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

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.

The readiness of addiction treatment agencies for health care reform.

The Patient Protection and Affordable Care Act (PPACA) aims to provide affordable health insurance and expanded health care coverage for some 32 million Americans. The PPACA makes provisions for using technology, evidence-based treatments, and integrated, patient-centered care to modernize the delivery of health care services. These changes are designed to ensure effectiveness, efficiency, and cost-savings within the health care system.To gauge the addiction treatment field's readiness for health reform, the authors developed a Health Reform Readiness Index (HRRI) survey for addiction treatment agencies. Addiction treatment administrators and providers from around the United States completed the survey located on the http://www.niatx.net website. Respondents self-assessed their agencies based on 13 conditions pertinent to health reform readiness, and received a confidential score and instant feedback.On a scale of "Needs to Begin," "Early Stages," "On the Way," and "Advanced," the mean scores for respondents (n = 276) ranked in the Early Stages of health reform preparation for 11 of 13 conditions. Of greater concern was that organizations with budgets of < $5 million (n = 193) were less likely than those with budgets > $5 million to have information technology (patient records, patient health technology, and administrative information technology), evidence-based treatments, quality management systems, a continuum of care, or a board of directors informed about PPACA.The findings of the HRRI indicate that the addiction field, and in particular smaller organizations, have much to do to prepare for a future environment that has greater expectations for information technology use, a credentialed workforce, accountability for patient care, and an integrated continuum of care.

Analyses of employment incentives and barriers for individuals with psychiatric disabilities.

OBJECTIVE: Individuals with psychiatric disabilities experience 90% unemployment rates; however, individuals experience 61% employment rates when engaged in high-fidelity individual placement and support programs. To build on current research of variables influencing employment outcomes, we hypothesized that an Incentive factor and a Barrier factor are related to employment status. This mixed method study developed the Employment Commitment Measure (ECM) and explored the correlation between employment commitment and employment status. METHOD: In our 1st phase of this mixed method study, we developed the ECM consisting of an Incentive factor with 5 items and a Barrier factor with 6 items through community-based participatory research. In our 2nd phase of this mixed method study, 198 randomly picked individuals with psychiatric disabilities completed a demographic survey and the ECM. We completed independent sample t tests with Bonferroni correction, cross-tabulated chi-square analyses, confirmatory factor analysis, Cronbach's alpha tests, a logistic regression, and a slope plotting. RESULTS: The ECM consists of 11 items, with 5 items loading on an Incentive factor and 6 items loading on a Barrier factor. Results indicated that the Incentive factor scores were associated with employment status and significant differences on Incentive factor scores between employed and unemployed participants. Results indicated nonsignificant differences between employed and unemployed participants by age, education, gender, ethnicity, housing, mental health tenure, and agency tenure. CONCLUSIONS: Our findings indicated incentives for employment may provide a better guide for correlations of and commitment to employment when compared to barriers. We discuss the implications for employment for individuals with psychiatric disabilities.

An e-health solution for people with alcohol problems.

Self-management of chronic diseases has been a research focus for years. Information and communication technologies (ICTs) have played a significant role in aiding patients and their families with that management task. The recent dramatic increase in smartphone capabilities has expanded the potential of these technologies by facilitating the integration of features specific to cell phones with advanced capabilities that extend the reach of what type of information can be assessed and which services can be provided. A recent review of the literature covering the use of ICTs in managing chronic diseases, including addiction, has examined the effectiveness of ICTs, with an emphasis on technologies tested in randomized controlled trials. One example of an addiction-relapse prevention system currently being tested is the Alcohol Comprehensive Health Enhancement Support System (A-CHESS) Program.

Explicating an evidence-based, theoretically informed, mobile technology-based system to improve outcomes for people in recovery for alcohol dependence.

Post-treatment relapse to uncontrolled alcohol use is common. Currently available communication technology can use existing models for relapse prevention to cost-effectively improve long-term relapse prevention. This paper describes: (1) research-based elements of alcohol consumption-related relapse prevention and how they can be encompassed in self-determination theory (SDT) and Marlatt's cognitive behavioral relapse prevention model, (2) how technology could help address the needs of people seeking recovery, (3) a technology-based prototype, organized around sexual transmitted disease and Marlatt's model, and (4) how we are testing a system based on the ideas in this article and related ethical and operational considerations.

The tip-sample water bridge and light emission from scanning tunnelling microscopy.

The light emission spectrum from a scanning tunnelling microscope (LESTM) is investigated as a function of relative humidity and shown to provide a novel and sensitive means for probing the growth and properties of a water meniscus on the nanometre scale. An empirical model of the light emission process is formulated and applied successfully to replicate the decay in light intensity and spectral changes observed with increasing relative humidity. The modelling indicates a progressive water filling of the tip-sample junction with increasing humidity or, more pertinently, of the volume of the localized surface plasmons responsible for light emission; it also accounts for the effect of asymmetry in structuring of the water molecules with respect to the polarity of the applied bias. This is juxtaposed with the case of a non-polar liquid in the tip-sample nanocavity where no polarity dependence of the light emission is observed. In contrast to the discrete detection of the presence/absence of a water bridge in other scanning probe experiments through measurement of the feedback parameter for instrument control, LESTM offers a means of continuously monitoring the development of the water bridge with sub-nanometre sensitivity. The results are relevant to applications such as dip-pen nanolithography and electrochemical scanning probe microscopy.

The educational goals of people with psychiatric disabilities.

OBJECTIVE: Many people with psychiatric disability have educational goals. In this paper, we survey a sample to describe the frequency of academic interests, specific goals related to this interest, and barriers that undermine education. METHODS: One hundred and four people from a large Midwestern mental health center completed the Educational Goals Survey (EGS) which was developed with feedback from two consumer focus groups. RESULTS: Almost two thirds of respondents never got beyond high school education. Of this group, 54.5% wanted to go back to school. Reasons for returning to school included improving one's job status and enhancing personal growth. CONCLUSIONS: Two sets of barriers emerged from the data; those which are consistent with any adult student and those which must be addressed because of disability. We make sense of these data by comparing results with the U.S. Census where appropriate.

Safe fabrication of sharp gold tips for light emission in scanning tunnelling microscopy.

Gold is the optimal tip metal for light emission in scanning tunnelling microscopy (LESTM) under ambient conditions. Sharp Au-tips of approximately 10 nm radius were produced reliably using a safe, two-step etching method in 20% (w/w) CaCl2 solution. Previous CaCl2-based methods have tended to produce blunter tips, while other etching techniques that do produce sharp Au-tips, do so with the use of toxic or hazardous electrolytes. The tips are characterised using scanning electron microscopy and their efficacy in LESTM is evidenced by high-resolution, simultaneous topographic and photon mapping of Au(111)- and polycrystalline Au-surfaces. Spectra of the optical emission exhibit only one or two peaks with etched tips in contrast to the more complex spectra typical of cut tips; this feature, together with the highly symmetric geometry of the tips, facilitates a definitive analysis of the light emission process.

It's Time to Stop Kicking People Out of Addiction Treatment.

Interventions by professional helpers that are later recognized as ineffective or even harmful have a long and colorful history. Some of the most widely practiced of such interventions have left later generations pondering, "What on earth were they thinking?" Lectures on the history of addiction treatment stir feelings of enlightened condescension amidst tales of treating morphine addiction with cocaine and other such idiocies, but occasionally a conference attendee asks the tough question: "How will the current era of addiction treatment be judged in the future?" And, of course, that is the rub, because it is so difficult to clearly see our own professional miscues and mistakes without the benefit of historical hindsight. This essay explores one practice-administratively discharging clients from addiction treatment-that we suspect will be judged harshly by historians of the not so distant future.

What works for mental health system change: evolution or revolution?

The mental health system has realized significant metamorphoses in the standards and practices of quality care for people with psychiatric disability during the past decade. Now change agents are wrestling with effective strategies that help real-world systems to adopt programs reflecting these metamorphoses. Two fundamental approaches to systems change are compared and contrasted here: evolution and revolution. First, the authors compare the different ways in which evolution and revolution might approach change in the mental health system. They do this by showing how they might influence the transformation of day treatment into supported employment programs. Then, the authors present the two approaches as naturally occurring change processes that work in tandem to affect real-world adaptations. Finally, they summarize practical strategies that change agents might adopt to realize evolution and revolution. Clearly, all stakeholder groups need to become strategic about system change so that real-world practices keep up with the ideals emerging in practice guidelines and evidence-based practice reviews.