatment, or MAT, and a shortage of cli-nicians trained in evidence-based sub-stance-use disorder therapies. So there’s growing interest in empirically vali-dated, mobile app-based therapeutic tools that allow providers to offer ther-apy, skills training and support to their patients in between face-to-face visits. Clinical trials of some digital tools have shown promising results in at least temporarily reducing relapse rates and keeping patients engaged in outpatient treatment. But use of these mobile apps is at a very early stage.
The first prescription digital thera-peutic products receiving Food and Drug Administration market clearance for patients with substance-use and opi-oid-use disorder are re-Set and re-Set-O, developed by Pear Therapeutics and distributed by Sandoz. Another, simi-lar product that has research support is A-Chess, which Geisinger Health Sys-
tem started using last fall at three of its medication-assisted treatment centers in Pennsylvania.Re-Set, for patients with addiction to alcohol and substances other than opi-oids, and re-Set-O, for those with opi-
oid-use disorder, are 12-week online
programs available by prescription, to
be used in conjunction with outpatient
treatment. Patients download the soft-
ware to their smartphones and key in
their access code

Patients using tools developed by Pear Therapeutics can take assessments using their
smartphones.

Every four days, they are prompted
to complete an assessment of whether
they’ve used, along with their triggers and
cravings. They also go through four cog-
nitive behavioral therapy lessons a week,
on issues like drug refusal skills, followed
by quizzes. Re-Set-O includes lessons re-
lated to compliance with anti-withdrawal
buprenorphine treatment.
The third component is motivation-
al incentives. When patients complete
a lesson and test negatively in a urine
drug screen, they receive a congratula-
tory message or gift card. The pleasure
they get from that offsets the negative
reinforcing effect of substance use, said
Dr. Yuri Maricich, chief medical officer
at Pear Therapeutics.
Re-Set and re-Set-O give clinicians
data from their patients’ responses, en-
abling them to focus on those issues
during in-person sessions.
Dr. Martin Frost, an addiction med-
icine specialist in Conshohocken, Pa.,
has used the Pear Therapeutics tools
with a dozen patients since November
and found them valuable.

The digital dashboard         

Allow  him and his colleagues to track each patient’s 
progress and discuss roadblocks. He and
one patient, using the lesson on relapse
prevention, pinpointed her triggers after
her brief relapse on opioids.
Another of Frost’s substance-use
disorder patients, Katie Burlingame of
Villanova, Pa., who works as a nanny,
said using re-Set-O has helped her avoid
negative thinking.
“When I’m feeling down in the dumps,
that’s when I do a
therapy session,” said
Burlingame, who has
been sober for more
than five years but was
feeling in a “lull” in her
recovery. “If the kids are
napping, I’ll read through a
module and take the quiz at
the end. It’s all on my phone
and I love it.” It’s covered by
her private insurance.
The A-Chess smartphone
app, now being used by Geising-
er’s MAT clinics, offers opioid-use
disorder patients regular check-ins, ap-
pointment and medication reminders,
and surveys. Providers receive notifica-
tions of patient trends such as increased
drug cravings. Patients receive interven-
tional content when A-Chess flags a risk
of relapse, such as visiting a high-risk
location.
Residential addiction treatment cen-
ters are eyeing digital tools to improve
continuity of care after patients leave
their facilities. Leslie Henshaw, a partner
at private equity firm Deerfield Manage-
ment, which owns Recovery Centers of
America, said her company is evaluating
nearly 20 different tools, including ones
that link patients to outpatient resources.
“You can do great with patients for the
28 days they’re in your building,” she said.
“But they pack their bag, and a huge per-
centage of the time patients don’t follow
through on finding an outpatient thera-
pist. This allows people to use their cell-
phone to get those visits scheduled.”
But there are several challenges hold-
ing digital therapeutics back, said Brian
Kalis, managing director of digital health
at Accenture. These include figuring out
a reimbursement model, distinguishing
tools that are rigorously tested from those
with less testing, overcoming legal and
regulatory barriers, and fitting the treat-
ment into providers’ workflow.
Yet digital therapeutics hold great
promise, he said. “The ability to get
simple access 24/7 fits better with the
reality of addiction than meeting in a
one-person setting. It provides privacy,
anonymity and convenience.” 

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